Gracefully Insane (18 page)

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:

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.

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”:

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.

The shrinks quickly segue into their “Diagnostic Tango”:

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”:

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.