Shoshana, December 21, 2007 (view all comments by Shoshana)
This rather superficial book can't decide whether it's a history of McLean Hospital, or celebrity dish about famous people who have been McLean patients, or a critique of psychiatry. It doesn't quite manage to be any of these, so it comes off as fairly meanspirited and catty. Adding to the problem is Beam's writing, which has an airy tone and seems to assert that author and reader are complicit and in agreement about Beam's negative views, coupled with Beam's lack of knowledge about the history and contemporary practices of psychiatry. Beam seems to relish describing treatments such as hydrotherapy and coldpacks that are not used today and would be considered bizarre in contemporary psychiatry. Because he does not place McLean's practices in the context of contemporaneous psychiatry, he implies by omission that only McLean was stupid enough to use these practices. This isn't so.
Beam's knowledge of current practice also seems scant. His diagnostic impressions when he speculates are often reductive and inaccurate, and his assertions about current diagnosis and treatment are strangely incomplete.
As a person who has worked in a number of inpatient facilities (both public and private, both before and in the era of managed care), I find myself in vehement disagreement with statements such as "A certain cynicism attends any hospital's long-term treatment of wealthy patients who pay their bills in full and who subsidize the care of less fortunate souls" (210). I disagree not because I think that all hospitals are great, or believe wholeheartedly in their interventions, or think they don't consider their bottom line, but because this is not how hospital staff think about and talk about patients. This is Beam's cynicism, not the attitude of the majority of people working in psychiatric facilities.
For better books about psychiatric hospitals, read Winchester's The Professor and the Madman: A Tale of Murder, Insanity, and the Making of the Oxford English Dictionary, Hunt's excellent Mental Hospital (from 1962), or any of the many complex and insightful accounts by patients and staff alike.
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In many ways, the history of McLean is the history of the last century of mental health care, although McLean as whole has been a kinder, gentler place than most mental hospitals. There are still stories of brutal, though well-intentioned, treatments: insulin shock therapy, icy hydrotherapy, electroshock therapy (with much higher levels of electricy than today's electroconvulsive therapy). Only a handful of lobotomies were ever performed at McLean, however, and the main emphasis was on milieu therapy -- the theory that providing structure and a relaxed, comfortable environment would go farther to help patients than any invasive procedure.
Of course, the milieu therapy led to a lot of long-term residents at McLean. In the heydey of psychoanalysis, the intake period was 40 days -- the actual treatment usually didn't start for weeks. This kind of treatment has fallen by the wayside in recent years, as health insurance and rising healthcare costs make it impossible for patients to afford more than the usual five day stay, and in turn, McLean is now a ghost of what it once was. It's easy to feel sort of nostalgic for the "old days" of psychotherapy, particularly since insurance and an overloaded system mean that many patients are diagnosed, given drugs, and only receive a very limited amount of talk therapy, if any at all. On the other hand, there's little evidence that McLean's milieu therapy was any more effective than the current methods, particularly in the case of psychotic patients. Still, one wishes somewhat for a happy medium -- no six month hospital stays, but enough time to offer a little caring and patience. As this book makes clear, however, this luxury was only ever available to the very rich, even when it was considered the best treatment for what ails you.
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Gracefully Insane is a captivating and entertaining biography of Boston's McLean Hospital, an asylum for the elite established in the early 19th century and still in operation today. Throughout are compelling and often humorous stories about both staff and the institution's inhabitants, some of whom included such celebrities as James Taylor, Robert Lowell, Sylvia Plath, Ray Charles, and Susanna Kaysen. Inseparable from the history of the hospital is the fascinatingly strange and unsettling history of early psychiatric treatment, my favorite parts of the book. Early techniques employed included ice-water baths, moral management, lobotomies, and insulin-induced comas. Satisfying on many levels, Beam's engaging writing will grab readers within the first few pages.
by Michal D.
by Chicago Tribune,
"Touching, humorous, illuminating — in short, irresistible."
by The New York Times Book Review,
"Alex Beam succeeds in telling several stories simultaneously, weaving an account of changing attitudes toward mental illness, the methods employed in its treatment and the shifting context of the larger culture into an entertaining narrative that centers on the hospital and its history."
by Boston Globe,
"[Beam's] book shapes extensive research into an absorbing saga braiding two overlapping histories: McLean's and psychiatry's....This is the work of a writer with a mind active and a heart awake."
by Entertainment Weekly,
"[Beam] elicits fascinating stories from both residents and staff...[and] has nicely traced the history of this institution and its inhabitants."
by Publishers Weekly,
"[A] fascinating, gossipy social history....More than a history of a psychiatric institution, the book offers an unusual glimpse of a celebrated American estate: the Boston aristocracy that produced, for nearly two centuries, an endless stream of brilliant, troubled eccentrics and the equally brilliant and eccentric doctors who lined up to treat them."
