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Mental Disorders

by Alex Beam
Public Affairs, 2001
Review by Meleah Maynard on Apr 30th 2002

Gracefully Insane

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 super-crazy."   


© 2002 Meleah Maynard


Meleah 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.