Thursday, July 29, 2010

Down the Road from McLean


My fascination with the sprawling 240 acre campus of McLean Hospital, in Belmont, Mass., and what was done there, began in 2003, the year I lost my job at The New York Times and days later found myself 270 miles south, at Silver Hill Hospital, in New Canaan, Conn., a premiere hospital that rivals, and in some estimations, is stronger than McLean . There, I was treated to my first experience in an acute, inpatient locked ward where I was evaluated for the first time by a psychiatrist and quickly diagnosed with a mood disorder that later turned out to be bipolar disorder. Over more recent years, especially when I struggle to maintain my stability, I think back to that place and wish, for a minute, that I could come up with some reason to return to its 60 acres, complete with a social worker who spends the day checking in on you, the constant psychiatric care, the intense medication management, the priest who comes, if you so choose, to pray with you and the buildings full of fellow travelers, a lot like me, on most days functional, in a moment in their lives where they are having a hard time coping with everyday.

When I got back from the hospital and my misdeeds were exposed in a 13,000-word article in The Times on Mother's Day, I sank into a deeper depression. As my doctor diligently worked to straighten out my medications and I worked to sort things out in therapy, I found that, on many days, I stayed in my apartment, writing, thinking, reading, trying to sort out my life. I found comfort on many days, when my friend, Christalle, would come down after work and bring movies to watch. One of them was Girl Interrupted. I instantly attached with it -- it reminded me how many other functional people have been locked in what many of us affectionately call the "bin," had made it through and were okay. It articulated something I had a hard time explaining to my friends who were "civilians" -- the ones who had not obtained their psychiatric hospital "degrees" -- that as traumatic as the experience of being hospitalized can be, it can also be a great opportunity for insight, for forging bonds with others who have been there and walked in your shoes, for recovery.

There is something about the level of care and, especially, the camaraderie that envelopes you in a milieu - a social setting, where something occurs or develops - and comforts you like a warm blanket in front of a fireplace on a cold night. Make no mistake, I realize that most people have never had the fortune of experiencing, or the misfortune of landing in, a place like Silver Hill. I know, after seven years of working with people with mental illnesses and most problems, that the average psychiatric hospital is a dingy, stuffy, locked ward, where you are lucky if you get to spend 15 minutes a day talking to your psychiatrist, a merely holding station until the medications kick, a warehouse of sorts. They have little to offer beyond temporary safety. And I know that I was blessed by a social worker for an outpatient treatment center and friends who made sure that I was not locked on the sixth floor of Bellevue on that May day in 2003.

Instead, after my initial stabilization over the course of a few days in the locked ward, I was able to get full and repeated psychiatric evaluations, participate in group therapy, art therapy and was manipulated to my great benefit by a team of nurses, doctors, social workers and others who noticed everything, conspired together and were treating you as you sat down for breakfast, when you were in therapy and even when they were sharing a cigarette with you on the back porch of the unlocked Main House. I use manipulated and conspired in a positive light, because their attention to the details of my and the other patients' behaviors were enormous benefits to my recovery and eventual release. They outmaneuvered me at every turn. I can remember the unspoken rewards system that allowed you to have extra time outside and with other patients; listening to one psychiatrist assistant as we stood out on the deck and he strummed his guitar, the young, eager and nervous resident who was the second of four psychiatrists to evaluate me during my stay and the friends I wrote about in the second chapter of my book, Burning Down My Masters' House: A Personal Decent into Madness that Shook The New York Times. I'll never forget the moment that I accepted my diagnosis of bipolar disorder, late a night, while sitting on the back patio of the main house, listening to a young honors student from the University of North Carolina-Chapel Hill recount how he was hospitalized and later diagnosed with bipolar after having delusions and hallucinations about God and storming into the dean of students' office to explain them. I could relate. In many ways. More importantly, I realized that you could be smart and have a mental weakness of the mind, a simple concept that I had been resiting for many years as I suspected something was wrong.


