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| A Visit to the Museum of the Cures | p. 1 |
| By the Best People, for the Best People | p. 17 |
| The Mayflower Screwballs | p. 35 |
| The Country Clubbers | p. 49 |
| The Search for the Cure | p. 73 |
| The Talk Cure: Freud and Man at Mclean | p. 93 |
| Welcome to the Twentieth Century | p. 117 |
| The Mad Poets' Society | p. 145 |
| Staying On: The Elders from Planet Upham | p. 169 |
| Diagnosis: "Hippiephrenia" | p. 191 |
| Physician, Heal Thyself | p. 217 |
| Life Goes On | p. 233 |
| Acknowledgments | p. 245 |
| Notes on Sources | p. 249 |
| Index | p. 257 |
| Table of Contents provided by Syndetics. All Rights Reserved. |
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Chapter One
A Visit to the Museum
of the Cures
Everyone makes the same comment: It doesn't look like a mentalhospital. The carefully landscaped grounds, dotted with four- and five-story Tudor mansions and red brick dormitories, could belong to a prosperous New England prep school or perhaps a small, well-endowed college tucked away in the Boston suburbs. There are no fences, no guards, no locked gates. Over time, of course, you see the signs. Iron grilles surround the staircases inside the few remaining locked wards. On some halls, the nurses' stations are enclosed in thick Plexiglas. The washroom mirrors are polished metal, not glass. But on first acquaintance, the only indication that you have entered one of America's oldest and most prestigious mental hospitals is a large sign jutting into Mill Street: McLean Hospital.
Although I had already interviewed several doctors in their offices, I took my first formal tour of the campus on a sunny, early-summer Saturday in 1998. McLean was hosting an orientation meeting for its neighbors in the well-to-do town of Belmont, Massachusetts. Our group of twenty could just as well have been bird watchers out for a jaunt. In fact, as we strode along the sculptured walkways cut through the scrubby New England forest, several men and women revealed themselves to be Audubon Society members, who instantly recognized the hospital's dense stands of oak and elm forests as nesting grounds for red-tailed hawk and horned and screech owls. There were two "soccer moms" in our group, real soccer moms, it turns out--they played soccer. Everyone was wearing sensible clothing for our tour of what was once America's premier insane asylum.
McLean was showing off its 240-acre campus to promote its new Hospital Re-Use Master Plan. Starting in the 1980s, neither private insurers nor government programs like Medicare and Medicaid were willing to finance the lengthy stays and staff-intensive therapy that had been McLean's specialty for almost two centuries. Whereas once well-heeled patients had checked in for months' if not years' worth of expensive, residential therapy, the standard admission was now the "five-day": time enough for a quick psychiatric diagnosis, stabilization on drugs, and release "into the community," meaning to a halfway house or, in the most hopeful scenario, back to one's family. By the early 1990s, McLean was losing millions of dollars a year. It came within a hair's breadth of being closed down. The hospital was foundering like a luxury ocean liner competing in the age of jet travel.
To save McLean, the businessmen who sat on the board of trustees opted to "restructure" the hospital. McLean had already shrunk dramatically; in the late 1990s, staffers were preparing just 100 beds a night, compared with 340 during most of the twentieth century. Entire buildings had already been closed. "It occurred to us that we had about 250 acres and 800,000 square feet of building space, and given the profile of the way we were delivering the medicine, we probably needed only 50 acres and 300,000 square feet," Charles Baker, a former chairman of the board, explained to me. The eventual Master Plan called for selling off about half the asylum's acreage and keeping an inner core of fifty acres for patient treatment and research labs. The rest would be given to the town as public open space. The idea was to raise $40 million, erase the hospital's outstanding debt, and rescue McLean.
The tours eventually had the desired impact; after years of town-gown bickering, Belmont finally voted to allow McLean to de-accession its real estate treasures in 1999. McLean had signed a deal to turn twelve acres of scrub forest on its southern perimeter into a mirror-windowed, 300,000-square-foot biomedical research park of the kind to be seen on the outskirts of Princeton, Atlanta, Seattle, or pretty much any white-collar, city-suburb in America. Twenty-six acres along busy Mill Street will be developed for town houses, to be priced between $600,000 and $650,000. At a separate briefing, an official of the Northland Development Corporation showed us how the new homes would be painted in earth colors, surrounded by trees, and kept low to the ground so as not to change the profile of the west-facing wooded hill. He briefly addressed the potential challenge of selling expensive homes abutting the grounds of an insane asylum, but he hoped it would not be a problem.
