Gracefully Insane Page 13

  But most importantly, Stanton and his crew changed the way McLean cared for its patients. He did not believe in electroshock therapy or insulin shock therapy, and he never approved a lobotomy. Stanton did not believe in doping patients into a zombielike state because it rendered them insensitive to the one cure he truly believed in: Freudian-style talk therapy. “He thought if you were really a good psychiatrist, you’d try to cure without drugs,” remembers Washburn, one of Stanton’s first trainees. “But if things got bad enough,”—Washburn laughs at the memory—“you could use drugs.”14 Never mind that Freud himself thought most schizophrenics dwelled well beyond the reach of psychoanalysis; Stanton thought otherwise. He committed his ideas to paper in an Atlantic Monthly article published in 1961, “Schizophrenics Can Recover.” The article, which had been stage-managed by Stanton and the McLean trustees to commemorate the hospital’s 150th anniversary, never really specified just how schizophrenics could “recover,” but it assigned Stanton a great deal of credit for thinking that they could. It even quoted an unintentionally comic exchange between Stanton and his mentor, Sullivan:“Damn it Harry,” [Stanton] said to Dr. Sullivan. “Schizophrenia is not all that tough. It should be easy to cure. We have been missing the point.”

  Sullivan was attentive. “What makes you say that?”

  Stanton suddenly felt helpless. He could not remember the point.

  The point was that there was no point. Neither Alfred Stanton in 1961 nor his successors in the twenty-first century had or has a workable program to “cure” schizophrenics or help them “recover.” But Stanton was more than eager to try.

  The new approach began the moment patients walked, or were wheeled, in the door. Previously, admission to McLean involved filling out a series of index cards. Stanton instituted the modern “work-up,” which sometimes consumed three weeks and culminated in a thirty-page report. In seemingly endless interviews, young residents ran patients’ life stories through complex theoretical “grids,” looking for clues about the origins of his or her illness. “Stanton felt that if you did a really lengthy history, you’d understand the problem,” says Washburn. “The idea was that you could see a life pattern, and the psychodynamic diagnosis would hit you in the face.” The work-ups, integral to McLean’s minimum-stay forty-day commitment policy, were hell on the residents and hell on some patients as well. When she checked herself into McLean in the mid-1960s, “I wanted to start working on my problems and start getting over them,” Alice Brock remembers. “But no, the first few months, they’ve got to observe you, and test you, and observe you, and test you, and then they decide on some kind of treatment, and then they assign you a therapist, and then you actually go into therapy.”

  Every new case was discussed every day, for several weeks running, at staff conferences run by either Stanton or Kahne, a strict taskmaster who quickly became known as “Genghis” Kahne. “All the residents used to shake in fear of him,” recalls Dr. Peter Choras. “He would say, ‘Tell me a problem,’ but it had to be a problem that was tough. So we’d present a tough problem, and he would say, ‘I want every one of you guys to give me a different way of managing this.’ When you got around the table to the fifth or sixth person, how many new ideas could you come up with to solve the same problem? It was scary.”15

  Stanton abhorred the laissez-faire McLean culture that allowed patients to publicly indulge their bizarre eccentricities without any intervention from the staff. These were the notorious “museum pieces of pathology,” some of whom did try to roam the grounds nude. One woman had what we would now call a shopping disorder. She filled her suite with boxes of clothes ordered from Jordan’s and R.H. Stearns. When McLean staffers phoned her family to send some of the boxes home, they refused to take any; the lady in question had been sending merchandise to them as well. Another elderly dowager was allowed to roam the grounds dressed in the flowing blue gowns of a Thomas Gainsborough portrait. According to Washburn, “Stanton called in the young residents, and said, ‘You are going along with psychopathology to allow this lady in blue to make a farce of herself. This is nothing to laugh about.’ And suddenly going along with craziness began to go out of fashion.”

  The aim was to mobilize every patient, even the raving lunatics. One Stanton disciple conducted hour-long therapy sessions while her patients were immobilized in packs: shrouds of cold, wet sheets wrapped around the entire body. “Stanton analyzed the most psychotic patient I’d ever seen,” remembers Choras. “He had her on the couch five days a week! That was rubbish—complete rubbish.”

