by Alex Beam
Public Affairs, 2001
Review by Meleah Maynard on Apr 30th 2002
Most histories having to do with
mental illness recount horrific tales of desperately ill people abandoned by
their families and doomed to spend their remaining years locked away in
dungeons with no one but their crazy cellmates to keep them company.
Alex Beam's, Gracefully Insane: The Rise and Fall of America's Premier Mental
Hospital paints a very different picture by showing us what happens when
the rich and/or famous are faced with a mental illness. Overcrowded prison
settings are not for them. In the world of the well-heeled, mental institutions
more closely resemble country clubs.
Since the early 1800s McLean Hospital
has been one of the institutions of choice among the elite. Using years of
research, including numerous interviews with former patients and staff, Beam
skillfully pieces together the history of the venerable facility from its
founding in 1817 to the present.
Located just outside of Boston,
McLean has at one time or another been temporary home to such notables as Ray
Charles, James Taylor, John Nash, Robert Lowell, and Anne Sexton. Sylvia
Plath's, The Bell Jar was based on
her stay at McLean as was Susanna Kaysen's, Girl
Interrupted, in which Kaysen complains about how she and other unruly
children of the well-to-do were shipped off to institutions when they became
difficult to handle at home.
Kaysen's theories on why she ended
up at McLean may not be too far off, Beam writes. Several doctors he
interviewed for the book admitted that there was a time in the 1960s when
adults were so out of touch with acid-dropping, sexually uninhibited teenagers
that being a hippie verged on being a diagnosable illness rather than a sign of
the times. In other words, "'hippiephrenia' was replacing
schizophrenia," one psychiatrist told Beam.
Considering the subject matter, Gracefully Insane could well have turned
out to be a dry academic tome. But Beam, who is a columnist for the Boston Globe, writes in a conversational
style that often reads as if the reader were listening in on a juicy gossip
session in a hospital break room. James Taylor, for example, spent years
claiming that he'd escaped from McLean while the press repeatedly noted that
his story couldn't have been true because he had entered the hospital
voluntarily. At one point, Taylor's sister Kate and his brother Livingston were
also receiving inpatient treatment at McLean.
Anne Sexton, Beam writes, was
committed to a Massachusetts mental hospital after her first suicide attempt at
the age of twenty-eight. Psychiatrists urged her to write poetry. Though she
eventually one a Pulitzer Prize, she was unhappy, she often said, because she'd
never been institutionalized at McLean like fellow poet, Sylvia Plath. Known
for her enormous capacity for insecurity, Sexton's jealously of Plath lived on
even in death. "After Plath committed suicide, Sexton published a bitch
essay/poem, griping that Plath had trumped her in their mortal combat."
Sexton eventually got her wish when she was committed to McLean Hospital in
1973 suffering from severe depression. She killed herself one year later.
Running alongside the history of
McLean Hospital is the story of psychology itself. Though McLean's setting was
much more hospitable than the crowded conditions suffered by the poor,
"treatments" used on patients there were often no less injurious or
life threatening than those being used elsewhere.
While doctors at McLean didn't go
in for every innovation on the mental health scene -- lobotomies, for example.
They did embrace the commonly used treatment of insulin coma, which was thought
to be a cure for schizophrenia. They also used electroshock therapy, ECT.
Beam interviewed McLean staffers
who said that thrashing movements of patients in the midst of electroshock
treatment often caused dislocated jaws and bone fractures. In some cases the
convulsions were so severe as to break ribs. One McLean aide who witnessed a
mass electroshock therapy treatment at a nearby hospital had this to say.
"I saw about one hundred patients getting shock therapy in a huge room.
They were all strapped down, and they were all twitching and jerking. This is
the way they did it. I could just feel the electricity going through the air.
There was no screaming, no physical agony, just this twitching."
In the hospital's heyday, patients
spent months, sometimes years, living in spacious suites in one of McLean's
many Tudor mansions that looked out on the facility's sprawling grounds and
golf course. For the most part, residents were free to roam about as they
wished. There were few rules and expectations. Bizarre behavior and strange
outbursts were taken in stride. On warm, sunny days it was not uncommon for a
patient or two to stroll through the beautifully manicured gardens in the nude.
From time to time a new McLean
administrator would get a wild idea and depart from the hospital's usual
practice of leaving their elite clientele alone to do as they pleased. One
tried water therapy and had staffers keep patients in warm baths for hours or
days at a time. Every few years it was decided that patients would be rousted
from their beds in the early morning to bathe, eat, and engage in an activity
of some kind. But those strategies never lasted. At one point it was even
recommended that ultraviolet irradiation of male patients' testicles be done
although even doctors admitted that they didn't really know what the
therapeutic affect of such a treatment would really be.
As the book's title suggests, the
hospital has fallen on hard times in recent years. By the late 1940s McLean had
become something of a dinosaur known for catering to the wishes of the rich and
bizarre. In the 1960s a rash of patient suicides rocked McLean after a new
administrator tried to implement a series of new rules that forced patients to
adhere to a strict schedule. A few years later a popular young doctor killed
himself by taking an overdose of his wife's sleeping medication. Charges of
sexual impropriety cost other doctors their jobs.
While the hospital may have been
able to recover from all of those things, the advent of managed care and the
introduction of drugs like Lithium and Prozac have forced full-service mental
institutions like McLean to change the way they do things or close. McLean was
not designed for today's brand of care in which patients are lucky to get five
days of inpatient treatment before being sent home with a tray full of meds and
instructions to call their doctor if they can't sleep or have dry mouth.
In order to survive financially,
McLean has downsized considerably in the last decade. Administrators there have
opened a new facility called the Pavilion. Beam sums up the place as a sort of
"mental hospital equivalent of Club Med" where patients able to pay
$1,800 a day out of pocket can get "virtually anything he or she
wants." Hospital staff describe the Pavilion's mission as returning to
what McLean does best -- serve those who can afford the very best. The ward is
not locked and, as one doctor put it, it is "for the less than
2002 Meleah Maynard
Maynard recently left the mental health field to pursue her first love,
writing short stories and book reviews. She has worked as a day treatment
counselor in Minneapolis, teaching people living with schizophrenia how to
write creatively and cook a well-balanced meal.