The Asylum on the Hill

Alex Beam, the author of Gracefully Insane, probes the rich past of McLean Hospital, a mental institution renowned for ministering to prominent, creative, and aristocratic patients

On a wooded hill on the outskirts of Boston, Massachusetts, lies a luxurious campus with sloping lawns, grand buildings of brick and stone, and a long, twisting drive. Though it gives the appearance of a prestigious prep school or small liberal arts college, it is in fact an institution for the mentally ill. McLean Hospital, as it is called, was founded in 1817 in accordance with a then-popular theory that advocated the removal of the mentally ill from the rigors of urban life in favor of a restful sojourn in a quiet, pastoral setting. In McLean's heyday, doctors and patients skated, skied, rode horses, and played tennis, golf, and croquet on the hospital's lawns. The facilities included a working farm, billiard rooms, bowling alleys, art studios, and men's and women's gymnasiums. McLean's patients, who were almost without exception wealthy and aristocratic, enjoyed sumptuous rooms with fireplaces, parlors, and private bathrooms. Some extremely wealthy patients even had replicas of their own homes constructed on the hospital's grounds. Patients included such luminaries as Frederick Law Olmsted (who designed the grounds), Robert Lowell, Sylvia Plath, Nobel Prize-winner John Forbes Nash (currently the subject of the movie A Beautiful Mind), and (some say) William James.

Today the atmosphere at McLean is comparatively subdued. The population of both doctors and patients has dwindled. Patients stay for only a few days rather than months or years, and their hospital bills are generally paid not by trust funds and family inheritances but by HMOs and Medicare. Many residence halls have been converted into office space or research labs. And Upham Hall, formerly the grandest of all the residence halls, now stands empty and in disrepair. In years to come, McLean will be transformed still further when the hospital's plan to sell off a significant portion of its land (to make way for a retirement home, an office park, and a housing development) takes effect.

Going forward, McLean undoubtedly hopes to leave its reputation as an aristocratic playground behind so that it can reposition itself as a modern center for research and cutting-edge treatment. But the hospital is also mindful and appreciative of its rich past. McLean's staff includes both an archivist and an official historian, and old portraits, busts, and antique psychiatric equipment are displayed throughout the hospital.

Several years ago Alex Beam, a columnist for The Boston Globe, became intrigued by McLean's mystique as a hospital that has ministered to so many prominent, creative, and aristocratic patients. The story of McLean's rise to pre-eminence, the range of (sometimes exotic) treatments it explored over the years, the patients it has served, and the role it has played in Boston arts and culture, Beam decided, deserved to be told. So in 1996 he began researching McLean's history. He toured the grounds, interviewed current and former patients and doctors, read published and unpublished accounts of life at McLean, and sifted through archival material.

The result is Gracefully Insane: The Rise and Fall of America's Premier Mental Hospital, published this month. The book, which Beam refers to as a "biography" of the hospital, is more than a straightforward chronology of the hospital's development. He proceeds, rather, by addressing a different aspect of the hospital in each chapter, ranging from a consideration of McLean's upscale clientele and décor to the effects of Freudian ideology on hospital life to the cachet of the McLean name among a certain generation of poets and writers. Taken together, these essays, (one of which, "The Mad Poets Society," appeared in The Atlantic's July/August issue), offer not just a glimpse into the life of a particular hospital, but a slice of American social history—and an account of a bygone era in the world of psychiatry.

In addition to a regular column for The Boston Globe, Beam contributes to The Atlantic, Slate, and Forbes/FYI. He lives in Newton, Massachusetts, with his wife and three sons.

He spoke with me by telephone on December 14.

—Sage Stossel

Alex Beam
Alex Beam   

What first drew your attention to McLean Hospital as a possible subject for a book?

McLean is sort of a mysterious, almost enchanted place that very intelligent people have passed through. There is a mystique about it as an upper-class, East Coast, artistic institution.

I wasn't aware of a book like this having ever been done about McLean or any similar place—like Bellevue in New York, or the Hartford Retreat, or Austen Riggs. So the subject was sort of a blank slate to me, and I saw it as a bit of a challenge.

Are there things that distinguish McLean from those other mental-hospital retreats?

In the nineteenth century and the early twentieth century—arguably up through the 1940s—Boston was a town of paramount importance in arts and letters. So you could say that because of McLean's combination of aristocratic heritage and its curious role as an institution that ministered to important figures in literature and the arts, it was somewhat different from other hospitals. Bellevue certainly occupies a place in American literary history, because there are plenty of brilliant confused New Yorkers who spent time there. But McLean seems somehow special to me.

