Gracefully Insane (4 page)

By the end of 1821, 146 patients had entered the asylum. One hundred and eighteen had left, and there had been six “elopements,” as escapes were called. Nine patients died. Twenty-nine were “removed by request” of the administration. Twenty-three patients were discharged as “improved,” nineteen “much improved,” and thirty-two “cured.” The asylum was thriving, already filled to capacity—Bulfinch had designed the wings for one hundred patients—and contemplating expansion. There was just one small problem: The hospital was $20,000 in debt.

Enter John McLean, “a truly noble specimen of Boston merchant,” according to a contemporary. McLean was born wealthy, increased his family’s fortune, and then, after a series of reverses, found himself in bankruptcy court. But if it is better to be born
lucky than to be born rich, it is best to be born lucky
and
rich. A ship of McLean’s, long presumed lost, sailed into Boston harbor one day, bulging with precious cargo. McLean promptly invited his former creditors, who had been stiffed in the bankruptcy proceedings, out to dinner at a local hotel and slipped checks with full repayment, plus interest, under their dinner plates. For reasons lost in the fog of time, in 1823, the fortunate, childless trader left a $120,000 legacy to the Charlestown Asylum. The trustees ordered up the traditional thank-you note of the time—a Gilbert Stuart portrait, which still hangs in the administration building
³
—and renamed the institution after their timely, unexpected benefactor.

Within just a few years of its opening, McLean would change character forever. In 1828, a democratically minded young Massachusetts legislator named Horace Mann delivered a passionate plea to his colleagues for a taxpayer-supported asylum, arguing that “the insane are the wards of the state.” Five years later, Massachusetts opened the Worcester State Asylum, which siphoned off poverty cases from McLean. By 1836, according to the newly appointed superintendent, Luther Bell, McLean had become home to “an improved class of sufferers.” “This increasing absence of patients from the pauper and humbler ranks of society,” Bell wrote, “has rendered the classification, especially of convalescents, far less embarrassing and difficult.” “Towns sent their paupers to Worcester,” explains historian Sutton, “while wealthier families showed more eagerness to refer mentally ill relatives to McLean, where they would no longer have to fraternize with the destitute.”

In 1839, the newly constructed Boston Lunatic Hospital, praised even by the censorious visitor Charles Dickens in his
American Notes,
also began receiving patients, and McLean was well on its way to becoming an upper-class institution. By the middle of the nineteenth century, Sutton writes, “Pauper patients became the
exception at McLean. Those admitted, usually in some emergency, were soon transferred to a less costly facility.” Turning the cold shoulder to society’s less fortunate was the subject of this rationalization in a midcentury annual report:

The glorious setting provided the perfect venue for the increasingly
popular moral treatment. Dr. Willard’s dunking/drowning regimen—not so far removed from the various coma-inducing therapies that would become popular during the 1930s—was on its way out. Even the theories of Philadelphia’s Dr. Benjamin Rush, “the father of American psychiatry,” were being questioned. Rush’s magnum opus,
Medical Inquiries and Observations upon the Diseases of the Mind,
held that madness was an arterial disease, “a great morbid excitement or inflammation of the brains.” An “unrestrained appetite,” he wrote, “caused the blood vessels to be overcharged with blood.” Thus, he advocated low diet, purges and emetics for vomiting, and hot and cold showers to slow down the overheated metabolism.

And bleeding. Rush was a world-class bleeder, once boasting that he drained 470 ounces from one patient during forty-seven bleedings. Rush was also a tool-bench tinkerer who contributed two mechanical inventions to psychiatry. One was the “gyrator,” a
rotating board to which patients suffering from “torpid madness” were strapped. Spinning at terrific speeds with the patient’s head away from the center, the gyrator pushed blood
into
the brain to stimulate activity. Rush also sold a “coercion chair,” called “the Tranquilizer,” which supposedly lowered a patient’s pulse and blood pressure by holding him or her immobile in the sitting position. A man of many parts, Dr. Rush was also a signer of the Declaration of Independence.