  In the summer of 1997, I traveled to Nantucket to speak with Ruth Tiffany Barnhouse, who did her psychiatric residency at McLean from 1953 to 1955, just as Alfred Stanton moved to Belmont. By the time I visited her, Barnhouse was a flinty, elegant lady in her eighties who smoked Nat Sherman cigarettes—and drew hostile stares—while we talked on a bench outside of Arno’s, a bustling fern bar on the island’s main drag. Barnhouse, who had left psychiatry to enter the Episcopal ministry and eventually taught at divinity school, was a strong believer in the mysteries of healing. Once inside the restaurant, I ordered the “Healthy Beginnings” brunch, and Dr. Barnhouse sneered. “I just refuse on principle to order any food that has the word ‘health’ in its description. The world began to go to hell in a basket when they substituted margarine for butter.” When we started talking about the hospital administration of the 1950s, Barnhouse could not remember the name of her former boss. “He was a big name and a jerk,” she said.

  He didn’t want to put anybody on those psychotropic drugs—that was low—he preferred to just talk to people. He was a psychoanalytic nut. I had one girl, a very, very sick girl who was alcoholic, suicidal, and a lesbian with a multiple personality disorder. She was terribly sick and in and out of the hospital. She was quite intelligent, and this guy would say, “Well, when she’s through treatment, she’ll go to college and this and this,” and that was just dumb. He could say that stuff and mean it, it was really weird. He hired a bunch of analysts and hired social workers and all that stuff.

  Of course, she meant Alfred Stanton.

  “Alfred Stanton.” Barnhouse’s friend and former colleague Robert Coles lingered on the name when I interviewed him in a noisy coffee shop not far from his house in Concord, Massachusetts. Coles, now a well-known writer and child psychologist, was a young psychiatric resident at McLean when Stanton came on the scene. “He represented so-called progress,” Coles recalled. “He brought in all the baggage of the wretched mid-twentieth century and totally messed up McLean. That was the beginning of the end”:When I came to the hospital in the mid-fifties, Stanton had just taken over. I was a young man, but I immediately identified with the old order, which is a little unusual. For some reason I didn’t like what they were doing, which was taking over this hospital whose ways and manners I liked. The residents there hadn’t really been regarded as psychiatric patients in the full twentieth-century sense of that phrase, which I felt had a reductionist and patronizing connotation at the hands of some of these talkers.

  George Eliot uses this term in Middlemarch: “the Christian carnivore.” These were the shrink carnivores. They were examining every nook and crevice, they were just devastating that hospital. Maybe some of that had some salutary effects, but I thought it was hurting a lot of people. I mean, there used to be a nice golf course, there were nice tennis courts, and suddenly all this was taking second fiddle to group meetings.... Here you have patients who have grown up in a world of stoic silence and privacy, and suddenly you have doctors who are coming “at” you and want to get you to talk and talk and talk. And then you find out they’re talking about you in the library, which no longer is a library most of the day, because they’re having meetings here starting at eight o’clock in the morning.

  You couldn’t do anything without having an hour or two of “thought.” There was pervasive self-consciousness that expressed itself in the most portentous, dreary language that I just thought was a lot of smog
and fog. I identified with some of the patients there, whose idiosyncrasies and ways of dressing and talking I kind of liked. We drank tea, ate food, we chatted. I remember having a discussion about “General Eisenhower” with a man who said, “I don’t like to call him president, he’s president because he’s a general.” Then he went into this long discussion that I thought was very well argued. I was impressed with this mobilization of intellect by a man you could dismiss as a manic depressive, which is what he was in the prelithium era.

  The patients were not without resources when commenting on what Coles, in an allusion to Hitler’s Germany, calls Stanton’s “New Order.” In 1958, the Patient Activities Association staged an elaborate musical, written by two patients, called Close to Home.

