Sunday, January 23, 2011

My First Trip to the Asylum

Worcester State Hospital
One of my first jobs was a case manager for a social service agency. We worked specifically with people who were (1) homeless (2) had severe mental illnesses and (3) had never received any sort of public services before. Being the newest case manager, I was assigned to work with people who were committed to the local state hospital because they were judged to be not guilty by reason of insanity. By law, each and every person in the hospital, regardless of background or status, had a community case manager to advocate for them and help them prepare to be released from the hospital at some point in the future.

These were people that most of society had considered hopeless. All had committed some sort of violent crime. All suffered from hallucinations and delusions that medication were unable to help. Some had been in the hospital since the 1950s! Most had never used an ATM, used a phone that didn't have a rotary dial, and of course none had ever even known there was an internet. 

I went to the hospital every two weeks to visit a handful of people. Every time I went it was a strange experience. The building was something that looked right out of a Dickens novel. I'd pull into the parking lot, register in the office, and pick up a set of keys. At least, I would try to pick up a set of keys. Sometimes other case managers had all the keys so I was left to fend for myself. 

Taunton State Hospital
I'd go to the building were my clients lived. Work my way through security. When the elevator door opened to the secure floor I'd feel most of the humanity get sucked out of the room. A mass of people would be on the floor. Some would watch TV, others would stare aimlessly out the window. I never saw a single hospital person interacting with the patients. 

The staff would all be locked inside the office area. There were always a group of patients banging on the door trying to get someone's attention. They'd usually be responding to some sort of hallucination or delusion. It was sad--and I was sad. I was not yet even 23 and thought I could change the world. I learned quickly there was not much to do to help these people. My sadness grew--in part because there was not help--but mostly because I could not help the staff there. I couldn't ever seem to convince anyone to care about the people banging at the door or staring out the window. 

Greystone Park State Hospital
I also had a sub-clinical anxiety in the hospital. I worried that someday I'd be mistaken for a patient, be stripped of my humanity, and refused exit and told that I was hallucinating and wasn't actually a case manager.   Of course, this came true in a way. One day there were no keys available were the social worker's checked in. There weren't even any ID badges. I did my visiting and had a meeting with staff. I left the staff offices for the elevator to leave. Of course I couldn't leave because I didn't have a key to operate the elevator. There were no staff on the floor to be found. As you  might be guessing, I soon joined the couple of people banging on the door of the staff office. My sub-clinical anxiety now a real thing: locked inside, ignored, trying to get the attention of the staff. 

It took me 20 minutes to get someone's attention.

I leave you today with these images from 19th century insane asylums. They were big, graceful, beautiful places. The hospital I visited was similar to these images--I know what they looked like in the early 1990s. Ever wonder what they looked like in the late 1800s or early 1900s?

These images are all of Kirkbride designed hospitals. Dr. Kirkbride was a 19th century physician and asylum superintendent who wrote about hospital design. He had an enormous influence on the conceptualization and construction of insane asylums in the latter part of the 19th century. The design of the building itself was seen as an agent of change to help patients return to sanity. You can find out more here. The views change a little bit when you look inside and away from the places where the administration worked.

Buffalo State Hospital

Iowa State Hospital

Cherokee State Hospital

Athens State Hospital


  1. I live very near where "One Flew Over the Cu-coo's Nest" was filmed, and actually written. Because of this proximity, I saw the movie at a very young age and it made a huge impression on me. The hospital where it was filmed is still in operation, although there is talk of replacing it. I would hope they have updated things since then-treatment and facility.
    It is very sad to think of how we have treated our mentally ill population in the past, and I can only hope things are improving.

