Gracefully Insane: Life and Death Inside America's Premier Mental Hospital

 
#111
Title: Gracefully Insane: Life and Death Inside America's Premier Mental Hospital
Author: Alex Beam
Publisher: PublicAffairs
Year: 2003
Genre: history, psychology
278 pages

This rather superficial book can't decide whether it's a history of McLean Hospital outside Boston, or celebrity dish about famous people who have been McLean patients, or a critique of psychiatry. It doesn't quite manage to be any of these, so it comes off as fairly meanspirited and catty. Adding to the problem is Beam's writing, which has an airy tone and seems to assert that author and reader are complicit and in agreement about Beam's negative views, coupled with Beam's lack of knowledge about the history and contemporary practices of psychiatry. Beam seems to relish describing treatments such as hydrotherapy and coldpacks that are not used today and would be considered bizarre in contemporary psychiatry. Because he does not place McLean's practices in the context of contemporaneous psychiatry, he implies by omission that only McLean was stupid enough to use these practices. This isn't so. Beam's knowledge of current practice also seems scant. His diagnostic impressions when he speculates are often reductive and inaccurate, and his assertions about current diagnosis and treatment are strangely incomplete.

As a person who has worked in four inpatient facilities (both public and private, both before and in the era of managed care), I find myself in vehement disagreement with statements such as "A certain cynicism attends any hospital's long-term treatment of wealthy patients who pay their bills in full and who subsidize the care of less fortunate souls" (210). I disagree not because I think that all hospitals are great, or believe wholeheartedly in their interventions, or think they don't consider their bottom line, but because this is not how hospital staff think about and talk about patients. This is Beam's cynicism, not the attitude of the majority of people working in psychiatric facilities.

For better books about psychiatric hospitals, read Winchester's The Professor and the Madman: A Tale of Murder, Insanity, and the Making of the Oxford English Dictionary, Hunt's excellent Mental Hospital from 1962, or any of the many complex and insightful accounts by patients and staff alike.