We still have psychiatric asylums, places where those intractable patients of minimal hope of improvement are kept. It is useful to look at the original sense of the word "asylum," which meant a sanctuary, where those inside could take refuge from the outside. Such refuge is no longer the fashion, with "community care" (and plenty of antipsychotic medicines) deemed a sufficient refuge for most. But the rich are different, as everyone knows, and it used to be that there were posh institutes where a family could house (or warehouse) a dotty cousin and could rely upon discretion to keep the patient quiet and quietly removed from society, or Society. Now there is a biography of one of these institutions, one which had a reputation among the moneyed as being the best in the business. _Gracefully Insane: The Rise and Fall of American's Premier Mental Hospital_ (PublicAffairs) by Alex Beam tells the story of McLean Hospital, which had a long guest register of famous and moneyed clients.
Beam does not spend much time on the early history of the hospital. In 1895 it moved to its grand grounds in the woodsy Boston suburbs and it became home to "an improved class of sufferers." It housed a rather amazing cast of characters, and perhaps in tune with the upbeat and upscale McLean atmosphere, they are presented as amusing eccentrics. Beam does not emphasize the pain of their conditions, but he does show the futility of treatment (insulin shock, hydrotherapy, talk therapies, electroshock) for most of them. As pharmaceutical therapies and then managed-care became the way to treat psychiatric patients, McLean lagged behind. Many of the patients stayed on and on, getting expensive care paid in a lump initial sum by families who never wanted to see them again. The hospital is selling off its grand properties and is also going back to its roots; a new, small facility called the Pavilion will take psychiatric care of those whose families can afford $1,800 a night, and it is proving to be popular.
McLean's story is thus part of the larger modern history of inpatient psychiatric treatment, but it is a peculiar one because of its elite patients. It is a remarkable list who stayed there, and they were not all distinguished only by having wealth. The poets Robert Lowell, Anne Sexton, and Sylvia Plath wrote about their stays, as did Susanna Kaysen, author of _Girl Interrupted_. John Nash, of _A Beautiful Mind_, was there, as were James Taylor and his brother Livingston and sister Kate. Ray Charles was there following a drug bust. The celebrity patients come and go through these pages, which more importantly contain a entertaining history writ small of American psychiatry.