Bellevue

by David Oshinsky

  Gregory had big plans for Bellevue. He quickly substituted “Psychopathic” for “Insane” in the Pavilion’s title—hoping, he said, to make the patients appear curable—and had the iron bars removed from most of the windows. Those who visited the wards saw more substantial changes: less reliance on narcotics and physical restraints. Appalled by the ignorance of fellow physicians about mental illness, Gregory lobbied to place psychiatry on par with other specialties in training medical students and interns. Close to half of the total admissions at Bellevue were patients suffering from alcoholism, blackouts, dementia, depression, drug psychosis, epileptic confusion, and other mental conditions, Gregory remarked. “Is it strange that the average physician’s knowledge of psychiatry is almost as crude as the layman’s?”

  In truth, Gregory had opinions on just about everything, few of which he kept to himself. Eminently quotable, he claimed that weight loss in women caused nervous breakdowns (he preferred the “plumper” variety), and that “twilight sleep” produced by anesthesia led to cases of insanity. From addiction to delinquency to the works of Sigmund Freud, a judgment would be rendered. Even when not seeking the spotlight, which was rare, Gregory seemed unable to avoid it. In 1925, he was assaulted and almost killed in a bizarre incident near the doctor’s midtown apartment. “LUNATIC WITH A PISTOL CHASES DR. GREGORY,” a headline screamed. “He Dodges Among Motor Cars After Bullet Grazes His Cheek.” Gregory was “put to bed” suffering from “severe mental shock.” His patient, “knocked senseless by the police,” was remanded to Bellevue for observation.

  Gregory’s crowning achievement came in 1926, when City Hall allotted funds for a six-hundred-bed psychiatric building on the Bellevue grounds. It followed an intense lobbying campaign by Gregory, including a well-scripted tour of the old pavilion by Mayor Walker, who declared: “I wouldn’t send my dog there.” At the groundbreaking ceremony, Walker grandly described the five-foot-tall psychiatrist as “perhaps the greatest little man in the world.” Another dignitary turned to Gregory and said, “The dream of your life is being realized.”

  It didn’t come cheap. McKim, Mead & White, the firm most intimately connected to Bellevue, was now a shell of itself. All three founders had died—Stanford White, the key figure, having been gunned down in spectacular fashion over an affair with a deranged millionaire’s wife. Instead, the city chose a rival group led by architect Charles B. Meyers, a favorite of Walker’s who, by happy coincidence, had just designed the luxurious Tammany Hall headquarters in lower Manhattan. Within a year, the cost overruns at Bellevue had reached $3 million—the work slowing to a crawl when the lead contractor took his sizable advance and fled to Europe.

  Mayor Walker soon followed him there. On the eve of his landslide reelection victory over reformer Fiorello La Guardia in 1929, the stock market crashed. Within months, the country slid into the worst economic depression in its history, with New York City, the financial engine, especially hard-hit. Suddenly, Walker’s extravagant ways didn’t seem nearly as endearing. Critics, emboldened by the crisis, accused the mayor of lining his pockets with kickbacks from contractors seeking business with the city. Even the Catholic Church weighed in, disgusted by Walker’s very public extramarital affair with actress Betty Compton. When a State Senate hearing validated most of the corruption charges, both Al Smith and sitting governor Franklin D. Roosevelt urged Walker to step down. In September 1932, the mayor tendered his letter of resignation and boarded an ocean liner for Europe with Betty Compton, whom he later married. No criminal charges were filed, though Walker remained abroad for several years until the threat of prosecution dissolved.

  Walker’s final legacy—the Bellevue Psychiatric Building—opened in 1933. Standing eight stories tall, it looked more like a fine hotel than a mental institution (if one ignored the high cement wall with wrought iron spikes on top). Mired in controversy—the Italian Renaissance facade didn’t quite match the somber mood of the Great Depression—it had taken seven full years to complete. “It was a big graft job; they made fortunes on the contract,” a Bellevue psychiatrist recalled. “If they had anything that was expensive, they just put it into the [place].”

  He wasn’t exaggerating. The building seemed a throwback to the grandest days of McKim, Mead & White. Jimmy Walker had rewarded Dr. Gregory—and City Hall’s favored contractors—in his notoriously overstated way. Why a mental facility needed “cinquecento porticoes, Michaelangelesque stairways, carved pediments, and fluted cornices” was, indeed, a mystery, wrote one perplexed observer, adding: “It appears to have been based upon a misapprehension of the Villa Medici.”

