Gracefully Insane (35 page)

Bruce Cohen’s job is, of course, light-years removed from that of Rufus Wyman. The first superintendent lived at the asylum and spent only five nights off the grounds in fourteen years. Cohen lives in Lexington with his wife and two children. He does resemble Wyman in that he takes hardly any vacation and never more than a week at a time. Wyman entertained patients at his dinner table and even threw rabbit shadows against the wall in the disturbed women’s dormitory. Although Cohen has been around long enough to remember the discontinued Morning Reports, when McLean’s ward chiefs would gather in the oak-paneled library across the hall to discuss “matters arising,” he rarely visits the wards any more. Overseen by highly trained specialists in, say, geriatric psychiatry or pediatric psychopharmacology, McLean’s different departments more or less run themselves.

Cohen is the very model of a modern mental health-care executive. He is, of course, a psychiatrist, and he is a prodigious researcher in his field of molecular biology. At age fifty-four, he has 307 scientific publications to his full or partial credit. No stranger to nerdspeak—he told me that his overlapping specialties of biochemical
research and brain imaging “interdigitate quite well”—he is also an effective communicator and businessman who speaks the language of lucre. Cohen and his development officers raised more than $5 million from donors in 2000, a record amount and a significant contribution to the hospital’s finances. He even has a sense of humor about McLean’s financial predicaments, invoking the old business gag, “We’re losing money on everything we do, but we’ll make up for it in volume.”

So what does Rufus Wyman’s successor do? Like every hospital administrator in America, he frets about money and survival. The hospital loses money on teaching, on most research, and on all outpatient care. Patients who occupy beds are a break-even proposition, and patent royalties—a relatively new and important category—and donors’ gifts help balance the books. But almost any line item in the budget can change quickly and unpredictably. During the 1997 passage of the Balanced Budget Act, McLean lost $2 million in Medicare reimbursements—poof!—two months before the beginning of its fiscal year. The prospective income stream from McLean’s work on Prozac II likewise vanished when Eli Lilly’s licensees abandoned the drug. Politicians and health maintenance organization executives now make the financial decisions that affect McLean’s future; these men and women have become Bruce Cohen’s core constituency. Cohen talks to them, lobbies them, jawbones them, and, in a not-so-subtle way, threatens them. The payers are always eager to take another bite out of McLean’s hide, to cut back the minimum stays, or to slash the office visits from fifteen minutes to ten. And Cohen is willing to fight back. “I’m feeling a little combative,” he said during our conversation.

Translation: We know who is disturbed and we know who is dangerously disturbed. Trust us to sort them out—and pay us to sort them out—or suffer the consequences.

It had not occurred to me that the $40 million Re-Use Master Plan would fail to save the hospital. I assumed the fresh capital would keep McLean alive for at least five years. But Cohen made no such assumptions. “Could the fate of an institution like this remain in the balance? Sure. Yes. I would be a fool to say to you that McLean’s problems have been solved just because we look so much better now than we did five years ago.” Cohen insists that he remains optimistic about McLean’s future, but he knows the world of mental health funding is one where almost anything can go wrong and often does.

One small contributor to McLean’s economic well-being is a brand-new ward called the Pavilion. For at least a decade, a small group of McLean doctors had been arguing for the creation of a high-end clinic to service the megarich, a sort of Mayo Clinic of mental health. The opportunity was there; the 1980s and 1990s produced their fair share of mixed-up plutocrats, and no one was competing for what Pavilion director Dr. Alexander Vuckovic calls “the old carriage-trade clientele.” But appearances mattered. How could McLean beg Massachusetts for increased Medicaid funding or cry poor to the town of Belmont for tax relief if they were running an $1,800-a-day clinic for the Donald Trumps of the world? When McLean did finally open the Pavilion in 1998, they did not put out a press release; they still have not. I first learned about it when a patient friend of mine called to inform me that he had met his new wife in the most pleasant circumstances imaginable: recuperating at the Pavilion.

To be fair, McLean is not hiding its new gold-plated clinic under a bushel. The Pavilion advertises discreetly (“Unparalleled psychiatric evaluation and treatment. Unsurpassed discretion and service.”) in upscale magazines. Furthermore, Vuckovic and his colleagues have talked up the Pavilion on the psychiatric grapevine. “McLean is still McLean,” he says. “People in the profession know who we are. The name travels far.”

Vuckovic, a psychopharmacologist by training, is smart and frothy, precisely the kind of person who should never be allowed to talk to journalists. When I entered his office at the Pavilion, he complained to me that he had spent part of the day arguing over a $25,000 bill with the Saudi Embassy. So much for “unsurpassed discretion.” Of course, he was more than happy to show off his new ward, one of McLean’s few unequivocal success stories in recent years.

The facility itself is unprepossessing, merely a group of renovated ground-floor suites on Wyman Hall. The Pavilion is the mental hospital equivalent of Club Med—one price, all included. For $1,800 a day, which is about double the price of a night on the regular wards, the patient receives virtually anything he or she wants: a psychiatric and psychopharmacological consultation, of course; a neurological evaluation; psychological testing; medical care; individual psychotherapy; and more. The bill is the bill; there are no separate, additional charges for pills, MRI scans, and the like. (The patient generally pays out of pocket.) The service has proved to be quite popular. When I went through in early 1999, all three suites were full, and McLean had a waiting list. Since then, three new suites have been added, and they, too, are fully occupied.

