Kirsten's Reviews > Gracefully Insane: The Rise and Fall of America's Premier Mental Hospital

Gracefully Insane by Alex Beam
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Feb 16, 08

bookshelves: read-pre-12-07, from-library, mental-health, non-fiction, psych-and-neuroscience
Read in February, 2006

The story of McLean hospital, one of the most famous mental hospitals in the US. Sometimes it seems as though anyone who's anyone spent time in McLean; throughout the 20th century it was famous for catering to the rich and famous with the utmost discretion. Among its "alumni" are poet Robert Lowell, Sylvia Plath (who based her novel The Bell Jar on her experiences there), James Taylor and his siblings, Susanna Kaysen (who wrote about her experiences in Girl, Interrupted), John Nash, and Ray Charles, just to name a few.

In many ways, the history of McLean is the history of the last century of mental health care, although McLean as whole has been a kinder, gentler place than most mental hospitals. There are still stories of brutal, though well-intentioned, treatments: insulin shock therapy, icy hydrotherapy, electroshock therapy (with much higher levels of electricy than today's electroconvulsive therapy). Only a handful of lobotomies were ever performed at McLean, however, and the main emphasis was on milieu therapy -- the theory that providing structure and a relaxed, comfortable environment would go farther to help patients than any invasive procedure.

Of course, the milieu therapy led to a lot of long-term residents at McLean. In the heydey of psychoanalysis, the intake period was 40 days -- the actual treatment usually didn't start for weeks. This kind of treatment has fallen by the wayside in recent years, as health insurance and rising healthcare costs make it impossible for patients to afford more than the usual five day stay, and in turn, McLean is now a ghost of what it once was. It's easy to feel sort of nostalgic for the "old days" of psychotherapy, particularly since insurance and an overloaded system mean that many patients are diagnosed, given drugs, and only receive a very limited amount of talk therapy, if any at all. On the other hand, there's little evidence that McLean's milieu therapy was any more effective than the current methods, particularly in the case of psychotic patients. Still, one wishes somewhat for a happy medium -- no six month hospital stays, but enough time to offer a little caring and patience. As this book makes clear, however, this luxury was only ever available to the very rich, even when it was considered the best treatment for what ails you.
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