Outpatient Commitment - An Asylum in the Community

(Re-Read Text pp. 169 to 176)

Does outpatient commitment recreate an asylum in the community? why or why not? Give at least 3 reasons for your answer, and then reply to one of your classmates.

Therapeutic Use of Hallucinations...WHUT??????

(READ THE KARON ARTICLE ON Bb -- FOUND IN MODULE 9 -- THEN READ THIS AND POST)

Historically, people with schizophrenia have been told that their symptoms (i.e., hallucinations) need to be medicated away. "Once you are stable, then we can address your other needs..." This week, as we consider deinstitutionalization and people's rights in the community, often it is hallucinations that mark people as "other" or "crazy." Hallucinations can be very stigmatizing.

The recovery movement offers a different narrative. One does not have to be "stable" and "symptom-free" before recovery can begin, quite the opposite in fact. The community is a place one can recover and learn to advocate for rights. One can have symptoms and live well in the community.

What if hallucinations were recast as unconscious needs? What if people in the community, family, and support professionals viewed hallucinations not as an aberration, but as communication? We all have dreams, and some of us even dabble in dream interpretation....what if hallucinations are just waking dreams? What if a recurrent theme in a person's hallucinations means something? A need breaking through into wakeful consciousness?

If we viewed hallucinations as communication, would we still want to medicate them away? Would people be seen as "crazy" by providers and/or society at large?

Reply with your reaction to this premise (using hallucinations in therapy), and the questions above. Then reply to at least 2 of your classmates' posts.

Walter Freeman, Howard Dully, and Lessons Learned

I have so many intense feelings after listening to Howard Dully's account of what happened to him. At 12 years old, he received a transorbital lobotomy, because his step-mother convinced an eager doctor, that the boy was unmanageable. Truth was, he had just lost his mom, and the adults had told him she had just "gone away." At the time she was replaced by this stepmother who was, at best, unkind to Howard.  Of course the cause of the problems was "Howard was a difficult child." That was the story the stepmother and Freeman told themselves.  It seems Howard's Dad was too disengaged to question his new wife's motives and/or judgment. The child, in this case, was labelled and treated, yet was NOT the source of the problem.

Do you think that this happens today? If so, give an example. If children are serving as sacrificial lambs so to speak, what can we do as practitioners to limit the risk to kids?

Answer these questions, and then respond to at least 2 of your classmates.

Milledgeville – Georgia Lunatic Asylum – Central State Hospital by Jackie Hayes

Georgia State Lunatic Idiot and Epileptic Asylum opened and accepted its first patients in December 1842.  It was later known as Georgia State Sanitarium, Georgia Lunatic Asylum, Milledgeville State Hospital and now is known as Central State Hospital.  Dr. Thomas Green oversaw the facilities during its first 30 years and utilized a family model of treatment in which patients were treated and cared for in the manner and kindness of extended family. At one time it housed 13,000 patients and covered approximately 2000 acres and utilized 200 buildings. Over 25,000 patients have died and are buried on the campus, although many grave-markers were thrown in the woods by groundskeepers and they include only numbers as opposed to names. The buildings on the campus resemble large plantation style historic buildings and due to the large population of patients include many rooms, long hallways, and various types of buildings that meet the needs of its large community.  Although the facility was built to support the children, adolescents, and adults with mental health issues, physical disabilities, and epilepsy, many patients were admitted with unclear diagnoses and mere descriptions as “funny.”  The place unfortunately experienced overcrowding with staff to patient ratios of 1 to 100 and utilized less than caring techniques of treatment.  Doctors used lobotomies, electroshock, insulin shock, confinement in cages and straitjackets, cold showers and steam baths.  In 1959, an Atlanta report named Jack Nelson investigated the facility and found that many former patients had been promoted to “doctor” status and participated in treatment of other patients.  At that time a mere 48 “doctors” were treating thousands but not one of the “doctors” was a qualified psychiatrist.  Nelson won a Pulitzer prize for his work.  From 1960 on, the hospital’s population continuously declined.  As the culture shifted to deinstitutionalization, more and more patients and families opted for community care.  In 2010, the Behavioral and Mental Health Department in Georgia determined that Central State Hospital should be closed.  The facility is currently open and caters to 200 patients but is continuously gradually diminishing its services and populations so that it may eventually close entirely.  Most of the buildings are in decay and only a handful are currently used to support the remaining population.

