Austen Riggs Center
Encyclopedia
The Austen Riggs Center is a psychiatric treatment facility founded in 1913 in Stockbridge, Massachusetts
.
, Austen Fox Riggs developed an innovative treatment regimen that both anticipated the rise of psychosomatic medicine and therapeutic psychology, and forged a new direction for the residential hospital.
Interested in the way that troubling thoughts and emotions might be bound up with organic disease, Riggs was influenced by the mental hygiene movement (also known as the social hygiene movement). He developed his residential model after observing a physician in Bethel
, Maine
named John George Gehring, who treated patients through strict daily regimens and treatments through suggestion.
Opening in 1913 as The Stockbridge Institute for the Study and Treatment of the Psychoneuroses, the Institute incorporated in 1919 as the Austen Riggs Foundation. Coinciding with the creation of the Menninger Foundation
in Topeka
, Kansas
, Riggs grew quickly; it had 100 patients by 1924, with average stays of four to six weeks. A staff of doctors handled no more than 10 patients each, and physicians in training joined regular staff meetings and conferences. A series of “green books" summed up Riggs’s "precepts for successful living" and Riggs encouraged a sense of community; an associate from the 1930s said that patients were encouraged to be “a valuable member of a united team.”
Unlike more theoretical approaches to treatment, Riggs tended to an earthy practicality. A skilled craftsmen himself, Riggs had what a colleague described as a “deep and almost Puritanic conviction that feeling must be kept under constant surveillance and control by doing.” His hospital featured an extensive occupational therapy shop equipped for weaving, carpentry, painting, and other handicrafts, and rooms for games and recreation. Riggs also had what he called “10 commandments” of successful living.
Though he denounced what he called Freud’s “mental gymnastics,” and criticized the Vienna doctors’ emphasis on sexual conflicts as the root of neurosis, Riggs’s practices bore commonalities with the emerging field of psychoanalysis. He believed neurotics to be troubled by the “residues of past experience,” and that they would heal in part by self-knowledge and adaptation to practical realities. Where Freud spoke of defense mechanisms, Riggs once said that a patient “cannot be deprived of the protection of his neuroses.” Where Freud spoke of coming to grips with the ordinary unhappiness of the world, Riggs spoke of the problem of “magnifying suffering by making a personal quarrel with pain.” The American Journal of Psychiatry has called Riggs’ system “a fully integrated conceptual system of ego psychology” that preceded Sigmund Freud’s attention to the field by ten years. Riggs also read Freud in the original German, as well as Pierre Janet
and Jean-Martin Charcot
in French.
Riggs’s books included Play: Recreation In a Balanced Life, Intelligent Living and Just Nerves. The New York Times described him as an “internationally known psychiatrist” who was “widely known to the general public for his books.”
came to Riggs as medical director. A friend of Anna Freud’s and a star of the burgeoning world of American psychoanalysis, Knight emphasized talk therapy and rehabilitation, and avoided common practices in psychiatric hospitals of the time, including electroshock, insulin coma, and lobotomy. Knight regarded medications as useful to “lessen distress, improve the patient’s behavior and increase his accessibility to psychotherapy,” but believed that ultimately a patient’s troubles “must be worked out in treatment, if it is ever to be worked out at all.”
A president of both the American Psychiatric Association and the American Psychoanalytic Foundation, Knight was an authority on borderline personality disorder
, which he said referred to patients who were “quite sick but not frankly psychotic.” Under his direction Austen Riggs began to receive more seriously ill patients, and to explore ways to put into practice Knight’s ideas that borderline patients needed a combination of structure and freedom in order to negotiate their own path toward health.
One major element of this culture began early in Knight’s tenure, when, facing some turmoil with a younger patient population, he convened a conference of patients and staff to work out philosophy and procedures of a therapeutic community.
By 1948, Knight had brought with him what the scholar Lawrence J. Friedman has called “the creative core of Menninger’s clinical psychology department and its research staff,” including David Rapaport, Roy Schafer, and Merton Gill (who wrote the text Diagnostic Psychological Testing) and Margaret Brenman-Gibson, the first non-physician to receive full clinical and research psychoanalytic training in the United States
In 1951, Erik Erikson
joined the staff at Riggs, completing a team that, according to an article in the Harvard Gazette, “turned the grand experiment of treating very troubled patients in an open therapeutic community into a Golden Age of conceptual and clinical inventiveness.” According to Friedman, Erikson “compared Riggs to the safe sanitarium in the Alps that Thomas Mann
had characterized in The Magic Mountain
.”