Down the hill from the town houses, McLean has convinced the American Retirement Corporation to build a 352-unit "elder-care center," an upscale retirement home. Other plots have been earmarked to placate various constituencies that hold McLean's fate in their hands. The 130 acres of open space, some of it abutting an Audubon Society sanctuary, should quiet Belmont's vocal environmentalists. The hospital will donate one and a half acres to expand--and silence--a neighboring housing development for the elderly. A private school on the hospital's northern border will get land for a new soccer field. And the town fathers of Belmont will be rewarded with twenty acres for their long-standing pet project, a cemetery expansion.
Throughout the process, McLean, a teaching hospital of Harvard University, has behaved with perfect decorum. I attended a citizens' meeting where an abutter who opposed the Master Plan objected to the "quick fix" cemetery expansion, which, he complained, would serve Belmont's needs for only the next seventy-five years. A development staffer working with the hospital replied, "We'll show you a picture of a forest cemetery in Sweden," invoking the Scandinavian penchant for tasteful, appropriately scaled development, even for cemeteries. At a Belmont Conservation Commission meeting, a small group of environmentalists demanded special consideration for a tiny brook flowing down the southern slope of the site of the proposed office park development, a stream that eventually reaches the Mystic River. The McLean lawyers huddled briefly and then agreed not to disturb any land within one hundred feet of the running water.
* * *
Although it still functions as a mental hospital, McLean is also a living museum. It is a museum of the grand Boston culture that was, for a century or more, synonymous with American culture. The names of the older houses we encounter on our tour--Appleton, Bowditch, Codman, Higginson--are the names of the roving ship captains who enriched and ennobled the Boston of the 1800s. Henry Lee Higginson was the man who founded the Boston Symphony Orchestra and later became an activist member of Harvard's governing corporation. Higginson is still remembered for a Harvard fund-raising letter that ended with this line: "Educate, and save ourselves and our families and our money from mobs!" William Appleton, a major nineteenth-century donor, was a typical Yankee trader; he freely admitted in his posthumously published diary that "my mind is very much bent on making money." He referred to his marriage as "a Matrimonial Speculation, the whole result of which is not ascertained." In addition to giving buildings, Appleton also created a special fund in the 1830s to help defray treatment costs of "desirable" patients for whom the initial $2.50-a-week cost was too steep.
Bowditch Hall is named for Nathaniel Ingersoll Bowditch, another great name from the sea. A sailor-mathematician, Bowditch's subtle improvements on celestial navigation allowed the Boston clipper captains, like John Codman and his heirs, to beat their competitors to Japan. More than one hundred years after its publication, his Practical Navigator remained the standard treatise in its field. When Bowditch died in 1838, captains of American, English, and Russian vessels in the Russian port of Kronstadt flew their flags at half-mast, and the cadets at Annapolis wore badges of mourning.
A century and a half later a young Boston writer and explorer, Rob Perkins, wrote a memoir about being a patient on Bowditch Hall:
Navigation is the art of going from what you know to what you don't know. The hall is named after Nathaniel Bowditch, another rigid man, the father of navigation. For centuries ships depended on his system. They went around the world on it, across oceans. For all I know, NASA sends up their rockets with his knowledge. It's all math and rational. There are many ways to navigate, but even knowing how doesn't necessarily keep you off the rocks. The man went nuts. His family locked him up in McLean Hospital. Later, they named the maximum security hall after him. There is a statue of him in Mount Auburn Cemetery holding a globe and a sextant in his lap. There is also a waiting list to get into both places, Bowditch and Mount Auburn Cemetery.
