Gracefully Insane

by Alex Beam

  And with Doctor Shein a lot of

  money and time

  And a few friends sticking around.

  One of Shein’s friends from Upham, who remembers him cheerily navigating the character foibles of the assembled Mayflower screwballs, felt he looked sad now that he had moved “up the hill” into the administration building. “They were promoting him up on the hill, out of the valley [Upham], and nobody was really all that sure that he wanted to do it,” this woman says. “He used to come back to Upham and visit. He was lonely, he talked longingly about the good old days. He seemed very stressed and not very happy. We all used to worry about him.” A peer who was meeting Harvey for the first time immediately concluded that his colleague was experiencing an agitated depression: “His hands were shaking, he couldn’t hold a pen.” Although it was not widely known, Shein had switched away from his longtime analyst Tartakoff and had begun to see Dr. Elvin Semrad, a revered presence at Massachusetts Mental Health Center, who was sometimes regarded as a healer of last resort. “I remember joking with Harvey about the Harvard appointment,” says Peter Choras, “and he told me, ‘For the first time in my life, it looks like the road is going downhill, not uphill.’ I assumed that he was thinking, ‘It’s easy now, I don’t have to keep climbing.’”

  On the evening of July 17, 1974, Shein invited the young residents from McLean to his home on Ward Street, in a comfortable neighborhood called Newton Centre. With the windows open to the still summer evening, Shein led a discussion of Sigmund Freud’s classic essay, “On Mourning and Melancholia.” As he said farewell to his young guests, Shein told them he would be leaving on vacation the next day and would not see them for a while.

  When Stephen Bergman walked into McLean the next day and began his usual bantering with the secretaries, they cut him short: “‘Did you hear about Dr. Shein?’ they asked, and I said no. ‘He’s dead. He killed himself last night.’ And I said, ‘Are you sure?’ and they said, ‘Oh yes,’ and they knew how many pills he had taken, and what kind. I was totally stunned.”

  According to the police report, Shein had swallowed 500 milligrams of chloral hydrate, a common sleeping medication, which had been prescribed for his wife.25 Mrs. Shein commented to one of the officers that her husband “had been depressed lately.” The attending doctor at Newton-Wellesley Hospital failed to revive Shein, who had apparently taken the pills three hours before the ambulance arrived. Although the Newton police labeled the incident a suicide, the state medical examiner, Nathaniel Brackett Jr., was more circumspect. He noted that Shein died of “acute pulmonary edema assoc w therapeutic level of long acting barbiturate in the blood.” He refused to speculate whether the death was a suicide or an accident. Harvey Shein, one of the most promising physicians of his generation, was dead at age forty-one.

  The death was shocking to Shein’s numerous friends in and around McLean. Many found the institutional reaction horrifying. Just a day or two after Shein’s suicide, the McLean psychiatrists gathered in Conference Room A of the administration building for their regular Thursday meeting. The atmosphere was tense; Shein himself had presided over the previous week’s meeting. Now, with one of their most cherished colleagues dead by his own hand, the assembled doctors were treated to a half-hour-long spiel on the trials and tribulations of the nursing department. “It was as if you were on the moon,” remembers Dr. Richard Budson, then a brash young doctor with a reputation for confronting authority.

  We were sitting there all grief-stricken, and the nurses are giving their presentation. I just broke in and said, “I’m terribly sorry to interrupt the nursing department, but I think it’s very important to process what happened to us.” And for the next hour people shared their despair and dismay in a profound way, which had to happen.26

  Peter Choras remembers,

  It was the worst-bungled way of managing it I had ever seen in my life, and not typical of Shervert Frazier at all. We got into a meeting a day or two after the suicide, and Sherv started to go through his agenda. It wasn’t until one of the more prickly people at McLean, Dick Budson, said, “What are we doing here, Sherv? Harvey Shein is dead.” There wouldn’t have been any discussion unless Dick had broken into that. People were very protective of Sherv. ... he was a lost man. Harvey was his heir apparent.