  Before long, however, its beds were full. Hard economic times meant more patients seeking free medical care—not just in Gregory’s building, but across the hospital. By 1933, close to a third of New York City’s adult labor force was out of work, with one public school student in five suffering from malnutrition. Shantytowns dotted the land from Red Hook to Central Park, where twenty thousand people now lived, many evicted from their apartments. Studies showed a fair share of those seeking government aid to be “first-time charity recipients” who had seen their well-paid employment disappear. There even was a name for them: “the new poor.”

  “For many New Yorkers,” a historian noted, “the economic catastrophe of the 1930s became a health catastrophe as well.” With so much hunger, emergency room doctors took to admitting patients just to get them a hot meal or two. Orthopedic departments noted a spike in foot problems because so many of the unemployed couldn’t afford a subway ride or a new pair of shoes. At Bellevue, an average day had the feel of an epidemic. One journalist likened it to “military hospitals after a great battle.” An immigrant patient, writing in Yiddish, recalled the “titanic task” of those who supervised her ward, where beds stretched into the corridors and out onto the balconies. Bellevue, she marveled, “is indeed a gigantic factory where healing is brought to mortal flesh.”

  Many entering Bellevue during the Depression had never been there before. Barely able to pay for food and rent, much less a private room at New York Hospital or Mount Sinai, they came knowing they wouldn’t be turned away. Meanwhile, the private hospitals were half full and teetering on bankruptcy. In the words of S. S. Goldwater, the city’s chief health officer: “There was a time when people feared the evil reputation of Bellevue. That has changed now.” The Depression had taught the middle classes what the lower classes knew all along. “Bellevue stands as an institution that can compare favorably with any in the world.”

  Even the upper-crust New Yorker seemed to agree. For decades following the Great Depression, its stories would juxtapose Bellevue’s fine medical care with its bare-boned environment—like getting a five-star meal at the local delicatessen. In one (nonfiction) piece, the writer takes a cab ride up First Avenue. Coming upon Bellevue, he claims that he’d recently been rushed there by ambulance after suffering a heart attack. “They treated me first-rate,” he tells the cabbie, who replies: “Now that’s a funny thing. My wife’s brother said almost the same words. Said he met some fine people in there, and the treatment he got from everybody was real good.” Surprised by his own candor, the writer notes: “I had to laugh at myself a little for having said ‘Good Old Bellevue!’ to a stranger. Yet that is the way I feel whenever I chance to pass the place—almost as if it were a school I had attended as a youth and could not let slip lightly from my mind. Indeed, it is almost that way—like an alma mater.”

  —

  In 1933, Dr. Gregory was entering his fourth decade at Bellevue, appearing secure, close to indispensable, in his role. As admissions climbed past twenty thousand per year, he hired a new crop of psychiatrists to handle the patient flow. Many were European Jews fleeing the Nazi rise to power. At NYU, psychiatry was one of several departments that employed them. Privately, Currier McEwen, NYU’s medical school dean, partnered with Albert Einstein to provide “at least 20 life-saving appointments to German/Austrian medical scientists”—a list that included Nobel laure
ate Otto Loewi.

  Before long, Gregory’s junior staff was filled with recent medical school graduates and political refugees. Younger and better educated than the typical “alienist” at Bellevue, they defined themselves largely by the research they did, which put them at odds with Gregory, who viewed patient care, not article writing, as the sole imperative in the current economic crisis.

  Gregory wasn’t opposed to research per se. He’d indulged it in the past when the prospects for success—and good publicity—outweighed the inconvenience. When Jimmy Walker wanted a study done on the deadly consequences of Prohibition, Gregory had been more than willing to oblige. When a well-connected scholar requested confidential patient records for examination, Gregory provided them. In one notable instance, he opened his files to researchers studying whether Jews had a higher incidence of mental illness than other groups, which many psychiatrists believed to be true. Earlier works on the subject, bearing ominous titles like “The Insane Jew,” claimed that centuries of persecution had produced a “hypersensitive race” with unique “psychogenetic” disorders. Living apart, barred from the more physical trades, Jews had survived by their wits in the mercantile world—a tense and sedentary existence favoring “overstimulation” of the mind and “underdevelopment” of the body, a combination ripe for “serious mental disease.”