During the Eriksons’ residence in Stockbridge, Joan Erikson, an artist and dancer, directed the Riggs’ Activities Program, which she expanded to include theater, dance, painting, sculpture, woodwork, gardening, and music. She also founded a formal Montessori kindergarten for local families, in which Riggs’ patients could apprentice — a program that continues today. According to Erikson biographer Daniel Burston, the Activities Program “became a unique, engrossing, and deeply healing experience for patients, which stood in stark contrast to the enforced passivity, boredom, and/or utter self-absorption that prevails in many treatment settings.”
The theater program at Austen Riggs was also influenced by William Gibson
, the playwright known for The Miracle Worker
. While in Stockbridge, Gibson wrote a novel called The Cobweb
, set at a posh psychiatric hospital, which was turned into a film starring Richard Widmark
and Lauren Bacall
.
Erikson pointed out that the Activities Program played a major role in preventing patients from succumbing to a narrow, negative identity produced by immersion in the “patient role.” He credited his wife’s work with teaching him the “curative as well as creative role of work,” which he found to be prominent in the life of Martin Luther.
Erikson also used his experience at Riggs to pursue the ideas he developed in his book Childhood and Society, which proposed a series of eight normative crises in every life, with potential at each stage for healthy growth and integration — and also pathologic development and mental illness.
, formerly of Chestnut Lodge
, came to direct Austen Riggs and brought his understanding of early attachment problems and psychotic vulnerability to the treatment program. According to his New York Times obituary, “Dr. Will was one of a small number of psychoanalysts who devoted their careers to trying to understand psychotic patients through long, intensive, therapeutic relationships with them.” The Times noted that Will wrote in more than 85 papers how psychotic thought states might be changed using only psychotherapy. Will retired in 1978 as medical director at Austen Riggs but continued on the hospital's board until his death.
Dr. Daniel P. Schwartz, the former director of the Yale psychiatric hospital, directed Austen Riggs from 1978–1991, and oversaw the hospital in an era in which both managed care and biological psychiatry came to dominate the field, and in which many legendary hospitals focusing on long-term psychotherapy – including Chestnut Lodge, the McLean Hospital, and Menninger’s —changed their missions considerably.
Under Shapiro’s leadership, Riggs increased its residential capacity from 56 to 73, and expanded the options for more cost-effective step-down programs. Shapiro retired in June, 2011.
A leader in the field of medical education, Dr. Rosen is a member of the National Advisory Council on Substance Abuse and Mental Health Services Administration of the Department of Health and Human Services; he is also Vice Chair of the Residency Review Committee of the Accreditation Council for Graduate Medical Education. He is an Examiner of the American Board of Psychiatry & Neurologyand served on the Executive Committee of the American Association of Directors of Psychiatry Residency Training.
Riggs’ second distinction is its long-term residential treatment in an era of managed care that emphasizes short-term hospitalizations and outpatient treatment for the seriously mentally ill. And unlike many hospitals that restrict the freedom of its patients, Riggs is entirely open, with patients free to come and go as they please. The hospital has no locked wards, seclusion rooms or privilege systems. This environment encourages patients to take charge of their treatment.
The minimum stay at Riggs is six weeks and the median stay is six months. Some patients receive residential treatment for several years, before stepping down to outpatient programs. Following the reorganization of the Menninger Foundation
in 2003, The New York Times described Austen Riggs as the last of the "elite private hospitals, often in bucolic settings," where patients can spend "months or years sorting out their lives" with treatment including intensive, long-term psychotherapy.
The Austen Riggs Center focuses its attention on individuals with serious mental illnesses for whom repeated treatments in outpatient settings have proved ineffective. The psychiatric terms for such patients are “treatment resistant” or “treatment refractory,” and the growing awareness of such individuals is reflected in the 800 percent rise in citations on the subject from 1999 to 2009.
On its website, Riggs identifies candidates for treatment there as people who have been “caught up in treatments that are at an impasse, characterized by chronic crisis management and interrupted by frequent short-term hospitalizations.” In an article published on lifesciencesworld.com, the director of admissions at Austen Riggs, Dr. Eric Plakun, said, “It’s fair to say that many patients who come to us are sick unto death. They’ve been through all the state of the art treatments. And the treatments have failed, so they are desperate and hopeless and deeply distrustful. They’re often on a dozen or more medications. And they often have one or another dramatic story — having jumped off some high bridge that everyone would know, or having survived an overdose or even a gunshot wound.” In 2007, the article noted, more than forty percent of incoming Riggs patients had made a serious suicide attempt before admission.
The goal of treatment, the Riggs’ website declares, “is to help individuals in such a struggle take charge of their lives more fully so that they may return to more productive treatments and more fulfilling engagement in the outside world.”
The typical census for Austen Riggs is about 70 patients. For the initial six-week treatment period, the fees are approximately $1,000 a day, which can be adjusted, according to need, as much as 25 percent. Costs are significantly reduced in step-down settings at Riggs. Without insurance coverage, the average cost to a patient at Riggs — including four-times a week psychotherapy, groups, activities, medication, housing and meals — is about $600 a day.
Stockbridge, Massachusetts
Stockbridge is a town in Berkshire County in Western Massachusetts. It is part of the Pittsfield, Massachusetts, Metropolitan Statistical Area. The population was 1,947 at the 2010 census...
.
Founding – 1946
A New York City internist who repaired to the bucolic countryside of Stockbridge while suffering from tuberculosisTuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
, Austen Fox Riggs developed an innovative treatment regimen that both anticipated the rise of psychosomatic medicine and therapeutic psychology, and forged a new direction for the residential hospital.
Interested in the way that troubling thoughts and emotions might be bound up with organic disease, Riggs was influenced by the mental hygiene movement (also known as the social hygiene movement). He developed his residential model after observing a physician in Bethel
Bethel, Maine
Bethel is a town in Oxford County, Maine, United States. The population was 2,411 at the 2000 census. It includes the villages of West Bethel and South Bethel...
, Maine
Maine
Maine is a state in the New England region of the northeastern United States, bordered by the Atlantic Ocean to the east and south, New Hampshire to the west, and the Canadian provinces of Quebec to the northwest and New Brunswick to the northeast. Maine is both the northernmost and easternmost...
named John George Gehring, who treated patients through strict daily regimens and treatments through suggestion.
Opening in 1913 as The Stockbridge Institute for the Study and Treatment of the Psychoneuroses, the Institute incorporated in 1919 as the Austen Riggs Foundation. Coinciding with the creation of the Menninger Foundation
Menninger Foundation
The Menninger Foundation was founded in 1919 by the Menninger family in Topeka, Kansas, and consists of a clinic, a sanatorium, and a school of psychiatry, all of which bear the Menninger name. In 2003, the Menninger Clinic moved to Houston. The foundation was started by Drs. Karl, Will, and...
in Topeka
Topeka, Kansas
Topeka |Kansa]]: Tó Pee Kuh) is the capital city of the U.S. state of Kansas and the county seat of Shawnee County. It is situated along the Kansas River in the central part of Shawnee County, located in northeast Kansas, in the Central United States. As of the 2010 census, the city population was...
, Kansas
Kansas
Kansas is a US state located in the Midwestern United States. It is named after the Kansas River which flows through it, which in turn was named after the Kansa Native American tribe, which inhabited the area. The tribe's name is often said to mean "people of the wind" or "people of the south...
, Riggs grew quickly; it had 100 patients by 1924, with average stays of four to six weeks. A staff of doctors handled no more than 10 patients each, and physicians in training joined regular staff meetings and conferences. A series of “green books" summed up Riggs’s "precepts for successful living" and Riggs encouraged a sense of community; an associate from the 1930s said that patients were encouraged to be “a valuable member of a united team.”
Unlike more theoretical approaches to treatment, Riggs tended to an earthy practicality. A skilled craftsmen himself, Riggs had what a colleague described as a “deep and almost Puritanic conviction that feeling must be kept under constant surveillance and control by doing.” His hospital featured an extensive occupational therapy shop equipped for weaving, carpentry, painting, and other handicrafts, and rooms for games and recreation. Riggs also had what he called “10 commandments” of successful living.
Though he denounced what he called Freud’s “mental gymnastics,” and criticized the Vienna doctors’ emphasis on sexual conflicts as the root of neurosis, Riggs’s practices bore commonalities with the emerging field of psychoanalysis. He believed neurotics to be troubled by the “residues of past experience,” and that they would heal in part by self-knowledge and adaptation to practical realities. Where Freud spoke of defense mechanisms, Riggs once said that a patient “cannot be deprived of the protection of his neuroses.” Where Freud spoke of coming to grips with the ordinary unhappiness of the world, Riggs spoke of the problem of “magnifying suffering by making a personal quarrel with pain.” The American Journal of Psychiatry has called Riggs’ system “a fully integrated conceptual system of ego psychology” that preceded Sigmund Freud’s attention to the field by ten years. Riggs also read Freud in the original German, as well as Pierre Janet
Pierre Janet
Pierre Marie Félix Janet was a pioneering French psychologist, philosopher and psychotherapist in the field of dissociation and traumatic memory....
and Jean-Martin Charcot
Jean-Martin Charcot
Jean-Martin Charcot was a French neurologist and professor of anatomical pathology. He is known as "the founder of modern neurology" and is "associated with at least 15 medical eponyms", including Charcot-Marie-Tooth disease and amyotrophic lateral sclerosis...
in French.
Riggs’s books included Play: Recreation In a Balanced Life, Intelligent Living and Just Nerves. The New York Times described him as an “internationally known psychiatrist” who was “widely known to the general public for his books.”
1947-1967
In 1947, Dr. Robert P. Knight, the former chief of staff of the Menninger FoundationMenninger Foundation
The Menninger Foundation was founded in 1919 by the Menninger family in Topeka, Kansas, and consists of a clinic, a sanatorium, and a school of psychiatry, all of which bear the Menninger name. In 2003, the Menninger Clinic moved to Houston. The foundation was started by Drs. Karl, Will, and...
came to Riggs as medical director. A friend of Anna Freud’s and a star of the burgeoning world of American psychoanalysis, Knight emphasized talk therapy and rehabilitation, and avoided common practices in psychiatric hospitals of the time, including electroshock, insulin coma, and lobotomy. Knight regarded medications as useful to “lessen distress, improve the patient’s behavior and increase his accessibility to psychotherapy,” but believed that ultimately a patient’s troubles “must be worked out in treatment, if it is ever to be worked out at all.”
A president of both the American Psychiatric Association and the American Psychoanalytic Foundation, Knight was an authority on borderline personality disorder
Borderline personality disorder
Borderline personality disorder is a personality disorder described as a prolonged disturbance of personality function in a person , characterized by depth and variability of moods.The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; the...
, which he said referred to patients who were “quite sick but not frankly psychotic.” Under his direction Austen Riggs began to receive more seriously ill patients, and to explore ways to put into practice Knight’s ideas that borderline patients needed a combination of structure and freedom in order to negotiate their own path toward health.
One major element of this culture began early in Knight’s tenure, when, facing some turmoil with a younger patient population, he convened a conference of patients and staff to work out philosophy and procedures of a therapeutic community.
By 1948, Knight had brought with him what the scholar Lawrence J. Friedman has called “the creative core of Menninger’s clinical psychology department and its research staff,” including David Rapaport, Roy Schafer, and Merton Gill (who wrote the text Diagnostic Psychological Testing) and Margaret Brenman-Gibson, the first non-physician to receive full clinical and research psychoanalytic training in the United States
In 1951, Erik Erikson
Erik Erikson
Erik Erikson was a Danish-German-American developmental psychologist and psychoanalyst known for his theory on social development of human beings. He may be most famous for coining the phrase identity crisis. His son, Kai T...
joined the staff at Riggs, completing a team that, according to an article in the Harvard Gazette, “turned the grand experiment of treating very troubled patients in an open therapeutic community into a Golden Age of conceptual and clinical inventiveness.” According to Friedman, Erikson “compared Riggs to the safe sanitarium in the Alps that Thomas Mann
Thomas Mann
Thomas Mann was a German novelist, short story writer, social critic, philanthropist, essayist, and 1929 Nobel Prize laureate, known for his series of highly symbolic and ironic epic novels and novellas, noted for their insight into the psychology of the artist and the intellectual...
had characterized in The Magic Mountain
The Magic Mountain
The Magic Mountain is a novel by Thomas Mann, first published in November 1924. It is widely considered to be one of the most influential works of 20th century German literature....
.”
During the Eriksons’ residence in Stockbridge, Joan Erikson, an artist and dancer, directed the Riggs’ Activities Program, which she expanded to include theater, dance, painting, sculpture, woodwork, gardening, and music. She also founded a formal Montessori kindergarten for local families, in which Riggs’ patients could apprentice — a program that continues today. According to Erikson biographer Daniel Burston, the Activities Program “became a unique, engrossing, and deeply healing experience for patients, which stood in stark contrast to the enforced passivity, boredom, and/or utter self-absorption that prevails in many treatment settings.”