You refer in Gracefully Insane to a history of McLean Hospital by McLean's official historian, Silvia Sutton, titled Crossroads in Psychiatry. How does what you do in your book differ from the purpose of an account like hers?

Silvia Sutton's book was an official history commissioned by the hospital in conjunction with its 150th anniversary. In a way, what I've written is almost the opposite of an official history. I wanted to write a biography of the hospital—about the look and feel. Sutton's work on the nineteenth century is excellent. And her work up until World War II was very, very useful to me, but later on I think she becomes beholden to the people who commissioned the book.

I have a chapter that I'm pretty proud of called "Freud and Man at McLean" that tries to address the issue of Freudianism at McLean and in American psychiatry in general. Sutton's funny and informative on that subject, but very, very brief. She doesn't allow herself to quote from the records of the three men who were Freud's patients and who later ended up at McLean.

I guess I'd like to think that my book is much less institutional and more oriented toward the stories that men and women tell about being there as patients and doctors.

The subtitle of the book refers to McLean as "America's Premier Mental Hospital," but in your account, the hospital is at times referred to in somewhat disparaging terms as "an aristocratic backwater" and "a high-class hotel for the mentally afflicted." By "premier" do you mostly mean in terms of luxury and class?

Premier is a word I chose to mean, I guess, "the most hoity-toity." It did stagnate as a backwater through most of the twentieth century, though I know that's not an accurate description of what it's like now.

The analogy that's always been useful for me is that it's sort of like a luxury ocean liner. McLean was premier in the same way that, say, the QE2 is the "premier" ocean liner traveling the seas. It was the most comfortable and the most high-end.

Your account emphasizes that many of McLean's patients have had successful creative careers as writers, musicians, or other kinds of artists. What's your sense of the relationship between madness, creativity, and McLean Hospital? Do you think there was something about the atmosphere at McLean that fostered creativity in people who previously hadn't explored that aspect of themselves?

I don't know. I think that's a bit romantic. I did write a chapter about those rock musician kids, some of whom, like Livingston and Kate Taylor, began their careers, really, at McLean. So the point could be made, as you formulate it, that it was a place where creative people got some forward momentum. But I don't really subscribe to that. Even though I know that I've romanticized the experience more than once in this book, the key point, sadly, is that it's a hospital for people who are sick.

A letter to the editor about your "Mad Poets Society" piece in The Atlantic suggested that by emphasizing the cachet of McLean among angstful literary types you ended up trivializing the genuine anguish of the mentally ill. How would you respond to that kind of charge?

I was shown two letters by The Atlantic, both with that thrust, one of which was published. The reason I didn't respond in the magazine is that I felt that it was a totally cogent, reasonable, and informed criticism.

To be fair to myself, though (speaking specifically about that excerpt that appeared in The Atlantic), I interviewed a woman whom I quote both in the article and in the book, named Ruth Barnhouse, who was Sylvia Plath's psychiatrist and who saved Sylvia Plath's life—at least for a period of eight years. For some reason, I didn't quote her saying this in the book, but she and others have said that there was a heavy air of self-dramatization about both Sylvia Plath and Anne Sexton. She spoke sort of disparagingly about these well-to-do poets for whom it was a glamorous exercise to show up in the mental hospital. Plath even confided in her journal that she could make a lot of money by writing a novel about McLean—which she then went on to do.

Robert Lowell, on the other hand, clearly didn't go there for reasons of narcissism, but because of serious illness. Lowell never wrote at McLean. He was too ill. And although he wrote two very beautiful poems about McLean—one about being there and one about coming home, those poems were composed in moments of clarity weeks or months later.

Do you think that Lowell himself—a major poet who was genuinely sick—is part of the reason that the persona of the institutionalized poet took on a certain glamour?

Yes. Plath and Sexton were (to use a pretentious Harold-Bloomian-type word), self-consciously Lowell's ephebes. He was a mentor to them and to a whole generation of poets. He was really one of the first self-identified public creative geniuses who wrestled with mental illness—mania in his case.

Your account makes it quite clear that McLean has always very carefully guarded its reputation and respectability. How were you received by the hospital's current doctors and administrators when you approached them about your research?

I was pleasantly surprised. They have an archivist; they're quite history-minded. And people were very generous and helpful. I mean, I was not really writing about the modern hospital. I hope that's clear to the reader. That was sort of my shield when I was there—I said, Look, I'm not here to write an exposé about what's going on now; I want to talk to you about things that happened in the fifties, sixties, early seventies.

