Gracefully Insane (32 page)

“Did you hear about Dr. Shein?” they asked.

 

 

I
n 1967, Walter Jackson Freeman, the father of the ice-pick lobot
omy, published a book called
Psychiatrist: Personalities and Patterns.
It is a generally undistinguished overview of the profession, for the most part a collection of poorly written profiles of Freeman’s heroes, the biologically oriented therapists like Manfred Sakel, the inventor of the insulin shock treatment, and António Egasmoniz, the Nobel Prize-winning lobotomy pioneer. Freeman, the archetypal hands-on kind of guy, lumped Sigmund Freud, Otto Rank, and Harry Stack Sullivan into one brief chapter called “The Great Theorists.” And yet, in a ghoulish final chapter entitled “Mortido: The Death Instinct,” Freeman hit on something. Eight of Freud’s closest disciples had killed themselves; why? He went on to suggest that “suicide might be called a vocational hazard for the psychiatrist.”

Freeman was a crackpot enthusiast; maybe he was even a little mad.
²³
But the mad often have special insights, and Freeman pursued this one as far as it would go. There was no literature on psychiatric suicide, so Freeman did his own research. He combed the obituary notices of the
Journal of the American Medical Association (JAMA)
to prove his point. When a reported cause of death seemed suspicious, he addressed the relevant state Bureau of Vital Statistics, with mixed results. Although his findings were far from scientific, they were provocative. He reported that 203 American psychiatrists had committed suicide in the seventy years from 1895 to 1965. He deduced, convincingly, that suicides were underreported by the medical profession and also that this seemed like a high number. As with his hurry-up-time’s-a-wasting lobotomies in his medical office, his methodology was suspect. But yet again, his work commanded attention.

Perhaps understandably, there is very little literature on the subject of psychiatric suicide. In 1980, two California psychiatrists revisited Freeman’s thesis, and—unlike most of his theories—it held up perfectly. Writing in the
Journal of Clinical Psychiatry,
Charles Rich and Ferris Pitts reported that “psychiatrists suicide regularly, year-by-year, at rates about twice those expected.” They used American Medical Association records instead of the
JAMA
obituaries that Freeman combed through; the
JAMA
understated suicide rates by about 20 percent, according to Rich and Pitts. But even this report was misleading, because they were comparing psychiatrists’ suicide rates to
doctors’
suicide rates, which are considerably higher than those for the general population. The two authors even allowed themselves a moment of what must have been unintentional levity: “The occurrence of suicides by psychiatrists
is quite constant year-to-year, indicating a relatively stable over-supply of depressed psychiatrists from which the suicides are produced.”

Why do psychiatrists kill themselves? Many admit that they entered the profession to wrestle with their own demons—“to find out what was wrong with me,” is the phrase I heard over and over again. Rich and Pitts confirmed this. Massaging their data, they hypothesized that one in every three psychiatrists suffered from a mood disorder like mania or depression. This, they wrote, is three times the incidence in the general population: “This would logically imply that psychiatry is depressing to the practitioner and/or physicians with affective disorder tend to select psychiatry as a specialty. For a variety of reasons, we believe the latter to be the case.”

Mental illness can be infectious. Nurses, psychiatric aides, and therapists are hardly indifferent to their surroundings in the mental hospital, and many of them break down themselves. As the doctors are fond of saying: No one is immune.

It is not uncommon for psychiatrists to check themselves into a sani
tarium or hospital, although they usually seek shelter outside their practice area to avoid the possible embarrassment of meeting patients or students inside the hospital. Boston doctors might travel to the Yale-New Haven Hospital or to the bucolic surroundings of Austen Riggs in Stockbridge, in the heart of the Berkshire mountains.

But some ended up at McLean. One well-known patient was Dr. Doris Menzer-Benaron, a prominent member of the Boston Psychoanalytic Institute, who spent a good deal of time with the “crazy ladies” of Codman Hall. Benaron was married to a prominent local psychiatrist, and she had trained some of the doctors at
McLean. For understandable reasons, she was regarded with great empathy by doctors and patients alike.

Another sad case was that of Julia Altschule, who was married to Dr. Mark Altschule, a cardiologist who also functioned as McLean’s one-man research laboratory from 1947 through the early 1960s. Julia had been a ballerina and assumed a curious Asian affect as she grew old at McLean, diagnosed as a chronic schizophrenic. She often wreathed herself in a black shawl, and wandered the grounds along “Julia’s path,” which took her from Codman Hall, behind Eliot Chapel, down over the Bowl, down to the Pleasant Street Lodge and back again. Julia would occasionally stop and talk with small children, as she did with Harold Williams’s two-year-old son. What did they talk about? “God only knows,” Williams now says. “I never heard a sane word come out of her.”

Nurse Maria Pugatch remembers seeing Julia at the head of the grand staircase in Upham Hall, where she lived for a time: “Imagine how spooky it was to come into this building, and there at the top of the stairs is this short little woman dressed entirely in black, speaking in a kind of a tongue. Sometimes when you drove into the hospital, she would be standing on the top of a hill, casting spells on you. Everyone said she was a witch.”

