Gracefully Insane (12 page)

We pick up the story in Dr. Cerletti’s words:

Electroshock therapy, too, was quickly accepted in the New World, mainly because it was deemed easier and safer to administer than the insulin or metrazol shocks. Just three years after the Rome experiment, McLean reported that forty-three patients, eleven men and thirty-two women, had received the new treatment. Psychiatrist-in-chief Tillotson noted that nine of the patients showed no apparent benefit. Thirty-four of them “responded with clinical improvements of varying degree and duration.” Of these, twelve were able to leave the hospital. As was often the case with all of the shock regimens, the patients hurt themselves. Even when securely strapped to a gurney, their bodies sometimes exploded into dramatic and extreme contortions.
¹⁰
Five patients suffered compression fractures in their spine. Two others dislocated their jaws. Rooting behind a bank of file cabinets in his office, McLean archivist Terry Bragg once showed me the first electric shock apparatus purchased by the hospital, a Reiter Electro Stimulator manufactured in Italy in 1938. It was a chunky, briefcase-like device weighing ten pounds, not unlike the portable radio transmitters that spies use in World War II movies. It had a “Sampler” switch with “Sample” and “Trial” settings, and a “Dosage Scale” with only two calibrations: “Low” and “High.”

None of the above-mentioned treatments originated at McLean. Indeed, none originated in the United States, and McLean was, in the scheme of things, a cautious adopter of new therapies. But McLean doctors did claim to have invented a curious goulash of the newly available therapies, to which they assigned the name “total push.” In two papers published in 1939, Kenneth Tillotson and Abraham Myerson (who had evinced such an interest in the upper-class predilection for schizophrenia) outlined
an ambitious mobilization program that they adopted for a group of thirty-three McLean patients. They chose some of the stupefied, chronic “back-ward” types, “who sit on benches, stand in a corner or pace automatically to and fro, grimacing, passive and absorbed in [their] delusions,” and decided to throw the book at them. Everything medical psychiatry had to offer was brought to bear on the target population: Nurses rousted them out of bed in the morning and forced them to go out on walks. Daily visits to the hydriatic suite for “showers, douches, massage and rubdowns” were de rigueur. Sports and athletics were emphasized, and the patients received better food. But meals were no longer available through room service; total push forced the patients to show up in the ward dining rooms to be fed. Patients who had been reluctant to eat were given a drug to stimulate their appetites. Vitamins were prescribed. The doctors forced men and women who had hovered around their wards in tattered bathrobes to dress neatly and present themselves to the general population. “Proper conduct” was reinforced with the granting of privileges, like access to “candy, ice cream ... delicacies, cigarettes, and cigars,” which were likewise withheld from malingerers. In his total push manifesto, Myerson seemed to be anticipating the future vogue of behaviorist psychology: “It would be interesting, but entirely impossible, to see what the effect of physical reward and physical pain would be, but society has not yet developed to the point where certain privileges and physical punishment can safely be used.” Beating up on the Brahmin clientele was hardly McLean’s style.

The psychological mobilization worked, supposedly, in tandem with the physiological shock therapies to get the dulled patients going again. (For some reason, Myerson also recommended the ultraviolet irradiation of the male patients’ testicles, although he freely admitted that this procedure was “not related insofar as we know at present to the general well-being of the individual.”) Not surprisingly, Tillotson declared total push to be a success. Of twenty-two patients he examined, he claimed that all had either
slightly, much, or markedly improved. There was no later follow-up study because the outbreak of World War II effectively ended the total push experiment. McLean’s luxurious 2:1 patient-to-staff ratio vanished into the wartime draft. A small army of male aides, nurses, and doctors left Belmont, and the staff-intensive total push experiment fell by the wayside.

In our own time, it is not so unusual for men and women to discuss
their stays in mental hospitals. Although most former patients still feel stigmatized by society at large, they know they are far from alone in their travails. From the high culture of literary memoirs to the low culture of talk shows, tales of life in the “bin” or the “zoo” are part of our cultural landscape.

But things were different in 1943, when a Boston businessman named Frank Kimball insisted on publishing the affecting story of his eleven-year stay at McLean. A trustee of Boston University, a churchgoer, and successful insurance and investment counselor, Kimball suffered a breakdown during his summer vacation in 1927. By his own account, he had become overwhelmed by his duties on his town’s planning board and by the press of business. In December 1931 he transferred from the Channing Sanitarium in Wellesley, Massachusetts, to McLean.

Kimball promptly fell into what Abraham Myerson called the “prison stupor” that results when the shock of hospitalization interacts with the instinctual social retreat of the mental patient. Kimball described a “life of semi-automatic activity, in a blue fog of futility.” His family rarely visited him: “What use was it for anyone to see me, when I sat like a wooden Indian? My handshake was cold, my greetings hardly more than dull murmurings.”

In addition to his depressed state, he started to hear voices, a symptom of deepening schizophrenia.

Six years into his stay, the doctors started to “push” Kimball into activity. The patient librarian had launched a bimonthly magazine,
The McLean Gazette,
and asked him to contribute book reviews. He did, and he enjoyed doing it; however, he never spoke with the librarian, choosing to communicate with her only through handwritten notes. Then, in 1942, his doctors recommended electroshock therapy. Although none of the shock regimens turned out to “cure” or even significantly alleviate chronic schizophrenia, they had proved useful in combating depression. Kimball thought it was worth a try: “I don’t remember much about it except for a dim recollection of trips in bathrobe and pajamas by wheelchair to the treatment room. There was little discomfort. I would be given the mild shock about 10:30 A.M., carried back to my room, and the first thing I knew I would awaken around noon, very much refreshed.”

After three months of treatment, Kimball was encouraged to telephone his wife, Edith.

Kimball went back home to the Boston suburb of Dedham. He
returned to his church, he returned to his favorite hobbies—playing the piano and writing letters to the newspapers—and he was invited to rejoin Boston University’s board of trustees. He served as toastmaster for his college class’s fiftieth reunion, he flew in an airplane for the first time, and he even revisited McLean, accompanying his daughter-in-law in a musical revue. He had been saved, and he freely admitted he was not sure how or why:

Lobotomies posed a classic clinical dilemma to the genteel, Harvard-
trained McLean doctors. By the late 1930s, the controversial procedure had attained a certain legitimacy. The Portuguese doctor António Egasmoniz had first invaded a patient’s frontal lobe in 1935, acting on the theory that destruction of the nerve connections behind the forehead broke up the “fixed ideas” that tormented schizophrenics. Almost immediately after reporting success in his first “leucotomies,” Egasmoniz was nominated for a Nobel Prize, which he won in 1949. (Leucotomy, from the Greek word for “white,” refers to the white fibrous material that Egasmoniz scraped from the front of the brain.) A brilliant and ambitious American doctor, Walter Freeman, seized on the Egasmoniz procedure and started performing “lobotomies” in Washington, D.C., in 1936. (Neither Freeman nor Egasmoniz was a surgeon, much less a neurosurgeon, a fact that did not escape their colleagues’ notice.) Freeman and his surgical partner, James Watts, removed more of the frontal lobe than had Egasmoniz, hence the new
nomenclature. They did not subscribe to Egasmoniz’s theory that psychosurgery broke up fixed ideas in the patient’s brain. Instead, they argued that lobotomy succeeded in severing contact between the frontal, “thinking” brain and the anterior, “feeling” part.

The results of the early lobotomies, indeed of all lobotomies, would prove to be equivocal. Eight of Freeman’s first twenty patients had to have second operations. The postoperative reports tended to be vague, and soon enough grisly accounts of scalpel fragments breaking off inside patients’ skulls began to surface. In promoting the procedure, science was the first casualty. Queried at a Boston psychiatric conference as to which kinds of patients were suited for lobotomy, Freeman answered, “The more this procedure is being used, the more indications there are for it.”

Freeman, who eventually collaborated on more than a thousand lobotomies, was convinced he had struck the psychiatric El Dorado. The doctor in him knew he should be cautious in reporting successes, but Freeman the promoter was unable to restrain his enthusiasms, especially when a reporter’s notebook or tape recorder happened to be nearby. “This woman went back home and in ten days she is cured,” Freeman said of his first patient, a sixty-three-year-old woman from Topeka, Kansas. The woman resisted the surgery when she learned that her hair would have to be cut; Freeman promised her that he would do all he could to save her lovely curls. After the operation, he noted sardonically, “she no longer cared.” His Norman Rockwell-like motto was “Lobotomy gets them home.”

The media eagerly beat the drum for Freeman’s “surgery of the soul,” psychiatry’s latest silver-bullet cure. “Surgery Used on the Soul-Sick,” read the
New York Times
headline; “Relief of Obsessions Is Reported.” In smaller type, the newspaper added that “new brain technique is said to have aided 65% of the mentally ill persons on whom it was tried as a last resort, but some leading neurologists are highly skeptical of it.” Similarly enthusiastic reports appeared across the nation in magazines and local newspapers. The lobotomy vogue “hit us like a bomb,” one American
neurosurgeon recalled. By 1949, doctors were operating on 5,000 patients each year. Some leading neurologists were in fact skeptical, but as a measure of last resort lobotomy had a certain appeal. Bluntly put, the Freeman-Watts procedure had indeed cleaned some “human salvage” out of the back wards of many hospitals. Why not at McLean?