Bowditch also was the stomping ground of Robert Lowell, the blue-blood poet who immortalized the locked men's ward in a famous poem, "Waking in the Blue" ("This is the way day breaks at Bowditch Hall at McLean's"). Lowell published his second volume of poems while at McLean. He even corresponded with Jacqueline Kennedy and Ezra Pound from the hospital. In his manic phases, Lowell held court at Bowditch. A visitor once saw him haranguing a small crowd of patients and staff while sitting on the bed of a young man named John Forbes Nash, who had been involuntarily committed from the Massachusetts Institute of Technology (MIT) in 1959. Lowell was a celebrity; when he showed up at McLean, "it was like seeing Princess Diana," one staffer remembers. But no one knew who Nash was or that he had already finished the research in game theory that would later win him a Nobel Prize. Two future Pulitzer Prizes (Lowell's) and a future Nobel in one room. An ordinary day on the wards at McLean.
I had never seen Appleton, the laid-back coed ward for the 1960s generation, nor Codman before. Codman, now closed, was once the women's geriatric ward. Psychiatrist Robert Coles remembers the "crazy ladies of Codman," who staged elaborate tea parties on silver service for him and other young residents in the late 1950s.
Wheeling back toward the Bowl, a perfect, concave expanse of grass where psychiatrists and patients used to play golf together, we pass South Belknap, originally the Belknap House for Women. Belknap is the "Belsize" of Sylvia Plath's novel, The Bell Jar . When the fictional Esther Greenwood "moves `up' to Belsize," she knows she is getting better. Plath observed, but did not celebrate, her twenty-first birthday at McLean and was elected to the Phi Beta Kappa Society while on the wards. Belknap was also a temporary home for Susanna Kaysen, the daughter of President John F. Kennedy's deputy national security adviser; she later wrote a best-selling memoir of her stay at McLean, Girl, Interrupted . One of Kaysen's ward mates was Kate Taylor, the daughter of the dean of the University of North Carolina Medical School. One day in 1968, Kate showed the other girls on her ward a test pressing of a record called simply James Taylor , which was soon to become the number-one-selling album in the country. One of the songs, "Knockin' `Round the Zoo," was about McLean. Smiling, wagging his head mournfully before youthful audiences all over the country, Kate's brother James would joke about his "degree" from McLean. Kate would have her own successful recording career. Her brother Livingston, who also punched his ticket at McLean, wrote a song that mentioned his favorite McLean doctor.
But even in the field of music, the Taylors were not McLean's most distinguished "graduates." That accolade would go to Ray Charles, who overlapped with Taylor at McLean in the mid-1960s. Following Charles's arrest at Logan Airport for possession of heroin, a broad-minded federal judge allowed the singer to kick the habit at McLean instead of rotting away in jail. Charles turned out to be a satisfied customer and a repeat visitor. In his autobiography, he reminisces about playing the piano on a minimum-security ward and "getting next to" the McLean nurses. Clay Jackson, a legendary musician from the heyday of Cambridge's Club 47-Joan Baez's first concert venue--and two of Van Morrison's brilliant sidemen also passed through McLean. They could have had a hell of a band.
As our tour inspects the proposed location for the biomedical office complex, I catch my first view of East House, a three-story Jacobean revival mansion originally designed to shelter thirty women patients in individual suites. After World War II, it became the women's maximum-security ward. A disturbing rash of suicides erupted at East House in 1960 and spread across the campus. I have a mimeographed collection of poems called "Behind the Screen: Poems from the Female Maximum Security Hall" written by three East House patients in 1969. About half the poems concern suicide.
Descending from Bowditch, we stroll through a perfectly arrayed orchard and catch a glimpse of the huge barn, once the centerpiece of a working farm that provided the hospital with its own milk, eggs, and produce up until 1942. With the onset of World War II, the livestock had to be killed to provide meat for GI rations. A few riding horses, available for patients and staff, were kept in the barn until the 1960s. One of the hospital executives leading our tour marvels that McLean was a self-sufficient community just fifty years earlier. It had its own operating rooms, tennis courts, music, theater and movie shows, and of course its own hair salon and barber. There was even a small chapel, built by the Eliots with stained-glass windows donated by other First Families--the Beebes, Noyes, Kidders, and Shaws. Back then, the entire Staff--the Harvard Medical School--trained doctors, the immigrant nurses, and even the janitors-lived on campus. Not so long ago, the only time McLean employees telephoned to the town of Belmont was to summon the coroner to package up the occasional corpse.
