Gracefully Insane (3 page)

The new movement had a name: moral treatment. A New York doctor named T. Romeyn Beck laid out its tenets in 1811:

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 the bath in his home, 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 chromeplated 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.
²
The days when Dr. Walter Freeman barnstormed the country in his Cortez camper-van, 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.

The idea of a rest cure, supplemented with occupational therapies, physical therapies, or talk therapies, seems natural to us. But it has proved to be an idea that we can no longer afford to believe in. First-class asylum care, characterized by lengthy stays and solicitous medical attention, has not been particularly successful. So-called outcome statistics are notoriously unreliable when judging mental hospitals. A hospital that specializes in the “worried well” will discharge many patients claiming to have recovered. But institutions like McLean, which has always been willing to grapple with schizophrenia and other severe disturbances, will not have a stellar success record. Perhaps one-third of severely disturbed patients improve under hospital care and leave in better shape than they came. Another one-third can be stabilized and show only marginal improvement; this group can be weaned from full-time care. And the rest probably belong in the hospital full-time.

These days, neither individuals nor insurance companies can afford to pay for residential care. A night at McLean now costs almost
$900. For the past twenty-five years, we have been embarked on a different path for treating the mentally ill. Ever since the emergence of Thorazine, the immobilizing “prescription straitjacket” introduced into widespread use in the late 1950s, drug therapy has supplanted asylum care as the order of the day. “Now they lock you up in a chemical jail,” is how James Taylor—who has been drug-free for almost twenty years—describes modern psychiatry. Yet for as much as it has been criticized, the “psychopharmaceutical revolution” has proved to be cost-effective in many instances. Now, severely disturbed patients can often live in halfway houses or low-security settings. Many drugs successfully treat, or at least ameliorate, conditions such as depression or compulsive disorders. But the causes and potential cures for schizophrenia—the “broken mind”—are still largely unknown. “Researchers are still in the dark about schizophrenia,” a March 2001 issue of the
Harvard Mental Health Newsletter
admitted. Mental health is the question for which we have yet to learn the answer. This book is, in part, a history of that question, and the many suggested answers.

But it is also a book about people. The last person quoted here is a patient, not a doctor, and a patient embarked, hopefully, on the road to a better life. People ask me why I undertook this project, and I have a series of responses, depending on their actual level of interest. Because McLean is an interesting place, full of great stories, I say. That ends most conversations. Because it was a challenge, I say to others; such a book has not been written. That satisfies many questioners. But one afternoon at the Iruna, the delightfully down-at-the-mouth Spanish café across from Harvard’s John F. Kennedy School of Government, Rob Perkins asked me why I had chosen to spend several years of my life researching the hospital. Rob had spent almost two years’ hard time as a patient at McLean and had written movingly about his experiences there. I respected him enormously, and I could not buffalo him the way I could everyone else. “Rob, life is impossible,” I confessed. “Who can’t understand the need for shelter? And who can’t sympathize
with the people who seek that shelter? And who could fail to be interested in a place that offered that shelter?”

So this is a book about the men and women who needed shelter more than most of us, or who, in some cases, were more honest about their need for protection than we are. And about an institution that provided that shelter, imperfectly, in our imperfect world.

Crazy people much more pleasant than I expected.

 

 

 

B
y the early nineteenth century, the city of Boston was already
two hundred years old. The great Yankee trades to Europe, the Caribbean, and the Far East were pouring money into the counting houses of India Wharf and into the vaults of new banks springing up on State Street. Boston, given to calling itself the “Athens of America,” was locked in a grand rivalry with Philadelphia and New York and hooked on new construction. The society architect Charles Bulfinch was remaking the face of the city, planting his distinctive, boxy, brick, federalist mansions along Boston’s main thoroughfares, culminating in his gold-domed masterwork,
the Commonwealth’s State House atop Beacon Hill. The city had just built five bridges spanning the Charles River. The first interurban railroad, the Boston and Albany line, was about to begin service. The city fathers trained in 7,700 tons of marble from Quincy quarries to erect the 220-foot-tall Bunker Hill monument, commemorating the famous battle, and imposed upon the doddering Marquis de Lafayette to lay the cornerstone.