As in the old days, the Pavilion places much emphasis on “the little conveniences and luxuries of everyday life,” to quote McLean’s 1863 annual report. Pavilion residents enjoy better food than that served in the cafeteria, and they can request room service. Each suite has its own telephone, satellite television hookup, and private bathroom—amenities not found on the other
wards. Fresh flowers appear every other day. The Pavilion is an unlocked ward, “for the less than super-crazy,” as Vuckovic puts it. Like the Packard limousines of the Franklin Wood era, town cars whisk Pavilion patients to and from Boston and Cambridge. Indeed, the Pavilion is a lot like ... the old McLean. Explains Peter Choras, one of the Pavilion’s early promoters, “It’s going back to what we used to do.”

McLean is not the land of the cure. At the end of the day, the hospi
tal’s goal is to succor patients, or right them, or just make them feel confident enough to give the real world, with all its ferocity and vicissitudes, one more try.

Returning to the hospital is a weighty issue for former patients. Rob Perkins talked with me about returning to Belmont, but it was not a high priority for either of us. Susanna Kaysen told me an old hall mate had once pressured her to return and had later committed suicide. It turned out that the woman was taking stock of her life before leaving it. When Kaysen’s memoir,
Girl, Interrupted
, was published in 1993, a
Boston Globe
editor asked her to pose for a profile in front of South Belknap. She told him to go to hell. Kaysen has since returned on occasion, peddling her sardonic celebrityhood. I once saw her amuse an appreciative audience in McLean’s modern cafeteria building with the line, “I’m always happy to be back at McLean ... because it feels so great to
leave
.” She did tell me that she enjoyed a visit with McLean’s Manic-Depressive and Depressive Association during her book tour “because it was such a relief to be there, and to be understood. It was fun for them, and it was fun for me. They didn’t ask, ‘Are you still crazy?’ It was like being with the native speakers of a language when you’ve been with non-native speakers, that’s what I would liken it to.”

The singing Taylors are often invited back, but James and Livingston do not like to go. McLean evokes no pleasant memories, and nobody presses the point. Their sister Kate, ebullient, beautiful, and gray-haired, has returned once. A few years ago, she traveled from Martha’s Vineyard to Belmont to deliver the commencement address for the Arlington School, in Eliot Chapel. “I am happy to say that I am speaking to you as an alumna of the Arlington School,” she told the boys and girls, and then she commented on her own life’s journey:

This book could never have been written without the cooperation of two
great Boston institutions, the
Boston Globe
and McLean Hospital.

The
Globe
allowed me ample time to pursue this project over the past several years. Editor Matt Storin and Managing Editor/Administration Louisa Williams approved my requests for leave. My supervisor, Deputy Managing Editor for Features Mary Jane Wilkinson, was extremely generous in granting me the flexibility I needed to finish this book. Living Section Editor Nick King sent me to Texas to write about the Anne Sexton poetry archive. Their successors, Mark Morrow and Fiona Luis, pretended not to notice when I sometimes seemed otherwise engaged. And I often relied on the excellent staff at the
Globe
’s library, overseen by Lisa Tuite, for research help.

McLean, led by Dr. Bruce Cohen, cooperated with me in every way that it could. The hospital’s archivist and registrar, Terry Bragg, is an accomplished mental health historian who always made time for my inquiries. Audrey Martin, Terry’s ever-present and helpful assistant, helped me in many ways. The hospital’s librarian, Lyn Dietrich, chased down many an obscure journal article for me. My friend Roberta Shaw, the hospital’s former director of public affairs, helped me arrange interviews, as did her successor, Cynthia Lepore. And special thanks for relaxing and informative conversation go to McLean’s delightful “Mrs. B,” Marion Bodeman.

I am grateful to these men and women for making themselves available for interviews: Dr. Abigail Stanton, Dr. Alfred Pope, Alice Brock, Dr.
Arthur Cain, Dr. Bernard Yudowitz, Mark Robart, Dr. Robert Coles, Dr. Bruce Cohen, Bruce Stanton, Bruce Cain, Dr. Richard Budson, Dr. Captane Thomson, Charles Baker, Clay Jackson, Constance Holian, Dr. David Lynn, Dr. Francis de Marneffe, Doug Drake, Douglas Holder, Dr. Edward Daniels, Eleanor Morris, Dr. Frederick Duhl, Dr. George Lawson, Golda Edinburg, Henry Langevin, Laurie Burgess, Barbara Schwartz, Parkman Shaw, the late Dr. Ruth Barnhouse, Frank Bidart, Susanna Kaysen, James Patterson, Dr. Paul Howard, Dr. Stephen Bergman, William Shine, Kate Taylor, James Taylor, Kenneth McElheny, Jack Thomas, Jeff Garland, Jim Garland, Dr. John Ellenberg, James Barr Ames, C. K. Williams, Dr. John Gunderson, Dr. John Livingstone, John Sheldon, Lloyd Schwartz, Jon Landau, Lois Ames, Robert Plunkett, Maria Pugatch, Michael James, Dr. Michael Sperber, Munson Hicks, Dr. Paul Dinsmore, Jonathan Bayliss, Paul Roberts, Rob Perkins, Dr. Peter Choras, Peter Storkerson, Dr. Phil Isenberg, Michael Punzak, Richard Wolfe, Dr. Shervert Frazier, Dr. Stephen Washburn, the late Irene Stiver, Dr. Thomas Bond, and Dr. Alexander Vuckovic. Some of these men and women were patients at McLean, and without their cooperation this book could not have been written. Several of my interview subjects asked to remain anonymous.