  The study, endorsed by local Jewish leaders, compared the records of thousands of Jews and non-Jews at Bellevue between 1914 and 1926. It concluded that Jewish psychiatric patients (especially men) suffered more from anxiety and depression than non-Jews, but less from alcoholism and drug addiction. The authors, who were Jewish, didn’t seem especially optimistic about the future. “We expect,” they noted, “a continuous growth in the number of Jewish patients.”

  The first refugee psychiatrist to arrive at Bellevue was Dr. Paul Schilder, a star pupil of Sigmund Freud. He was followed, in short order, by European-trained psychiatrists Walter Bromberg and Fredric Wertham, and the Romanian-born psychologist David Wechsler. All would leave their mark—Schilder in psychotherapy, Bromberg in drug addiction, Wertham in forensic psychiatry, and Wechsler in human intelligence testing—the popular Bellevue-Wechsler scale. All saw themselves as members of a modern profession in which reputations were forged by attending prestigious conferences and publishing in specialized journals. It was a new generation that looked down on Dr. Gregory, who believed that the cause of most mental disturbances could be traced to the stresses of modern life upon temporarily overwrought people, not to their buried neuroses. Good food, rest, and a reassuring manner would solve all but the most difficult cases, he believed, along with counseling and medical attention for those suffering from drug and alcohol withdrawal.

  A collision was inevitable. In 1934, a group of Bellevue psychiatrists sent a withering memo to the city hospital commissioner titled “Gross Defects in the Management of the Psychopathic Division.” The memo took direct aim at Gregory, describing him as a tyrant who spent his time dispensing “special favors” to his Tammany friends. As an example, it claimed that “a niece of the former Commissioner Donahue was treated for 4 months in a suite of two rooms while other patients were sleeping on the floor of crowded wards.” Even worse, the woman was an outlander—“a resident of the state of New Jersey.”

  Mostly, though, the memo painted Gregory as someone whose time had passed. It mocked his “disgraceful ignorance” of new psychiatric methods and condemned his “failure to adequately encourage the staff in the scientific work [and] publication of papers.” Little wonder, it concluded, that “younger physicians and interns” were now looking elsewhere for jobs.

  Subordinates took to calling him “Mean Ass Gregory.” “We rarely saw him except when he wanted to bawl us out,” a junior colleague recalled. Discipline was enforced by example, as when Gregory fired an intern who had overslept and arrived late on the ward. In another case, he terminated a recent hire for taping a patient’s mouth closed. “She was screaming, ‘Oh My God they are killing me’ and people were gathered out in the street…wondering what was going on,” the doctor explained. “I did it purely as a therapeutic measure, as an emergency procedure…and I beg you to reconsider….To err is human, to forgive is divine.” Gregory didn’t budge. The doctor left in a rage.

  Theories abounded as to the root cause of this behavior, with Gregory’s “startlingly diminutive stature” usually winning out. He did, after all, wear elevator shoes, lecture from a raised platform, and confide to a colleague that he never married because he feared having children no taller than himself, though rumors of homosexuality also circulated among the staff.

  Once, Gregory might have brushed off these critics, but times had changed. His political support had collapsed with Jimmy Walker’s demise; the Tammany chiefs no longer provided cover. Indeed, Walker’s bitter rival, Fiorello La Guardia, was sitting in the mayor’s chair. And La Guardia’s choice for hospital commissioner, S. S. Goldwater, held a deep grudge against Gregory from battles long past.

  Calling Gregory a Tammany hack, Goldwater demanded his resignation. “The alliance between the director of the psychiatric division and the political organization under which he rose to power was a sinister one,” Goldwater said. Bellevue deserved better.

  If Goldwater had any evidence, he never supplied it. Even the American Journal of Psychiatry, no friend of Gregory’s, called the offensive against him “crude, stupid, and heartless.” Years later, one of the conspirators described the “coup at Bellevue” as a generational clash reflecting the changing standards of the medical profession. What most bothered him—in retrospect—were the methods employed in tossing Gregory aside. “Almost overnight,” he recalled, “residents, junior physicians, and psychologists grouped together against [his] administrative oppression. Charges and countercharges flew. Clandestine meetings were held….A kind of minor hysteria developed.” The irony was that Gregory had hired every one of these conspirators in his quest to fill Bellevue with the best young talent he could find.

