On August 20, 1810, two Boston doctors circulated an appeal for "a hospital for the reception of lunatics and other sick persons." (Some sources, including, until recently, Mass Moments, erroneously date the letter to August 10.) The time had come to provide more humane care for sick people than they generally received at home. Reform-minded Bostonians pledged funds to establish both Massachusetts General Hospital and the state's first asylum for the insane. Soon named McLean Hospital, the asylum opened in 1818 on an expansive site in Charlestown. In 1888 it moved to Belmont, where Frederick Law Olmsted consulted on the selection of a beautiful park-like campus. By then, McLean had become a haven for the wealthy Bostonians whom the poet Robert Lowell called "thoroughbred mental cases." In its golden age, McLean was the most famous mental institution in America.
As the nineteenth century opened, few places in the new United States had as much wealth, learning, and culture as Boston. But for all the handsome buildings, the large private libraries, the well-educated elite, the city had no hospital. New Englanders had long considered the care of the sick to be a family matter; if the family could not provide care, the town took responsibility. In cases of mental illness, the care was often inadequate, with deranged people left chained in their caretaker's outbuildings or even in the town jail. The indigent mentally ill were sometimes sent to the town poorhouse, where their treatment was little better.
The men who issued the 1810 appeal came from prominent families, and they persuaded other members of the city's elite to build a hospital for the sick and an asylum for the mad. Within a year, the legislature had chartered two institutions, a general hospital and an insane asylum.
Massachusetts General Hospital would open its doors in 1821, three years after the asylum, located on a former estate in Charlestown, admitted its first patient.
The approach to mental illness at the Charlestown Asylum for the Insane reflected the influence of European doctors, who had come to believe that confinement, beatings, and generally inhumane conditions exacerbated mental illness. They proposed what they called "moral treatment" a peaceful and well-ordered environment, complete with "books, conversations. . . music, and employment of the body in agricultural pursuits." This kind of treatment was effective, but it was also expensive. Fortunately, in 1823 a wealthy Boston merchant named John McLean offered to endow the Charlestown asylum. In gratitude, the trustees renamed it in his honor. It has been known as McLean Hospital ever since.
When Dorothea Dix and other reformers convinced the legislature to expand the state's public asylum in Worcester in 1841, the result was a change in the patient population at McLean. It increasingly served mentally ill people from affluent families. For a substantial fee, McLean offered a "rest cure" that included daily activities such as riding, bowling, gardening, literary conversations, and excursions all under the supervision of trained physicians. By the middle of the nineteenth century, McLean, with its well-maintained grounds, extensive gardens, and elegant accommodations, had become a home-away-from-home for some members of the Brahmin elite; residence there was regarded less as a stigma than an interesting accomplishment.
Key to the treatment was providing a pastoral retreat from city life. By 1888, however, Charlestown was choked with factories, slaughterhouses, and freight trains. A new site was found on an estate in Belmont, eight miles to the west. The buildings were designed as a series of luxurious "cottages." The great Frederick Law Olmstead, who believed deeply in the curative powers of landscape (and who would someday be a patient at McLean himself), helped choose the site. When the campus opened in 1895, it defined a new ideal for a modern mental institution.
For nearly three quarters of a century, McLean offered families that could afford it a pleasant, even fashionable, place to send a mentally ill parent, child, spouse, or sibling. It also offered the latest in a continuously evolving arsenal of therapies and cures. Its Harvard-affiliated physicians established the nation's first clinical laboratory located in a psychiatric hospital. They tried a range of therapies, from water cures and electroshock treatments to psychoanalysis and psychotropic drugs, with varying degrees of success.
Sadly, some patients were never cured; they became lifelong residents of Boston's "country club" for the mentally ill. One of the saddest cases was John Warren, Jr. He was three years old when his father John Sr. helped establish the institution. As a deeply troubled 33-year-old, he was committed to McLean, where he spent the rest of his long life, alternately behaving as a cultured gentleman and a violent maniac.
McLean gained a national reputation in the twentieth century, when its patients included artists who later immortalized their experiences in poetry, story, and song. Among the most famous patients were poets Robert Lowell, Sylvia Plath, and Anne Sexton, writer Susanna Kaysen (author of Girl Interrupted), and musicians Ray Charles and James Taylor.
With the growth of employee health insurance in the 1960s, McLean began to serve patients from a wider range of socio-economic backgrounds. But what the insurance industry gave, it soon took away. Fewer and fewer policies covered the long-term residential care that was McLean's strength. An ever-smaller number of patients could afford to pay for it themselves.
In the 1990s, the hospital was forced to downsize, and in 1999 the trustees "restructured" the institution. Fifty-one acres of the campus were sold to developers and another 140 acres were permanently dedicated to public open space. The effort was successful, and McLean remains one of the nation's preeminent psychiatric research hospitals -- celebrating its bicentennial in 2010-11.
Crossroads in Psychiatry, by Silvia B. Sutton (American Psychiatric Press, Inc., 1986).
Discovery of the Asylum, by David Rothman (Aldine, 2002).
Early Years of the McLean Hospital, by Nina Fletcher Little. (Francis A. Countway of Medicine, 1972).
Gracefully Insane: The Rise and Fall of America's Premier Mental Hospital, by Alex Beam (Public Affairs, 2001).