  Scored to original music, Close to Home is an hour-long parody of life at the Belmont Hill Bettering House, where patients just want to be loved, but doctors insist on analyzing them. The protagonist, Andy, has a drinking problem that has landed him a stay at the Bettering House. After belting out his opening number, “The Forty-Day Commitment Blues,” Andy meets the pair of young psychiatric residents assigned to his case, who have been practicing inscrutable stares in front of a mirror before his arrival.

  BOTH: We are brimming full of questions In our aggravating way With an enervating come-back To anything you say ... We gesticulate with glasses Primly puff upon our pipes As we make our diagnosis Casting you into type.

  The shrinks quickly segue into their “Diagnostic Tango”:

  BOTH: It began by suppression Went on to repression Causing regression To covert aggression And overt depression There’s quite clearly displacement With ego replacement Simple denial That Life is a trial And all remaining is id.

  2ND PSYCH.: Yes!

  BOTH: And all remaining is id.

  1ST PSYCH.: There is symptom conversion A dash of perversion Some introjection And ample projection Back to the womb he has slid.

  2ND PSYCH.: Yes!

  BOTH: Back to the womb he has slid.

  IST PSYCH.: There is thought dereistic And daydreams autistic Oddball delusion That life is illusion He’s slightly loose in the lid.

  2ND PSYCH.: Yes!

  BOTH: He’s slightly loose in the lid. OLE!

  Psychiatrist Number 2 clearly got good grades at Harvard Medical School. He is awarded a solo in which he explains that all thinking can be reduced to mere “mental mechanisms”:In this age of automation

  Thought is free association

  Anna Freud’s hallucination

  Tells us how our minds are made....

  A change of heart, reaction formation

  Admiration is idealization

  When love’s no more than identification

  This formulation or symbolization

  Is one big hell of a rationalization.

  Dreams are just dissociation

  Memories—incorporation

  Fear, of course, invokes castration

  Or vice versa may be said.

  The patient characters are a genial collection of McLean oddballs. Andy’s new friend Homer has been in the hospital forever. “I wouldn’t think of leaving,” he says.

  HOMER: I love it here. It’s great. Tennis. Occupational therapy. Evening entertainments of universally outstanding quality.

  ANDY: How come they don’t just sort of kick you out?

  HOMER: I can generally tell when they are about to suggest it again. Then I just think up something rather horrifying for my therapist. You know, something rare. A nice traumatic primal scene. It works every time.

  Addie, one of the two female leads, is the “Belle of Belmont Hill.” She confesses to “primitive instincts”:Beautiful Belle of Belmont Hill

  Truly unruly morally

  Sex is the vexing core of me

  Seeking a Jack to be his Jill. . . .

  Horribly boring being coy

  Shyly beguiling smiles are bunk

  Better if sweater and shorts have shrunk

  My standard ploy: “I WANT A BOY!”

  Close to Home ends happily. The shiftless Homer works up the courage to leave the Bettering House and takes Addie with him. Andy and his girlfriend Cassie sing a beautiful duet, “In Love, Sort Of,” and decide to ask the psychiatrists if they can leave Belmont to start a new life together. In the face of so much true love, even the shrinks briefly shed their forbidding masks, singing that “everyone is human after all.” They graciously release Cassie and Andy, who reprise their love duet with these lines:Hello, farewell,

  Nothing seems to last

  Live now, love now

  Before the dream has passed.

  Can we tell what comes tomorrow

  No, no. Our time we must borrow

  We are in love,

  Truly, in love.

  Close to Home was a great success, playing to packed houses on three separate evenings in the Pierce Hall auditorium. The show even went on the road, to the Austen Riggs sanitarium in Stockbridge, Massachusetts. There was talk of going to New York, if not to Broadway then perhaps to Bellevue or to the Bloomingdale Asylum. In real life, alas, not all endings are happy. The Close to Home story ends on a mixed note, combining the grievous and felicitous events that make up real life in a mental hospital. The female librettist committed suicide. Composer Sam Heilner, who played the piano during the show, later returned to his job at the Boston Globe.16

