Blue Dreams

Breaking In

It is easy. I climb a crumbling low stone wall and push my hand through brambles to find an open window covered with torn strips of a metal screen, the trim rotten, the blistered white paint falling in jagged flakes as I part the remnants of the screen and, balancing carefully, thrust one leg through the old aperture. This very window was once barred, but now, lifetimes later, it yields with barely a nudge. It is as if this old building—heavy with history, loaded down with dreams and screams and maniacal memories—wants me to know all the horror it holds. As if it yields to me because I come as some sort of witness to days long gone, to a time when we treated the mentally ill in ways we might call mentally ill, plunging them into ice-cold baths, or nosing needles under their sunken skin to dose them with so much insulin that they hurtled into fathomless comas, lying on cots or in iron beds, their minds frozen until light finally made its way in and the patients reemerged. If insulin didn’t cure patients of their monsters and bi-headed beasts, we sometimes severed the fibers of their burning brains, leaving them docile as dolls.

Inside, this old asylum is mostly dark. Outside, it is a beautiful summer evening redolent of roses that grow along the low stone wall and pour across the upper fields overtaken with white-headed weeds and pink clover. Years and years ago, these same fields were closely mowed, as if by controlling the scalps of grass the staff could somehow also leash the brains of the madmen and women this institution contained. The grounds were quite lovely back then. The buzz-cut green and the exuberant roses and the stone walls lent a bucolic look that stood in stark contrast to the insides of the actual hospital building, where I stand in the late dusk of a June day, the sky outside the color of periwinkle. The outside smells of damp summer, the inside of mothballs and something stale but impossible to name.

By crawling through the window I have officially trespassed on state property, and yet I feel I must see these haunted halls. As my eyes adjust to the dimness of this dead place I can make out doors, dozens of them lining a corridor littered with medicine carts. The impression is of a place humming and hurried one moment and abandoned the next, as if an announcement came down from on high to jump ship and people left everything in mid-motion, the carts haphazardly strewn about, the prescriptions now faded and lying curled on the floor. I bend to right an overturned flask and then pick it up, holding it to the evening’s last light, against which is visible a faint golden glow from the liquid it once contained. I set the flask aside, then make my way forward through the murk and bump into a stack of books, toppling it to release a flutter of wings and the shrieking of birds—tiny birds with yellow vests who have built their nest amid the disintegrating tower of tomes.

Metal beds on wheels flank the long hallway, with its aged linoleum floor warped and bulging, broken in spots. The walls, painted a seasick green, are shedding, and there are closets stacked with rolled-up towels and rusty medicine cabinets. A while later, having ascended the stairs to the fifth-floor hall, I pass a canvas cot, and then, in a small room, a long bed over which are suspended the wires and suckers that were attached to shaved skulls for electroconvulsive treatment, current fed through the cranium that for some reason seemed to have some positive effect.

Crammed into a corner on the highest floor, the sixth, is a tiny square of space with a single caged bulb screwed into the buckling ceiling, the damp dirt floor beneath it clawed by who knows how many hands. This could well have been the “quiet room,” where patients were sent when their behaviors could no longer be controlled. Down below me, and beyond the fields that surround the structure, the city streets thrum. Through one of the dirt-speckled windows I can just make out a pair of women pushing strollers. A man walks by with a baguette tucked under his arm as vendors hawk their wares beneath bright umbrellas striped and swirled and dotted—a picture of perfection that serves only to deepen the gloom of this building soon to be razed, sent tumbling into a heap of broken brick by the crane’s wrecking ball.

Founded in 1833, this state hospital was once a bustling institution, forty miles west of Boston. In the 1920s, ’30s, and ’40s, this hospital, like a host of other mental hospitals (called then insane asylums) scattered around our country and abroad, was a place to send the crazed and “idiotic,” a place equipped with what today seem like terribly primitive tools to handle the screaming, sweaty bodies of men and women hounded by hallucinations in an era long before managed care and medication. A hundred years ago, even eighty years ago, very few people were confident that chemicals could mend the mind, which as recently as the nineteenth century was believed to dwell not in the brain but somewhere in a spirit or soul immune to chemical intervention. Those afflicted with serious mental illnesses—schizophrenia, bipolar disorder, severe depression, and autism—often lived out their lives between the walls of hospitals just like this one, undergoing questionable cures that, while never intended to harm, rarely worked.

In 1991, more than 150 years after it first opened, this hospital at last closed its doors, meeting the same fate that had already befallen many other such mental hospitals in the decades following the deinstitutionalization movement that gathered momentum in the 1960s, when President Kennedy, whose sister Rosemary had been the victim of an early and failed prefrontal lobotomy, provided funding for community mental health centers, a move that was further encouraged by the passage of President Johnson’s Medicaid and Medicare bills. In 1955, at their peak, American mental hospitals held 560,000 patients nationwide, double the number at the turn of the twentieth century. By 1988, three decades later, that figure had fallen to 120,000.

One of the phenomena that truly made this sea change viable—allowing patients to be treated in the least restrictive setting possible, whether that was in a community health center or at home with their families—was the discovery, in the early 1950s, of a blockbuster drug called chlorpromazine. When branded and marketed as Thorazine in this country and Largactil in Europe, this new drug stabilized untold thousands of schizophrenic, psychotic, and otherwise mentally ill patients and eventually brought about a sustained exodus from mental hospitals in the United States and abroad.