Florida State Institution by Liz Nitzel

The Florida State Hospital for the Insane in Chattahoochee, Florida was originally a military arsenal in the Seminole Wars then it became a state prison but in 1876 it became the State Hospital. The prison already had a history of abuse and it appears that the abuse and unlawful imprisonment continued throughout the next hundred years.
One famous patient, Emmett Foley, is depicted in the movie, “Chattahoochee,” based on the real life experience of a Korean War veteran who returns from war to realize that he cannot afford his family. He attempts to set up a situation to have the police murder him but he is captured and sent to Chattahoochee. Emmett endears horrific living conditions and beatings but soon he decides to document the treatment in the hospital and slip it out of the institution in a bible while his sister is visiting. This prompted an investigation and reforms.
In 2016, Chattahoochee was back in the news when budget cuts led to staff reductions and overcrowding. The Institutions in Florida received $100 million in budget cuts then started doubling up patients in rooms without regard for safety. On April 23, 2016, a 60 year old patient is stomped to death by his 19 year old roommate, this is following a similar incident in January of 2015.
Today the Florida State Hospital is depicted on its official website like a country club with beautiful fountains and happy people of diverse races walking down a perfectly manicured sidewalk. The mission statement reads: “Partners with Stakeholders to Promote Competency Restoration, and Personal Recovery and Resiliency through a Trauma Informed Approach.” The deaths began in the early days of the institution as depicted on a Facebook page: Florida State Hospital’s Lost and Forgotten. The more recent deaths caused by patient neglect, failure to follow safety protocol are still being revealed in newspapers and still protected by laws, Luis Santana, a 42 year old man had been given 5 strong antipsychotic medications then left in a bathtub to die.




https://en.wikipedia.org/wiki/Florida_State_Hospital

http://www.rogerebert.com/reviews/chattahoochee-1990
http://www.tampabay.com/news/floridas-mental-hospitals-are-still-violent-and-deadly-w-video/2295763
http://www.myflfamilies.com/service-programs/mental-health/fsh
https://www.facebook.com/Florida-State-Hospitals-Lost-and-Forgotten-324351667756430/

Western North Carolina Insane Asylum- North Carolina- by Shea Shattuck-Faegre

The Western North Carolina Insane Asylum- later to be known as Broughton- opened in Morganton, North Carolina in 1883. It was a massive, sweeping brick manor located on a 263 acre plot.
It was originally built after Dorthea Dix directly worked to influence the General Assembly of North Carolina to appropriate funds for such an infrastructure to house the mentally ill.
People of varying races, both male and female, and including school-aged patients, were committed there. People from all social strata made their way to the institution by means of voluntary and involuntary committal. In its early days, the Asylum served people from 53 counties in North Carolina.

For a brief time, the facilities took on what was known as the “colony approach”, where farm-style houses were built so that some of those committed could live in a more home-like environment, and a number of community activities existed. Beginning in the 1920’s, and over the years, many other facilities and features were added to the layout of the asylum. The institution even hosted socials for others in the outside community at one point.

Despite the grand facilities, the addition of client specific wards (such as men’s and women’s tb wards) and an amusement hall, things were rather unpleasant for many of the residents and employees for some time.  Firstly, since its original opening, male patients did much of the arduous construction of roads around the facilities. Clark Cahow, who wrote extensively about the hospital, also summarized other problems with the Asylum, describing “insufficient and poorly trained staff”, and “overworked professional personnel,” with “inadequate facilities”. The patient numbers were around 300 patients per doctor, and 13 patients for 1 staff. Nurses worked 15 hour shifts, often 7 days a week, and were poorly paid. It is no wonder that the conditions were then found to be so deplorable by Jim Tomison, a prominent lawyer and activist who had checked himself into the institution in 1940. A newspaper later published a series of articles describing the conditions there. An anonymous woman coauthored the articles with Tomison; she was from a prominent family and had been admitted due to a nervous condition. They described the conditions as terrible. There were rats, roaches, and frequently guests with TB mingled with the others. Patients aimlessly milled about their wards, often screaming in agony. Overall, it seemed as though the patients were not getting the care that they needed.
In the 1960’s, there came a concerted period of deinstitutionalization, and funds and facilities were created to decrease patient density, and to work to release people to the community.  An educational facility was also opened for school-aged children in the 1960’s. The Asylum is still active, and is today known as Broughton.

http://www.asylumprojects.org/index.php?title=Broughton_Hospital

http://docsouth.unc.edu/nc/asylum1884/asylum1884.html

http://www.chasinghannah.com/blog/2013/9/5/the-charlotte-news-articles-tom-jimison-and-the-morganton-womens-ward

ATHENS LUNATIC ASYLUM by Suzanne Posey

 

The Ridges, formally Athens Lunatic Asylum operated in Athens, OH from 1874 until 1993.  The bricked architecture was characteristic from lavish Victorian-era with a “bat-wing” floor plan. It was housed on over 1000 acres of land and the building itself was 853 feet long and 60 feet in width. Seven cottages were built to house more patients.  The males lived in the left wards and females in the right. Each had their own dining halls as well. The facility sustained itself with its own farm and livestock.