The McLean clientele did receive primitive drug therapy for perceived medical maladies. Purgatives like Epsom salts, calomel, and cochineal were added to food served to overanxious patients. Doctors administered occasional doses of tincture of opium for pain. The colorful eighteenth-century English physician Thomas Dover, perhaps best known for rescuing Alexander Selkirk, the model for Daniel Defoe’s Robinson Crusoe, formulated an opium-ipecac compound called Dover’s powder that continued to be used well into the nineteenth century. Venesection, purging, and vomiting induced with antimony salts were still used to combat specified ailments. One superintendent dosed five women patients, four of them manic and one paranoid, with tincture of hashish, “an apparently pure and perfect extract” forwarded by a physician in Calcutta. The experiment failed.

Physical restraints were rarely used. McLean’s first superintendent, Rufus Wyman, once boasted that “chains or strait jackets have never been used or provided in this asylum.” In fact, McLean did use some mechanical restraints, such as hand muffs and leg manacles, and the hospital even bought a knockoff of Rush’s Tranquilizer chair. And shortly after buying the Barrell mansion, the trustees opted to build five “strong rooms” to house “raging female patients.” In 1836, these were removed after the construction of a “cottage for female patients in seclusion.”

But the emphasis was on moral therapy, which Wyman distinguished from medical treatment in an 1830 address to the Massachusetts Medical Society:

For the well-to-do burghers of Boston, McLean’s luxurious rest cure was a lot like living at home. It was in the heyday of moral therapy, under Wyman’s successor Luther Bell, that McLean expanded and gentrified its premises. Carpeting, wallpaper, mirrors, open fireplaces, and elegant furniture now graced the halls. In two new houses, built with Appleton money, each patient had a sitting room, a bedroom, and a bath. There were also lodgings for private servants. Here is how Wyman’s son Morrill remembered life at his father’s institution:

Sometimes proper etiquette was therapy enough. A nineteenth-century McLean memoirist named George Ellis recalled the dramatic arrival at Charlestown of a well-turned-out woman in her carriage, screaming that she was engulfed by flames. Superintendent Bell arrived to greet her with the words, “Madam, come with me, and you shall have water.” At that, Ellis writes, “She smiled pleasantly, took the proffered arm, and passed into the Asylum as if bent on a stroll through its beautiful gardens.”

“By the end of Bell’s administration in the late 1850s,” writes the historian Sutton, “McLean had evolved into an institution tilted in the direction of the privileged classes, and so it would remain.”

Small wonder that when William Folsom, the effete, Phillips Exeter
and Harvard-trained apothecary, assumed his duties at McLean in 1825, he found the “crazy people much more pleasant than I expected.”

Folsom lived at the asylum’s mansion house with superintendent Rufus Wyman and often dined with Wyman’s family, as did many of their patients, according to Wyman’s son Morrill: “The more quiet also passed their evenings in the physician’s family,
and always appeared and were treated as gentlemen.” Some patients tutored Wyman’s children, and one even gave Folsom dancing lessons!

Although he had completed his course work at the Harvard Medical School, Folsom was still a student. In modern parlance, he was interning under Dr. Wyman and attended his mentor’s operations both inside and outside the asylum. Folsom’s diary recorded three postmortems carried out on McLean patients, only one of which he logged into the asylum case book. Although medically invaluable, postmortem dissections were illegal in Massachusetts before 1830.

Folsom worked hard, rising early each morning to study either the Bible or a medical textbook. He assiduously updated patient records, itself an important therapeutic innovation. And he spent several hours each day socializing with the patients, often at tea time or after dinner. Just twenty-two years old, Folsom kept a diary of the year he spent working in the McLean pharmacy in 1825. It provides a rare window into daily life inside the hospital within just a few years of its opening.