McLean had already shrunk dramatically in the late 1990s, staffers were preparing just 100 beds a night, compared with 340 during most of the twentieth century. To save McLean, the businessmen who sat on the board of trustees opted to 'restructure' the hospital. The hospital was foundering like a luxury ocean liner competing in the age of jet travel. It came within a hair's breadth of being closed down. By the early 1990s, McLean was losing millions of dollars a year. Whereas once well-heeled patients had checked in for months' if not years' worth of expensive, residential therapy, the standard admission was now the 'five-day': time enough for a quick psychiatric diagnosis, stabilization on drugs, and release 'into the community,' meaning to a halfway house or, in the most hopeful scenario, back to one's family. Starting in the 1980s, neither private insurers nor government programs like Medicare and Medicaid were willing to finance the lengthy stays and staff-intensive therapy that had been McLean's specialty for almost two centuries. McLean was showing off its 240-acre campus to promote its new Hospital Re-Use Master Plan. Everyone was wearing sensible clothing for our tour of what was once America's premier insane asylum. There were two 'soccer moms' in our group, real soccer moms, it turns out— they played soccer. In fact, as we strode along the sculptured walkways cut through the scrubby New England forest, several men and women revealed themselves to be Audubon Society members, who instantly recognized the hospital's dense stands of oak and elm forests as nesting grounds for red-tailed hawk and horned and screech owls. Our group of twenty could just as well have been bird watchers out for a jaunt. McLean was hosting an orientation meeting for its neighbors in the well-to-do town of Belmont, Massachusetts. Although I had already interviewed several doctors in their offices, I took my first formal tour of the campus on a sunny, early-summer Saturday in 1998. But on first acquaintance, the only indication that you have entered one of America's oldest and most prestigious mental hospitals is a large sign jutting into Mill Street: McLean Hospital.
The washroom mirrors are polished metal, not glass. On some halls, the nurses' stations are enclosed in thick Plexiglas. Iron grilles surround the staircases inside the few remaining locked wards. There are no fences, no guards, no locked gates.
The carefully landscaped grounds, dotted with four- and five-story Tudor mansions and red brick dormitories, could belong to a prosperous New England prep school or perhaps a small, well-endowed college tucked away in the Boston suburbs. Everyone makes the same comment: It doesn't look like a mental hospital.
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