  2. There is still a state hospital operating in Elgin, ILLINOIS, close to where I live. It has been greatly downsized now, but still has people in there. Years ago, there was a tall steel fence around the property and the patients walked the grounds, sometimes just in circles. I always broke my heart to see this and I wondered what help if any do they get. My aunt back in the '50's was a patient there. Don't know why, but my mom would visit her often. She would always tell my mom that 'I have to get out of here, they are making me crazy'. Much to the family's sadness, she somehow found a way to escape and months later was found dead in her home in the basement hiding under a table. This is a very sad story and I wish I really knew what happened here since this was family. But they places never really helped the people, my opinion. Or do people actually get to a point that they are 'beyond help'? God forbid if that is the case. Then what do we do as a society??

  3. Thanks for commenting Linda. Having been inside some of the best--and some of the worst--psychiatric facilities in the United States I'd have to say it's a mixed bag. As with most everything else, people get what they (can) pay for. Those with financial resources or stellar insurance can get access to some fantastic care that is life-transforming. Those with little or no financial resources or less than ideal health insurance plans get very little. Our most vulnerable--many who have chronic mental illness--often do not have the means for life-transforming treatment and receive very little.

    I think we can do--and should do--so much better.

    None of this is intended to be disrespectful of many of the dedicated, caring, and hard working people in psychiatric facilities. I think many of the people working on the inside are doing the best they can with very little.

  4. Thanks for commenting, Mary. The scene you describe is all too common: broken down people with little hope and not much else to do but walk in circles. It breaks my heart too.

    Did you know as late as the 1950s many people with epilepsy were institutionalized in asylums? It's part of our hidden past as a country that is almost never spoken about.

    I don't think anyone is beyond help: thought I don't think that help always equals healing. I think that we can treat anyone--no matter how sick or ill--with dignity and respect.

  5. Wow! I remember reading about these primitive institutions back in Psyc 101! Just insane how people with mental illnesses were treated back then. I agree with the author when he said that people should be treated with respect regardless of their mental state. Learning the history of psychology was somewhat disturbing! Thanks for sharing...

  6. I cute my teeth in a similar setting. The work was very profound and meaningful - and humbling.

  7. Hi Jason,

    Somehow your narrative was played with black and white picture in my head. Your experience was contemporary, but the nature of the experience felt like you were in Bedlam during the Victorian Era... like you said, very Dickensian.

    You said the staff had no interaction with residents. Did you have a sense that they intentionally zapped the patients' presence or acted as if the patients were invisible? Or even the staff acted like THEY were invisible?! Very intriguing.

    And most importantly, what would be the rational of such a behavior? Makes their work quicker or bearable? Or it was the culture of that certain hospital that no one would question?

    1. Hi Shuko --

      What great questions! This will have to become a blog post in the very near future. My quick response is that I think the staff became habituated to the constant stream of people knocking on the door responding to various hallucinations.

      Perhaps many of the staff started out eager and willing to be present for the patients.

      "No Mr. X, the KGB isn't monitoring you through the fillings in your teeth."

      Maybe the tenth time, or the hundredth, the answer became emptiness and the staff ignored the reality of the patient. I'll write more about this!

    2. I'd have to agree that staff becoming habituated to the situations that arise over and over has a lot to do with why they don't respond. Also, hospitals are often understaffed, and they are just too busy with day-to-day operations to be present for patients.

      This is tragically unfortunate because instead of creating a healing environment hospitals create a feeling within patients that they are merely being housed until released. At least this has been my experience with crisis stabilization units. I was literally dumped out into a side parking lot after one release because the tech didn't have time to walk me up to the front of the building!

      It frightens and makes me sad to think of hospitals 50 years, 150 years ago. If staff are overwhelmed now even with access to computers, modern conveniences, more comfortable accommodations, better medication and greater understanding of mental illness, I don't want to imagine how patients from previous decades/centuries felt.


    3. That is so sad--and such an important story to share. Many look toward past abuses in psychiatric hospitals and think we've changed. There may be less systematic physical violence and abuse--yet there are myriad tragedies and horrors that go on daily.

      I was just watching a Frontline episode on the web yesterday about how prisons have become the new asylums. I think I'll post that show in a separate blog post.