In managing the cases of clients now who are struggling with difficult issues, I still employ the Silver Hill approach of paying attention to the details, behavior modeling, gentle confrontation, attentiveness, respecting their right to be the leading advocate in their health and recovery, and explaining all of the details to clients. It's what I hospital should be; it's also what health insurance companies don't want to pay for.

Although I didn't notice it until last week, I have been feeling a little down lately. There is a lot of isolation in the initial steps of starting your own business. Contract negotiations, regulatory paperwork and setting up accounting and billing systems and the lack of daily connection with the colleagues that I have spent the last few years working with at Ashburn Psychological Services. I had also returned from a trip from my beloved New York City and was returning to my regular life, which can always be as much of a let down as it is energizing.

It should have come as no surprise to me when I was Googling Girl, Interrupted, the popular 1999 film, starring Winona Rider and Angelina Jolie, that tells the story of Susanna Kaysen, who spent months in 1960s at McLean (parts of A Beautiful Mind, the story of Dr. John Nash, the Nobel laureate who was diagnosed with something between schizophrenia and bipolar disorder (schizoaffective disorder, perhaps, according to author and former reporter Sylvia Nassar's account in the book by the same name).

As opposed to now, where the average inpatient psychiatric hospital stay is less than seven days, like most of her fellow patients, Kaysen spent upwards of 18 months at McLean. The first four weeks alone were devoted to observation, diagnosis and treatment planning, which now occurs in a matter of a few minutes at most hospitals. Kaysen was rushed to the hospital after some mild suicidal ideation. She had been having some delusions and also had an affair with the husband of her parents' friend. She's the type of patient who probably could not make it past the insurance-run admissions process at most hospitals today. There are the bonds she develops with fellow patients, learns a great deal about herself, observes some of the absurdities of psychiatric treatment of the day, as well as its benefits. Through the horror, the confusion, the relationships and the treatment, Kaysen emerges a stronger woman who goes on to lead what, by most accounts, was a productive and happy life.

It's a no wonder to me, given how I was sliding a bit, I turned to a link to Gracefully Insane: The Rise and Fall of America's Premier Mental Hospital, a book at McLean Hospital, written by Alex Beam, a journalist I once worked alongside at The Boston Globe. When it arrived at my office a few days later, I learned about the psychiatric hospital that served poets, like Sylvia Plath and Robert Lowell, singers like Ray Charles and Kate Taylor and James Taylor, as well as adolescent girls like Kaysen, homeless people from the Boston area and a host of others. Several wrote some of their most noticeable works from or about the hospital, and others signed recording contracts while in there.

As one doctor explained in the book, "Music therapy at McLean was a path to greatness." The psychiatric assistant who started pulling bands together, some that played outside the hospital campus, noted that it had just started as an activity to keep the patients engaged and that eventually some doctors became aware that some therapy was occurring there, however unintentional. For all the problems at McLean and other mental hospitals of the time (from water treatments for mental illnesses to lobotomies and not-so evidence-based electric shock therapy - to be distinguished from today's electro-convulsive therapies), there was something beautiful about the type of treatment and betterment that came from the psychiatric hospitals of the middle part of the last century, and the ones like Silver Hill, who carry on that same treatment today, through combining revenues from insurance companies with donations to insure a high quality of care. The book made me think of the several clients I had referred to Silver Hill over the years, and the positive outcomes for them along the way.

It made me think that how the best therapy occurs outside of the formal moments and in relationships. And it made me think that the psychiatric assistant who played the guitar for us outside, might have been one of the most important parts of my stay. The strums of his guitar gave me peace and told me it was ok at a time when I just didn't know anymore who I was or what was in my future.

As traumatic as it was, I wish that more of my clients could have the same experience, the same opportunity for nurturing, growth and change. It made me think that I hope that, at least in this area, the psychiatric hospitals of the future look a little less like the ones of today and a little more like the ones of yesterday.