Gracefully Insane

by Alex Beam

  Psychiatrists who analyzed Liebman always mentioned his intelligence and his ability to articulate his dilemmas, even if he seemed incapable of solving them. In this first letter from McLean, Carl correctly predicted a long stay:I am here as long as the doctors “see fit.” ... My condition here will be a vicious circle. It will be continually worse. The doctors will not release me now and presumably they will not release me later—and not for many years. When I am released it will be too late and in addition the people in whose recognition of modest achievements I might have taken pleasure will be dead. Prof. Freud will be dead—perhaps you will be dead.

  Almost immediately, Carl’s father wrote back, explaining the family’s motivation for the forced commitment.

  Dear Carl,

  You may not have appreciated our heartache and worry for you while you were home, but it was there all the time. We felt that in spite of trying to fit in with all your wishes your being at home did not keep you from becoming increasingly ill. You yourself often complained that you felt as if you were standing on your head and could not control yourself. You know as well as we that should you have lost control you would have been forced into a state institution where your chance of helpful medical treatment can not be compared with McLean. It was difficult for us to make this decision and we did not consult you because we knew that we could not get you to agree—since having had analysis for so many years—you did not believe in psychiatry.

  Even the analysts Doctors Freud, Mack Brunswick, Brill and Nunberg felt that analysis could no longer help you, having tried it for over nine years, and the ones consulted here insisted it was only fair to give you medical treatment. Whatever you may think about us, we have considered your welfare above our own.

  Carl contemptuously dismissed the McLean routine as “eggnogs, shower-baths and occupational ‘therapy.’” But in fact, the hospital had many cures in mind for him. Within months of Liebman’s arrival, Dr. Manfred Joshua Sakel passed through McLean and met with him, among others. Not surprisingly, Liebman’s parents authorized Sakel to perform his innovative insulin coma therapy on Carl. There is no evidence that it accomplished much. Nurses’ notes indicate that Liebman remained paranoid. Around Christmas time in 1935, a nurse took him shopping in nearby Waverley Square.

  On going out into the street, patient kept walking around looking behind him. Stopping several times to look behind him and to stare into space. Patient on seeing anyone coming down the sidewalk would rush onto the pavement outside the parked cars, apparently to avoid meeting them. Mr. Liebman did not seem conscious of the traffic. ... On returning after crossing the railroad tracks on which a train was approaching, patient suddenly stopped, turning quickly walked back toward the bars, saying “it seems good to see a train again.”

  Carl also attempted a feeble “escape” that year. He attacked a fellow patient in 1943. In 1948, he made a supervised visit to his parents in New York. The following year, psychiatry unveiled its latest panacea for Carl’s suffering. Yet another doctor from New York’s Upper East Side traipsed up to McLean in 1949 to examine the disturbed patient. As always with doctors, Liebman impressed him with his general articulateness and mastery of certain conversational subjects. “My recommendations that topectomy be performed rather than a lobotomy were based on the patient’s apparent intellectual preservation and the desirability of maintaining as much intellectual function as possible,” this doctor wrote. Liebman underwent a topectomy, performed by the man who had invented the procedure, in the operating room at McLean.

  Just a year later, another New York doctor traveled northwards from Craig House, a pricey psychiatric sanitarium, to interview Carl. “I took the opportunity of asking him whether he considered his illness a neurosis or a psychosis and I used those words,” Dr. Jonathan Slocum reported to McLean’s superintendent Dr. Franklin Wood. “His answer was that he was not qualified to say, but that he believed that the diagnosis of ‘Paranoid schizophrenia was probably correct.’” Slocum continued:I am certain in my own mind that the one thing this man must not have is freedom. I believe firmly that his greatest unhappiness comes not from his being restricted, but from his conflict. I have not been asked for a recommendation, but I would say that he should go on as is and if he becomes unmanageable, that a deep lobotomy should be considered, because he possesses [sic] a great threat to those around him.

  The radical lobotomy was never performed.

