Boston Globe columnist Alex Beam has recently published Gracefully Insane: The Rise and Fall of America's Premier Mental Hospital. In this book, Beam candidly presents the history of McLean Hospital from its inception in 1817 as the Charlestown Asylum through its move in 1895 to Belmont, Massachusetts and Fredrick-Law-Olmsted-designed grounds to its current implementation of a Master Plan to save itself. Woven into this quite readable account are the fascinating stories of some of the "thoroughbred crazies" who are part of the McLean legend as well as a survey of the therapies and "cures" that parallel the hospital's history.
Alex Beam grew up in Washington, DC, in a family whose father was a career diplomat. Beam has been the Moscow and Boston bureau chief for Business Week. He was a John Knight Journalism Fellow at Stanford University in 1996-97. Alex Beam has published two novels about Russia, Fellow Travelers and The Russians Are Coming! and has written for the Atlantic Monthly, Slate and Forbes/FYI. Beam is arguably Boston's best newspaper columnist — arguable because he frequently appears on the "Best" lists of local publications which are, of course, candidates for controversy. He lives in Newton, Massachusetts with his family.
Robert Birnbaum: When did you decide you wanted to do a book on McLean Hospital?
Alex Beam: The idea had been festering — to choose a bad word — for a while. Maybe three years or so. I'm not from Boston — I'm from Washington DC — and I've been here 18 years. If you write for a living, if you are a journalist like I am — McLean is sort of the place in the fog that looms on the landscape. You hear about it. If you are 48 years old like I am, you meet peers who've been there. And you are not quite sure why. I don't have a background of mental health problems. It's much more a part of the intellectual landscape here in Boston. So it began to interest me about 7 or 8 years ago. Then I noticed that there is a lot out there about McLean, if you stitch it all together…not only [by] the great writers but some of the less-great writers. You start seeing things that you can use that are about McLean. My first pass at this book was an oral history of McLean. Meaning it was my first intention. It wasn't at all successful.
RB: Oral history meaning the first-person testimony of former residents and workers of McLean Hospital?
AB: Exactly. A book comprised solely of 1st person accounts of nurses, doctors and patients organized into chapters. One of the more successful examples of this genre — that may not be pleasing to everyone — is George Plimpton's book on Edie Sedgwick. It's doable. In fact, during my research I heard that someone was trying to put together an oral history of Austin Riggs in Stockbridge.
RB: McLean Hospital looms large in the cultural landscape of Boston unlike other institutions around the country?
AB: Well, that would certainly be my impression. I'm a native of Washington, DC, and I don't remember any of my friends, my friend's friends or parents going to Chestnut Lodge in Rockville, Maryland or to St. Elizabeth's, which is across the river in Anacostia. Perhaps some of my parents' friends did have breakdowns, but it wasn't something that was part of the oral culture. And the written culture — obviously since I exploit that in this particular book... And that's the only other place I have lived.
RB: Is that a reason why you have referred to McLean as the "premier mental hospital"?
AB: Well, 'premier' is my choice of words. Certainly I was groping for a superlative that would draw people to the book — it's not the best; that would be a falsehood. A small falsehood but one that intelligent people would notice. So in my opinion 'premier' is certainly allowable in terms of the aristocratic social/literary element. The only other remote contender would be Bellevue in New York, about which I know very little.
RB: And does this also have to do with the notion that for a long time, the grand culture of Boston was synonymous with American culture, and McLean seems to be woven into that?
AB: Yes, precisely. It's a laugh line when I give talks and I say that Boston was once an important place. It's not intended to be a laugh line. Boston is a wonderful place, I've come to realize. Throughout the 19th century and a large part of the 20th century, there were — to be somewhat reductionist — three important cities in America. New York, Philadelphia and Boston, and well into the 20th century you could have made the case that Boston was the intellectual capital of America.
RB: Where does the phrase "Athens of America" come from?
AB: I wouldn't know. Emerson is credited with calling it the "Hub of the Universe."
RB: I thought it was Oliver Wendell Holmes, Sr.
AB: Really? I think you may be right.
