Under Observation: Life Inside a Psychiatric Hospital

The stories of six patients in a psychotic disorders unit explore the inner psyche and chronicle the work of doctors and researchers with patients suffering from severe disorders

Ostensibly a slice of life inside McLean Hospital in Belmont, Mass., during a two-week period in the spring of 1993, but actually a report on the status of psychiatric treatment today. Berger first wrote about McLean in We Heard the Angels of Madness (1992), a book that she co-authored with her sister Diane, describing her nephew's descent into manic depression. Here, her co-author is a psychiatrist in charge of a unit for patients with severe psychosis. The narrator is Berger, with Vuckovic always referred to in the third person. Together they construct composites of a number of patients, who are also shown interacting in numerous group meetings. Among these composites are: Kiesha, a delusional pregnant woman whose husband insists she not be medicated; David, a suicidal man who is given electroconvulsive therapy; Glenda, a chronic paranoid schizophrenic who is switched to the latest miracle drug; and Matt, a substance abuser who has had attention deficit hyperactivity disorder since childhood. Admission and discharge notes, replete with medical jargon and abbreviations, are included for each, possibly to lend these composites a touch of authenticity. More interesting are two scientists at McLean's research center: Ross Baldessarini and Frances Benes. Descriptions of their work provide the authors with the opportunity to give some history of psychiatric diseases and their treatments and to explain current trends in neuropharmacology and neuroanatomy. Whether intentional or not, the impression is left that psychiatry is an infant science struggling to come to terms with a bewildering variety of therapies. McLean comes off as a humane treatment center providing the best care possible given the budgetary constraints of our present system and the limits of our present knowledge. The patient notes are a trifle gimmicky, and the accounts of group meetings become tiresome, but the writing sparkles when the subject is scientific research. -- Copyright ©1994, Kirkus Associates, LP. All rights reserved.

Berger (We Heard the Angels of Madness, LJ 4/1/91) and psychiatrist Vuckovic describe life at one unit of McLean Hospital, a psychiatric facility near Boston, during a typical two-week period. Since only the sickest patients are given inpatient treatment, crisis management is the style in mental hospitals today. Doctors must achieve quick results through psychopharmacology, stabilizing patients enough to allow them to benefit from outpatient care. Although each chapter focuses on an individual patient, allowing the reader some familiarity, the stories are told from the psychiatrist's and his staff's points of view, relating the frustrations and successes they meet each day. Separate chapters describe the study of mental illness and the treatment that is carried on within the research arm of the hospital. Recommended for both lay readers and professionals.
--Marguerite Mroz, Baltimore Cty. P.L.
Copyright 1994 Reed Business Information, Inc.

McLean Hospital is a 180-year-old private institution in Belmont, Massachusetts, and a teaching hospital for Harvard. Medical writer Berger became interested in it through chronicling the experiences of a manic-depressive nephew. With McLean psychopharmacologist Vuckovic, she shows that many of the hospital's problems and activities exemplify national trends. The powers and regulations of both government agencies and insurance companies weigh heavily on it. McLean's patient census has declined by a third during the past five years, and the average length of a patient's stay has fallen from 81 to 13 days. By alternating between group discussions and individual case histories in the text, Berger and Vuckovic also explain different psychiatric illnesses and approaches to them and the relationships among psychiatrists, nurses, and patients, and they take a close look at McLean's research activities, particularly Francine Benes' work with GABA, a neurotransmitter that slows down electrical impulses passing from one nerve ending to another. William Beatty