The rise and fall of the state hospital system.

PERCHED ATOP A HILL overlooking a small college town in Ohio (United States), Athens State Hospital--now known as The Ridges--has an imposing presence that the banners for the art gallery in the central building do little to diminish. While a fraction of the building is currently in use by Ohio State University, the majority of the aging Kirkbride hospital has been left to the peaceful solitude of its own decay. The hallways and rooms, still peppered with fragments of the past, are rife with uncharted mold and bacteria; the walls have become intricate murals of the eroding lead paint that dusts the floor and poisons the air.

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In many senses, Athens State Hospital is an anomaly. It has been incredibly well preserved and protected from thieves and vandals, and reminders of its history are still intact. Most state hospitals, such as Byberry State Hospital in Philadelphia, have been completely left to the elements and are easily accessible to anyone who cares to research them and risk getting caught by the meagre security forces that guard them. Such sites are frequently seen as a problem to the communities they are part of, due in part to the fact that an entire subculture of self-titled urban explorers has developed, populated by people ranging from those with a deep and abiding respect for the sites to those who look at them as opportune sites for graffiti and vandalism. While these sites are extremely toxic, the dangers are often invisible to those who enter. Asbestos and lead particles in the air do not affect one's health immediately and rotting floors often give no signal of their structural weakness until it is too late. Furthermore, these sites are on prime locations for development, yet their historical significance is undeniable, and often the cleanup of hazardous materials makes costs prohibitive.

While now famous for the abuses and horrors that took place inside, most state hospitals were initially beautiful, idyllic campuses founded in the late 1800s, largely in response to the tremendous need for mental health care for veterans of the United States Civil War suffering from what would later be labelled post-traumatic stress disorder. Public awareness of the need for adequate and full-time care for the mentally ill was higher than ever, and reformers like Dorothea Dix (1802-1887) and Thomas Kirkbride (1809-1883) helped promote what would become an unparalleled movement to create asylums funded by state and local governments to tend to the needs of the mentally ill. Such facilities were founded on the curative principles of healing through humane treatment, labour and the natural beauty of the sprawling campuses on which the hospitals were built, and were intended to be self-sustaining. As such, the food was grown and the grounds maintained by patients, and by all accounts the treatment provided was a vast improvement on the universally poor care afforded to the mentally ill prior to this era.

But such times were not destined to last. After the turn of the century, state hospitals became warehouses for an increasing number of people who society deemed undesirable, including criminals, the poor, homosexuals, those with unorthodox religious views, unwanted children, the elderly, syphilitics, alcoholics and anyone else who was inconvenient to those around them. During this period, it was frighteningly easy to commit a wife who was no longer wanted, children who misbehaved or aging parents whose care was too cumbersome.

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As populations swelled past the capacity for which the asylums had been designed, the level of care plummeted, and with such diverse populations being cared for in the same wards, consistent treatment was impossible. Cuts in funding during wartime and the depression forced many patients to sleep on floors or in hallways. Treatment reached critical proportions during the Second World War, when funding and supplies were unavailable and the majority of able-bodied staff were involved in the war effort. The care for patients also became unimaginably nightmarish: there were wards full of malnourished, unclothed and filthy patients, who were forced to eat rotten food and sleep in quarters that were falling apart, often fatally exposing them to the elements. With staffing ratios at unthinkable levels (at times 1 staff member to 200 patients) and facilities crammed to nearly double their intended capacities, abuse by staff also became incredibly problematic. Patients were severely beaten, raped, prostituted, denied medical care and otherwise mistreated to levels that are beyond comprehension. One cannot help but think when looking at pictures from this period that the patients are nearly indistinguishable from Holocaust survivors.

In his book, Mad in America: Bad Science, Bad Medicine, and The Enduring Mistreatment of the Mentally Ill, Robert Whitaker makes a compelling argument for how the Holocaust and the treatment of the mentally ill in this period both were founded on the same principles of eugenics and the cleansing of "undesirables" from society: the stated goal of the concentration camps was the extermination of Germany's upper-echelon groups deemed detrimental to society, while the same, if unstated, goal in the United States mental health system was attained through forced sterilization and lethal neglect.