And yet Boston lacked a hospital.

New York, Baltimore, Philadelphia, and even Williamsburg, Virginia, had been operating large public hospitals for more than fifty years, all of which accepted mental patients as well as the sick and infirm. But Boston maintained only a quarantine station on nearby Rainsford Island and the public dispensary, which gave outpatient care to the poor. The mad or delirious were either cared for at home, packed off to the (Bulfinch-designed) Almshouse for the destitute, or farmed out to specialized boarding houses. In his book
The Mentally Ill in America,
Albert Deutsch mentions a

Two physicians from esteemed Boston First Families, James Jackson and John Collins Warren—it was Warren’s uncle who urged the Colonials not to fire until they saw the whites of their British enemies’ eyes on Bunker Hill—adopted the hospital cause and circulated a petition to the city’s Yankee oligarchs in 1810:

Jackson and Warren, “charter members in a society that had only charter members” as Cleveland Amory called them, reminded the Puritan legatees of their responsibilities:

The doctors’ plea did not fall on deaf ears. But it did fall on the ears of merchant princes who were temporarily short on cash. Thomas Jefferson’s foreign trade embargo had ended only the previous year. Moreover, the reason for the embargo—the diplomatic complications of Europe’s Napoleonic Wars—had not disappeared. Indeed, things would get worse before they got better. The British blockaded American ports during the War of 1812 and paralyzed Yankee shipping. Jackson and Warren failed to raise the needed funds.

They did, however, obtain a charter from the Commonwealth of Massachusetts and formed a corporation of fifty-five members. Then as now, the trustees of the Massachusetts General Hospital and the Charlestown (later McLean) Asylum hailed from the New
World aristocracy. Former president John Adams moderated the first meeting. Other members included his son, the future president John Quincy Adams, a future vice-president, a future Supreme Court justice, and a future Harvard president. By the end of the war, economic health was restored, and the merged hospital projects moved forward. The asylum, sited on a spit of land overlooking the harbor in Charlestown, opened its doors in 1817, several years before the Massachusetts General Hospital. (At midcentury, this area incorporated itself as Somerville, and McLean was sometimes called the Somerville Asylum.) This was partly because Jackson, Warren, and their supporters raised money for the asylum more quickly than for the hospital and partly because they happened upon a fortuitous real estate deal for McLean.

The ill fortunes of one Joseph Barrell, who had once employed the architect Bulfinch in his counting house, proved to be a boon for the asylum. Barrell, a horticultural enthusiast, had built what some thought to be the most beautiful country home in New England, an eighteen-acre estate adorned with hundreds of ornamental plants and fruit trees imported from Europe. He had embellished the property with stables, dovecotes, greenhouses, a rose-covered summerhouse, fountains, and even exotic fish pools. His terraced gardens swept down to the water. Atop them sat a Bulfinch-designed, three-story, English-style manor house with a southern view over Miller’s Creek, a tributary of the Charles, and an eastern exposure to the river’s mouth and the harbor.

But Barrell luxuriated in his Charlestown aerie for less than ten years before succumbing to debts and death in 1804. In 1816, the hospital trustees bought the estate for just $15,650, a great bargain compared with the $23,000 they paid just a few months later for the four acres of undeveloped Boston land that was to become the Massachusetts General Hospital. After the purchase of the Barrell estate, Bulfinch added three-story wings to each side of his brick manor house—a men’s ward and a women’s ward—and the new asylum opened for business.

For several years, McLean was the only mental hospital in Boston, and it attracted a fairly diverse patient population. Still, because the incorporators did not want their new hospital to become “a merely pauper establishment,” they successfully resisted the legislature’s demand that they admit charity patients for free. Instead, they assessed fees on a sliding scale. Charity cases dependent on municipal support were billed $2.50 a week, to be paid by their town of residence. The administration reserved the right to show preference for donors’ families or for patients from towns that had aided the hospital financially. Patients trickled in, which was fine with the administrators, who were learning on the job. Patient Number One, as McLean’s official historian Silvia Sutton sardonically notes, “might have come from Central Casting”: