A HISTORY OF MCLEAN HOSPITAL

By Keith Newell

 

This is the way day breaks in Bowditch Hall at McLean’s;

the hooded night lights bring out “Bobbie,”

Porcellian ’29

a replica of Louis XVI

without the wig—

redolent and roly-poly as a sperm whale,

as he swashbuckles about in his birthday suit

and horses at chairs.

 

– Robert Lowell, “Waking in the Blue,” 1959[1]

 

McLean Hospital is the oldest hospital in New England. From its origins as an “insane asylum” in Charlestown to its current status as the preeminent psychiatric hospital in the country, it has been a part of Boston’s history for nearly 200 years.

 

As Alex Beam writes in Gracefully Insane, a history of the hospital, “Although it still functions as a mental hospital, McLean is also a living museum. It is a museum of the grand Boston culture that was, for a century or more, synonymous with American culture.”[2]

 

In the early 19th century, Boston was flourishing culturally, and expanding in size, but it lacked a hospital. New York City and Philadelphia had established public hospitals during the 18th century, with separate wings for mentally ill patients. Boston had only a public dispensary, an almshouse, and a quarantine at the city harbor.

1825 Boston map with caption

Reverend John Bartlett, chaplain of the almshouse, was disturbed by the poor treatment of the mentally ill there. Patients were housed on beds of straw in filthy cells, with only pails to use as toilets.

 

As the reverend later wrote, “The wretchedness of this class of patients and their miserable condition in the Almshouse moved my feelings exceedingly.”[3] Bartlett addressed a letter to numerous wealthy Bostonians, requesting that they establish an asylum for the insane.

 

Two recipients of the letter were John Collins Warren and James Jackson, both Harvard-educated physicians from prominent families. (Warren was the nephew of Joseph Warren, who had been president of the Massachusetts Provincial Congress; Jackson’s father, Jonathan Jackson, had been a member of the Congress of the Confederation.)

Warren Jackson with caption

 

Warren and Jackson circulated a petition in 1810 to establish “a hospital for the reception of lunatics and other sick persons.”[4]

 

 

The Commonwealth of Massachusetts granted a charter in 1811, founding the Massachusetts General Hospital Corporation. Former President John Adams presided over the corporation’s first meeting that year. Other members included John Quincy Adams, James Bowdoin, and John Thornton Kirkland. Among the board of trustees were Stephen Higginson, Josiah Quincy III, and T. H. Perkins.

 

The trustees approached the Boston architect Charles Bulfinch to design the asylum. Bulfinch had already made his mark on Boston’s cityscape, having designed the Massachusetts State House and expanded Faneuil Hall. (He had also designed the almshouse that was proving inadequate as a treatment facility.) Now he would design Boston’s first general hospital, and its first asylum for the mentally ill.

 

The site of the asylum was a lavish estate on Cobble Hill in Charlestown. Bulfinch had built it in the 1790s for the Boston merchant Joseph Barrell, in the style of an English country manor, and it had been regarded as “the most beautiful country house in New England.”[5]

Bulfinch stairs with captionBulfinch mansion with caption

Barrell had since died, and the hospital trustees purchased 18 acres of his former property for about $15,000. Bulfinch modified the house with two wings to accommodate male and female patients.

 

“The “Asylum for the Insane” opened its doors in October of 1818. It functioned as a division of Massachusetts General Hospital, which opened three years later in Boston.

Bulfinch blueprint with caption

The asylum’s first superintendent was Rufus Wyman, a Harvard-educated doctor from Woburn, MA. Wyman followed the principles of the “moral treatment” movement in psychiatry, developed in Europe in the 18th century. Moral treatment meant that patients, previously referred to as “inmates,” would no longer be chained, caged, or beaten, as had been common practice. They would be housed in hygienic conditions, and enjoy an atmosphere of comfort and safety, even leisure.

 

McLean would cater to an “improved class of sufferers,” as one annual report put it.[6] An

asylum apothecary wrote in his journal in 1825, “Find crazy people much more pleasant than I expected—& easily managed by the attendants.”[7]

 

The hospital was renamed the McLean Asylum for the Insane in 1826, after John McLean, a wealthy shipping magnate who bequeathed more than $100,000 to it. McLean had declared bankruptcy after one of his ships, carrying valuable cargo, was presumed missing. When it sailed back into Boston harbor, McLean found that he was rich again.