RB: I am not from Boston, and I had never heard it before I came here, and I have only heard the "Athens of America" appellation here…
AB: (laughs) You hear it here a lot.
RB: Your skillful weaving of three major story lines makes me wonder how large the first draft of Gracefully Insane was?
AB: The first draft was quite similar to the finished book. The main issue from the point of view of the editor was what I think is now Chapter IV, "The Search for the Cure." The main problem — and in my opinion it's not fully resolved in the book — was how do you weave in story of the evolution of the therapies. Because it's an important story. And that was, to use the euphemism that business people are fond of, the key challenge. I wouldn't claim that we resolved it perfectly.
RB: There is certainly a lot of information here. Holly Brubach in The New York Times Book Review mentioned that you did not delve into the darker and more "desolate interior landscapes of the mentally ill," but the catalogue of remedies and treatments, from teeth pulling, to large intestine removal, to 17 forms of water treatment and various shock therapies and on and on that you present seemed sufficient…You feel like you should have done more?
AB: Well, Robert. At my own college 25th reunion, I surprised myself. No one even asked me this question, I almost asked it of myself, which is, I write a newspaper column for the Boston Globe, and I asked myself the question, "What are my intentions?" I realized my intentions were perfection. I wanted to write a perfect 750-word column. I'm judging what I produced against the ideal possibility of what would have been perfect, and I would never claim that this comes close. I think one of the things that I am very proud of is that I don't think anything hits you over the head. It's meant to keep the man or woman reading the book, the way I enjoyed writing the book.
RB: Your book has been out for a little while, and you have had a chance to go out and talk about it, give readings, get reviewed. Are there things you would like to revise, wish you had included?
AB: Very minor things, frankly. The strongest, most principled and reasoned honest criticism of the book is one that you mentioned, [it] takes different forms. It says Alex shies away from the darkness. I'll give you a specific example. A wonderful woman gave me her diary of her time at McLean. It's too dark for me; it's too horrible. Her experience…it's not in my book. Not for reasons of permission or anything. In my friend Rob Perkins' book Talking to Angels…Rob, in my opinion, looks McLean in the eye… and a couple of chapters in Susanna Kaysens' book where you go into a room with mattresses, there is excrement smeared on the wall and someone is trying to kick the screen out of the window. That stuff happened, and there is relatively little of that in my book…I always, when I talk about the book, at least in public, I always read Sylvia Plath's beautiful letters from the campus, because I was denied permission to include them in the book. They are just gorgeous...
RB: Why were you denied permission?
AB: There is a whole world out there about the Plath estate. They legitimately — and well within their rights — denied me permission. Although I am not enamored of Sylvia Plath, I am enamored of those letters. And there are a couple of poems that dropped out by accident, that maybe I wish were in the book. But, I am really quite pleased with the result.
RB: Is there or was there ever a "snake pit" aspect to McLean?
AB: No, no. Virtually every interview I have conducted would mention The Snake Pit, the famous Olivia de Haviland movie. If this were a book about Metropolitan State, this would be a different book. I'm not covering up or embarrassed by things. There were backward cases at McLean. People in terribly gruesome shape. But as opposed to Metropolitan State, there would be three of them on a small ward as opposed to 50.
RB: Was McLean the first American institution to use the so-called "moral treatment"?
AB: No, I think the Philadelphia Hospital — since it predated McLean and since it was part of the York retreat/Phillipe Pinel movement, I'm assuming (although it's dangerous to assume) that McLean was not the first.
RB: Was the 'moral treatment' part of what asylums provided? When the Worcester Hospital opened up in 1836, did it provide moral treatment?
AB: Yes, all these asylums, whether they be Kirkbride asylums (which is a hospital organized around a central ward) or the McLean model or I guess you could call it the Olmsted model (which are separate houses) because he designed about 5 asylums. If you go out to Northampton — it's a public hospital and the grounds are unbelievable. In fact, the state is very eager to get some real money for the grounds. Danvers, where the movie Session 9 was filmed, the idea is always salubrious open spaces. What changed, of course, in the public system is that buildings became very, very crowded. So you had a very insalubrious environment inside the buildings.
