Gracefully Insane

by Alex Beam

  They did, however, obtain a charter from the Commonwealth of Massachusetts and formed a corporation of fifty-five members. Then as now, the trustees of the Massachusetts General Hospital and the Charlestown (later McLean) Asylum hailed from the New World aristocracy. Former president John Adams moderated the first meeting. Other members included his son, the future president John Quincy Adams, a future vice-president, a future Supreme Court justice, and a future Harvard president. By the end of the war, economic health was restored, and the merged hospital projects moved forward. The asylum, sited on a spit of land overlooking the harbor in Charlestown, opened its doors in 1817, several years before the Massachusetts General Hospital. (At midcentury, this area incorporated itself as Somerville, and McLean was sometimes called the Somerville Asylum.) This was partly because Jackson, Warren, and their supporters raised money for the asylum more quickly than for the hospital and partly because they happened upon a fortuitous real estate deal for McLean.

  The ill fortunes of one Joseph Barrell, who had once employed the architect Bulfinch in his counting house, proved to be a boon for the asylum. Barrell, a horticultural enthusiast, had built what some thought to be the most beautiful country home in New England, an eighteen-acre estate adorned with hundreds of ornamental plants and fruit trees imported from Europe. He had embellished the property with stables, dovecotes, greenhouses, a rose-covered summerhouse, fountains, and even exotic fish pools. His terraced gardens swept down to the water. Atop them sat a Bulfinch-designed, three-story, English-style manor house with a southern view over Miller’s Creek, a tributary of the Charles, and an eastern exposure to the river’s mouth and the harbor.

  But Barrell luxuriated in his Charlestown aerie for less than ten years before succumbing to debts and death in 1804. In 1816, the hospital trustees bought the estate for just $15,650, a great bargain compared with the $23,000 they paid just a few months later for the four acres of undeveloped Boston land that was to become the Massachusetts General Hospital. After the purchase of the Barrell estate, Bulfinch added three-story wings to each side of his brick manor house—a men’s ward and a women’s ward—and the new asylum opened for business.

  For several years, McLean was the only mental hospital in Boston, and it attracted a fairly diverse patient population. Still, because the incorporators did not want their new hospital to become “a merely pauper establishment,” they successfully resisted the legislature’s demand that they admit charity patients for free. Instead, they assessed fees on a sliding scale. Charity cases dependent on municipal support were billed $2.50 a week, to be paid by their town of residence. The administration reserved the right to show preference for donors’ families or for patients from towns that had aided the hospital financially. Patients trickled in, which was fine with the administrators, who were learning on the job. Patient Number One, as McLean’s official historian Silvia Sutton sardonically notes, “might have come from Central Casting”:A father asked to have his son received as an inmate.... He informed them that he believed his son to be one of those spoken of in the Bible as “possessed with a devil”; and, when asked what remedial measures he had adopted, replied that he was in the habit of whipping him. The young man was entirely cured, and became subsequently a peddler, in which vocation he displayed so much Yankee shrewdness that he acquired a property of Ten or Twelve thousand dollars.

  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 building3—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:Paupers ... or those in the lower walks of life, whose means are limited, are provided for by various City, County and State Institutions. It has seemed necessary to maintain here, a class of accommodations and a style of living more than simply comfortable, and even in a degree, luxurious [emphasis added], meeting the wants, artificial though they may be, of those in a higher social position, and possessed of a competency, who in a state of disease cannot be placed in the best condition for cure, or even present relief, unless surrounded by the comforts to which they have been accustomed.

  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 puls
e 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: The treatment of insanity chiefly depends upon the connection between the mind and the body. If there be inflammation of the brain, or its membranes, it is to be treated as inflammation of those parts. If there be other organic disease, whether of structure or of function, in any part of the body, medical treatment will be required.

  But in mental disorders, without symptoms of organic disease, a judicious moral management is more successful. It should afford agreeable occupation. It should engage the mind and exercise the body; as swinging, riding, walking, sewing, embroidery, bowling, gardening, mechanic arts; to which may be added reading, writing, conversation, &c, the whole to be performed with order and regularity. Even the taking of food, retiring to bed, rising in the morning &c, at stated times, and conforming to stated rules in almost everything, is a most salutary discipline. It requires, however, constant attention and vigilance, with the greatest kindness in the attendants upon a lunatic. Moral treatment is indispensable, even in cases arising from organic diseases.