Your look into McLean's past turned up a fair amount of sordid history—waves of suicides not fully documented in the official records, sexual-harassment scandals, a plagiarism scandal... Is that about what one would expect to find in any longstanding mental institution's past? Or do you think that McLean's ethos of secrecy and tendency to keep problems hidden led to more of those kinds of problems than one might find elsewhere?

I think that any and all institutions that provide that kind of care are always extremely secretive. You and I would cringe if we went through the files of, say, Metropolitan State Hospital. So I don't have a basis for making any conclusions about scandals at McLean. I'm leaning toward thinking that just because I decided to put this one institution under the microscope because of its high standing and visibility in American society doesn't mean that if I were to put another institution under the microscope we wouldn't come up with analogous shortcomings.

Did reviewing the long list of bizarre and outlandish psychiatric treatments that have been tried and discarded at McLean and other hospitals over the years negatively affect your opinion of psychiatry as a science?

In order to artfully dodge that question, my book self-consciously ends at a real breaking point, or caesura (to use another pretentious word), in psychiatry, which is now becoming an organic science of the brain. I know it's easy to be cynical about psychiatry's attempts to come to grips with disturbed people by injecting them with the blood of rabid horses and so on. It's a laugh, and I play it for laughs in a way, but that aside, these doctors really were trying to cure people—with mixed results.

As a layperson I suspect (and many people have said this) that the chemical compounds that they put in your bloodstream nowadays—that they essentially put into your brain—are still blunt instruments, though perhaps somewhat sharper than before. I don't really know. I don't take psychotropic drugs myself. But any literate person can see that it's not as if we live in a much saner society now.

When a longstanding mental hospital like McLean closes down (as almost happened in the mid-1980s and again in the mid-1990s) what becomes of all their confidential patient records?

That's an interesting question. I don't know the answer.

You described those records as "mini-biographies" of people's lives. I know they have to be kept confidential, but it seems like they could be a great resource someday for someone who was doing social-history research.

I completely agree. I'm kind of hung up on McLean's records myself, even though I've never been allowed to see them.

I'll tell you an institution I would write another book about. It's called Adams Nervine, which was a women's hospital that used to be near Boston's Arnold Arboretum. It's where William and Henry James's sister Alice was, and Henry Adams's wife Clover. I've been told second-hand that its records were destroyed when the hospital closed down. The records of Adams Nervine must have been just an amazing portrait of a certain stratum of American womanhood in the nineteenth century. It's a shame that they're gone. In the same way, I think it would be a great loss to get rid of McLean's records. Thank God it's not an issue right now. But it could be a real issue sometime. They've told me that all of their records are currently well preserved, but if the hospital shut down I have no idea what would happen to them.

You described some periods in McLean's history when the patients have been mostly older and the atmosphere on campus has been like that of a retirement home. And you described other periods (like the late sixties) when there was an influx of young people and the general feeling was that the place had become overrun with unruly teenagers. Was there a particular age group that seemed dominant in your own recent visits?

It's mixed. It's a very different population now, because seventy percent of the patients are there with some form of government subsidy. So actually there's no way to categorize them at all in terms of how they look, what their age is, and so on. Most of the patients are not there for a very long time. Their presence there I think is solely determined by the quality of the insurance they have and the quality of the state's commitment to them. It's hard to generalize. The patients you see just look like people who are sad—they're people grappling with illness.

You did write that McLean has developed something called "The Pavilion" which sounds as though it's carrying on the old upscale tradition in that it caters to wealthy people who pay their own way.

You can paint yourself a glamorous portrait of the Pavilion, but when you get there it's just kind of like an Embassy Suites with doctors available. There are only six beds there now, but they're always full, and they generate a great deal of revenue. It's a small but lucrative element of the new McLean.

A lot of it is actually for executives. I think McLean took a look at the Mayo Clinic, which had developed something along those lines, and said, Hmm, it would be nice to get a piece of that. American companies spend a great deal of money on the physical—and it turns out also the mental—health of their upper tiers of executives. It's a good market for McLean to tap.

You characterize researching McLean as akin to "visiting a very foreign, very interesting country." As the hospital downsizes, narrows its focus, and shortens the average stay, is it your impression that McLean will lose its "differentness" and end up becoming a more prosaic place?

I guess it will. It will be harder to find—it will be buried behind an office development, behind a retirement community, and behind an upscale housing complex. So you won't be able to drive in as you can now with orchards on your left and stables on your right. Those will be destroyed.

It was the nineteenth-century ideal to help sick men and women by removing them from crowdedness. That will all be gone.