No landscape is more complex than the human psyche. Nestled amid a hillside neighborhood of million-dollar mansions cleaved by Valley Road and the Silvermine River, Silver Hill Hospital hardly appears a vehicle for navigating such terrain. Its dozen or so clapboard buildings, scattered across the rolling landscape, are more typical of a bucolic boarding school campus on Masterpiece Theatre than a retreat for healing.
Behind the placid exterior is a state-of-the-art facility known for generations as an aid station to troubled minds, one that has recently gotten an infusion of new life and purpose from Greenwich-based talent. Google the words Silver Hill and you come across sundry mentions of celebrities treated there, from novelists to actors to political figures. The staff of Silver Hill won’t confirm or deny the identities of any patients, adhering to a strict confidentiality rule, but the president and medical director of Silver Hill,
Dr. Sigurd H. Ackerman, is not nearly as reticent about its longstanding reputation as “Betty Ford East,” a dry-out farm for the rich and famous.
“That’s extremely unfortunate,” Ackerman says. “It probably misrepresented the situation forty years ago. It certainly misrepresents it now.”
A gruff man with a kindly face, Ackerman took over in 2003. His small, pine-paneled corner office has a bay window on one side, fireplace on the other, bookcases behind doors of gilt grillwork and randomly placed leather chairs. This has been the office of every medical director at Silver Hill since it was founded in 1931, located in a squat, jutting, centrally located structure known as Doctors’ House. Ackerman’s own touches here include photos of him taken in his windsurfing days and a platter of York Peppermint Patties he calls his private form of avoidance therapy.
A psychiatrist, Ackerman began his career in full-time research, testing early maternal separation in animals. Before coming to Silver Hill, he was at St. Luke’s Roosevelt Hospital in New York, first as chairman of psychiatry and then for three years as president. He is still a professor of psychiatry at Columbia University, a post he held in his St. Luke’s days. He joined Silver Hill, he says, because “I was being pulled further and further away from psychiatry,” what Silver Hill is all about.
As an independent not-for-profit facility, Silver Hill is a bit of an anomaly in this age of managed care. Many others that began with similar missions have either closed in the face of enormous regulatory pressure or merged with larger hospitals, thus diluting their mission. Silver Hill has remained true to the vision, if not the exact formula, with which it was founded seventy-five years ago. And it boasts impressive results.
According to Ackerman, since Silver Hill began tracking its degree of success, it has found its relapse rate for substance abuse patients is about 20 percent after a year. “That’s the opposite of what it is nationally,” he explains. For readmission to hospitals for patients suffering from psychiatric disorders, it is 12 percent at Silver Hill, again well below the national norm, he notes.
Patients at Silver Hill often suffer from dual disorders that feed off each other. Ackerman estimates that this is typical for 65 to 70 percent of patients admitted to psychiatric hospitals nationwide.
“They may come in with a bipolar disorder but when you do a history, it turns out they abuse substances,” Ackerman notes. “They may come in with alcohol abuse or cocaine abuse, but then you discover that they have a mood disorder or an anxiety disorder or a psychosis. When they get here, they find out it [treatment] is not that simple.”
From the sun-dappled tree boughs that cast long shadows across its undulating campus to the Regency-era paintings of horse-riding gentry lining the wainscoted walls in the lobby of Main House, Silver Hill emanates a sense of tranquility. Although doctors administer electroshock therapy here — ECT is a common element at all psychiatric facilities these days — the feeling of the place, with its polished wooden floors and chintz upholstery, is more akin to a bed-and-breakfast than One Flew over the Cuckoo’s Nest.
Silver Hill began life as the Silver Hill Inn, an ordered setting for helping patients who were “nervous, depressed, anxious or malingering.” Occupational therapy–style care was the focus, very much in tune with the prevailing bull-moose zeitgeist of the Eastern-establishment aristocracy in those days. There was a woodworking shop. Patients dressed for dinner, men in jackets and ties. Founder Dr. John A. P. Millet couldn’t have come from higher society stock: John Singer Sargent had painted his portrait when Millet was four.
Lisa Benton, Silver Hill’s director of performance improvement and risk management, recently helped organize a seventy-fifth anniversary history exhibit. “It was not a hospital-like experience at all,” she says of the inn. “It was a very structured environment. You can see on this list of daily activities that there were times for everything, including having a glass of milk or using the bathroom. Between one forty-five and three each afternoon, patients were required to rest in bed, doing nothing.”
As a mental-health therapist, Benton agrees some of this was very forward thinking. Yet looking through old files reveals some fustiness, too, particularly in the instruction of the staff. For example, nurses were allowed to smoke only when seated (a standing smoker, it was believed, increased a patient’s nervousness) and were barred from talking about their own friends and family “as that is likely boring to the patients.” Another notice Benton discovered mandates thespian skill: “Nurses are requested to pretend to like any and all food served in the dining room to better the morale of the patients.”