  Carl Liebman’s condition never improved. But he did become better known. Although the first analysts trained primarily in Freudian methods showed up at McLean in the late 1930s, it was not until the centennial of Freud’s birth—1956, when his face appeared on the cover of Time magazine—that virtually every man and woman entering psychiatry were steeped in Freudian teachings. The New York and Boston Psychoanalytic Institutes, which certified “genuine” Freudian analysts, reigned supreme. The top spots in academic psychiatry were reserved for the men and few women who had undergone a multiyear training analysis with an Institute-certified doctor. Small wonder that Carl Liebman became a celebrity at McLean.

  Liebman stories abound, such as his greeting doctors on the manicured pathways with the salutation “I am my father’s penis.” That greeting ended when one interlocutor countered with “Good morning, Mr. Penis.” In his old age, Liebman had substituted a relatively common hand-washing fetish for the more exotic jockstrap fixation of his youth. “He thought he was tainted with a sexually transmitted disease, and if he could, he would get a hold of surgical tape and bind his hands,” recalls Dr. Paul Dinsmore, who administered Upham while Liebman was there. “Then he would get contractions, which was a shame, because he was a talented artist. He could have had more privileges, but when he got off the grounds he would go down to Corbett’s drugstore and get more surgical tape to bind his hands.”

  By the 1960s, Liebman was just another debilitated old man serving out his sentence at McLean. Nurse Constance Holian remembers him as unsociable but popular among the dotty Upham crowd. He was famous as the Man Who Knew Freud, but he was hardly an advertisement for the achievements of talk therapy: “We used to joke that Freud didn’t do him much good,” she recalls.

  7

  Welcome to the Twentieth Century

  Damn it Harry, schizophrenia is not all that tough.

  It should be easy to cure.

  Alfred Stanton to Dr. Harry Sullivan

  The McLean culture of relaxed, custodial care for mildly-to-verybatty aristocrats reached a nadir in the immediate postwar years. Franklin Wood, the bow-tie-wearing Rotarian, ran the hospital on a cash-and-carry basis, relying on his tiny three-ring spiral notebook for guidance on all matters of policy, personnel, and patient care. Visiting the wards with a red carnation firmly planted in his lapel, Wood represented the end of an era. He would be the last nonpsychiatrist to run the hospital, and he would be the last director to occupy the stately superintendent’s residence, where he stabled his family and a brace of pet Dalmatians, just down the hill from Eliot Chapel. Harvard had appointed Wood for his administrative skills; the clinical work was overseen by the psychiatrist-in-chief, Kenneth Tillotson. A bumptious, outgoing soul, Tillotson would later earn a footnote in literary history as the doctor whose electroshock therapy so traumatized Smith College junior Sylvia Plath that she attempted suicide shortly thereafter. But first Tillotson would gain wider renown, which unexpectedly transformed him and his hospital into the laughingstocks of Boston.

  Tillotson had a roving eye, and it landed on his subordinate, one Anne Marie Salot, a twenty-eight-year-old nurse who is described in Silvia Sutton’s official history of McLean as “a very good looking brunette.” Salot had had an affair with her boss, which, she claimed in a complaint to the State Department of Mental Health, had cost her her job. (Her complaint also stated that Tillotson’s continuing interest in her was jeopardizing her mental health.) Not surprisingly, her charges cost Tillotson his job. The McLean trustees, hastily assembled in the downtown offices of “Mr. Boston,�
�� their chairman Ralph Lowell, gave Tillotson the heave-ho.

  In time-honored Brahmin tradition, McLean managed to keep l’affaire Tillotson quiet. The resignation of the hospital’s chief psychiatrist and his disappearance from the roster of the Harvard Medical School went unnoticed. The Boston Braves were in the World Series; the press had more important stories to cover. But then the state decided to pursue morals charges against the pair, and the media circus was on.