RB: Is there a definite, identifiable point of change?
AB: I wouldn't know.
RB: Late 19th century?
AB: I would guess.
RB: It wasn't planned, the overcrowding just happened?
AB: I'm sure the analogy to regular hospitals would hold…the VA hospitals weren't meant to be bad.
RB: You cite an interesting group of examples of patients and cases, John Warren, Stanley McCormack and Carl Leibman and more. What is the principle of confidentiality that operates here? For instance, you couldn't ascertain whether William James had a stay at McLean?
AB: The principles of confidentiality as I explain in the book — McLean makes no records available unless it's your own record and you ask for it. Or in the instance that you cite of someone who is not living, if every living relative asks for the record. I don't think I ever suggest or imply that McLean furnished me with any medical records. They didn't. I used what I would call standard journalistic techniques in gathering these records. As a parenthesis, I knew going in that there was a subculture of McLean records out there. I remember 15 years ago, a close friend of mine quoting a young friend of his, who was a resident of McLean, we used to pass around James Taylor's records. I remember that crystal-clearly. In the very beginning I learned that some Freud letters had been stolen from the McLean archives back in the '60s. So I knew that there was a subculture out there of historically minded psychiatrists — who for whatever reason had — copied [records]…Theft, I don't even want to associate myself with theft. I do know that were some classic Boston intellectuals who had copies of some records. The [William] James records are out there somewhere, I was told. I never located them.
RB: Why is the question of whether William James had a stay at McLean of concern? Especially since there is no indication that if he was there he had a long stay?
AB: I've never been some one who says that gossip is trivial or irrelevant. So it has gossip value. And then if Linda Simon, one of James' many biographers, were here, I'm sure she would make a much more compelling case. It's a hole in someone's biography. I love the detective story about the James records and thing about the great "dorsal collapse" is so 19th century. Those words themselves are so evocative.
RB: So it's a more interesting issue because you can't get a handle on it. The information should be there but isn't?
AB: Of course, it is so tantalizing.
RB: Do you feel that there is a kind of romanticized association between mental illness and a high level of creativity?
AB: Yes, but I would use precisely those words. It's romantic but somewhat misguided. Fair critics of my book — although possibly people might misread it — might say I would "romanticize" mental illness. There is a romantic association, but it's really bogus.
RB: How much are you responsible for presenting the extent of the suffering of a Lowell, Plath or Sexton or the Taylors as a counterpoint to their creativity?
AB: I think that I was straight, generally speaking, in the book about all those people you mentioned. Lowell was ill. Maybe I could have said it more directly. Lowell didn't write at McLean. He was sick, in the grips of depression. The suicides speak for themselves. I think I am being a little too hard on myself. I never take a lah-de-dah attitude towards suicide. One thing that isn't in the book is the nature of the Taylor's distress. They're living. They are successful people. They helped me. The fact they were there at a very young age was in the book. There are things about a lot of people I wish that I didn't know.
RB: Why was the suicide of Harvey Schein, a psychiatrist at McLean significant? It's not like suicide was uncommon at the hospital.
AB: This was an important event in the life of the hospital. It's not every day that a doctor kills his or herself. And it's not every day that the number 3 person at a hospital who is on a meteoric track — if I hadn't been convinced that that wasn't an important event in the life of the hospital and the life of the patients I wouldn't have written about it. It did also allow me to write about the incredibly dark subject of psychiatric suicide.
RB: Schein was a devotee of the philosopher Wittgenstein?
AB: Yes, he was a devoted student of Wittgenstein.
RB: I think 3 or 4 of Wittgenstein siblings killed themselves…
AB: I hardly know anything about him. Something that is not in the book is that Schein hand-copied lecture notes from a man who had actually heard Wittgenstein speak.
RB: The Master Plan gets implemented — the selling off of almost 200 acres of the 240 acre grounds — the creation of The Pavilion, with its $1800 a day suites and McLean still has almost $9 million a year deficits. Can it survive?