Who were the patients of Silver Hill back then? Photographs in the exhibit show faces that are white, neat, middle-aged, vaguely troubled. One elderly woman sits like a study in depression by Rodin, resting her forehead against her hand. Those early residents certainly appear worse off than the young men and women in sweatpants and dungarees who walk the campus today. Silver Hill Inn followed a simple four-point program: work, rest, exercise and play.
“That’s all there was then,” Ackerman notes. “There were no medications. There were no very specific forms of psychotherapy as there are now. When you fight a battle and don’t have guns, you throw stones or whatever you can do.”
Ackerman notes that the patients Silver Hill sees now are “much more ill,” people who back in the 1930s would have likely been left to languish in state institutions.
By the 1960s, Silver Hill, not previously known for treating alcoholism, was earning a reputation in developing complex programming for dual diagnoses, similar to the dual-disorder therapy Ackerman speaks of today. Programming became more elaborate and modernized. “We were not trying to pretend we were not a hospital anymore,” Benton notes.
Today, Silver Hill includes an acute-care facility with eighteen beds offering high-security treatment for dangerously ill patients. There are specialized inpatient programs for psychiatric disorders, addictive disorders and dual disorders, including a protocol that incorporates the chemical Suboxone, the latest therapy for weaning patients off drugs and alcohol. The Dialectical Behavioral Therapy program helps so-called borderline patients regulate their feelings better by charting their emotional highs and lows day by day. Other offerings are designed to help troubled youngsters or people with eating disorders.
If someone today was designing a psychiatric hospital from scratch, it probably wouldn’t look like Silver Hill, Ackerman admits. “It’s very awkward to have all these buildings spread all over the place,” he says. “On the other hand, even though you wouldn’t do it this way now, it’s quite wonderful. There are problems associated with it, but many, many advantages.”
These days, Ackerman and his colleagues are focused on improvements to the physical plant. Ruurd G. Leegstra, a Greenwich resident and Silver Hill’s chief financial officer, points to the Jurgenson Building, where some group therapy sessions take place. A recent renovation there created a spacious interior not unlike a ski lodge, where patients gather, swap experiences and sip tea.
“We have a four-year plan to renovate Main House, redo another house that’s obsolete and then do a huge landscaping renewal, get it in the type of condition so patients will enjoy it even more,” Leegstra says.
Another element Silver Hill’s leadership is working on is improving relations with New Canaan. Relations with the host town have not always been good. They bottomed out in the 1980s, when Silver Hill was trying to build its acute-care facility, designed to serve patients who require constant supervision, for example, suicide risks. For a time, visions of Jason Voorhees on Valley Road danced in people’s heads.
Ackerman ascribes much of that misconception to a failure on Silver Hill’s part to better describe its mission. The facility has always been shrouded in a certain amount of mystery, in part because of what it does and in part because of its celebrity clientele (signs on campus warn against photography).
“The common story you hear goes like this: ‘I lived around here for thirty years, I drove past it every day of my life, I’ve never been in.’ Well, they’re welcome to come in.” That wasn’t always so, Ackerman admits, but it is now. “We want to be an open part of the community.”
Silver Hill has recently raised money for its ongoing refurbishment by selling off nineteen acres, but ask Steve Stillerman, chairman of Silver Hill’s board of directors, if he would ever consider selling off the remaining forty acres and moving Silver Hill to cheaper, more ergonomically sensible digs, and he just chuckles. “A lot of patients feel comfortable being in New Canaan,” he says. “From what I hear from doctors, it’s part of the cure. It provides a very relaxed, noninstitutional feeling.”
A thirty-seven-year Greenwich resident, Stillerman feels Silver Hill’s low-key ambience, along with a general change in thinking nationwide, has taken some of the stigma out of mental illness: “In general, up to about now, people never wanted to talk about emotional problems. It was lowest on the list. Just like twenty-five years ago people didn’t want to talk about cancer. It has opened up a lot.”
Valerie’s Story
Valerie had tried dealing with her alcoholism and drug dependency before, but the place she checked into hadn’t worked out.
“It was horrible,” she recalls. “There was no freedom. You couldn’t be a human being.”
Her daughter Alexandra urged her to apply somewhere else. Valerie’s family had a pattern of substance abuse she needed to conquer. But how? After some joint prayer, Valerie called a substance-abuse help line and was told about Silver Hill. Alexandra did a little research and suggested that her mother give it a try.
