Gracefully Insane (34 page)

How, I asked, did Shein die? At the time, Frazier replied, another doctor investigated Shein’s death and concluded that it was accidental. “Now that I look back on it, I think maybe he had the feeling that because I was relatively new here, I didn’t need to suffer the shock of suicide of a senior staff person. I think it was probably a suicide, if I had to add everything up that I’ve learned since.”

Shein’s colleagues traveled to Rhode Island to hear him eulogized at the Sugarman Funeral Home in Providence. “I went to his funeral, and I have never seen so many people crying in a funeral room in my life,” remembers Dr. Edward Daniels. “The people I was sitting with didn’t just sob, they were wailing.” When discussing his friend’s death, John Livingstone remembered Harvey’s fascination with Wittgenstein and with Wittgenstein’s contention that language could be a straitjacket that limited our ability to understand and describe the world. “Here’s an example,” Livingstone said to me:

T
he past twenty-five years have been a time of troubles for full
service mental hospitals. The world has given up on long-term, residential mental health care, or at least it has given up paying for it. The moral therapy of Philippe Pinel and the twentieth-century milieu therapy belong to history now. Insurance companies, health maintenance organizations, and the federal government’s Medicare and Medicaid programs have been cutting back drastically on patient reimbursements for mental health. Psychopharmacology is the order of the day, and to health-care executives that means quick diagnoses, rapid drug prescriptions, and hopes for the best. Follow-up visits, generally limited to fifteen minutes, are for discussing the drugs’ side effects and altering the initial prescription. The new order is tough on patients and hard for psychiatrists too. “How can you know how somebody is doing if you don’t have enough time to ask, ‘How are you feeling? How are your relationships?’” asks Dr. Bruce Cohen, the current president of McLean. Cohen, a molecular biologist by training, has devoted his life to psychopharmacological research, but even he—as head
of the hospital, especially he—is uncomfortable with McMental health. “It is not enough to sit with somebody and say, ‘So, do you have dry mouth? Have you had any hallucinations lately?’ That doesn’t work.”

All over the country, hospitals like McLean have shut their doors. The Olmsted-designed Bloomingdale Asylum, like McLean, is trying to sell portions of its campus to developers to stay alive. During the writing of this book, Chestnut Lodge, Alfred Stanton’s old stomping ground, went out of business. In the past quarter-century, McLean has had two near-death experiences, one in 1983, when the administration tried unsuccessfully to sell the hospital to a health-care conglomerate, and again in 1998, when Harvard considered closing it down. Although it is true that the hospital’s most serious problems were economic, some of McLean’s wounds were self-inflicted.

During the 1980s, McLean endured a series of embarrassing scandals. Three of its best-known doctors, including Edward Daniels, dubbed the “Mayor of McLean” for his legendary ability to keep his colleagues’ psychiatric appointment books full, were accused of sexual harassment by female patients. The men all protested their innocence, but all relinquished their licenses to practice medicine. Then Shervert Frazier, the psychiatrist-in-chief and former head of the National Institute of Mental Health, lost his job in a plagiarism scandal that was reported on the front pages of both the
New York Times
and the
Boston Globe.
In the scheme of things, Frazier’s infraction was relatively minor; his McLean colleagues felt he had been done in by jealous rivals on the Harvard campus. Once the brouhaha settled down, Frazier was quietly reinstated at McLean, although not in his former position. The publication of Stephen Bergman’s roman à clef,
Mount Misery,
which depicted many of his former McLean colleagues as lunatic, sex-crazed pill-pushers, was an additional annoyance. The hospital’s reputation within Boston’s tight-knit medical community was badly tarnished.

But the news was not all bad. Frazier had raised money to build a new, modern, research building, and McLean doctors made discoveries of world-class significance. Dr. Seymour Kety published his famous “Danish twins” study that revealed an apparent genetic basis for schizophrenia, for which he won academic medicine’s highest prize, the Albert Lasker Award. McLean doctors made important contributions to the development of Eli Lilly Company’s “miracle pill,” the antidepressant Prozac. Drs. Martin Teicher and Jonathan Cole published a controversial study warning of potential suicide risks among Prozac users, and Teicher became the lead scientist in an effort to reformulate the wonder drug. (That effort came to naught, and McLean lost several million dollars a year in anticipated royalties and license fees.) Throughout the decade,
U.S. News & World Report
continued to place McLean at or near the top of its list ranking the top private mental hospitals in the country.