AB: They certainly hope it will survive. They are angry at me for emphasizing the negative, if you will, about their present situation. They are angry at me about the subtitle that refers to the 'fall' of America's premier mental hospital. The purpose of selling off the 200 acres is, of course, to save the hospital. One thing that is not in the book — I did not anticipate this happening, nor did McLean — is that even though the town of Belmont has approved the rescue plan, it is in now tied up in the courts. Neither Bruce Cohen, the director of McLean, nor I would have foreseen that. I don't have any insight into their profit or loss statements at the moment. Bruce says they are doing quite well. They are certainly not losing $9 million dollars a year. I suspect, like the Boston Herald, they are either a million up or a million down at this point. However, this is a standard business restructuring. It's absolutely essential to the continuing life of the hospital.
RB: Even as it continues what is McLean?
AB: It's different. It's become a dispensary, I've realized. They treat something between 9 and 10 thousand outpatients a year. They have highly talented and trained doctors working almost exclusively in the field of psychopharmacology — it's Bruce Cohen's field as well — the reason I am comfortable writing about the "fall" of McLean is that McLean that I wrote about doesn't exist anymore. All these buildings that I am in love with, the one on the cover, Upham, they are shuttered, they are all closed. Residential moral and talk therapy are in radical decline and the beds flip over there almost like a hot sheet motel — that's a pretty ugly analogy. They don't have three hundred beds, they have a hundred beds and the beds have to turn over because no one has an insurance plan that will pay.
RB: So treatment is basically pharmacological?
RB: No analysis, no other kind of therapy? What's the longest one might stay?
AB: It depends on someone's means, still. Oddly, the wealthiest and the most destitute are the two categories most likely to get a couple weeks at McLean. The State of Massachusetts is concerned. There are people that they don't want outside of a sheltered situation. Basically, we are talking a number of days. It's wrong of me to suggest that there is no more analysis. A lot of people pay for analysis, obviously. What's changed is this notion that it's a place of medium-term shelter. That it's not.
RB: Is there still anyone who thinks analysis helps deeply disturbed people? Or is there any cure for deeply psychotic people?
AB: No. Freud didn't think he could help deeply psychotic people…There is a Newsweek cover story on schizophrenia. Obviously it's something we haven't figured out how to "cure." Although, there has been some stabilization. At the risk of lecturing you, Robert Whitaker has a book out called Mad in America. I like the way it's written. It takes a very different…it's a very angry book. It's a very aggressive book and takes an extreme view of doctors as mad scientists tinkering with the schizophrenic mind.
RB: Why isn't what we have today a continuation of the way you describe the curative landscape — as a Wild West — between 1930 and 1954?
AB: But it's different. I made that point myself that 50 years from now our children will be laughing at this, at the bludgeoning of the brain with chemicals, which is how we "treat" depressed and schizophrenics now. But that's reductionist to say that there has been no progress, in at least the stabilizing of people. There are people who will say, into a microphone, that they couldn't function before. Now they can function somewhat. That's good. Robert Whitaker would say, because he has said, "Well, moral therapy worked, too." To think that there has been no progress on this front is counter-intuitive. The fact that you and I haven't died from tuberculosis at our ages…you can't deny that some things have evolved in a positive way. I would say that would apply to the science of mental health as well.
RB: I wonder about what happens every time a new syndrome or disorder is identified. A few years ago it was sleep disorders and there — and I have no idea how they made these estimates — were supposedly 70 to 80 million undiagnosed cases…
AB: But Robert, also eating disorders — still, it is a matter of degree there is a difference between the ludicrous puffing…I take issue with, You can't just name a disorder because they are different qualitatively…
RB: I'm not disagreeing with you. I am wondering how these diagnoses are made and where the numbers come from. For instance, how many people suffer from depression?
AB: Well, now we are talking. You are not interviewing me and that's fine, I'm not an expert on depression anymore than you are. It would seem that we are certainly more aware of depression than we used to be. I would say, perhaps, overly aware. Like every time I feel bummed out just because I have a comfortable life in the suburbs, somebody might call me depressed. Whereas if I had a less comfortable life and had to work a lot harder somebody might say, "Get off your ass. You have a family to feed." Obviously there is a socio-economic element to depression. Schizophrenia I am less sure of. For me to somehow suggest that people are faking schizophrenia isn't fair or accurate.