The patients included Civil War veterans likely suffering from PTSD, rebellious children,  elderly parents whose family did not want to care for anymore, women deemed unable to run their farms and violent criminals who experienced mental illness.

 During the first three years of operation, the leading cause of insanity among the male patients was masturbation. This was a common belief in the 19^th century. For women, the three leading causes of insanity were puerperal condition, change of life, and menstrual derangements.  Originally The Ridges was a calm and peaceful place. The grounds were like a park with gardens and water fountains. Patients were put to work in the greenhouses, orchards, with the livestock, or in the carriage shop. The more sedate were also allowed recreational activities like boating, painting, dancing and picnics.

However, it became overcrowded and the treatments for most became horrendous as this asylum was known for the lobotomy procedure, as well as hydrotherapy, electric shock, and psychotropic drugs. By the 1950's, the Ridges housed almost 2000 patients, which was over 3 times it capacity. The staff number never changed though. By the 1980'’, treatments like the lobotomy was frowned upon the buildings began to be donated to Ohio University with 300 patients left.

During its time, open, many of the patients were never discharged and there are approximately 1,930 people buried at the three cemeteries. It is said to be haunted with one corpse stain that continues to reappear.

 

For ore information see:

 

https://en.wikipedia.org/wiki/Athens_Lunatic_Asylum

http://www.forgottenoh.com/Ridges/ridges.html

http://www.complex.com/pop-culture/2013/01/crazy-mental-asylums/athens-lunatic-asylum

http://hauntedathensohio.com/the-ridges-mental-health-institution/

Philadelphia State Mental Hospital at Byberry by Michelle Chasse

The Byberry Mental Hospital was opened in 1907 in Northeast Philadelphia and The facility included over fifty buildings with peak patient population was over 7,000 in 1960. The hospital was one of the biggest institutions in Philadelphia. The original intent of the facility was as a small work farm and turned into something to relieve overcrowding at surrounding mental asylums in Philadelphia known as a custodial institute. The theory of the founding physician Benjamin Rush was to give patients proper treatment, and keep them away from normal people.
The patients at Byberry were often sent from closing hospitals and were a range from homeless, poor, and criminally insane. The patient experience at Byberry was appalling, and only escalated the longer the facility was open. Being a custodial institute this hospital got onslaught of patients that made it harder and harder for the facility to remain humane in it’s treatment. While patient numbers rose there was 14 on-staff physicians, 90 nurses and one attendant for every 300- 400 patients. Many patients lost their lives at this facility due to their illnesses and neglect, but before the state takeover in 1938 there were almost no records taken of patients and the numbers of the deceased are not known.
In 1938 the hospital was taken over by the State to help the institution concur internal problems, but the hospital remained involved in many abuses towards patients. A Life magazine reporter Albert Maisel focused on the lack of proper staffing at Byberry in an article he released to the world, but because of the increased need of places to put mentally ill people the hospital continued on. Unfortunately even as the times changed and the era of deinstitutionalization was in full swing Byberry continued to commit in humane acts and was well known for it. In 1989 the hospital was shut down after the Commonwealth of Pennsylvania appointed a task force subsequently called the Blue Ribbon Committee finally looked into the years of abuse at the hospital.

For more info: https://en.wikipedia.org/wiki/Philadelphia_State_Hospital_at_Byberry
 https://philadelphiaencyclopedia.org/archive/byberry-philadelphia-state-hospital/
http://www.philadelphiastatehospital.com/

The Connecticut Hospital for the Insane by Sandy Weirs-Haggerty

In 1868, two initial parts of the Connecticut General Hospital for the Insane (now called Connecticut Valley Hospital) were opened in Middletown, CT on the Connecticut river.  The physical layout was inspired by the work of Dr. Thomas Kirkbride and was built in Second Empire Style.  Large stone buildings, four stories high, made up the initial construction of the hospital.  There were eight wards on either side of the central building.  Over time, more land was acquired to total around 650 acres and 80 buildings.  The hospital was constructed to specialize in the humane treatment of the insane.  The goal was to construct buildings that positively impacted mental health and created an environment conducive to treatment.  Some spaces were decorated with books, photographs, and art and the goal was to reduce stigma around mental illness and create a sense of normalcy.  Those who complied with the regimens lived closest to the central building and those who were more violent were furthest away from the center of the building. 

Activities and amenities were included to help instill a sense of civility for the patients and increase responsibility.  To promote wellness, there was a carpenter shop, a baker shop, lecture hall, chapel, billiards room, and bowling.  Patients also had the option of working on the hospital farm.  A strict regimen was established, which included bells that would ring to dictate movements of patients and staff. 