  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:Some of the boarders were quite at liberty to come and go as they pleased. These found their own occupation and amusement; one was a frequent visitor at the reading-room of the Boston Athenaeum, and might have been seen daily among the literary gentlemen who associated there. A constant effort was made to increase the means of occupation and amusement for all. Walking in the airing courts or in the country with attendants, going to church on Sunday, visiting places of interest on other days were the most common.... A rowboat upon the Charles River, then attractive and unpolluted, was in frequent use, affording an amusement particularly relished by those who had been sailors....

  In summer, excursions in the harbor in large boats gave a pleasant sail, a run upon the islands, a chowder on board, and all the enjoyment of a day away from home. There was bowling, gardening, the exercise of the mechanic arts, books, papers, and various games. Chess was a favorite with some; the physician was an excellent player, and not unfrequently met with a worthy antagonist among his boarders.

  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.

  Sunday 8 May

  Walk to Norton’s road intending to go to meeting at Camb., but ascertained the bells were done tolling, & returned home. Sat in my chamber musing. P.M. [ ... ] Read a little in Bible. Walk with Col. G[oodwin, the steward], met Alex. Hamilton.[ ... ] In wing, reasoned with Amelia M. about being discontented & unruly—rcd advice pleasantly—hope it will do her some good. Miss E. is very jocose—says she recd an invitation to walk this eve. from a Gentleman of high standing. Wishes to start in stage for N. Haven tomorrow & will breakfast at Washburn’s Hotel.

  Bed 10

  Sat. 14 May

  Rose 5. Walk to Camb. [a walk of about ten miles round trip].... 7:30 breakfast at home. In wings til 11:45 when began to work on Records. ... 1, dine—Newspapers—1:45 Records til tea 6:30. Col. G. sat in room after tea—talk of F., B., P., &c [patients]. In wings K. silly & obscene today—Mrs. G. excited—With Dr. [Wyman] in S. wing—Ruth S. talked—Girls in III Story pleasant & orderly. Dr. amused them with Rabbits of Shadows.

  Mo. 11 July

  4:30—Kept awake by Dogs & heat from 3:30. Called Col. G. who goes this morn. to Bridgewater. Very hot at 4 P.M. + 92 degrees in Steward’s room. Dr. [Wyman] conversed on Intellectual Philosophy last night & this morn. Read a little on Cutaneous diseases in Good [John Mason Good’s The Study of Medicine]. 10 A.M. visited female wing with Dr. Afterward til 3 P.M. copying cases. Waiting on company some time. Very hot, can’t read. In garden for fruit 6-6:30. After tea walk with P.—shower bath—patients—Journals 2 days—bed

  Thurs. 3 Nov.

  CHARLES G. of Quincy eloped at tea time from his room, taking out a window and tieing sheets &c together—brick found in room.

  Wednesday 9 Nov.

  Rose 6. Read Psalms. Visited patients. Walk with attend.
& patients to Camb—I called a moment at C’s and left directions for Ar. Root saw [sister-in-law] Sarah & S. Eliz. Home 11. records & Patients till eve. Mrs. P died at tea time&Iclosed her eyes. Mrs. Wyman, with [daughter] Eliz. in my room, talked of Mrs. P. &c

  The published version of Folsom’s diary even includes the asylum’s regular weekly menu. Breakfast rarely varied: bread, butter, cheese, and coffee or cocoa. “Supper every day” was Souchong tea, bread and butter, and perhaps toast. Then cameDinner

  Sunday, Soup, meat and vegetables, and bread; or beans or peas, baked, and pudding

  Monday, Roasted beef or veal, or lamb, pork or mutton. Vegetables, bread and pudding

  Tuesday, Salt beef boiled, vegetables, bread, pudding, or fresh fish, vegetables and pudding.

  Wednesday, as on Sunday....

  Patients’ relatives dropped in often, as did the trustees’ Visiting Committee, who took their duties seriously; either Folsom or Wyman escorted them through the premises once a week. In town for the Bunker Hill festivities, the Marquis de Lafayette was supposed to visit the asylum, but he lingered too long at the Massachusetts General Hospital across the river and never showed up. One dignitary who made a point of including McLean on his itinerary was His Highness Bernhard, Duke of Saxe Weimar-Eisenach, who appears in Folsom’s diary:Tues. 2 Aug.

  Rose 5:45!!! Attend to B. very sick. the Asylum is this day visited by Duke Bernhard of Saxe Weymer, who arrived in a Dutch sloop of war at Boston, a day or two since—also by Mr. Quincy, Mayor, to whom I am introduced by Dr. Wyman.