RB: Let me back up. The DSM [Diagnostic and Statistical Manual of Mental Disorders] has 297 identifiable disorders one of which is "borderline personality" which seems to describe anyone … It's troubling to look at this diagnostic jargon and it's vagueness.
AB: They are vague. There has to be a third person sitting in on this discussion, there has to be a doctor who has treated schizophrenic people ...I hate to keep picking on Robert Whitaker, but I don't believe that these people are all witch doctors. I don't believe schizophrenia is societally exaggerated. There are people who hear voices, there are people who can't fathom this world. I mean I interviewed some of them. We mentioned the Newsweek cover story on schizophrenia. Well that's driven by the success of this movie, A Beautiful Mind. Nash, who is mentioned in my [and who the movie is about] book is a far from uninteresting person and his war with his disease — whatever we choose to call it — is a very interesting war. Very unfathomable.
RB: I was moved by the sort of ultimate reason you gave for writing this book besides the interesting stories and that such a book hadn't been written before. That is, you wanted to write about a place that provided shelter to people who needed it a little more that the rest of us. Was that an after thought? That is, did you know this before you started?
AB: No. It happened there, I was sitting with my friend Rob, who is an emotional guy and [as he wrote in the book] I think he asked me, "Why did you devote so many years to doing this book?" That was sort of towards the end. And as I have said, when you are with someone like him you have to tell the truth. And I just blurted that out. And then after I blurted it out, I wrote it down. And I realized…there is a tiny bit of context [necessary here]. Fifteen years ago I tried to write a book about young monastics. I went to monasteries. I guess, personally, this issue of shelter is one that haunts me. I also tried to write a book on 5 Divinity Street [in Cambridge, MA] where Tim Leary and Richard Alpert brought the Harvard Class of '60 and gave them LSD. I was again fascinated by a special place, a place where magical things happened. I mean to call McLean a place where magical things happened is mildly inane. Although, Sylvia Plath described it like that. But it's a very, very special place. Yeah, shelter is a…I have children of my own. Having shelter and not having shelter is probably the great dynamic. The one I talk about obsessively, albeit only to myself, is being in the world and not being in the world. That's the fascination of the monastic choice.
RB: Have there been unforeseen consequences from writing Gracefully Insane?
AB: They've all been pleasurable. There have been no unforeseen negative consequences that I can think of. Though there may be. The people who are in the book seem content. I should mention that people come out of the woodwork. A woman who sang the lead in the musical Close to Home [a musical created and produced by patients at McLean] is now in touch with me. A poet named Marilyn Coffey who wrote one of the most beautiful poems I have ever read — though I forgot to include it in the book — the man who played piano with Ray Charles on Upham has been in touch with me. The nice thing that doesn't happen a lot…I guess this book has found the audience I hoped it would find, at one level. I think my best readers have been very generous and feel I wasn't out to get anyone. I wasn't out to write an expose of the hospital and that I treated people the way they would want to be treated. That's all anyone can ask. For me, anything good is an unforeseen consequence. (laughs)
RB: Is that because as a newspaper columnist you are frequently riling up people?
AB: No, it's just different. I had the time. I had a lot of time.
RB: Did you go to Public Affairs [publisher] by choice?
AB: This man named Geoff Shandler was about the 7th editor to see it. He's no longer at Public Affairs. He was really young. He still is. He loved the proposal He's the guy who said to me, "I see this as a travel book." I have a whole separate obsession with travel literature as the literature of discovery. And I said, "Yes, this is a travel book." This is about me going there, in the sense of the tourist. Larger, more commercial houses definitely had an opportunity to buy the book. One piece of feedback that I've gotten that sort of makes me cry in a way…a friend of a friend turned down the proposal for an important publishing house. So I asked this woman — one person removed — "Why did she turn it down?" Obviously, my feelings were a little bit hurt. And this woman — and I should say for context the speaker was someone who just loved the book — and she said my friend said, "I thought it was going to be a boring book." I just went, "Wow." This could have been a lot of things, but it wasn't going to be boring a book. Anyways, who knows?