  Shein’s friends blamed Frazier for overloading Shein; “People were in a blaming mood,” one psychiatrist remembers. Frazier contributed to the atmosphere of crisis and cover-up by refusing to acknowledge Shein’s suicide. “Harvey M. Shein died suddenly on July 18, 1974,” was the official statement released over Frazier’s signature. The newspaper obituaries reported that Shein had died of a heart attack, adding no further details. “Nobody would talk about it, but everybody knew,” says Stiver. “People challenged Frazier at meetings I attended, and he would say, ‘We don’t know yet, we’ll look into it, it’s not at all certain. ...’ And then he would close the conversation.”

  “Even though people knew that he had committed suicide, and they even knew what pills he had used,” Stephen Bergman says,the administration position was to deny that.... At one point, someone said to us residents—you’ve got to remember, these were my first two weeks as a psychiatrist—“No, no, that was just a rumor that he killed himself, he died of a fatal disease.” That was the exact quote. I mean, wait a second! That was really, really, really destructive to us.

  But the patients knew, lots of them. Imagine how the patients felt. He had been treating patients for depression, and here their doctor commits suicide!

  John Livingstone recalls,I remember being over at Harvey’s house before the funeral, and Sherv was there, and this doctor from [the Psychoanalytic Institute] was there, and they were all taking over. The story was “death, cause unknown.” There was the McLean brand name to protect, and of course the stigma to the Institute. It was damage control, spin doctoring. At that point, they were controlling what they could control.

  Ever since he was involved in a plagiarism scandal in the 1980s, the once media-friendly Shervert Frazier has not been meeting with many journalists. But Frazier granted me an hour of his time—a fifty-minute-long psychiatric hour, because at age seventynine he was still seeing many patients—with no strings attached. He was as Bergman described him: intensely charming, intelligent, and above all, Texan—tall, gregarious, and outgoing—the kind of person one rarely encounters in the paneled halls of McLean Hospital. Among his other credentials, Frazier is the former Texas commissioner of mental health who cemented his academic reputation with an analysis of Charles Whitman, the deranged rifleman who killed sixteen students from his perch on the observation deck of the University of Texas Tower in 1966.

  There is no question that one cannot ask a psychiatrist, and Frazier evinced no difficulty in talking about Harvey Shein. “He was admired and revered here,” Frazier told me. “He was extremely bright, a good clinician and a good teacher.” Shein’s suicidehad a great impact on me and on the staff. I was very sad. He was one of the brightest people I ever knew. I didn’t know anything about what was going on in his mind, though I’ve learned a lot of it since—that he was in psychoanalysis, he was uncovering all kinds of things, that he was clinically depressed and that he had a couple of psychiatrists working with him and treating him.

  How, I asked, did Shein die? At the time, Frazier replied, another doctor investigated Shein’s death and concluded that it was accidental. “Now that I look back on it, I think maybe he had the feeling that because I was relatively new here, I didn’t need to suffer the shock of suicide of a senior staff person. I think it was probably a suicide, if I had to add everything up that I’ve learned since.”

  Shein’s colleagues traveled to Rhode Island to hear him eulogized at the Sugarman Funeral Home in Providence. “I went to his funeral, and I have never seen so many people crying in a funeral room in my life,” remembers Dr. Edward Daniels. “The people I was sitting with didn’t just sob, they were wailing.” When discussing his friend’s death
, John Livingstone remembered Harvey’s fascination with Wittgenstein and with Wittgenstein’s contention that language could be a straitjacket that limited our ability to understand and describe the world. “Here’s an example,” Livingstone said to me: Why did Harvey Shein commit suicide?

  Well, we know the cause of his death; he killed himself because he swallowed an overdose. We can certainly come up with some reasons why he killed himself: He was overinvested in his career, he was losing ground in his personal relations. Or maybe it’s a false question. Maybe it’s not a question at all, but a statement of our own pain.