John McLean portrait with caption

As Silvia Sutton writes in Crossroads in Psychiatry, “He promptly invited his former creditors, who had been shortchanged in the bankruptcy proceedings, to dine at a Boston hotel and slipped a check for the balance due, principal plus interest, under each plate. Of such stuff is the Boston legend made!”[8]

 Portrait of Somerville asylum mid 1800s with caption

Horace Mann, then a young state representative, delivered a speech to the legislature in 1828 declaring that “the insane are the wards of the state,”[9] ushering in the era of public psychiatric hospitals in Massachusetts. The first to open was the Worcester Insane Asylum, in 1833. Worcester and McLean would soon represent differing socioeconomic classes of patients. As Sutton writes, “Towns sent their paupers to Worcester while wealthier families showed more eagerness to refer mentally ill relatives to McLean.”[10]

 

Outside of McLean, harsh treatment persisted in psychiatry. Dorothea Dix visited asylums and jails across Massachusetts, and was appalled at what she witnessed. In an 1843 address to the state legislature, she wrote: “I proceed, gentlemen, briefly to call your attention to the present state of Insane Persons confined within this Commonwealth, in cages, closets, cellars, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience.”[11]

 

At McLean, the scene was quite different. Male patients enjoyed the used of a billiard table, a piano, a library, and a carpentry shop. Female patients founded the “Belknap Sewing Society.” Dancing parties were held weekly. For Boston’s upper class, the asylum was a home away from home.

 

The Cobble Hill area of Charlestown became part of the town of Somerville in 1842. By the middle of the nineteenth century, Sutton writes, McLean “had evolved into an institution tilted in the direction of the privileged classes, and so it would remain.”[12] An 1851 annual report emphasized that the asylum should seek “to afford the fullest means of comfort, and even of luxury, to a class of patients who had been used to a generous mode of life.”[13]

 

By the 1870s, railroad tracks, factories, and slaughterhouses had sprouted up all over Somerville. The asylum’s “once bucolic campus found itself an island in an industrial wasteland.”[14] The trustees decided to build a new campus elsewhere. They approached architect Frederick Law Olmsted to locate a site.

Asylum map 1884 with caption

Olmsted, a native of Connecticut, had designed Central Park in New York City, and would go on to shape the landscape of Boston, developing the “Emerald Necklace” of urban parks. Olmsted chose a site of 114 acres in Waverly, MA (now Belmont), writing to the trustees that the site had a “decided advantage in the great numbers of well-grown trees and in local picturesque interest.”[15]

 

The hospital purchased the site in 1875 for $75,000. But they largely ignored Olmsted’s suggestions to create a grouping of cottages for patients. The asylum was renamed the McLean Hospital for the Mentally Ill in 1892. That year, construction began on the new campus. The new McLean campus in Belmont opened in October of 1895. The site included a working farm, which provided most of the food for the hospital until the 1940s.

 

The new campus featured all the same amenities as its predecessor (carriage rides, games, concerts, and painting classes). It also featured two gymnasiums—one for each gender—that were used for physical exercise and social interaction. Nurses were trained in massage. “Hydrotherapy” treatment, including steam rooms and shower units were used to help pacify patients.

 

Life at McLean held a certain glamor. As Clover Adams quipped, “The insane asylum seems to be the goal of every good and conscientious Bostonian.”[16]

 

(Frederick Law Olmsted suffered from mental illness later in life, and checked into McLean in 1898. He would spend his final years there, bitter that his vision for the hospital had not become a reality.  Upon viewing the campus in Belmont, he reportedly exclaimed, “They didn’t carry out my plans, confound them.”[17])

 Eliot chapel revised caption

As it began a new century, McLean developed its own brand of moral treatment.  Administrator Earl D. Bond described it as “a microcosm holding all kinds of psychotic patients in pure culture. They were not contaminated by ‘wonder drugs,’ tranquilizers, psychoanalysis and shock treatments.”[18]

 

Bond described six therapeutic forces at work in the hospital at this time. First, patients had personal space. Second, they were grouped together by illness. Third was “promotion” in treatment—gaining increased levels of independence in relation to progress. Fourth was recreation; fifth, a warm and supportive environment. The sixth force was psychotherapy, in which patients would be treated as their doctors’ equals.

 

McLean introduced more intensive treatments during the 1930s, some of which would later be discredited. Doctors induced convulsions through the use of a drug called Metrazol and through electroconvulsive therapy (ECT). Insulin shock therapy deliberately put patients into a coma in an attempt to cure them. Psychosurgery, including the infamous lobotomy procedure, was not common at McLean, but was performed in some cases.

 

By the 1940s, psychiatrist-in-chief Kenneth Tillotson was experimenting with “hypothermia treatment,” in which a patient’s body temperature was lowered by 10 to 20 degrees. One patient died after a 50-hour session.

 

The hospital endured its first sex scandal in the late 1940s, after it was revealed that Dr. Tillotson had been romantically involved with a young nurse, Anne Marie Salot. Tillotson was forced to resign, and both of them were charged with immoral acts. The two defendants pled guilty and paid a fine. Tillotson’s career at McLean was over. As Sutton writes, he became “persona non grata because he had committed the unpardonable sin of tarnishing McLean’s respectability.”[19]

 

Beginning in the 1950s, the hospital became a magnet for Boston’s most distinguished poets. Sylvia Plath was admitted in 1953, following a suicide attempt. The experience inspired her novel The Bell Jar.