RB: I asked about Public Affairs because they make something about being dedicated to the standards of I.F. Stone, Ben Bradlee and Robert Bernstein…
AB: You should interview Peter Osnos [the publisher]. The fact is they had this really smart, talented, young guy — Geoff Shandler — who got poached to a much bigger house. He's just smart. They are small. They don't pay a lot of advances. They push books that are getting good reviews. They don't push books that aren't getting good reviews. And they do some really interesting books.
RB: You mentioned an oral historical approach that is a collection of first-person accounts. Is this story over for you?
AB: Yes. yes. Will there be a return to Gilligan's island? Inevitably there's a return. I hope…the correct answer is, it's over. I'm enjoying this period of my life now because this book is being well received, and it's just fun for me. I'm not working on another book. I'd loved to write an article sometime about the people I have met through the publication of this book, dotting some 'I's and crossing some 'T's. It's over. It's absolutely over. Yup.
RB: Has the publication of this book affected your role as a newspaper columnist? Do people view you differently?
AB: Well, I had published two other novels. It's not easy to publish a book. The novels didn't do well. They didn't find their audiences. We could read portions of one of them and say, "Well, it's not that good." Their role in my life was analogous to the role of this book in my life. The reason I am relaxing and happy is because this is a great first experience for me. Where people are warming to something I've done of book length. I've had some nice breaks with this book. I still write twice a week for the Globe and will be for the foreseeable future because that's the only way I can make a living. People ask quite legitimately, "Am I going to make any money off this book?" I have no idea. I assume no.
RB: You've been a Globe columnist for about ten years. As you write your columns, do you think about the body of your work? Are there themes, or is the task more immediate?
AB: Both. Filling the space in a way that interests both me and the reader is the top priority. Body of work would be a little…
RB: There is something of a pattern that I have detected…
AB: Well, go ahead.
RB: You can be extremely unkind to woman novelists.
AB: Yes, yes, others have made that point.
RB: Given that you have published two novels yourself [and understand the effort and difficulty], I wonder where that comes from?
AB: Yes, I semi-wonder where that comes from. Annie Proulx I can't abide. To be fair to myself, these are woman novelists who have huge reputations and who can take the…
AB: Take the hits.
RB: Barbara Kingsolver.
AB: But I went back on Barbara Kingsolver. I went nuts over Poisonwood Bible. The thing is, the sin is hypocrisy. I did think the one early book I read of Kingsolver's was awful. But I loved The Poisonwood Bible and did a piece about Lumumba, there was a Lumumba craze about a year ago. So, I'm not dishonest, let's put it that way.
RB: Are you interested in writing another novel?
AB: Interested but fearful. They call the Navy the senior service, my conclusion is that fiction is the senior service. I'll be very direct. I could walk out of here and write a 250-page novel. But I'm not sure that I could handle everything that would flow from that. Whereas with this book or any non-fiction book, someone might say, "Oh, chapter 6 isn't that good, I'll go to chapter 7. He's writing about the Freud people. Wow. He's done a good job with the Freud people." As a casual observation — like this Andrea Barrett book I mentioned — there's really only about six or seven works of fiction put forward by the culture at one time as "worth reading."
RB: I missed your reference to Andrea Barrett.
AB: I quoted her in my column…
RB: I recently talked to her. What did you think of Servants of the Map?
AB: I haven't read it [yet].
RB: How did you come to quote her?
AB: I've written columns that my editors hate about people and institutions that have the same name, I've written about five of them over the years —talk about a body of work. A friend pointed out that both Andrea Barrett and Bill Weld had written novels about the flooding of some central New England towns, obviously the creation of the Quabbin reservoir — but they both named the reservoir Stillwater. Which is the title, of course, of Weld's new book and in Barrett's book, Forms of Water. It was a coincidence. It turns out they both hike near the Stillwater reservoir in the Adirondacks That's the kind of lunatic item of interest I like to include in my column.
RB: Thank you very much.
AB: Thank you very much.