  “Dr. K.J. Tillotson and Nurse Held on Morals Charge,” the Boston Sunday Globe announced on November 2, 1948. The Boston papers salted their coverage with eloquent photos of the comely Ms. Salot and the staid Dr. Tillotson, whose mousy, bespectacled wife always accompanied him to the courtroom. (At one hearing, readers learned, “Miss Salot was clad in a white wool dress, tailored black coat and black hat with veil, and fashionable strapped black suede shoes.” There is no offsetting description of Mrs. Tillotson.) Tillotson was mischievously described as “a world famous psychiatrist” because he had once testified in Washington on behalf of Esquire magazine, which had started printing girlie pictures for its GI audience in 1942. In its quest to yank Esquire’s second-class mail permit, the post office found a psychiatrist to inveigh against the magazine. But Tillotson showed up to defend the “good clean pictures glorifying good figures and a tribute to American womanhood.” Sutton writes, “That episode was resurrected from the depths into which it had supposedly sunk and was repeated again and again in newspaper articles as though it were evidence of Tillotson’s lascivious nature.” When the hullabaloo reached fever pitch, Tillotson and Salot quickly copped guilty pleas to dodge the limelight. Like a purged commissar, Tillotson, who had run McLean in the early 1930s and had served as psychiatrist-in-chief for fifteen years, saw his name vanish from the official histories of McLean and its parent, the Massachusetts General Hospital. Explains Sutton, “Officially, Tillotson had become persona non grata because he had committed the unpardonable sin of tarnishing McLean’s respectability.”

  The press ridiculed McLean because a juicy sex story is a juicy sex story but also because the hospital was in a position to be ridiculed. Across the country, psychoanalysis and psychology, infant sciences in America between the wars, were gaining rapid acceptance after World War II. The Army trained a generation of psychiatrists to treat soldiers suffering from shell shock and other battlefield traumas, and once demobilized, these men fanned out across the country to bolster the reputations of the top sanitariums: the Menninger Clinic in Topeka, Kansas; Austen Riggs in Stockbridge, Massachusetts; or Hillside in New York. In Boston, the state-run Boston Psychopathic Hospital, later the Massachusetts Mental Health Center, had eclipsed McLean in reputation. Even the Veterans Administration hospitals were centers of innovation and creative thinking. But the rush of change had left Wood, Tillotson, and McLean in its wake. The hospital had become an undistinguished backwater.

  A visiting psychiatrist who spent a summer at McLean in the 1950s reported that “the atmosphere is almost medievalistic or feudalistic.” This visitor continued, “Pay is at a stinkingly low level because it is presumably offset by altruistic satisfactions and loyalty rewarded.” Pay and money, as it happened, were very much on Franklin Wood’s mind. In one of his annual reports, he complained that “the problem of money has become all important.” A key factor in McLean’s rising costs, he intimated, was the staff’s vulgar desire to be compensated with lucre rather than with room, board, and paternalistic love. Some “employees of many years of faithful service behind them” still seemed to enjoy their work and do their jobs “because they feel they are doing their part to help others. Yet this group of people is becoming smaller every year,” Wood wrote. Altruism was in increasingly short supply: “No longer does the feeling of satisfaction in a job well-done and the helping of others serve as a goal. Money seems to be the predominant aim of today.”

  Midcentury McLean “had a very mixed reputation,” remembers Stephen Washburn, who grew up in nearby Newton, attended Harvard Medical School, and joined the hospital staff in the mid-1950s:I heard really wild stories about McLean, about people running across the campus in the nude, and then of course there was this story about Dr. Tillotson, and that was a disaster for the hospital. It had this kind of seedy reputation from Dr. Wood’s day. There was not a lot going on except that people were being entertained.

  McLean needed a savior, and they needed one fast.

  In 1955, the trustees decided to hire Alfred Stanton, a tall, cerebral New Jersey native who had recently moved to the Veterans Administration hospital in Boston. Stanton was brainy, moralistic—he was reared a Quaker, and even as an adult addressed his brother in “thees” and “thous”—and medically modern. Psychoanalytically trained, he was an intellectual disciple of Harry Stack Sullivan, a neo-Freudian who believed psychotherapy could be successfully applied to severely disturbed schizophrenics. At the Chestnut Lodge sanitarium in Rockville, Maryland, Stanton worked closely with Frieda Fromm-Reichmann, a prominent exponent of Sullivan’s theory that mental illness stemmed not from childhood trauma but from damaged interpersonal relationships. Fromm-Reichmann was perhaps better known to a mass audience as the empathetic “Dr. Fried” who cures the troubled “Deborah Blau” in Hannah Green’s best-selling autobiographical novel I Never Promised You a Rose Garden. Stanton himself makes a brief appearance in the book as the unfriendly “Dr. Royson,” who takes over Deborah’s case while Dr. Fried is on vacation. The author invokes the doctor’s “austerity of manner” and “icy logic” and even assigns him a nickname: “Dr. Snake-tooth.” (More disturbingly, she burns herself with a cigarette to protest the unwanted change of therapists.) Stanton, invariably described by colleagues as formal and stuffy, was nothing if not self-aware; he pointed out the unflattering passage to his elder son in a bookstore. “He didn’t take offense at it,” Bruce Stanton recalls. “He kind of chuckled and said it was his literary claim to fame.”