Great and Desperate Cures

One way of grasping the meaning of Thorazine is to know the types of treatments that preceded it, treatments which the former University of Michigan psychologist Elliot Valenstein has called “great and desperate cures.” There was, for instance, insulin coma therapy, first used by Austrian psychiatrist Manfred Sakel in 1927, in an attempt to treat opiate addicts in withdrawal with small doses of insulin. Some of these patients, however, slipped into hypoglycemic comas, and when they awoke, following an emergency administration of glucose, their personalities seemed altered. Addicts who had been defensive, angry, difficult were now “tranquil and more responsive.” This led Sakel to wonder whether deliberately inducing comas in schizophrenic patients might produce a similar recovery. He set about trying this and claimed miraculous results after inducing comas, sometimes as many as sixty times in a two-month period, in his schizophrenic patients. Perhaps unsurprisingly, patients emerging from these comas did appear more docile, but the treatment carried severe risk—including death and irreversible coma.

Convulsive therapies were also popular during the first half of the last century. Before electroconvulsive treatment (ECT) was developed, convulsions were brought on by injecting patients with drugs. Ladislas Meduna, a psychiatrist working in Budapest, noted that epileptics who also had schizophrenia appeared to have fewer seizures and that, conversely, schizophrenics who suffered from epilepsy would often have spontaneous remissions of their psychoses after a seizure. Meduna chose first camphor and then metrazol, a white crystalline drug employed as a respiratory or circulatory stimulant, to induce seizures in schizophrenic patients. Afterward, his first test subjects rose from their beds and asked, in perfectly lucid ways, when they could go home. “I felt elated and I knew I had discovered a new treatment,” Meduna said. “I felt happy beyond words.”

What was the operating theory behind metrazol therapy? Some claimed that it gave the mentally ill a near-death experience that set them straight once the seizures were over. Instead of scaring schizophrenics to death, the thinking went, it scared them back to life. Patients coming out of metrazol shock often called for their mothers, or begged the nurses to hold them, childlike behavior which their physicians considered proof that the seizure had altered their personalities for the better. No longer raucous or caught up in the clutch of hallucinations, metrazol patients were frequently friendly and cooperative, and this led doctors to believe that with enough treatments, the positive behavior would become habitual.

Metrazol therapy, however, had a host of thorny problems. When asylum physicians beyond Meduna tried it on their patients, the seizures the drug caused were horrific. The treatments filled their patients with dread, and they begged to be spared the injections, which caused their whole bodies to writhe and spasm in convulsions of such ferocity that they frequently suffered fractures: dislocated shoulders, broken femurs, clavicles, scapulae. One patient compared it to being “roasted alive in a white-hot furnace.” And yet it was not uncommon for patients to have as many as forty metrazol injections.

Other treatments, some of which caused patients degrees of discomfort we can only imagine, since seemingly they left behind no record of their experiences, involved the injection of animal blood and castor oil and massive doses of caffeine. For quite some time, sleep therapy became a popular intervention in the treatment of schizophrenia—a kinder although no less dangerous undertaking. Patients were fed a cocktail of tranquilizing tonics and drugs meant to send them into slumbers that, in some cases, lasted as long as two or three weeks. The rationale: in states of deep rest the nervous system might find its precarious balance again. It’s true that some schizophrenics were actually helped by sleep therapy, but there were a number of fatalities as well. Patients’ lungs filled with fluid, pneumonias developed, or vomit was aspirated—all in a time before penicillin.

In 1938, Italian psychiatrist Lucio Bini discovered that he could cause convulsions in mental patients using electricity instead of drugs. Bini tried his new therapy on catatonic patients, some of whom were helped by this charge to their systems, as they emerged from their catatonia and began conversing with those around them. Others, however, as they lay on the table, seized to no effect at all, the voltage so high they flopped like fish, again and again, as the body was charged and changed, in a mode of treatment that seems barbaric to the modern mentality. (Electroconvulsive therapy, which actually can be extremely effective in severe depression that has failed to respond to antidepressant medications, is still used today, the theory being that the electrical current “resets” the brain. But the voltage is much lower, the treatment is typically used on only one hemisphere, and patients are given muscle relaxants so they do not have violent seizures.) Other hospital-based therapies of the time included ice wraps, freezing baths, or just plain old restraints, with the patient simply tied to a chair while his dreams and demons wafted.

Were the lengths to which these psychiatrists went to calm the mad mind heroic, or simply cruel? Canadian doctor Heinz Lehmann, for instance, noting that the psyches of his schizophrenic patients seemed much clearer when they were felled by high fevers, sought out ways of inducing in his patients the most extreme temperatures he could, going so far as to inject turpentine into the abdominal wall of one female patient in the hope that the infected abscess formed in the wake of such a procedure would cause a fever high enough to quell her hallucinations. Some have criticized Lehmann for what they consider cruelty, but it’s more likely that this doctor, who would later become one of the first North American prescribers of Thorazine, had the best of intentions, so driven was he to find ways of suppressing psychosis.