  Alfred Stanton had his critics; he had them all his life. But there is no doubt that he succeeded in introducing McLean to the twentieth century. Not only did he modernize patient care at the hospital, but he also laid the groundwork for future innovations. He helped launch the day care, or outpatient, program, an important change for a hospital that had always viewed itself as a high-class hotel for the mentally afflicted. In the 1960s and 1970s, medical insurers would come to favor such partial-payment, nonresidential plans over the costlier inpatient schemes. Gradually, Stanton changed the demographics of the inpatient population, refusing to let his asylum become a storage facility for batty Brahmins and reaching out to different, more-challenging cases. As the 1960s progressed, he correctly deduced that troubled young people might benefit from sojourns at McLean and that affluent parents would be willing to finance them. It was on Stanton’s watch that McLean opened the Arlington School, an accredited high school for boys and girls living inside and outside the hospital. Just as important, he traveled the country, jawboning government and private funding agencies for grants and promoting McLean as a first-class teaching hospital of national renown.

  But his tenure at the helm of McLean ended on a plaintive note, following two successive, apparently uncontrollable waves of suicides. Although the deaths were never mentioned in the hospital’s annual reports, they were described as an “epidemic” in published research papers.

  Psychiatrists who worked at McLean in the early 1960s have trouble remembering the precise dates of the suicides because they spiked in two different years. Six patients killed themselves during the 1961/1962 academic year, and then seven committed suicide in 1965/1966. In between the two spikes, there were seven additional suicides. These were very high numbers for a 250-patient hospital. Dr. George Lawson, a McLean psychiatrist, distributed an informal paper in 1966 that put McLean’s numbers in context—a context that amounted to a scathing indictment of the Stanton regime. From 1936 until 1956, the year Stanton arrived, McLean experienced seven suicides, an average rate of 0.35 a year. In the first decade of Stanton’s regime, Lawson wrote, “thirty-six people have died by suicide who were either patients of the hospital or intimately connected with its treatment programs.” So suicides had increased tenfold under Stanton, and the rate compared unfavorably with that of other mental hospitals. “The present rate of 3.6 [suicides a year] is three times higher than the overall mental hospital average, or a rate of 150 times higher than the general population,” according to Lawson. “Stanton had advertised to the psychiatric world that if you can’t take care of the desperately ill, we can at McLea
n,” recalls one doctor. “So many patients arrived there having failed at Shepherd Pratt or at Chestnut Lodge. They arrived with the expectation that they had come to the best mental hospital in the world, and when they began to fail, they were hopeless.”

  Stanton himself, a cool customer in staff conferences and in one-on-one analyses, was distraught by the suicides and the impact they were having on his hospital’s reputation. In response, he committed what many consider to have been a cardinal error: He tightened his supervision over the ward administrators. By so doing, he broadcast his concern about the deaths. But at the same time, he instructed his subordinates never to discuss the suicides with the patients, who were of course fully informed through the hospital grapevine. “Stanton behaved in the most uncharacteristic way of not wanting to discuss it,” says Irene Stiver, the woman whom Stanton hired as the hospital’s first clinical psychologist. “He was afraid that the situation would escalate if you allowed people to talk about it. I think it was very poor clinical judgment, but he was the psychiatrist-in-chief and he was the one responsible. He got into this crazy thing about how we couldn’t even bring the subject up at conferences.”

  Some psychiatrists lied to their patients about the suicides, and some did not. The patients picked up on this conflict immediately; indeed, it is precisely the kind of destabilizing disagreement described in Stanton’s book The Mental Hospital. “The preoccupation with the avoidance of suicide is so great that it is immediately and accurately telegraphed to the patients, which places a dreadful weapon in the service of their anger,” Lawson wrote in his critique. And the more disturbed patients were perfectly willing to wield the weapon. Even patients who were monitored twelve times an hour on five-minute “checks” managed to kill themselves. Suicide pacts arose; two women swallowed cyanide in the kitchen of an apartment where their therapists allowed them to live. A group of young women on South Belknap, the ward that Susanna Kaysen would later make famous in her book Girl, Interrupted, branded themselves the “OSS girls”: “Over-Sexed, Over Sixteen, and Over-Suicidal.” A young man hanged himself inside Eliot Chapel. “They said he should have hung himself on the sign outside McLean,” one administrator remembers, “because that’s what the hospital specialized in.”