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.

Categories: General, MentalHealth