As the war ended, several major exposes brought the abysmal treatment of the mentally ill to light. A photo essay, entitled "Bedlam 1946", in Life Magazine and Albert Deutsch's 1948 publication, The Shame of the States (Mental Illness and Social Policy: the American Experience), helped raise public awareness of the plight of the inmates in many psychiatric hospitals. While this served to ameliorate the situation somewhat, most of the measures taken to remedy the problems were short-lived. Overcrowding and insufficient care continued to be problematic, although less so than during the years of the Second World War, and abuse of patients continued unabated. There is simply no way to encompass all the cruelties heaped on the patients; most are familiar with lobotomies, which gained popularity as they produced manageable patients, albeit those whose cognitive functioning had been permanently impaired. A particularly barbaric variation of this treatment was performed at Athens State Hospital by Dr. Walter Freeman (1895-1972), who made use of neither anesthetics nor an operating room, and whose careless technique shocked even other doctors and nurses familiar with the procedure. Another common form of treatment was hydrotherapy in which a patient was placed in a tub, which would be filled with either scalding or freezing water, and a sheet was zipped around the neck so only the head was sticking out. Depending on the temperament of the staff, the patient might be left in such a state for days without even a pause to use the bathroom. As the hospitals' intent was less to cure than to warehouse patients, the purpose of the treatments was less to produce any measurable improvement in their condition than to subdue them, making them convenient for the staff.

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During the late 1960s and 1970s, the advent of the "chemical straight jacket" Thorazine changed the face of mental health care. Neuroleptics like Thorazine produce a myriad of intensely uncomfortable, frightening side effects and were in fact later identified by Soviet political dissidents as one of the worst tortures they were subjected to in the "psychiatric centres" where they were confined. They produced docile and compliant patients however, and their use was far-reaching and indiscriminate in the American mental health system. As their use became more widespread and the push for deinstitutionalization was spearheaded by President John F. Kennedy and newly formed patients' rights associations, the focus of hospitalization shifted from containing patients for the remainder of their natural lives to bringing their behaviours to manageable levels that would allow community integration. While this policy was in many ways beneficial, the treatment at hospitals continued to be an inhumane and dehumanizing process. In his book, entitled The Shoe Leather Treatment, referring to the common "treatment" of kicking patients until they were compliant or too injured to resist, former patient Bill Thomas relates that after years in state hospitals, a brief stay in prison after an escape attempt seemed an immeasurable improvement in his quality of life.

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Coupled with the push to reintegrate patients into society, this flagrant abuse and neglect finally led to the closure of many asylums. Even this process was messy, however. Under President Ronald Reagan's policies, which often led to dumping clients out of hospitals with inadequate aftercare, the homeless populations soared. When the closure of Byberry State Hospital was initiated in 1986, three patients drowned in the Schuylkill River before the Pennsylvania Governor decided to slow down the process to a manageable level. This process continues to this day and the problematic nature of providing care for the mentally ill continues to haunt us. Harrisburg State Hospital in Pennsylvania recently shut down, forcing communities and mental health providers to scramble to find alternatives for patients with higher treatment needs. Many patients now in communities may require assistance for the rest of their lives in dealing with mundane chores most take for granted, such as buying groceries and paying bills, because they were never exposed to these problems during their hospitalization.

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The ever-present issue of what to do with state hospital facilities is also difficult. In many cases, the land and buildings will be almost immediately reclaimed, sold to developers or used as state agency offices. Several facilities, such as Danvers State Hospital in New York, are being converted into high-priced apartment buildings, although some ex-patients and mental health workers view this as a move only slightly more tasteful than making apartments out of Auschwitz. Other facilities like Dixmont have been completely demolished by large companies, which see the sites as development gold mines and have no problems bulldozing unmarked gravestones in patient cemeteries to make way for their projects. Some, such as Pilgrim State Hospital in New York, were partially used, abandoned and demolished. Countless more sites have been completely abandoned, standing until the roofs collapse under the weight of years of water damage or until they are burned by arsonists. Almost none are protected historic sites that visitors can enter to learn about their checkered past.

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Two examples stand out, however, as thoughtful ideas for reintegration of the properties into the communities. The state hospital in Fairview, Connecticut, has been turned into a public park--the buildings are well secured and the grounds well kept--where during the day one finds community members jogging, picnicking or walking their dogs. Ironically, by being open to the public, theft and vandalism have taken significantly less of a toll on the buildings compared to other state hospitals whose grounds are off-limits.

Athens State Hospital is a fantastic example of proper maintenance of an historic site. The university uses portions of many of the buildings and as such the grounds are well-maintained, beautiful and secure. It has an excellent section on its website dedicated to the history of the facility; the wings of the old Kirkbride hospital are in better condition than nearly any other state hospital in the country. Also unlike many other asylums, Athens State Hospital sits securely on a hill overlooking the small college town. While entering it requires a respirator and permission from the faculty, its rich and multilaycred past remains intact for now, serving as a poignant reminder and an epitaph to the many shattered lives that passed through its doors.

Matthew Murray's work in mental health spurred a deep interest in its history. Trying to capture the amazing beauty of the asylums led him to photograph other abandoned sites before they are gone forever, including prisons, factories, military and industrial buildings, farms and houses. His photographic work can be viewed at his website gallery, www.abandonedamerica.org.

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