Summary: The Prelude to Ice Cream

McLean Hospital has hosted many famous patients, including Ray Charles, James Taylor, Robert Lowell, and Sylvia Plath. Kaysen wonders whether poets are particularly vulnerable to mental illness. McLean boasts a beautifully landscaped campus and sits on a hill outside the affluent town of Belmont, Massachusetts. Occasionally, the girls are taken into town for ice cream, a field trip that requires a complex system of chaperones and privileges. Patients can be restricted to the ward, as Lisa is. Others require one or two nurses to accompany them off the ward. Better-behaved patients travel in groups or even, though rarely, by themselves. The nurses are nervous as the group makes its way into Belmont, whether because of the complexity of the duty or embarrassment, Kaysen is unsure.

Summary: Ice Cream

On a spring day soon after Daisy’s suicide, the nurses decide to take the girls into town. Kaysen muses that good weather gives people the courage to commit suicide. On the way to Belmont, Kaysen reflects on the natural beauty flowering around her; even the nurses seem less on edge. Kaysen finds that the tile pattern on the floor of the ice cream parlor troubles her. The alternating black and white pattern makes her think of indecision, as though the irregular tiles represent too many choices. The girls order their ice cream in typical fashion, playing suggestive word games with the flavor names. The boy behind the counter inadvertently asks the girls an innocent question with a sexual undertone. Perhaps because of the high spirits of the day, no one takes advantage of the opportunity.

Summary: Checks

Days on the ward are punctuated by “checks,” periodic inspections by the nurses. The checks, which occur every five, fifteen, or thirty minutes, are intrusive, interrupting the girls’ activities. The familiar sound of the turning doorknob “murder[s]” time, in Kaysen’s opinion. When time is quantified in such small measurements, it moves by too quickly.

Summary: Sharps

The girls are forbidden to possess anything remotely sharp for fear that they might injure themselves. Scissors, razors, pins, earrings, and even belts are prohibited. Patients struggle to eat with plastic or cardboard cutlery. Shaving one’s legs is a particularly trying experience. Nurses need to check permission forms and supervise the shaving. Kaysen is eighteen and supervised by a nurse only four years older than she. Perhaps because of the humiliation, many of the girls on the ward have hairy legs. Kaysen jokes that her fellow patients are “early feminists.”


Ray Charles, Robert Lowell, Sylvia Plath and other famous former residents of McLean Hospital share a gift for poetry. Poetry is often distinguished from prose by its structure, a mosaic of rhythm, meter, and highly ordered composition. Although poetry can be free form, it is typically governed by a complex series of interior rules. Kaysen, who admits to a fascination with patterns and order, believes that the mentally ill are drawn to poetry’s insistence on organization, perhaps as a form of relief from the chaos of their minds. The appeal of “meter and cadence and rhythm” seems to “make its makers mad,” in Kaysen’s eyes. Kaysen draws a comparison between the chaotic but ordered nature of poetry to the occasional trips the ward takes to an ice cream parlor in town. Town residents see only an unruly gaggle of nurses and mental patients making its way through the streets, but the procession is actually as carefully ordered as a sonnet. The complexity of the nurse-to-patient ratios that govern the size of the group corresponds to the internal systems of poetry.

The punishing “checks” system illustrates the numbing intrusiveness of life in confinement and reveals the nature of the girls’ concept of time. The nurses conduct their checks with robotic regularity, determining how much time passes between checks in accordance with the likelihood that a patient will harm herself. The most grueling check schedule doesn’t permit “enough time to drink a cup of coffee, read three pages of a book, [or] take a shower.” The process underscores the girls’ helplessness in the face of the nursing authorities and the impossibility of even momentary reprieve; Kaysen discovers that her graduation to half-hour checks is meaningless, as her roommate remains on a fifteen-minute schedule. When time is quantified so minutely, one’s awareness of its passing is acute and painful. Kaysen describes checks as like a “pulse,” a neverending reminder of life slipping away.

Confiscation of “sharps,” any possessions that the nurses deem potentially dangerous to the girls, further infantilizes the patients. The confiscations can be deeply personal, from graduation pins to favorite earrings, and even absurd, as in the removal of belts because of the spike in the buckle. The girls are both at the mercy of their guardians and profoundly dependent on them, unable to make any decisions without the consent of authority. This infantilization reaches its peak in the act of shaving. Kaysen can only use a razor on her legs in the presence of a nurse, who is only a few years older than she. The patients are humiliated by their state of confinement in the most personal aspects of their lives.