Marie Balter suffered from clinical depression and was misdiagnosed with schizophrenia. She was placed in several foster homes and mental institutions throughout her life. In her autobiography, Marie discusses enduring hallucinations, delusions, and suicidal thoughts. She was eventually correctly diagnosed with endogenous depression but had endured improper treatments, including overmedication, due to her initial misdiagnosis. Some factors that may have contributed to Marie's depression include a difficult childhood, lack of parental support, and feeling isolated in institutions.

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Nobody’s Child
Mari H. Bennett
Abnormal Psychology
PS 360
Dr. Alford
April 9, 2015
Saint Mary-of-the-Woods College

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Abstract
The purpose of this paper is to briefly discuss the struggles that Marie Balter experienced during
her lifetime. In her autobiography, Nobody’s Child, Marie explains the emotional turmoil she
endured as a result of her clinical depression. The book begins in 1935; Marie is a five year-old
named “Pat,” living with her sisters and alcoholic mother. Shortly after being introduced to
Marie’s unstable life, readers follow her journey through the foster care system, a strict Catholic
home, several mental institutes, rehabilitation, marriage, and eventually, college. In her book,
Marie dealt with a misdiagnosis of schizophrenia, which resulted in improper medication and
“toxic psychosis.” She was eventually informed that she should have been diagnosed with
endogenous depression and panic attack. However, Marie decided to fight for her life so she
could earn independence from “The Castle,” her mental institute of 20 years. Through
diagnostic resources, readers can investigate which psychological disorder Marie Balter truly
suffered from for a majority of her young life. This paper will assess the history of the patient
and the features of the patient’s symptoms. It will also review the various perspectives on the
causes of the disorder and the treatments received by the patient. Lastly, the paper will discuss
how Marie was affected emotionally as a result of her disorder.

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History
“Pat” Balter was born in 1930 to a drunken single mother. After five years of living with
her sisters and unstable mother, Marie was placed into the foster care home of the Bartellos,
“Ma” and “Pa” of Gloucester, Massachusetts. The couple renamed their new child “Marie.”
Within a year Marie “had mastered the Italian spoken in her adoptive home and settled into a
sheltered and severely disciplined working-class Catholic girlhood. At 14, however, she was
removed, at her own request and on the recommendation of a social worker, to St. Therese's
Home for Girls, and she lived for much of the next couple of decades in one institution after
another: a home for indigent women, the psychiatric ward of a general hospital, finally Sutton
State Hospital, known to its residents as ‘the Castle’” (Mairs, 1991). While at the Castle, Marie
learns that “Ma” had passed away from her diabetic condition. This event sunk Balter into one of
the lowest points of her life. In her book, Marie wrote on her feelings of the tragic event. “With
Ma gone, there’s no one left to care for me, no one who’s concerned about what will happen to
me… I want very much to put the pieces of my life together, but I don’t believe that I’m equal to
the task” (Balter, 1997). Marie eventually puts her life back together after participating in the
Castle’s rehabilitation workshop, marrying her husband, Joe, and enrolling into college to pursue
a career that focused on assisting the mentally ill. Marie had overcome a lot of psychological
challenges after leaving the Castle. When Ma had passed away, Balter began hearing her
deceased foster mother’s voice in her head telling her to kill herself. “I spend most of my time
sitting in a chair off the alcove listening to this voice, believing that Ma wants me to die but not
knowing whether I should kill myself or whether I should defy Ma and keep on living…then I
withdraw into myself, a blank stare masking the dialogue that continues to rage within” (Balter,
1997). Balter’s social skills were poor, as she constantly felt like a burden to the Castle’s staff.

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Features
In her book, Marie writes that she was experiencing audible hallucinations and delusions
of Ma inside of her head, telling her to commit suicide. After battling an immense feeling of
guilt, refraining from eating, and excluding herself from any contact with the other patients of
the Castle, Marie informed her psychiatrists about her condition. Balter is given massive doses of
Stellazine; the maximum recommended dosage of the drug was 40 milligrams, but by the end of
the program, she was receiving 2,500 milligrams a day. Marie was diagnosed with
schizophrenia. Her doctors instituted “the massive dosage program as a last resort, trying
desperately to break into [Marie’s] tortured world and pull [her] out” (Balter, 1997). However,
these massive dosages led to a toxic reaction of overmedication or “toxic psychosis,” making
Marie’s panic attacks much worse. Additionally, Balter was wrongly medicated because her
diagnosis of schizophrenia was false. Years later, Marie had learned that her diagnosis should
have been endogenous depression and panic attack.
According to Ronald Comer, author of the textbook, Abnormal Psychology, “today’s
clinicians usually concentrate on recognizing both the situational and the internal aspects of any
given case of unipolar depression.” When distinguish unipolar depression, one must ask if it is
exogenous, which follows clear-cut stressful events. In a patient suffering from exogenous
depression, he or she lacks any physical symptoms, such as sleeping or eating. Endogenous
depression responds to internal factors that seem to “come out of nowhere.” In his article,
“Endogenous Depression,” Michael Kerr of Healthline.com explains the symptoms of the
disorder. “Individuals with endogenous depression often experience anhedonia along with
feelings of hopelessness, helplessness, worthlessness, guilt, or self-hate. Other symptoms that
may accompany endogenous depression include: fatigue or lack of energy, irritability and