The theater program at Austen Riggs was also influenced by William Gibson
William Gibson (playwright)
William Gibson was an American playwright and novelist. He graduated from the City College of New York in 1938.He was of Irish, French, German, Dutch and Russian ancestry...
, the playwright known for The Miracle Worker
The Miracle Worker
The Miracle Worker is a cycle of 20th century dramatic works derived from Helen Keller's autobiography The Story of My Life. Each of the various dramas describes the relationship between Keller—a deafblind and initially almost feral child—and Anne Sullivan, the teacher who introduced her to...
. While in Stockbridge, Gibson wrote a novel called The Cobweb
The Cobweb
The Cobweb is a 1996 novel written by Neal Stephenson with J. Frederick George, a pseudonym for Stephenson's uncle, historian George Jewsbury...
, set at a posh psychiatric hospital, which was turned into a film starring Richard Widmark
Richard Widmark
Richard Weedt Widmark was an American film, stage and television actor.He was nominated for an Academy Award for his role as the villainous Tommy Udo in his debut film, Kiss of Death...
and Lauren Bacall
Lauren Bacall
Lauren Bacall is an American film and stage actress and model, known for her distinctive husky voice and sultry looks.She first emerged as leading lady in the Humphrey Bogart film To Have And Have Not and continued on in the film noir genre, with appearances in The Big Sleep and Dark Passage ,...
.
Erikson pointed out that the Activities Program played a major role in preventing patients from succumbing to a narrow, negative identity produced by immersion in the “patient role.” He credited his wife’s work with teaching him the “curative as well as creative role of work,” which he found to be prominent in the life of Martin Luther.
Erikson also used his experience at Riggs to pursue the ideas he developed in his book Childhood and Society, which proposed a series of eight normative crises in every life, with potential at each stage for healthy growth and integration — and also pathologic development and mental illness.
1967–1991
In 1967, after Knight’s death, Dr. Otto Allen Will, Jr.Otto Allen Will, Jr.
Otto Allen Will, Jr. was a U.S. psychiatrist whose work in psychoanalysis focused on treatment of schizophrenic / schizophrenia patients using intensive psychotherapy. He is also credited for his advancement of Attachment Theory and Milieu therapy .- Training :Dr. Will received his medical degree...
, formerly of Chestnut Lodge
Chestnut Lodge
Chestnut Lodge was a historic building in Rockville, Maryland, United States, well known as a psychiatric institution. It was a contributing property to the West Montgomery Avenue Historic District.-History:...
, came to direct Austen Riggs and brought his understanding of early attachment problems and psychotic vulnerability to the treatment program. According to his New York Times obituary, “Dr. Will was one of a small number of psychoanalysts who devoted their careers to trying to understand psychotic patients through long, intensive, therapeutic relationships with them.” The Times noted that Will wrote in more than 85 papers how psychotic thought states might be changed using only psychotherapy. Will retired in 1978 as medical director at Austen Riggs but continued on the hospital's board until his death.
Dr. Daniel P. Schwartz, the former director of the Yale psychiatric hospital, directed Austen Riggs from 1978–1991, and oversaw the hospital in an era in which both managed care and biological psychiatry came to dominate the field, and in which many legendary hospitals focusing on long-term psychotherapy – including Chestnut Lodge, the McLean Hospital, and Menninger’s —changed their missions considerably.
1991 – June, 2011
In 1991, Edward R. Shapiro assumed the role of medical director/CEO of Austen Riggs. An authority on family and organizational systems, Shapiro expanded Riggs’ focus on working with family members to facilitate patients’ treatment, and increased the number of social workers on staff from one to eight. Shapiro also emphasized Riggs as a resource for “treatment resistant” individuals, who were unable to be treated successfully elsewhere.Under Shapiro’s leadership, Riggs increased its residential capacity from 56 to 73, and expanded the options for more cost-effective step-down programs. Shapiro retired in June, 2011.