When Valerie was ushered into one of Silver Hill’s 108 inpatient units, she was struck immediately by the contrast to where she was before. “My room was really nice,” she recalls. “I had a roommate, and I had my Bible, my reading materials and a schedule. When it came time for lunch or dinner or breakfast, they just let us all down, and we walked over together. We had chefs. That was the best part. It wasn’t prepackaged food; we could make up our plate and sit with whoever we wanted in a dining setting, which is great.”
Silver Hill’s psychiatric staff worked with Valerie to figure out what was at the root of her problem. “I found out why I fell into the bottle: My mother passed away when I was fifteen, and I never really got a chance to grieve for her,” Valerie explains. “My sis, she stepped right in, she took over, she was great and then she passed away in 2000. That’s when I just jumped into the bottle, where I was grieving for both of them.”
Facing the root cause helped Valerie eliminate the symptom. She found herself looking at the situation without emotions, not throwing tantrums but calmly analyzing a situation and accepting life for what it is.
“Anybody that I can help … my first two words are Silver Hill,” Valerie avers. “Nobody else can help you like they do right here.”
Elizabeth’s Story
Not so long ago, Elizabeth’s main mission in life was drinking herself to death. She remembers knocking back a half gallon of vodka a day. Frequently depressed and arguing with her husband, she lost sight of any kind of future. Prayer had always been important to her, but she stopped that, too, closing what she thought of as “the sunroof” between her and God.
When her husband suggested that she seek residential psychiatric counseling at Silver Hill Hospital in New Canaan, Elizabeth was dubious. What could strangers do to help her work through her own most coveted secrets? How would she feel in sharing them?
“That’s a bit daunting,” she recalls thinking at the time. “I really thought I was coming here to kind of interview the hospital. The next thing you know I was here for ninety-one days.”
For Elizabeth, it was a time of prayer and meditation, of connecting with people she had never met, who were going through exactly the same thing. There were group therapy and individual sessions and twelve-step programs designed to wean her not only from alcoholism but also from its root causes.
By the time her three months at Silver Hill were over, Elizabeth was seeing life as a gift again, one she wanted to share with as many people as possible. Volunteer work, in particular cooking for the homeless, became a passion.
“One of the things I learned at Silver Hill is how to have coping skills and how to employ them,” she explains. “Every problem doesn’t have to end at the bottom of a glass.”
Kristin’s Story
Kristin still remembers the day ten years ago when she was working out with the rest of her college volleyball team and the coach called her out. “Lose some weight!” were his words, and they echoed with growing force over the days and weeks that followed. “I was deep into laxatives, diuretics, diet pills,” Kristin explains.
Life had flatlined into a ping-pong circuit between gymnasium and bathroom. A therapist she was seeing recommended Silver Hill Hospital. After checking in, Kristin was brought to Main House, where she would live for the next thirty days. Staffers met with her, checked her for scars and bruises, and quickly made her feel completely bereft of privacy. “They give you your freedom but somebody’s always watching you,” she notes.
Managing a bowl of cereal for dinner, Kristin spent the first night at Silver Hill staring at the ceiling. “What did I get myself into?” she remembers thinking.
What she had gotten into was an environment of supervised meals, group therapy sessions with others sharing the same disorder and, most daunting, a meeting with her mother, to whom Kristin had to explain for the first time that she was bulimic. Gradually, she became more at ease talking about her situation with doctors, nurses and fellow patients. More important, she began feeling comfortable about herself, who she really was rather than how she feared she was seen by others. Silver Hill gave her a formula for living day by day.
“It’s a great atmosphere, everything’s so pretty there,” she says. “Very calming and relaxing. It’s what people need if they’re going through a very hard time.”
Maura’s Story
The day Maura arrived at Silver Hill had already been eventful: She had just left Norwalk Hospital, where she had been treated for intoxication. She had hit bottom, and everyone, from her boyfriend to the people who ran the employee assistance program at work, said it was time to change. She lasted only a couple of days in New Canaan before checking herself out, going home and getting drunk again the next day.
“I called Silver Hill and asked them if I could come back, and they worked with the insurance company and somehow got me right back in,” Maura remembers. “They have a very rigorous program where you’re busy constantly, you’re in meetings or in one-on-one sessions or you’re just spending time alone, trying to get to know yourself better, trying to get healthy again, get all the toxins out of you.”
After thirty days, Maura went home and has stayed sober, using the tools and checklists she was given. She says the Serenity Prayer “eighty million times a day,” and remembers her counselor’s words to take care of herself first.
“I would say that coming to Silver Hill is a wonderful experience,” Maura concludes. “It’s not a pleasant one, it’s very scary, but what you get out of it, there’s no words I can even say. As long as you go out and use the tools that you’re taught from Silver Hill, then I think everyone can make it.”