At odd moments during our walk, huge, spreading, seventy-foot-tall copper beeches heave into view. The staffers accompanying us seem well briefed; they know the fate of each of these towering, golden-brown giants. "This one is slated for preservation .... This one over here? No, this is where the parking lot will be." Trees are a very big deal at McLean. The developers working on each of the commercial parcels had to inventory every tree more than two feet tall and have practically apologized personally each time a "signature tree" has been cut down or replanted. Indeed, a forester employed by Northland reminded a McLean gathering I attended that New England is now far more wooded than it was 150 years ago, when most of the land had been cleared for agriculture.
Virtually every doctor more than sixty years old has a copy of the hand-drawn poster "The Trees of McLean" hanging on his or her office wall. Created by two patients with the help of a specialist from Harvard's Arnold Arboretum in 1966, it is a precise map of each important tree on the McLean grounds. One of the creators, Stewart Sanders, went on to become a prominent naturalist in the Boston area. In later years, he performed the Audubon Society Christmas bird count on the McLean grounds and even drafted maps of fox habitats and woodcock flight patterns that included some of the hospital territory. "I wanted to control people's actions in the future," Sanders told me. "I was showing that this was where the trees were, this was where the foxes were so that they wouldn't be disturbed." Now in his sixties, Sanders is a studious yet emotional defender of open space in the Boston area. He was one of the men who won the hundred-foot setback for the threatened brook at the Conservation Commission hearing. "I gave an emotional plea that when the people of Massachusetts enacted the Rivers Protection Act, they meant to include brooks, because they understood that brooks become rivers. It's very nice that they have fountains at the Burlington Mall, but my heart needs a brook."
It is impossible not to be transported by the beauty of McLean. "We are very proud of our hospital. It is very attractive and looks more like a college campus than a mental hospital," the Babbitty World War II-era director Franklin Wood once boasted. (Wood was an occasional source of unintended humor. Rejecting a suggestion by patients that he erect signs to guide them around the grounds, he said, "If you don't know where you are, then you're in the right place." Writing in the hospital's annual report, he contributed this gem: "It is not healthy to be depressed.") Four-fifths of the grounds are just that: grounds, not buildings. This is the patch of rolling, rocky New England woodland that the great landscape designer Frederick Law Olmsted chose for McLean in the late nineteenth century. Olmsted knew what he wanted: a setting that would allow every patient's window to face south and that would have enough space so that the men's buildings would not look in on the women's wards. He foresaw that patients should be segregated according to the acuity of their illnesses. He surveyed two other sites but favored "the wooded land of Belmont, judiciously thinned to groups and glades, opened by walks of long curves, and easy slope." It would provide, he wrote to the hospital trustees, "more incitements to tranquilizing and recreative voluntary exercise for convalescent and harmless monomaniac patients" than would rival parcels in Arlington and Waltham. Twenty-five years later, Olmsted, debilitated by a series of brain hemorrhages, found himself living in McLean's Hope Cottage, a single-patient home perched on a ridge above a terraced hillside garden. He had lost many of his faculties but not his sense of orientation. Ever the landscape connoisseur, Olmsted noticed that the buildings were not as tightly grouped as he had suggested in an 1875 sketch for the trustees. Moreover, they now faced the beautiful western sunset and not the southern horizon, as he had recommended. Surveying the setting, he exclaimed: "They didn't follow my plan, confound them!"
* * *
McLean Hospital is not just a cultural museum. It is also a museum of the many therapies advanced over more than two hundred years to relieve mental illness. In large part, the story of McLean is the story of an idea that originated in Europe at the end of the eighteenth century. The idea was that a relaxed life in a pastoral setting would go a long way toward alleviating the suffering of the mentally ill.
