The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution (25 page)

“She never should have had any of us,”
Mercier said
.

The asylum was more than a century old. It looked like a medieval fortress, constructed of four-foot-square stones that glowed bloodred in the sunset. A giant bell tower rose three stories higher than the rest of the imposing structure. Iron bars covered the windows. Visitors passed through a great iron gate and drove along a twisted path among gnarled trees, past cottages for the senior staff, and up a steep hill before finally reaching the baroque administration building. A grand stairway led to the administration’s main entrance. Two clinical wings extended from either side of the main building—one for men, one for women. Each wing had a secondary wing set back from its neighbor, and behind each secondary wing was yet another. The design was maddening, resembling the endless labyrinths of the mind.

In 1927, Katharine McCormick had established the Neuroendocrine Research Foundation at Harvard to fund research she hoped would lead to a cure for her husband’s severe mental illness. Harvard at the time had used McCormick’s money to conduct studies among mentally ill patients at the asylum in Worcester, and Hudson Hoagland had been one of the Harvard scientists assigned to the project. Back then, there were no laws banning the use of mental patients in scientific experiments. So when Hoagland and Pincus set up their foundation in Shrewsbury years later, they viewed the local asylum as a convenient resource. In fact, they conducted experiments there so often that the Foundation maintained a laboratory in the asylum’s main building and kept scientists there year-round.

By the 1950s, the hospital housed three thousand patients and one thousand staff members (though only about thirty doctors). The man in charge was an enormously overweight Harvard grad named Dr. Bardwell Flower. “Dr. Fartwell Blower,” the staff called him
behind his back
. The food was so poor that patients in the rear wards who received little sunlight were often treated for scurvy. The stink of excrement and disinfectant slapped visitors in the face. A single nurse or attendant cared for one hundred patients at a time. Security was lax. Worcester officials congratulated themselves for seldom using restraints on patients, but sometimes their attempts at leniency backfired. In 1943,
one inmate beheaded another
. And it was not unusual for patients to bind and gag their doctors or nurses and walk out of the hospital. By the mid-1950s, doctors were beginning to experiment with chlorpromazine for schizophrenia, but most still relied on shock treatments, lobotomies, and barbiturate sedatives. The treatment of mental illness remained a rough and imprecise science, one that outsiders found deeply disturbing to witness. Dr. Enoch Callaway recalled that one patient with a lobotomy worked as a maid. Once, when he and his wife briefly resided in one of the hospital’s apartments—“the honeymoon suite,” they called it—the lobotomy patient came in and tried to change the sheets while the bed was still occupied. But most moments were not so amusing. Dr. Callaway watched as “warehouse-like rooms” filled to capacity with “
patients who have defeated our best efforts
.” In some ways, he said, it was a model mental hospital. In other ways, it was a snake pit.

It was not difficult for Pincus to obtain permission to experiment on patients at the asylum. No permission slips needed to be signed. It would appear that Dr. Flower was simply pleased to have a few more physicians on hand in his enormous hospital. It helped, too, that McCormick offered money to paint and refurbish some of the asylum’s wards in exchange for cooperation in the progesterone study. And so they began administering progesterone and estrogen in varying doses to women diagnosed with paranoia, schizophrenia, melancholia, manic depression, chronic alcoholism, Alzheimer’s disease, Pick’s disease, and more.

Not all the women at the Worcester State Hospital were chronically ill, however. All over the country in the 1950s, mental hospitals experienced a population explosion of their own. Ironically, some of the women who voluntarily checked into the hospital were those who might have been most helped by an oral contraceptive such as the one Pincus was testing. They were women suffering from anxiety or depression, conditions prompted or exacerbated by too many pregnancies or the strains of taking care of large families. Some women were not necessarily mentally ill but crumbling under the pressure of abusive husbands or domestic conditions they could no longer bear. Mildly ill patients received counseling, rest, and barbiturate sedatives. The more seriously ill, including women such as Florence Kouveliotis, were treated with electroshock, insulin shock, and lobotomies. Chronic cases who didn’t respond to treatment at the Worcester State Hospital were steadily moved to higher floors and more distant wings of the hospital until they made it to the second and third floors of the third wing, which the staff referred to as “the back wards,” giving profound new meaning to the expression “Out of sight, out of mind.” Women on the back wards were issued so-called “strong dresses,” garments made of heavy blue-gray canvas with reinforced stitching on the hems, sleeves, and neck. No belts or ties were provided. They all had their hair shorn to shoulder length. “Since we had no effective and safe sedatives,” Dr. Callaway wrote, “most of them milled about in aimless agitation,
defecating and urinating
as the urges arose.” Many of the women were disheveled and malnourished. Some of them would fling themselves at guards or fellow patients, biting, scratching, and
pulling hair in frustration
. When he was assigned to perform an annual review on one of the women in the back wards, Dr. Callaway said, “
I could not help imagining
her as a young woman, full of hope for the future, and never dreaming that she would end her days waiting for death in a warehouse full of broken minds.”

The back wards offered one of the most miserable collections of human beings imaginable, but they also supplied a nearly endless array of patients for research projects like the one Pincus was planning.

“You could do experiments there you
would never think of doing these days
,” Callaway recalled. “You never asked the patients for permission. Nobody supervised. We gave amphetamines to schizophrenics once. I’d say, ‘John, would you mind if I gave you a shot to see what it does to you?’ And he’d say, ‘Oh, sure doc.’ The amphetamines just made them more talkative.”