  Stanton had another, more imposing claim to literary fame. In hiring him, McLean had hired the man who wrote the book on the modern mental institution—literally. Just one year before he came to McLean, Stanton had published The Mental Hospital, coauthored with sociologist Morris Schwartz. (Schwartz would become famous to a different generation as the title character of the best-selling book Tuesdays with Morrie.) The two men had spent three years observing the complex relationships among doctors, nurses, staff aides, and patients on the disturbed ward of the Chestnut Lodge sanitarium in Rockville, Maryland. The result was the 492-page book, clearly written by the dense standards of psychoanalytic literature, which remained a standard text for budding psychiatrists well into the 1960s. One Boston doctor now in his sixties remembers his supervisor commenting upon a severe, ongoing disturbance on the locked ward of Massachusetts Mental Health Center with the words “Gentlemen! I give you Stanton and Schwartz.”

  Stanton’s book—the profession regards the ideas as his, the writing as Schwartz’s—advanced the idea, in fact, proved that even a well-funded, well-run, small hospital like Chestnut Lodge could exacerbate mental illness. He even had a theory how this happened, as explained in a chapter titled “Pathological Excitement and Hidden Staff Disagreement.” “Whenever a patient showed manic excitement, he was always the subject of disagreement between two people who were often unaware of their own disagreement,” the authors wrote. Stanton showed that tiny misunderstandings between bit players on the ward—a nurse forgetting to tell a patient where her clothes had been hung up was one of his famous examples—could cause great turmoil among incarcerated schizophrenics. Small events could prompt patients to “tear the ward apart,” the authors noted, adding, “If the ward is put back together, the manic state will disappear.”

  Alfred Stanton’s assignment was to drag McLean, kicking and screaming if necessary, into the twentieth century.

  What confronted Stanton and his team of Young Turks was “Dickensian,” according to Dr. Merton Kahne, one of the doctors who followed Stanton into his new
job. Horses and cows, left over from the days of the fully operational farm, still roamed the grounds. Some nurses and aides chose not to accept Social Security payments, so certain were they that McLean would always provide for them. “A great deal of nursing time was spent in taking care of things like sending gifts to people, sending flowers, writing thank-you notes, getting the fur coats off to storage when the summer came around,” Kahne recalls. “The nurses had to make sure they didn’t lose a coat—that was a very important thing.” When he expressed interest in seeing an occupational therapy class, he was led into a small, airless room behind the hospital auditorium. “There were these old ladies rolling cloth into tampons. God knows how long that had been going on.” Almost half the patient population was over seventy-five; the hospital had become a dumping ground for wealthy families to warehouse gaga Uncle Milton.

  Things changed, and quickly. In a symbolic gesture, Stanton chose to live in Wellesley rather than to move his family into the baronial superintendent’s residence. Stanton immediately hired a full-time psychologist—a woman no less—charged with building a professional department to backstop the medically trained analysts. He also brought on board a chief of social work, who in turn hired a raft of social workers to help manage the complex relations between the hospital and patients’ families. And Stanton beefed up the residency training program, with the intention of luring top-quality medical students out to the sleepy Belmont campus.

  A number of small changes in patients’ lives had a cumulative impact. The disturbed wards had high fences surrounding modest yards; the new regime took them down. Stanton extended visiting time from a few hours a day to all daylight hours. For the first time, male nurses worked on female wards and vice versa. Patients finally gained access to telephones and no longer had to sign a pledge of good conduct to receive off-grounds “privileges”—a term Stanton loathed. The new doctors even allowed pets onto the halls, a reform eventually rescinded in the face of strenuous objections from the nurses, who had to clean up after the animals.