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Introspections   |    
Raggedy Ann
Paul Kettl, M.D., M.H.A.
Am J Psychiatry 2008;165:21-22. doi:10.1176/appi.ajp.2007.07060975
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She looked thin and frail when I entered her nursing home room. On the wall to the left were two framed black-and-white pictures from a bygone era. One showed an attractive woman in her early 20s in a “flapper” dress with long jewelry hanging around her neck. The other showed a remarkably beautiful young woman with her hand behind her long hair in a movie star-like pose. I sat down on her bed next to Raggedy Ann and Andy dolls.

I was seeing an 85-year-old woman who had been referred because of her recurrent depression, and she was sitting in her motorized wheelchair across from me. I had already talked with her primary care physician about what we planned to do with her antidepressant medications.

“Have you ever had treatment for depression?” I asked.

“Yes,” she said quietly but firmly. She had been a psychiatric nurse and answered the question not only to give information but to demonstrate that she was not ashamed of the question or the answer. I reviewed her vegetative signs, current medications, medical problems, and medication side effects. I proceeded with a mental status examination.

Finally, I just could not help it. I asked, “Who is that in the picture?”

“The one on top is my mother,” she said, “and the one below is me.” “I never knew my parents,” she added. Her mother, the “flapper” in the picture over her head, had died in childbirth with the patient. Her father stayed around only for a few days after the tragedy and then he left, leaving the patient to be reared by her maternal grandparents. “My grandmother told me that my mother said in her late teens, ‘I’m going to get my picture taken,’ and had that photo taken a year later. My picture was taken when I was the same age as my mother. What do you think of that?” The resemblance was uncanny.

She went on to tell me how she had gone through school and then nursing school. She had become a nurse at the local psychiatric hospital and worked there for several years until one day a female patient screamed, “You’re one of them!” and attacked her. In reviewing her medical records, I made note of her fractured hips and scoliosis. She said her doctors said most of her orthopedic injuries were a result of that attack.

She married, but after decades, her husband left her. He got a divorce. “I don’t know how,” she said. “He never told me about it.” She seemed confused that after a long and unhappy marriage her husband would divorce her at age 65. He left her, too. Then her daughter died after a long illness in the same nursing home in which she was now living.

She had become known in the nursing home for making Raggedy Ann and Andy dolls and giving them to patients who appreciated her work. Next to me was a completed set. She was working on a new doll, and only the head of Raggedy Ann was there in an incomplete version. The smile was painted on; the hair was red and stringy.

The discussion of her depression had moved on from antidepressant doses to the picture of the mother she had never met, the father who had left her, the husband who had divorced her, and the daughter who had died in the same building. She had been a nurse but had been assaulted by one of her psychiatric patients. The smile was painted on, and the determination remained irrepressibly present. Still, throughout her life, she had been dragged around and had the stuffing yanked out. She was depressed, as she freely admitted, but the story was more complicated than the dosing of a selective serotonin reuptake inhibitor. The charm that was in the picture above on the wall was still there. Next to her, talking with her, I could feel her pain, with her determination being almost palpable. Her wisdom had developed over years of experiences and losses. She began life without a mother but with her mother’s spirit, charm, and good looks. However, through life, she had been dragged through more than was fair. She was Raggedy Ann. Over and over, she had made the doll she could paint the smile on and could fill her empty space beneath. Ever the nurse, she then gave her dolls to others.

She thanked me for coming, and I commented on how nice the doll looked. She said simply, “I’d love to give you one, but that’s all I have left.”

+Address correspondence and reprint requests to Dr. Kettl, Pennsylvania State College of Medicine, 500 University Dr., Hershey, PA 17033; pkettl@psu.edu (e-mail). Introspection accepted for publication June 2007 (doi: 10.1176/appi.ajp.2007.07060975).

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