Katherine's history is clouded by a couple of issues. They revolve around the circumstances of her birth and of her mother's illness. They shaped Katherine's very life. Although no reasonable physician would, or should, diagnose without examining a patient, I choose to offer some of my own thoughts. They are not definitive and should not be taken as fact.

Ethel Sasse's second pregnancy resulted in a full term delivery. If Katherine was born on June 9, 1909, then her mother was probably impregnated in early September, 1908. Chris Sasse was not in Yankton at the time, but Charles Trail certainly was. An unmarried male physician of 33 years, living in a small city in South Dakota, might take advantage of the opportunities available to him at work. While the male and female wards at the Yankton State Hospital were separate, the doctors had access to the wards. It certainly is not an impossibility that Trail fathered Katherine. Somehow, Mead's clinical notes seem to omit one certain fact: Did he really seek out and interview ex-employees of the female wards? I doubt that there were many ex-employees who worked there in August and September, 1908, who totally disappeared by the following January, 1909. I also wonder what else Nurse Graham might have known.

Ethel's mental illness today is described in terms of mania and depression, or manic-depressive psychosis, although the term "bipolar disorder" is more common today. Grolier's 1995 Multimedia Encyclopedia (Grolier Electronic Publishing, Inc.) says this about the illness:

Bipolar disorder is a medical disorder with strong psychological impacts. It was once known as manic-depressive psychosis. Three basic forms of the disorder are observed: one in which the resulting dominant psychological state is depression, one in which the dominant state is a highly elevated mood, and one in which these states frequently alternate. In all three forms at least one manic state occurs. The mood changes are also far more severe than in other disorders involving mood swings. In the manic phase a person is inappropriately optimistic and grossly overestimates his or her positive attributes, shows speeded movement and speech, undergoes intellectual disorganization, and has pathologically bad judgment. In the depressive phase a person exhibits slowed speech and movements in addition to depression. In either phase it is not unusual for hallucinations, delusions, or both to occur.

Bipolar disorder develops at least once in about 0.5 to 1 percent of the population. The first episode usually takes place in persons in their twenties, and it occurs equally in both sexes. Its causes are unknown but may be rooted in some genetic defect. Stressful life experiences may be contributing factors but do not seem to trigger its onset. In some 15 to 20 percent of people with untreated mood disorders, the condition may be fatal. Lithium salts are a common medical treatment, but side effects of this drug can be severe. Newer drugs such as Prozac and Anaframil have also shown promise. Even without treatment perhaps 85 percent of the persons with the disorder survive, but without treatment most of them will not be fully functional.

Certainly Ethel was unable to take advantage of modern therapy for the illness. She appears never to have been fully functional after the death of her first and last children. Given the apparent hereditary predilection of this illness, all need to be aware of it.

Once last problem Ethel, and more obviously Katherine, faced was living with an alcoholic. Alcoholism like bipolar disorder is genetically linked. Chris' father and Chris himself were most certainly alcoholics. They were, along with Ed Flynn, the men-who-mattered in Katherine Sasse's early life. Katherine subsequently married an alcoholic. Katherine recognized this later in her life, and courageously took steps to change the things she could for her family's future. She grew to understand this disease, and with this growth she came to accept the things she couldn't change. It was a lesson well-learned. At the end of her life she knew serene wisdom.