  12

  Life Goes On

  The past twenty-five years have been a time of troubles for fullservice mental hospitals. The world has given up on long-term, residential mental health care, or at least it has given up paying for it. The moral therapy of Philippe Pinel and the twentieth-century milieu therapy belong to history now. Insurance companies, health maintenance organizations, and the federal government’s Medicare and Medicaid programs have been cutting back drastically on patient reimbursements for mental health. Psychopharmacology is the order of the day, and to health-care executives that means quick diagnoses, rapid drug prescriptions, and hopes for the best. Follow-up visits, generally limited to fifteen minutes, are for discussing the drugs’ side effects and altering the initial prescription. The new order is tough on patients and hard for psychiatrists too. “How can you know how somebody is doing if you don’t have enough time to ask, ‘How are you feeling? How are your relationships?’” asks Dr. Bruce Cohen, the current president of McLean. Cohen, a molecular biologist by training, has devoted his life to psychopharmacological research, but even he—as head of the hospital, especially he—is uncomfortable with McMental health. “It is not enough to sit with somebody and say, ‘So, do you have dry mouth? Have you had any hallucinations lately?’ That doesn’t work.”

  All over the country, hospitals like McLean have shut their doors. The Olmsted-designed Bloomingdale Asylum, like McLean, is trying to sell portions of its campus to developers to stay alive. During the writing of this book, Chestnut Lodge, Alfred Stanton’s old stomping ground, went out of business. In the past quarter-century, McLean has had two near-death experiences, one in 1983, when the administration tried unsuccessfully to sell the hospital to a health-care conglomerate, and again in 1998, when Harvard considered closing it down. Although it is true that the hospital’s most serious problems were economic, some of McLean’s wounds were self-inflicted.

  During the 1980s, McLean endured a series of embarrassing scandals. Three of its best-known doctors, including Edward Daniels, dubbed the “Mayor of McLean” for his legendary ability to keep his colleagues’ psychiatric appointment books full, were accused of sexual harassment by female patients. The men all protested their innocence, but all relinquished their licenses to practice medicine. Then Shervert Frazier, the psychiatrist-in-chief and former head of the National Institute of Mental Health, lost his job in a plagiarism scandal that was reported on the front pages of both the New York Times and the Boston Globe. In the scheme of things, Frazier’s infraction was relatively minor; his McLean colleagues felt he had been done in by jealous rivals on the Harvard campus. Once the brouhaha settled down, Frazier was quietly reinstated at McLean, although not in his former position. The publication of Stephen Bergman’s roman à clef, Mount Misery, which depicted many of his former McLean colleagues as lunatic, sex-crazed pill-pushers, was an additional annoyance. The hospital’s reputation within Boston’s tight-knit medical community was badly tarnished.

  But the news was not all bad. Frazier had raised money to build a new, modern, research building, and McLean doctors made discoveries of world-class significance. Dr. Seymour Kety published his famous “Danish twins” study that revealed an apparent genetic basis for schizophrenia, for which he won academic medicine’s highest prize, the Albert Lasker Award. McLean doctors made important contributions to the development of Eli Lilly Company’s “miracle pill,” the antidepressant Prozac. Drs. Martin Teicher and Jonathan Cole published a controversial study warning of potential suicide risks among Prozac users, and Teicher became the lead scientist in an effort to reformulate the wonder drug. (That effort came to naught, and McLean lost several million dollars a year in anticipated royalties and license fees.) Throughout the decade, U.S. News & World Report continued to place McLean at or near the top of its list ranking the top private mental hospitals in the country.

  Such successes made the bad economic news all the harder to swallow. The forty-day work-up of the Anne Sexton era was long gone. By the 1990s, insurance plans would generally pay for a thirteen-day stay at a mental hospital. Now the norm is five days. Alfred Stanton once diagnosed a patient by saying, “she has the eyes of a schizophrenic”; such intuitive, ludicrous diagnoses are a thing of the past. Psychiatrists and the insurance payers now hew closely to the syndromes and conditions described in the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV), a detailed checklist of 297 mental diseases published by the American Psychiatric Association. (Homosexuality was included as recently as the DSM-II of 1974.) The DSM has attracted its share of ridicule—one writer noted that both President Bill Clinton and Hillary Rodham Clinton could be institutionalized under its conditions—but it is one of the few working documents recognized across the profession. Using the DSM and insurance-company guidelines, today’s psychiatrist must stabilize, diagnose, treat—usually with a drug prescription—and release a disturbed man or woman in less than a week. Sometimes doctors carpet-bomb patients with prescriptions, hoping that one of the drugs will work. Here is a portion of a 1993 McLean medical record reproduced in Under Observation, an account by Dr. Alexander Vuckovic and Lisa Berger of a year on the McLean wards:On admission, she was taking Depakote 500 mg bid [twice daily], Trilafon 8 mg qhs [at bedtime], Zoloft 300 mg qAM [in the morning], Ativan 1 mg qid [once daily] prn [for] anxiety, Motrin 600 mg tid [three times daily] prn muscle pain, Firoicet 2 tabs bid prn H/A [headache], Spironolactone 25 mg qid prn premenstrual dysphoria, and Synthroid 0.2 mg as empirical mood stabilizer therapy.