by Library Journal,
"[A] quirky work of social history....[A]n oddly entertaining narrative that reads easily and supplies fascinating details about business, pop music, and literary figures....Name-dropping is rampant, reflecting one former patient's view that staying at McLean was comparable to attending a progressive college."
by Miles F. Shore, M.D., The New England Journal of Medicine,
"Gracefully Insane is an engaging piece of Sunday-supplement journalism built around stories of the patients and the people who cared for them. It relies heavily but narrowly on the official history of the hospital, but its most important source is interviews conducted by the author with a number of informants....[F]ull of captivating stories that, in the end, add up to a sorry rehearsal of the slogans that have long stigmatized persons with mental disorders and the people who treat them."
by Barron's Financial Review,
"An engaging history of the psychiatric treatment of the American socioeconomic elite since the early 19th century."
by The Washington Post,
"Beam tells good stories and with an appropriate tone — intrigued and respectful, but not pious."
An entertaining and poignant social history of McLean Hospital--temporary home to many of the troubled geniuses of our age--and of the evolution of the treatment of mental illness from the early 19th century to today
Barbara Taylors The Last Asylum is a haunting memoir about illness and the psychiatric health system. A well-regarded historian of nineteenth-century British history and literature, Taylor hasnt merely written an account of the British asylum system—shes been a patient in it. Her battles with mental illness were sufficiently severe to lead to her institutionalization in the early 1980s, not long before the longstanding system began to change dramatically. Socially conscious and self-aware, Taylor writes incisively about her own position and privileges in various systems. She speaks clearly, bravely, and explicitly not only about her own experience but about the contemporary treatment of the mentally ill and the need for society to provide, in some sense, asylum for those who need it.
In the late 1970s, Barbara Taylor, then an acclaimed young historian, began to suffer from severe anxiety. In the years that followed, Taylor’s world contracted around her illness. Eventually, her struggles were severe enough to lead to her admission to what had once been England’s largest psychiatric institution, the infamous Friern Mental Hospital in North London.
The Last Asylum is Taylor’s breathtakingly blunt and brave account of those years. In it, Taylor draws not only on her experience as a historian, but also, more importantly, on her own lived history at Friern— once known as the Colney Hatch Lunatic Asylum and today the site of a luxury apartment complex. Taylor was admitted to Friern in July 1988, not long before England’s asylum system began to undergo dramatic change: in a development that was mirrored in America, the 1990s saw the old asylums shuttered, their patients left to plot courses through a perpetually overcrowded and underfunded system of community care. But Taylor contends that the emptying of the asylums also marked a bigger loss, a loss of community. She credits her own recovery to the help of a steadfast psychoanalyst and a loyal circle of friends— from Magda, Taylor’s manic-depressive roommate, to Fiona, who shares tips for navigating the system and stories of her boyfriend, the “Spaceman,” and his regular journeys to Saturn. The forging of that network of support and trust was crucial to Taylor’s recovery, offering a respite from the “stranded, homeless feelings” she and others found in the outside world.
A vivid picture of mental health treatment at a moment of epochal change, The Last Asylum is also a moving meditation on Taylor’s own experience, as well as that of millions of others who struggle with mental illness.
Its landscaped ground, chosen by Frederick Law Olmsted and dotted with Tudor mansions, could belong to a New England prep school. There are no fences, no guards, no locked gates. But McLean Hospital is a mental institution-one of the most famous, most elite, and once most luxurious in America. McLean "alumni" include Olmsted himself, Robert Lowell, Sylvia Plath, James Taylor and Ray Charles, as well as (more secretly) other notables from among the rich and famous. In its "golden age," McLean provided as genteel an environment for the treatment of mental illness as one could imagine. But the golden age is over, and a downsized, downscale McLean-despite its affiliation with Harvard University-is struggling to stay afloat. Gracefully Insane, by Boston Globe columnist Alex Beam, is a fascinating and emotional biography of McLean Hospital from its founding in 1817 through today. It is filled with stories about patients and doctors: the Ralph Waldo Emerson protégé whose brilliance disappeared along with his madness; Anne Sexton's poetry seminar, and many more. The story of McLean is also the story of the hopes and failures of psychology and psychotherapy; of the evolution of attitudes about mental illness, of approaches to treatment, and of the economic pressures that are making McLean-and other institutions like it-relics of a bygone age.
This is a compelling and often oddly poignant reading for fans of books like Plath's The Bell Jar and Susanna Kaysen's Girl, Interrupted (both inspired by their author's stays at McLean) and for anyone interested in the history of medicine or psychotherapy, or the social history of New England.
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