Today
Donald E. Rosen, M.D., is the Medical Director/CEO of the Austen Riggs Center. A board certified psychiatrist and psychoanalyst, Dr. Rosen was previously Associate Professor and Director of Residency Training, Department of Psychiatry at Oregon Health Sciences University (OHSU) in Portland, Oregon. Before joining OHSU in 1999, he served in many administrative and teaching positions during the 15 years he was at Menninger Clinic, including: Director of Psychiatry; Medical Director, MenningerCare Systems; Director of the Menninger Leadership Center; and President of the Active Medical Staff. He was also the Founding Director of the Professionals in Crisis Program, Director of Athletic Services, and Director of Addiction Services.A leader in the field of medical education, Dr. Rosen is a member of the National Advisory Council on Substance Abuse and Mental Health Services Administration of the Department of Health and Human Services; he is also Vice Chair of the Residency Review Committee of the Accreditation Council for Graduate Medical Education. He is an Examiner of the American Board of Psychiatry & Neurologyand served on the Executive Committee of the American Association of Directors of Psychiatry Residency Training.
Treatment Approach
Within psychiatric circles, Austen Riggs stands out in two major respects. First, at a time of rapid decrease in psychotherapy —just 29 percent of office-based visits to psychiatrists involved psychotherapy in 2004-5, down from 44 percent in 1996-97 — the Center organizes its treatment around intensive psychodynamic psychotherapy with a psychiatrist or clinical psychologist. The value of the “talking cure” was bolstered in 2008 by a meta-review of 23 studies involving 1,053 patients reported in the Journal of the American Medical Association. The study found that psychotherapy, given as often as three times a week, relieved symptoms including anxiety and borderline personality disorder better than many shorter-term therapies. Though medication is administered to a vast majority of Riggs' patients, the Center follows the principles of "psychodynamic psychopharmacology," which means that it pays attention to the demonstrated ways in which relationships between patients and mental health professionals impact the efficacy of medication.Riggs’ second distinction is its long-term residential treatment in an era of managed care that emphasizes short-term hospitalizations and outpatient treatment for the seriously mentally ill. And unlike many hospitals that restrict the freedom of its patients, Riggs is entirely open, with patients free to come and go as they please. The hospital has no locked wards, seclusion rooms or privilege systems. This environment encourages patients to take charge of their treatment.
The minimum stay at Riggs is six weeks and the median stay is six months. Some patients receive residential treatment for several years, before stepping down to outpatient programs. Following the reorganization of the Menninger Foundation
Menninger Foundation
The Menninger Foundation was founded in 1919 by the Menninger family in Topeka, Kansas, and consists of a clinic, a sanatorium, and a school of psychiatry, all of which bear the Menninger name. In 2003, the Menninger Clinic moved to Houston. The foundation was started by Drs. Karl, Will, and...
in 2003, The New York Times described Austen Riggs as the last of the "elite private hospitals, often in bucolic settings," where patients can spend "months or years sorting out their lives" with treatment including intensive, long-term psychotherapy.
The Austen Riggs Center focuses its attention on individuals with serious mental illnesses for whom repeated treatments in outpatient settings have proved ineffective. The psychiatric terms for such patients are “treatment resistant” or “treatment refractory,” and the growing awareness of such individuals is reflected in the 800 percent rise in citations on the subject from 1999 to 2009.
On its website, Riggs identifies candidates for treatment there as people who have been “caught up in treatments that are at an impasse, characterized by chronic crisis management and interrupted by frequent short-term hospitalizations.” In an article published on lifesciencesworld.com, the director of admissions at Austen Riggs, Dr. Eric Plakun, said, “It’s fair to say that many patients who come to us are sick unto death. They’ve been through all the state of the art treatments. And the treatments have failed, so they are desperate and hopeless and deeply distrustful. They’re often on a dozen or more medications. And they often have one or another dramatic story — having jumped off some high bridge that everyone would know, or having survived an overdose or even a gunshot wound.” In 2007, the article noted, more than forty percent of incoming Riggs patients had made a serious suicide attempt before admission.
The goal of treatment, the Riggs’ website declares, “is to help individuals in such a struggle take charge of their lives more fully so that they may return to more productive treatments and more fulfilling engagement in the outside world.”
The typical census for Austen Riggs is about 70 patients. For the initial six-week treatment period, the fees are approximately $1,000 a day, which can be adjusted, according to need, as much as 25 percent. Costs are significantly reduced in step-down settings at Riggs. Without insurance coverage, the average cost to a patient at Riggs — including four-times a week psychotherapy, groups, activities, medication, housing and meals — is about $600 a day.