 

Robert Lowell, a Boston Brahmin whose ancestor John Lowell had been a founding member of the hospital, checked into McLean five years after Plath (and would return four more times during his life).

 

Lowell described the conditions at Bowditch Hall in a 1958 letter to poet Elizabeth Bishop: “It was like entering some ancient deceased sultan’s seraglio. We were treated to a maze of tender fussy attentions suitable for very old ladies: chocolate scented milk at 8:30; a lounging and snoozing bed-spread after meals.”[20]

Bowditch with a caption

Anne Sexton ran a weekly poetry workshop at McLean from 1968 to 1969, and would become a patient herself a few years later.

 

Adolescents were being admitted in record numbers during this time. By the late 1960s, teenagers accounted for almost a third of all patients. McLean’s music therapy program began to include rock and folk music in addition to classical and jazz.

 

As the patient census skewed younger, psychiatrist Merton Kahne recalled that “the old definition of the Proper Bostonian used to be someone who lived on Beacon Hill and had an uncle in McLean…Now it was someone at McLean who had an uncle on Beacon Hill.”[21]

Arlington School with caption

Among the teens admitted during the 1960s were James Taylor, a budding songwriter, and Susanna Kaysen, who would publish the bestselling memoir Girl, Interrupted more than 25 years later.

 

In the aftermath of a cluster of patient suicides in the 1960s, the hospital was traumatized by different type of tragedy in the mid-1970s: a psychiatrist’s suicide. Dr. Harvey Shein, a brilliant doctor with a bright future ahead of him at McLean, took his own life in 1974, at age 41. His colleagues were devastated.

 

One doctor recalled that at Shein’s funeral, people “didn’t just sob, they were wailing.”[22] It was a cruel irony that Shein had tried to bring the difficult topic of suicide to the forefront in psychotherapy, as a way of preventing its occurrence.

 

The late twentieth century was a turbulent period for McLean. While the hospital made important contributions to the study of schizophrenia and borderline personality disorder throughout the 1980s, the decade ended with the resignation of longtime psychiatrist-in-chief Shervert Frazier, who had been charged with plagiarism.

 

During the 1990s, the hospital was shaken by sex scandals and financial turmoil.

McLean suspended prominent psychiatrist Edward M. Daniels in 1990, after four former patients alleged that he had sexually abused them. The state medical board found Daniels guilty two years later, and stripped him off his medical license.

 

Another McLean doctor, Martin H. Teicher, was accused of sexual misconduct, but was cleared in 1993. The same year, Dr. Harold Williams was temporarily suspended after he admitted to having sexual contact with a patient.

 

Medical malpractice lawsuits did not bring down the hospital. But changes in the health care market nearly did. As health care costs skyrocketed, insurance companies drastically reduced what they would cover. So did Medicare and Medicaid. Long-term residential treatment gave way to the tight restrictions of managed care.

 

The average length of stay decreased significantly. In the early 1900s, it was more than 10 months; by the end of the century, it was fewer than 10 days. There were not enough patients to keep the hospital in business, and it was losing millions of dollars a year. As author Lisa Berger wrote in 1994, “In the face of a plummeting patient population, survival dictates that McLean find another way to offer treatment.”[23]

 

The administration implemented layoffs and pay cuts, shut down units, and even auctioned off antiques for cash. Partners Healthcare, McLean’s parent company, was ready to close down the hospital. Boston magazine published an article called “Last Days of the Asylum.”[24]

 

The trustees fought back, and proposed a “Master Plan” to save the hospital. McLean would sell off large parts of its 240-acre campus for redevelopment and open-space preservation. After much negotiating, the town of Belmont approved the plan in 1999.

 

That year, McLean opened “The Pavilion,” an exclusive residential program located in Wyman House on the Belmont campus. It was a pioneering “self-pay” program for patients with the financial means to pay out of pocket. (The current rate is more than $50,000 for a two-week stay.) The approach was reminiscent of McLean’s early years. As Dr. Peter Choras put it at the time, “It’s going back to what we used to do.”[25]

The Pavilion with caption

The new millennium has been a time of innovation and growth for the hospital. The Master Plan rescued the hospital from the brink of closure. McLean outlived the public hospitals that largely went extinct by the end of the 20th century.

 

Since the mid-2000s, the hospital has opened six high-end residential programs throughout Massachusetts and Maine, with plans to open a seventh. Daily rates range from $650 to nearly $2,000; as with the Pavilion, insurance is not accepted. Residents are typically expected to stay for at least 30 days. By emphasizing longer-term residential care for those who can afford it, McLean has come full circle.

