Beautiful Minds

We live in the twilight of the empire of asylumdom. Until two or three generations ago, we followed the example of our Victorian forebears, consigning legions of the awkward, the inconvenient and the impossible to purpose-built museums of madness. Most of them were vast and straggling outposts of the welfare system, vainly aspiring to the status of medical institutions; a few smaller and more plushily appointed, where the most batty and dotty representatives of what passes for an American aristocracy could be kept discreetly under wraps.

Nowadays, we have embraced what our Orwellian leaders have dubbed “community care.” The mad and the mopish, the dolorous and the downcast, the delusional and the demented have been “decarcerated.” Cast out of the institutions where once they were locked away and instead doped up with the miracle pills of modern psychopharmacology, they subsist at the margins of civilized society, most of them repressively tolerated in the most deteriorated sectors of our urban areas. Meanwhile, bereft of the human flotsam and jetsam that once provided their raison d’etre, the edifices that once housed the alienated are in their death throes.

Alex Beam, a columnist for the Boston Globe, has written a biography of one of these decrepit near-corpses, the McLean Asylum, a place he dubs “America’s premier mental hospital.” If McLean has a claim to preeminence, it is not because it came first (Philadelphia and New York built their bins some decades sooner, as did colonial Williamsburg). Nor is it because it was a center of psychiatric innovation or by some measure “better” than several of its competitors. To the contrary, it was largely a therapeutic backwater, notwithstanding its academic affiliation with Harvard Medical School. It was from its up-market clientele (Boston Brahmins, literary icons such as Robert Lowell and Sylvia Plath, the mad mathematician and sometime Nobel prizewinner John Forbes Nash, and, as it began to spiral downward, spoiled rich kids from the 1960s generation, such as the singing Taylor brothers, James and Livingston, and their sister Kate) that the luxuriously appointed asylum, set in grounds designed by Frederick Law Olmsted, obtained its status and its standing.

Beam makes little of the McLean asylum’s 19th century history. He recalls the founding of the asylum in the late 1810s and briefly sketches its early history in a Charles Bulfinch-designed building in Charlestown, Mass., but he fails to mention one of the greatest ironies of its early years: that it was the poor and working classes who contributed most generously to the initial funding of the establishment, relying upon assurances that their needs would be met, only to be shut out once it became apparent that the rich would not tolerate confinement of their relations alongside the socially inferior.

Beam’s biography skates lightly over the hospital’s youth and early adulthood, focusing its gaze rather on the last century of the asylum’s life--the period that followed the institution’s move from what had become an area of slaughterhouses and slums to the leafy Boston suburb of Belmont. There, amid acres of rolling grounds, about 160 patients lived in surroundings that, on the surface at least, mimicked the country-house lifestyle many of its affluent patrons had enjoyed prior to their breakdowns.

For a time, the establishment’s wealthiest patron was Stanley McCormick, heir to the McCormick Harvest Machine Co. (later International Harvester) fortune. McCormick was a one-man gravy train for the psychiatric profession, despite their collective inability to do anything for him. In his post-McLean years, a series of shrinks danced attendance on him. One psychoanalytically inclined gentleman was paid the princely sum of $150,000 a year (in 1927) to devote his entire attention to “mad McCormick” (with the usual lack of success), until he was fired amid the acrimony of an lawsuit launched by the patient’s wife (herself embroiled in endless disputes with Stanley’s blood relatives).

Psychoanalysis appealed to a segment of McLean’s clientele, and a whole succession of patients were subjected to the dubious ministrations of talk therapists, with generally dismal results. Not that they were spared assaults from the other weapons in the psychiatric arsenal. To the contrary, Beam recites a litany of failed and often frightful therapeutic interventions of a somatic sort visited upon those who occupied the wards. Being rich and mad, it turned out, did not spare one the encounter with lobotomy, insulin coma therapy or a variety of shock therapies, or even with a melange of the lot concocted by McLean physicians and administered under the label of “total push therapy.”

A journalist by training, Beam wants to tell a good story, and he prefers interviewing the living to slogging through the archives. So it is to the events and personalities of the last half century that he most closely attends. A string of doctors and patients pass before us, each contributing to a portrait of an institution that once insisted on a six-week preliminary residence before offering either diagnosis or prescription for its patients, and that offered for many of the too wealthy a sheltered sojourn apart from the cares of the world--a stay that often continued to their deaths.

But the managed-care revolution, and the relentless escalation of the costs of in-patient care, compounded by the feckless management styles of some of its leaders, eventually landed McLean in the soup. Save for the odd celebrity such as Ray Charles (who elected to stay for some weeks in the hospital to avoid jail for a drug bust), few could afford its inflated charges. The in-patient population shrank, the shrinks failed to adjust to the new realities, and the whole place began to fall apart. The institution’s new master plan calls for selling off much of its 250 acres of rolling grounds for redevelopment, donating other land to the township as open space (a bribe to obtain the necessary planning approval), and setting up a new, small, super-expensive unit, the Pavilion, which for $1,800 a night will offer its wares to the tiny segment of the population that can afford such indulgence. It is not certain that even these drastic moves will allow it to survive.

*

Andrew Scull is the author, with Jonathan Andrews, of “Undertaker of the Mind: John Monro and Mad Doctoring in 18th Century England.”Being rich and mad, it turned out, did not spare one the encounter with lobotomy, insulin coma therapy or a variety of shock therapies.