  By the early 1990s, explains Charles Baker, a former McLean board chairman, “we had an exquisite factory for a product we weren’t selling anymore.” Because private insurers were fleeing mental health, McLean started signing multimillion-dollar contracts with Medicare, which covers the elderly and the disabled, and with Medicaid, for lower-income patients. Doctors grumbled that McLean had become a “welfare hospital.” If so, it was a money-losing welfare hospital. By the middle of the decade, McLean was losing up to $9 million a year, on an annual budget of only $80 million. The administration adopted desperate measures, laying off 30 percent of the staff. The hospital even sought the last refuge of the Brahmin dowager: They sold off the silver. In 1994, McLean put 238 separate items up for auction, including several lots of silver tea sets once used on the wards, a Paul Revere bowl, oriental rugs, some venerable grandfather clocks, dozens of pieces of hand-crafted furniture, and some paintings by American masters William Otis Bemis and John La Farge. Virtually all of the items had been languishing in the attics of Higginson House gathering dust. (Indeed, several rugs, tea sets, and pieces of furniture had already gone missing from the various halls, another powerful argument for the auction.) A hospital spokesman told the press that McLean hoped to net between $200,000 and $300,000 for the antiques. But many of the items had suffered damage from improper storage or had been overvalued by enthusiastic appraisers. In the end, McLean made only $160,000, one of many disappointments during this bleak period.

  Morale at McLean was extremely low. Here is how one researcher who had been visiting the campus described the mood during the mid-1990s: Returning to McLean, she wrote,was a little like coming back to a tree-lined London neighborhood after the Blitz.... Administrators were frantically trying to cut costs. Nearly all the non-medical services—food preparation, laundry, lawn care—had been farmed out to independent contractors, and gardener
s, cafeteria workers and others who had worked at the hospital, sometimes for decades, had been dismissed. Hospital units were opened and closed and reorganized like circus tents.... A third of the staff had been fired, the base salary of the rest would soon be cut in half, and many had left voluntarily in the hope that things would be better elsewhere. The administrators were behaving in ways that seemed sadistic to those under them, as if they were hoarding food in a severe famine. (However, they also probably saved the hospital from bankruptcy.) One clinician told me that at a rare meeting of clinicians, the hospital director showed a slide entitled “Your Options in Dealing With Managed Care” with a bulleted recommendation: “Move to Wyoming.” No one laughed.

  In 1997, Harvard consolidated all of its teaching hospitals into one huge company, Partners HealthCare System. For all the lip service accorded to the sanctity of the hospitals’ medical mission, this was a garden-variety corporate merger. The managers at Partners had to demonstrate the efficiencies of the new combination, and eliminating overlapping services was an obvious first step. Partners had a small, top-notch psychiatry department at the downtown Massachusetts General Hospital and a money-losing, satellite operation sprawling over 240 acres of valuable real estate in Belmont. For the chairman of Partners, a former Harvard Business School dean, this was a no-brainer: Close down McLean.

  Although no longer composed of Appletons, Lowells, and Putnams, McLean’s board of trustees still included some the area’s most influential businessmen and was not a group to be trifled with. They launched a furious counterattack. Pursuing a full-court diplomatic offensive with donors, academics, and state officials, the board succeeded in changing Partners’s mind. To rescue the hospital, they devised the Hospital Re-Use Master Plan. McLean would sell off or give away 200 of its 250 acres and about half of its buildings, raising $40 million in the process. Olmsted’s marvelous campus would be subdivided into luxury homes, an office park, and a housing complex for the elderly. The 300-bed hospital would become a 100-bed hospital. The trustees had destroyed a large portion of the hospital in order to save it.