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  Gregory’s ordeal was not quite over. A crushing final indignity awaited. In past years, Gregory had testified at dozens of high-profile criminal trials. His track record rivaled those of his Bellevue colleagues Charles Norris and Alexander Gettler—the three men sometimes appearing together in court. Whenever an insanity plea was raised in a high-stakes proceeding, one could count on Gregory’s presence. In 1915, he had attested to the sound mental state of Father Hans Schmidt, the only Catholic priest ever to be executed on American soil following Schmidt’s conviction for killing his lover and throwing her dismembered body into the Hudson River. The following year, Gregory had debunked the insanity defense of a fellow physician, Arthur Waite, who was found guilty of butchering his wealthy in-laws in what the New York Times called “the swiftest trial of a sensational murder case in years.” In 1934, Gregory had helped shred the insanity claim of the prominent banker Joseph Harriman, convicted of embezzling close to a million dollars by describing the defendant as “quite intact mentally.” Hardly a year went by without a banner headline reading: “Court Orders Delay Until Dr. Gregory Finishes His Examination” or “Dr. Gregory Finds [Defendant] Apparently Normal.” Then, in 1935, came the case of Albert Fish.

  The details were revolting. The previous year, Fish had sent a letter to the family of Grace Budd, a ten-year-old girl who disappeared from her Brooklyn apartment in 1928. Confessing to the crime, Fish couldn’t resist torturing Budd’s parents with the hideous details. “First I stripped her naked,” he wrote. “How she did kick—bite and scratch. I choked her to death, then cut her into small pieces so I could take my meat to my room, cook, and eat it. How sweet and tender her little ass was roasted in the oven….I did not fuck her tho I could have had I wanted. She died a virgin.”

  Fish, a sixty-five-year-old house painter, wasn’t simply a cannibal, but a serial killer as well. Once in custody, he admitted to molesting dozens of children and murdering at least fifteen. The press dubbed Fish the
“Brooklyn Vampire”; many believe him to be the model for the grotesque Hannibal Lecter in Silence of the Lambs. “What I did must have been right or an angel would have stopped me,” Fish explained. Given the graphic confession, the only issue facing the jury was the defendant’s state of mind—whether to declare him insane and send him to a mental institution or to find him sane and send him to the electric chair.

  Much of the trial centered on Bellevue’s responsibility for what had transpired. Indeed, the one thing that the prosecution and the defense could agree upon was the hospital’s egregious negligence in allowing a violent lunatic to freely walk the streets. “Oh, you’ll hear plenty about Bellevue before this trial is finished,” said the scornful district attorney. “Yes, Bellevue has a lot to answer for,” replied the lawyer assigned to Albert Fish by the court.

  At issue was the discovery that Fish had twice been committed to Bellevue for observation in the years between the kidnapping of Grace Budd in 1928 and his arrest for her murder in 1935. In both instances he’d been examined for sending obscene letters through the mail, and in both instances he’d been declared “harmless”—and released. Under withering cross-examination, the now-retired Dr. Gregory claimed that the records on Fish were “not voluminous” because Fish himself was “not an insane person.” When asked why no one had taken the time to seriously examine the writings of someone whose family history was studded with madness, Gregory blamed the workload imposed upon his staff. “If I had more help, I could have gotten a lot of interesting things from a psychiatric point of view,” he said, adding that Fish was “just one of many sent to us from the courts.”

  Things went further downhill for Gregory when Fredric Wertham, one of the discontented refugee psychiatrists he had hired, took the stand for the defense. Given free access to Fish in the weeks before the trial, Wertham laid out a narrative so eerily repulsive that one could only marvel at Gregory’s use of the words “harmless” and “not insane.” Here was a man who burned himself with hot pokers, engaged in bloody episodes of self-flagellation with a nail-studded paddle, and repeatedly stuck metal objects into his rectum. (X-rays taken following the arrest showed twenty-nine rusted needles lodged near his pelvis.) “I always had a desire to inflict pain on others, and to have others inflict pain on me,” Fish matter-of-factly told Wertham. “I always seemed to enjoy everything that hurt.”