Huddled in a tiny, one-room lab in a tunnel just beneath the main administration building, her husband devoted much of his life to discovering a cure for his wife’s illness. Working with pots and pans instead of test tubes and petri dishes, Altschule kept searching for the biological roots of his wife’s illness. He experimented with different megavitamin recipes, occasionally tube-feeding them to catatonic schizophrenics in the hopes of mobilizing them. He also tried to isolate an extract of the pineal gland, which he injected into schizophrenics, hoping for a cure. “Like all therapy in schizophrenia, it worked in the beginning, or seemed to, and didn’t lead anywhere,” remembers Dr. Alfred Pope, a friend and colleague of Altschule’s. “The pineal had been considered a vestigial organ that did nothing,” Pope adds, “and Mark deserved credit for putting it on the map. It
turned out to be a minute but important organ, especially in relation to sleep mechanisms.” But it does not play a role in the neurobiology of schizophrenia.
²⁴

Worse tragedies than a doctor’s wife’s madness were to befall the hospital. On Father’s Day, 1962, Williams, the hospital’s doctor on call, decided to look in on a young resident named Wellington Cu, whom Williams himself had urged to transfer to McLean from a post in New York City. Cu had been depressed and acting strangely. He had broken up with his girlfriend and was also having problems with the immigration authorities, who had threatened to deport him back to the Philippines. Cu, an ethnic Chinese, had been raised by his grandmother in Shanghai and did not speak Tagalog. As it happened, McLean’s suicide epidemic was in full swing. Cu’s friend and fellow resident Dr. John Ellenberg thinks as many as eight patients had killed themselves during the previous year. “There was this business of suicides going around,” he says, “and we were trying to figure out among ourselves why this was happening.” Dr. Captane Thomson encouraged Cu to emigrate to Canada, and the two men even bought a footlocker together. “‘That will be my casket,’ is what he said,” Thomson remembers. “He was dropping broad hints. We said, ‘Come on Wellington, don’t be so discouraged. We know you can get through this.’ You know how you try to jolly people along and help them out. None of us thought he would take his own life.”

Mounting the stairs of Waverley House, the white clapboard three-story colonial home where the cheery young assistant Earl Bond had lived in 1909, Williams had a premonition of fear. “I had the feeling that someone was dead there,” says Williams, “and there he was lying on the bed.” On Father’s Day, Cu had taken his
own life with an overdose of barbiturates—intended to be passed on to Cu’s sister—that his father had mailed to him from the Philippines. In a suicide note, Cu thanked all of his friends and wrote that if it hadn’t been for them he would have killed himself sooner. Then he explained that he had ingested twenty-six Seconal tablets, “one for every miserable year of my life.” Ellenberg remembers that the note carefully did not blame “this person or that person, so it was a list of everybody who could have possibly intervened. He accused everybody he could by saying he didn’t blame them.”

In the presence of the dead body, Williams recalls, the two doctors had no idea what to do. “Luckily, Ellenberg had some religious training, and he had that to fall back on. We went back downstairs, he put on his hat and said, ‘Let’s have something to eat and say a prayer.’” In a neighboring bedroom, Ellenberg sang kaddish for the deceased Chinese-Filipino resident. “Then,” says Williams, “we wondered whom we should call first. We decided to call Stanton and ruin his entire month.” Once at the scene, even Stanton was not quite clear about the proper procedure for disposing of a corpse. Eventually they located an Episcopal priest who knew how to handle these things.

“Wellington once said to me that the worst thing you can do to someone is to kill yourself on his doorstep,” Williams recalls. “Well, that’s exactly what he did to McLean.” More than a decade later, another doctor took aim at the hospital and hit squarely on the mark.

During the years that I interviewed people for this book, I joked that I
was actually building an impressive archive of tape-recorded restaurant and coffee shop sounds, what radio reporters call actuality. And indeed, I have put together a sort of audio field guide to clattering spoons, crashing crockery, and the repeat visits from solicitous
serving people, asking me and my interviewee if everything was all right. My interview with Dr. Stephen Bergman falls into this category, a “sounds of Starbucks” classic. We met in a mini-mall near our homes in Newton, Massachusetts, a city that boasts the largest per capita infestation of psychiatrists and psychologists in America. Newton, inevitably dubbed a “leafy suburb” when sports announcers come by to cover a Boston College football game, is quite precious. Indeed, there was a protest of sorts when Starbucks opened the location where Bergman and I decided to meet, as the Seattle-based giant was invading the territory of a popular, previously existing coffee bar around the corner.

Bergman, a tall, imposing, bald eagle of a man, is in his mid-fifties and has written three novels under the pen name Samuel Shem. He is well known in the Boston medical establishment, if not well liked. His first novel,
House of God,
was a bawdy, artfully written roman à clef about his year spent training in the emergency room of Boston’s Beth Israel Hospital. Relentlessly realistic (and thus unflattering) in its portrayal of the medical establishment, it alienated virtually every important doctor in the city, sold well, and has since become a classic among medical students. Bergman’s third novel was
Mount Misery,
a similarly disguised account of his psychiatric residency at McLean, where he developed an instant attachment to an intense, cigar-smoking young administrator named Harvey Shein.

Bergman picks up his story after his stint at Beth Israel: