Gracefully Insane


Another post from the History Book Club.

Gracefully Insane, by Alex Beam

Alex Beam’s Gracefully Insane tells the history of Boston’s McLean Hospital. It is one of the oldest in the country, and as Beam writes:

It is … a museum of the many therapies advanced over more than two hundred years to relieve mental illness.

Not the very oldest therapy: before the 19th century, the dominant idea was to “wake” patients from madness by barbaric treatments. For example, at Paris’s notorious Bicetre asylum, the inmates were

loaded down with chains and shackled to floors and walls with irons, at the mercy of cruel attendants armed with whips and the authority to use them freely. … One German asylum lowered patients into a dungeon filled with snakes. Even England’s King George III was beaten by an attendant during one of his asylum stays.

A doctor Willard of Massachusetts would lower patients into a tank of water “until the bubbles of air ceased to rise, after which he was taken out, rubbed, and revived — if he had not already passed beyond reviving!”

This all changed in 1792, when the enlightened French doctor Philippe Pinel took charge of Bicetre. “The idea was that a relaxed life in a pastoral setting would go a long way toward alleviating the suffering of the mentally ill.” The new approach was termed moral treatment.

After a few false starts, the worthies of Boston opened an asylum in the pastoral setting of Charlestown (now part of Somerville) in 1817. The first board of trustees included John Adams and John Quincy Adams, as well as a future Supreme Court justice and a future Harvard president.

In its early years, the Charlestown Asylum admitted patients rich, poor, and in between. By 1823 it labored under a $20,000 debt. A bequest of $120,000 from one John McLean saved the asylum and bestowed its new name.

In 1833 the Worcester State Asylum opened its doors, in 1839 the Boston Lunatic Hospital. McLean soon became the abode almost exclusively of the wealthy. In 1895, McLean relocated to its palatial Belmont location. Designed by Frederick Law Olmstead, it resembles a college campus rather than a hospital. Olmstead himself became a patient there later on.

Let us sample some theories, treatments, and patients over the years. In Philadephia, Dr. Benjamin Rush (a signer of the Declaration of Independence) “held that madness was an arterial disease, ‘a great morbid excitement or inflammation of the brains. … [An] unrestrained appetite caused the blood vessels to be overcharged with blood.” He prescribed low diet, vomiting, and bleeding. He also invented a “gyrator” and a “coercion chair”; McLean bought a knockoff of the latter. But McLean emphasized moral therapy. The residences were scarcely less luxorious than the patients’ homes, with sitting rooms and servants quarters, and often one patient to a building. Excursions on the Charles, or to the Boston Athenaeum: many of the “Mayflower screwballs” lived out their lives in these pleasant accomodations (including one of Emerson’s brothers).

Seventeen different forms of hydrotherapy, emetics, tincture of opium — all found use in the 19th century. Lobotomies debuted in the 1930s, in Italy, even winning a Nobel prize in 1949. An American doctor promoted the operation, barnstorming the country and performing over 1000 “ice-pick” lobotomies, often sans anesthesia. McLean was not immune to the craze: in 1947 they lobotomized 7% of their patients, all women as it happened. One medical historian wrote, “With surgical fees running as high as $600 an operation, psychosurgery had become a lucrative side-specialty.”

Shock therapies (insulin and electroshock) became popular midcentury. (Electroshock has one of the longest pedigrees going: in the 1st century AD, electric eels were used to treat the Emperor’s headaches.) But the real game-changer was Freudian psychoanalysis.

Freudianism came slowly to McLean. Partly from direct experience with its less savory aspects: in 1924, Dr. Horace Frink was admitted to McLean for treatment. Frink had cofounded the New York Psychoanalytic Society in 1911, and became a patient of Freud’s in 1921. Freud encouraged Frink’s affair with Madame Bijur, a wealthy married patient of Frink. Freud wrote to Frink:

… you are not yet aware of your phantasy of making me a rich man. If matters turn out all right let us change the imaginary gift into a real contribution to the psychoanalytic fund.

One modern scholar commented, “the question has to be raised whether it was not Freud’s fantasy that he would become a rich man from Mrs. Bijur’s becoming Mrs. Frink …” The husband threatened a scandal but died before things blew up in Freud’s face. Frink married Mrs. Bijur, but the marriage ended with Frink’s second suicide attempt. This got him committed to McLean; their old-fashioned remedies restored him to good mental health in 5 months.

In the 1930s, one Carl Liebman shuttled from analyst to analyst before finally landing on the doorstep of Abraham Brill, America’s Number One Freudian. Brill noted that all the analysis had “not at all changed his delusional trend … [Liebman] imagined that he was followed by detectives.” Meanwhile, a letter from Liebman’s sister to McLean officials explained that the worried family “had him followed by detectives from the time he left Vienna. He knows nothing of this.” Liebman never improved, but lived out the balance of his life in McLean’s comfortable environs.

By midcentury, McLean was known as a backwater. A quote from the director: “If you don’t know where you are, then you’re in the right place.” (A sex scandal in the 40s did not help.) So in 1955, the trustees hired Dr. Alfred Stanton as new director, coauthor of The Mental Hospital and a prominent Freudian. Indeed, Stanton was more Freudian than Freud, believing (unlike Freud) that psychoanalysis could cure schizophenia. As one doctor recalls, “He thought if you were really a good psychiatrist, you’d try to cure without drugs.”

Alas, Stanton proved better at writing books and papers than running McLean. Morale plummeted. McLean suffered through two suicide epidemics in the 60s. As an ironic capstone to his career, he resigned as psychiatrist-in-chief in 1967 and spent the next 15 years sheparding a comprehensive research study that established that psychoanalysis could not help schizophenics.

This study, published in 1985, also helped usher in the modern era of psychopharmacology. This era has not been kind to McLean. In the 1990s, substantial financial losses forced the trustees to reorganize the institution, selling off many assets and 80% of its land, and repurposing the remainder. The new McLean focuses more on research. But with a nod to its illustrious tradition, it also opened a special ward, the Pavilion, a sort of “high-end clinic to service the megarich”.


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