Borden Cottage with caption

Although the hospital has survived its financial woes, the 21st century has had its share of setbacks. Another doctor-patient sex scandal emerged in 2006, causing hospital president Jack Gorman to resign and surrender his medical license.

 

The McLean “brain bank,” the world’s largest collection of brain tissue, experienced a catastrophic accident in 2012, when a freezer malfunction ruined 150 valuable tissue samples. A fire damaged the abandoned Codman House building in 2016.

 

Other developments have been positive. In the aftermath of the 2013 Boston Marathon bombing, McLean collaborated with law enforcement agencies to establish the “LEADER” program, designed to treat police officers, soldiers, and paramedics suffering from illnesses such as addiction, depression, and post-traumatic stress. Since December 2016, McLean has sponsored a mental illness awareness campaign at Boston’s Logan International Airport, called “Deconstructing Stigma.”

 

For all its setbacks and scandals, McLean remains a preeminent institution. U.S. News and World Report consistently ranks it as the best freestanding psychiatric hospital in the country. And its role in the history of Massachusetts is considerable. Buildings still in use today, such as Appleton House, Bowditch House, and North and South Belknap, bear the names of distinguished Bostonian benefactors of the past.

de marneffe building caption

William Appleton was a businessman and U.S. congressman. Mathematician Nathaniel Bowditch pioneered nautical navigation. Mary Belknap descended from an original Pilgrim family with deep roots in Boston; Joseph Belknap witnessed the Boston Massacre, and Jeremy Belknap founded the Massachusetts Historical Society.

Belknap grave with caption

For two centuries, McLean has been a vital part of Boston’s history and culture. As one reviewer of Gracefully Insane put it, “the McLean psychiatric hospital can be considered as much a Boston institution as Fenway Park or the Old North Church.”[26]

bicentennial signing with caption

 

[1] Robert Lowell, “Waking in the Blue,” in Robert Lowell: Selected Poems, Expanded Edition (New York: Farrar, Straus, and Giroux, 2006), 125-126.

[2] Alex Beam, Gracefully Insane: The Rise and Fall of America’s Premier Mental Hospital (New York: PublicAffairs, 2001), 4.

[3] Silvia B. Sutton, Crossroads in Psychiatry: A History of the McLean Hospital (Washington, D.C.: American Psychiatric Press, 1986), 10.

[4] Sutton, Crossroads in Psychiatry, 12.

[5] Sutton, Crossroads in Psychiatry, 17.

[6] Sutton, Crossroads in Psychiatry, 67.

[7] George William Folsom, Early Years of the McLean Hospital, ed. Nina Fletcher Little (Boston: Francis A. Countway Library of Medicine, 1972), 29.

[8] Sutton, Crossroads in Psychiatry, 45.

[9] Sutton, Crossroads in Psychiatry, 54.

[10] Sutton, Crossroads in Psychiatry, 54.

[11] Dorothea Dix, “I Tell What I Have Seen—The Reports of Asylum Reformer Dorothea Dix,” American Journal of Public Health 96 no. 4 (April 2006): 622-624.

[12] Sutton, Crossroads in Psychiatry, 67.

[13] Nathaniel Ingersoll Bowditch, A History of the Massachusetts General Hospital (Boston: Printed by the Trustees from the Bowditch Fund, 1872), 468.

[14] Webster Bull and Martha Bull, Something in the Ether: A Bicentennial History of Massachusetts General Hospital, 1811 to 2011 (Beverly, MA: Memoirs Unlimited, 2011), 89.

[15] Justin Martin, Genius of Place: The Life of Frederick Law Olmsted (Cambridge, MA: Da Capo Press, 2011), 311.

[16] Ernest Samuels, Henry Adams (Cambridge, MA: The Belknap Press of Harvard University Press, 1989), 200.

[17] Bull, Something in the Ether, 90.

[18] Sutton, Crossroads in Psychiatry, 185.

[19] Sutton, Crossroads in Psychiatry, 248

[20] Saskia Hamilton, ed., The Letters of Robert Lowell (New York: Farrar, Straus, and Giroux, 2005), 315-316.

[21] Beam, Gracefully Insane, 198.

[22] Beam, Gracefully Insane, 231.

[23] Lisa Berger and Alexander Vuckovic, M.D., Under Observation: Life Inside a Psychiatric Hospital (New York: Ticknor & Fields, 1994), 253.

[24] Andrew Cohen, “Last Days of the Asylum,” Boston magazine, March 1997, 62.

[25] Beam, Gracefully Insane, 243.

[26] M.A. Turner, “More Than Just a Celebrity Psych Ward: McLean Hospital Has Roots in Boston’s Eccentric, Scandalous Social History,” Hartford Courant (Hartford, CT), January 6, 2002.