Such successes made the bad economic news all the harder to swallow. The forty-day work-up of the Anne Sexton era was long gone. By the 1990s, insurance plans would generally pay for a thirteen-day stay at a mental hospital. Now the norm is five days. Alfred Stanton once diagnosed a patient by saying, “she has the eyes of a schizophrenic”; such intuitive, ludicrous diagnoses are a thing of the past. Psychiatrists and the insurance payers now hew closely to the syndromes and conditions described in the
Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV),
a detailed checklist of 297 mental diseases published by the American Psychiatric Association. (Homosexuality was included as recently as the
DSM-II
of 1974.) The
DSM
has attracted its share of ridicule—one writer noted that both President Bill Clinton and Hillary Rodham Clinton could be institutionalized under its conditions—but it is one of the few working documents recognized across the profession. Using the
DSM
and insurance-company guidelines, today’s psychiatrist must stabilize, diagnose, treat—usually with a drug prescription—and release a disturbed man or
woman in less than a week. Sometimes doctors carpet-bomb patients with prescriptions, hoping that one of the drugs will work. Here is a portion of a 1993 McLean medical record reproduced in
Under Observation,
an account by Dr. Alexander Vuckovic and Lisa Berger of a year on the McLean wards:

By the early 1990s, explains Charles Baker, a former McLean board chairman, “we had an exquisite factory for a product we weren’t selling anymore.” Because private insurers were fleeing mental health, McLean started signing multimillion-dollar contracts with Medicare, which covers the elderly and the disabled, and with Medicaid, for lower-income patients. Doctors grumbled that McLean had become a “welfare hospital.” If so, it was a money-losing welfare hospital. By the middle of the decade, McLean was losing up to $9 million a year, on an annual budget of only $80 million. The administration adopted desperate measures, laying off 30 percent of the staff. The hospital even sought the last refuge of the Brahmin dowager: They sold off the silver. In 1994, McLean put 238 separate items up for auction, including several lots of silver tea sets once used on the wards, a Paul Revere bowl, oriental rugs, some venerable grandfather clocks, dozens of pieces of hand-crafted furniture, and some paintings by American masters William Otis Bemis and John La Farge. Virtually all of the items had been languishing in the attics of Higginson House gathering dust. (Indeed, several rugs, tea sets, and pieces of furniture had already gone missing from the various halls, another powerful argument for the auction.) A hospital spokesman told the press
that McLean hoped to net between $200,000 and $300,000 for the antiques. But many of the items had suffered damage from improper storage or had been overvalued by enthusiastic appraisers. In the end, McLean made only $160,000, one of many disappointments during this bleak period.

Morale at McLean was extremely low. Here is how one researcher who had been visiting the campus described the mood during the mid-1990s: Returning to McLean, she wrote,

In 1997, Harvard consolidated all of its teaching hospitals into one huge company, Partners HealthCare System. For all the lip service accorded to the sanctity of the hospitals’ medical mission, this was a garden-variety corporate merger. The managers at Partners had to demonstrate the efficiencies of the new combination, and eliminating overlapping services was an obvious first step. Partners had a small, top-notch psychiatry department at the downtown Massachusetts General Hospital and a money-losing,
satellite operation sprawling over 240 acres of valuable real estate in Belmont. For the chairman of Partners, a former Harvard Business School dean, this was a no-brainer: Close down McLean.

Although no longer composed of Appletons, Lowells, and Putnams, McLean’s board of trustees still included some the area’s most influential businessmen and was not a group to be trifled with. They launched a furious counterattack. Pursuing a full-court diplomatic offensive with donors, academics, and state officials, the board succeeded in changing Partners’s mind. To rescue the hospital, they devised the Hospital Re-Use Master Plan. McLean would sell off or give away 200 of its 250 acres and about half of its buildings, raising $40 million in the process. Olmsted’s marvelous campus would be subdivided into luxury homes, an office park, and a housing complex for the elderly. The 300-bed hospital would become a 100-bed hospital. The trustees had destroyed a large portion of the hospital in order to save it.

Years ago, when I described this project to a friend, he responded,
“Oh, that sounds like a travel book.” Working with McLean certainly felt like visiting a very foreign, very interesting country. I remember sitting with archivist Terry Bragg in his ground-floor office in the administration building when a young man dressed like a bicycle messenger—yellow nylon blouse, Spandex tights—walked through his open door. A delivery? No, the man had bicycled down to McLean from a campsite on Boston’s North Shore, about thirty miles away. He had loaded his bike onto a train in South Carolina after seeing McLean’s Dr. William Pollack on a public-television broadcast. Pollack was promoting his book
Real Boys,
about the challenges facing adolescent males, and he had struck a chord with this visitor. Pollack had an office across the hall, but he was not in. Terry gently told this man who had traveled a thousand miles to consult a doctor he had seen on television
that Pollack might well show up later and that he was welcome to wait outside. The man walked back into the corridor, and Terry and I went back to work. “That happens all the time,” he told me.

My McLean journey ended in President Bruce Cohen’s spacious corner office, previously occupied by Franklin Wood, Alfred Stanton, and Shervert Frazier. The office is the closest thing the hospital has to a museum. The original Gilbert Stuart portrait of John McLean hangs above the fireplace. Among the antique gadgets on Cohen’s shelf is a century-old microscope that belonged to August Hoch, one of the McLean doctors who traveled to Santa Barbara to care for International Harvester heir Stanley McCormick. While Cohen and I talked, sitting on opposite couches, I was gazing over his shoulder at a black marble bust of Rufus Wyman, the first superintendent of the Charlestown Asylum, who reported for work in 1818.