Though the patients were accessible and largely cooperative, they were still not ideal subjects. Conditions in the asylum were so dire that Pincus’s team of researchers feared for their safety. His section heads sent a memo titled “
SUBJECT: GENERAL LABORATORY CONDITIONS
,” which read, in part:

[W]e wish to inform the directors
that the working conditions in these laboratories after 10 P.M. when the night watchman finishes his rounds are not safe. The laboratories are easily accessible to patients even when all the doors are locked. Since it has been the practice of some people at the technical level to work at night, it is felt by us, being responsible for their welfare, that some directive should be forthcoming to establish the conditions for such practices.

Pincus managed to enroll sixteen women—all of them classified as psychotics—for his first round of progesterone tests. He also gave the hormone to sixteen men to see how it would affect their sterility—and, while he was at it, to see if it might help with their mental illness.

Unfortunately, these tests did not prove helpful. The women were not having sexual intercourse, which made it difficult to be certain they weren’t ovulating. It was similarly difficult to tell whether the compounds affected ovulation because psychiatric problems disrupted the menstrual cycles of many of the women. As for the men, Pincus believed that the progesterone might lower their sperm counts and reduce their sexual desire. It’s not clear if he was interested in this for purposes of birth control or merely for curiosity. Sanger and McCormick had made it clear that they weren’t interested in a birth-control pill for men. They didn’t trust men to take the responsibility, and they wanted women to possess control of their own bodies and their own fertility. But even if progesterone failed as a contraceptive for men, or if his sponsors were uninterested in such a thing, Pincus thought there might be another useful application. If progesterone subdued a man’s libido, the hormone might be administered in combination with psychotherapy
to cure men of homosexuality
. In the end, though, his tests were inconclusive. One psychotic male subject appeared to have shrunken testicles after taking progesterone for five months. Nurses said the same patient became more “feminine” while taking the hormone. The investigation went no further in part because the researchers couldn’t persuade the male asylum patients to produce semen samples. They did observe the frequency with which the men masturbated but found no change. They also concluded, according to Pincus, that the men taking the progesterone “
were just as psychotic
as they were when we began to give them the drug.”

With no more time to waste, it was back to Puerto Rico.

NINETEEN

John Rock’s Hard Place

F
OR JOHN ROCK,
the time had come to make a decision.

Was he in? Was he going to commit to a project that would put him in direct opposition to the Catholic Church, the same church to which he had been devoted since boyhood?

Rock was not only a practicing Catholic but also a respected medical doctor with a thriving practice and a spotless reputation. What’s more, he was sixty-four years old and nearing mandatory retirement from Harvard, and he had begun thinking about launching an independent practice. Pincus, Sanger, and McCormick were all gambling by getting involved in the search for an oral contraceptive, but they were outsiders with little to lose except their time or money. Rock had more on the line.

By 1954, he had seen enough of Pincus to know how the scientist operated and to know that
it made him uncomfortable
. Rock believed there would be no harm in giving women heavy doses of progesterone for a few months, especially when it offered infertile women hope of becoming pregnant on the rebound. But he had doubts about putting women on the
hormone for prolonged stretches
. The potential side effects were serious. The regimen was taxing. And no one knew what kind of long-term health or reproductive problems might arise. He reminded Pincus, as well as McCormick and Sanger, that the work should not be rushed.

McCormick, ever anxious to push forward, grew frustrated at times with Rock’s conservative approach to science. “Dr. Pincus is imaginative and inspirational,” she wrote. “Dr. Rock is informative and
very realistic about medical work
.” McCormick was astonished at the difficulty of the testing and marveled that any women would agree to it. She suggested paying participants to cooperate, but
Pincus and Rock refused
. What they needed for the tests, McCormick said, perhaps facetiously, was “a cage of ovulating females.” Rock explained to McCormick that his patients—and other patients, as well—were not to be exploited. These were “people who want babies,” he said. They were emotionally fragile and needed tender care. They were also young and looking forward to long lives as mothers and grandmothers. He would not do anything that might damage their health “for just
an abstract research thing
.”

Sanger didn’t trust him. Yes, she admitted, he was charming and handsome. And yes, Rock had shown commitment to the cause when he had agreed to enroll his patients in clinical trials with Pincus. Still, Sanger refused to believe that a Catholic gynecologist could ever truly dedicate himself to the cause of contraception. “Abram, Abram,” she wrote to Abraham Stone when she learned that Planned Parenthood had appointed Rock chairman of one of its scientific research committees,
“What has happened to you to allow the enemy to walk in the front door?”
If Pincus had not come to Rock’s defense, Sanger might have shoved Rock off the team. But Pincus needed Rock to give him legitimacy in the medical community.

Another concern was Rock’s health. He had suffered a major heart attack in 1944, followed by several smaller ones. Two years after the first attack, a car accident had killed his eldest child, Jack. Over the course of the 1940s, his wife had suffered a number of illnesses that had left her partially paralyzed. Through it all, Rock pressed on with his work. He eliminated salt from his diet and gave up smoking tobacco, stuffing his pipe with corn silk instead. Perhaps the health scares and personal tragedies freed him to take more chances and do what he believed was right. Here was a doctor who had devoted most of his career to fertility treatment who was now beginning to focus his time and energy on the opposite side of the issue—contraception. Did that make him a rebel? Rock did not see it that way. He was interested in solving the central problems surrounding human reproduction. In Rock’s mind, there was no reason to be afraid of contraceptive research; it was a close relative to fertility research. Nor was there any reason to be afraid of discussing sex.