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difficulty concentrating, social isolation, insomnia or hypersomnia (excessive sleeping), changes
in appetite with corresponding weight gain or loss, suicidal thoughts or behaviors. On more
severe cases, patients may also experience psychotic symptoms such as hallucinations or
delusions.” Marie expressed her lack of energy to socialize with the fellow patients, but would
rather walk back to her room, crawl into bed, and roll the covers over her head. The staff had to
force feed her several times, and she would get easily frustrated with the nurses and conditions of
the hospital. Her hallucinations made her thoughts race, and thoughts of suicide were present.
Possible Causes
There are various perspectives on the causes of abnormal behavior: biological,
psychodynamic, behavioral, cognitive, humanistic-existential, and sociocultural. Biological
theorists believe that abnormal behavior is a result of anatomical and biochemical problems in
the brain and body; viral infections, genetic inheritance of abnormalities and evolution are
thought to be causes of abnormality. Psychodynamic theorists believe that an individual’s
behavior is led by “underlying psychological forces” (Comer, 2013). The psychodynamic
model’s leading explanation to the causes of abnormal behavior is early childhood conflict and
traumatic experiences. Behaviorists focus on the idea that behavior is developed from three
learning methods: classical conditioning, operant conditioning, and modeling. Cognitive
therapists believe that understanding human thought is the key to comprehending human
behavior. If signs of abnormality are present in their clients, cognitive therapists point to
maladaptive assumptions and illogical thinking processes. The humanistic-existential model
believes that humans require philosophical issues such as values, meaning, and self-choice to be
satisfied in life. According to this theory, humans experience abnormal behavior when their drive
to self-actualize is tampered with. Lastly, the socio-cultural model focuses on social labels, roles,

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social connections, and the family system. Those that follow the “family-social” perspective
believe that society deems individuals as “mentally ill,” and those that are labeled act
accordingly. Others believe that socioeconomic status can link to abnormal behavior.
In order to diagnose patients, clinicians collect information from observations, tests, and
interviews to construct a “clinical picture” to find the causes to a client’s disturbance; the
clinician’s psychological perspective can influence their clinical picture of a patient. When a
patient shows similar symptoms of a particular mental disorder, diagnosticians assign that client
to the correct disorder. Clinicians follow the guidelines of the Diagnostic and Statistical Manual
of Mental Disorders, which works by a system of classification.
Three theories that I believe explain the causes for endogenous depression in Marie
Balter are human-existential, psychodynamic, and socio-cultural. The human-existential
perspective is a possible explanation to Balter’s disorder because she had an immense difficulty
experiencing a proper development. Adolescents require the opportunity to self-actualize, and
feel a sense of worth, and meaning in their life. As a child, Marie’s mother selectively disowned
her, sent her into foster care, while still raising her other siblings. Also, once she had entered the
home of Ma and Pa, Marie became isolated from her peers, and even her adopted family. In
addition, the psychodynamic approach supports the claim that Marie had a failing childhood. Her
mother was an alcoholic, and her foster care parents were incredibly stoic and unaffectionate.
After being raised in an authoritarian household, Marie began to fear her new parents and feel
unwanted. Lastly, the socio-cultural perspective is a possible explanation to the causes of
Marie’s depression because of her label of “foster child.” In a society that looks down upon
orphans and the homeless, Marie was labeled as an “outsider.” When she lived in mental

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institutions for the entirety of her adolescence, Marie’s nurses were judgmental and cold towards
her situation.
Treatments
After a horrific experience with the antipsychotic drug Stellazine, Marie’s system goes
into a detox of medication. Balter did not receive direct therapy from a psychologist. However,
after gaining independence from the Castle, Marie began living on her own, and babysitting the
children of her close friends. These events helped her gain confidence in herself and her ability
to live on her own. Balter forced herself to get better, taking steps to eat more, socialize with
others, and participate in other activities she would have normally refrained from. This
successful treatment is an example of modeling, which is suggested by behaviorists. Marie did
these actions because she was inspired by a few friendly nurses from the Castle. In awe of her
ability to balance a family, full-time job, and a healthy lifestyle, Marie decided to follow in their
footsteps. Treatments that are available for this disorder are SSRIs, electroconvulsive therapy,
and cognitive-behavioral therapy. I would not recommend SSRIs for Marie because the extreme
damage that was caused to her body from the toxic psychosis; medication is not as effective as
talk therapy has proven to be for depression.
Emotions
Just like individuals diagnosed with major depressive disorder, Marie was having a very
difficult time feeling needed, finding hope, and understanding why she had to endure such
emotional turmoil her entire life. Marie was abandoned by her mother, controlled by her foster
parents, isolated from her peers and abused for defying the rules of the mental institutions. She
was also internally damaged by her misdiagnosed schizophrenic medication, and later suffered
from bladder cancer. After being diagnosed with cancer, her one and only husband Joe lost faith

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in his wife’s recovery and was sent to the Castle to receive treatment. On an ominous New
Year’s Eve, her husband died, leaving her angry and confused on how to continue on in her
hopes of helping the mentally ill. Patients that are diagnosed with endogenous depression have
extreme difficulty explaining the causes of their symptoms. Disheartened, patients struggle to
speak to others about their condition.

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References
Balter, M., & Katz, R. (1991). I'm Really Crazy Now, Treatments, and Fighting for My Life. In
Nobody's child. Reading, Mass.: Addison-Wesley.
Comer, R. (2013). Models of Abnormality; Clinical Assessment, Diagnosis, and Treatment;
Mood Disorders. In Abnormal psychology (8th ed., pp. 80-81;111;224). New York, New
York: Worth.
Kerr, M. (2012, March 29). Endogenous Depression (G. Krucik, Ed.). Retrieved March 14, 2015,
from http://www.healthline.com/health/depression/endogenous-depression#2
Mairs, N. (1991, June 2). Goodby to the Mental Ward : NOBODY'S CHILD: The Marie Balter
Story, By Marie Balter and Richard Katz (Addison-Wesley: $17.95; 204 pp.). Retrieved
March 17, 2015, from http://articles.latimes.com/1991-06-02/books/bk-229_1_marie-
balter