The theory's most famous champion was Philippe Pinel, an enlightened French doctor to whom the Revolutionary government had handed the keys of Paris's most notorious hellhole, the Bicetre Asylum, in 1792. Pinel was a failed rural practitioner who had devoted himself to the study of mental illness after a friend suffered a nervous breakdown, fled into a forest, and was devoured by wolves. "The Bicetre," wrote historian Albert Deutsch, "owned a questionable distinction: it ranked with the worst asylums in the world. There the patients, or rather the inmates, were loaded down with chains and shackled to floors and walls with irons, at the mercy of cruel attendants armed with whips and the authority to use them freely." (Terrorizing mental patients, in the hopes of "waking" them from madness, was common all over Europe. One German asylum lowered patients into a dungeon filled with snakes. Even England's King George III was beaten by an attendant during one of his asylum stays.) Pinel's first act, immortalized in a famous painting by Robert Fleury that shows a patient kissing his hand in gratitude, was to strike the chains off fifty-three of the filthy, bedraggled "beasts" that had been remanded to his care. Most of them proved to be quite harmless. Their previously violent behavior had mimicked the violence visited upon them by their keepers. Pinel introduced elementary hygiene, humane living conditions, and occupational therapies as substitutes for the leg irons, whippings, and brutal beatings that were the norm in European and American asylums. The same year in England, a Quaker named William Tuke founded the York Retreat for the mentally disturbed, a manor house so named "to convey the idea of what such an institution should be, namely, a place in which the unhappy might obtain a refuge; a quiet haven in which the shattered bark might find the means of reparation and safety."
The new movement had a name: moral treatment. A New York doctor named T. Romeyn Beck laid out its tenets in 1811:
This consists in moving patients from their residence to some proper asylum; and for this purpose a calm retreat in the country is to be preferred: for it is found that continuance at home aggravates the diseases, as the improper association of ideas cannot be destroyed. A system of human vigilance is adopted. Coercion by blows, stripes and chains, although sanctioned by the authority of Celsus and Cullen, is now justly laid aside....
Tolerate noisy ejaculations; strictly exclude visitors; let their fears and resentments be soothed without unnecessary opposition; adopt a system of regularity; make them rise, take exercise and food at stated times....
When convalescing, allow limited liberty; introduce entertaining books and conversation, exhilarating music, employment of body in agricultural pursuits ... and admit friends under proper restrictions. It will also be proper to forbid [the patients] returning home too soon. By thus acting, the patient will "minister to himself."
Beck's outline could have served as a mission statement for McLean; for its predecessor, the Philadelphia Hospital; for the Bloomingdale Asylum outside New York; for the Hartford Retreat; or for the Menninger Clinic through the first half of the twentieth century. More than a hundred years after Beck wrote, McLean's superintendent George Tuttle had this to say about the hospital "cures" of 1913: "There have been no striking changes during the year in methods of treatment. Emphasis is still laid on the superior advantage of out-of-door exercise, full feeding, and hydrotherapy for its tonic or soothing effect, as against sedative and hypnotic drugs, which practically are never prescribed."
The hydrotherapy treatment that Tuttle mentions likewise dates back to the eighteenth century. Another famous French painting, Jacques-Louis David's The Death of Marat , depicts the emaciated revolutionary slumped over in his hydrotherapy bath at the Charenton Asylum, after being fatally stabbed by Charlotte Corday. You cannot tell by looking at the Bowditch and Wyman buildings that a half-century ago, the basements of these stately halls were given over to hydrotherapy baths just like those in the David painting, with their long tubs and sail-like canvas covers intended to prevent patients from drowning. (Some did anyway.) The so-called Scotch douches, showers in which the patients were surrounded by needle-like jets of water and then hosed down with ice-cold water from chrome-plated fire hoses--"medieval torture instrument[s]," one doctor called them--were dismantled in the 1950s.
Over the years, McLean supplemented the rest cure with the various weapons that appear and disappear in the psychiatric armamentarium. Only a historian, or a doctor past retirement age, would recognize such terms as "total push," "metrazol shock therapy," or the most alluring of the lot, the "continuous sleep cure." And yet everything that was old becomes new again. Electroshock therapy, now rebranded "electroconvulsive therapy (ECT)," is still prescribed for recurring, stubborn depression. The days when Dr. Walter Freeman barnstormed the country in his Cortez campervan, proselytizing for while-you-wait ice-pick lobotomies for patients "sedated" by electroshock, are history. But selective psychosurgery still figures in the mental health portfolio. And imagine my surprise when I read in a 1999 McLean brochure that "Milieu Therapy is Alive and Well," which of course it is. The impetus behind milieu, a 1950s coinage, is almost exactly analogous to Pinel's eighteenth-century intuition that mental patients, like anyone else, might be able to shed some of the stress and pains of their afflictions in the bucolic environment of a suburban hospital.
(Continues...)
Excerpted from Gracefully Insane by Alex Beam. Copyright © 2001 by Alex Beam. Excerpted by permission. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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