Unfortunately, the intended results were not achieved due to overcrowding.  Immediately after the initial opening, there was more and more demand.  Once the hospital was deemed complete in 1871, the 450 beds were not nearly enough.  Extensions were not approved until 1881 and this still did not meet the demand.  Basic custodial care was the emphasis as the hospital became a dumping ground for anyone needing this care which included epileptics, alcoholics, and intellectually disabled.  The patient to staff ratio was 230:1 by 1890. There were some improvements when new superintendents assumed control in the late 1800’s.  Hydrotherapy was introduced, a reorganization of the hospital layout, and development of a pathology department to look at microbiological causes of mental illness were part of these improvements.

In 1908, Clifford Beers, who was committed to the hospital for a year and a half, published a book entitled A Mind that Found Itself.  This book shed light on his experience and what he witnessed at the hospital including lack of therapy, abusive staff, and poor conditions. This work helped advance the movement of institutional care as a last resort. In the 1950’s the peak population was around 3000.  There is a cemetery on the grounds that has 1652 graves. Connecticut Valley Hospital, as it is now called, still is in operation as a psychiatric hospital that provides inpatient care for forensic, severe addiction, and geriatric treatment.   

 

http://www.asylumprojects.org/index.php?title=Connecticut_State_Hospital

https://connecticuthistory.org/designed-to-heal-the-connecticut-general-hospital-for-the-insane/

http://opacity.us/site156_connecticut_valley_hospital.htm

 

Athens Lunatic Asylum-Athens, Ohio by Toni Carter

The Athens Lunatic Asylum was opened in 1887 in Athens, Ohio.  Its name changed many times through the years, eventually being called the Athens State Hospital and the The Ridges Mental Health Institution. The Athens Asylum was built based on the Kirkbride Plan concepts. The asylum was located on 141 acres of farmland.  The original structure included a main building that was used for administration as well as 2 wings, the left for males and the right for females with the plan being no contact between them.  The original plan  for the asylum was to house 572 patients. Farming and orchards were added to the grounds of the asylum by early 1900s and were tended to by patients and staff. The asylum provided meat, eggs, and vegetables to the surrounding area. There were many acres of land to walk on.

 The Athens Lunatic Asylum was opened initially to provide assistance after the Civil War.  The Athens Lunatic Asylum provided housing for males and females in separate wings. The program was open for about 100 years, and during that time, treatment  was provided for  many "illnesses" of that time including seizures, high sex drive, and anxiety, to name a few. In addition, veterans from the Civil War who struggled with symptoms that would now be considered Post Traumatic Stress Disorder were placed there.  People who had committed violent crimes and who had mental disabilities identified at that time were also placed in the Athens Lunatic Asylum. People with Tuberculosis also sometimes resided at the asylum.

At its opening, the Athens Lunatic Asylum followed the Moral Treatment program and included work and rest as well as hobby activities to promote and support the people who resided there. Over time, inhumane treatments were introduced and became routine practice including lobotomies, hydrotherapy, electroshock treatments, and use of  insulin shock treatment. Some of the staff lived on the grounds while others lived in the community nearby.  Some staff were trained to provide treatment while others had no training at all. It was reported by many people who lived in the local area and worked there that many patients died due to some of the treatment practises.

Over time, it became common for people who could no longer afford to take care of their elderly and children to leave them at the asylum. Overcrowding became a significant problem. People began to be treated like prisoners warehoused in seriously overcrowded conditions without enough staff or treatment. Eventually, community programs became the priority.  Patients at the asylum were either transferred out or dumped out into the streets, becoming homeless.

Billy Milligan, a man accused of multiple crimes including several rapes on the campus of Ohio State University during the 1970s.  He was placed here.  He was eventually acquitted of his crimes due to the legal defense of having multiple personality disorder. Billy Milligan was the first person to use the defense of insanity for having multiple personality disorder, claiming he was not aware of committing the crimes because 2 of his other personalities had done so.  He was also the first person to be acquitted using this defense. His story was written by Daniel Keyes, The Minds of Billy Milligan. 


For more information see:

http://www.gutsandgore.co.uk/asylums/athens-lunatic-asylum/
http://hauntedathensohio.com/the-ridges-mental-health-institution/
http://athenshistory.org/asylum-walking-tour/
http://danielkeyesauthor.com/milligan.html

Danvers State Hospital by Dustin Greenlaw

Built in 1874 and opened in 1878, the Danvers State Hospital was a massive architectural feat that sat atop Hathorne Hill (where the Salem Witch Trials judge John Hathorne once lived) in Danvers, Massachusetts. The 700,000 square feet, Gothic-style building was designed based on the Kirkbride plan where one central administrative building had four wings off both sides. Kirkbride believed that this design allowing exposure to natural light and air circulation were crucial to an environment that would help cure patients. Danvers State Hospital was originally established to provide residential treatment and care to the mentally ill and criminally insane. Over time its functions expanded to include a training program for nurses, pathological research laboratory, and operating school clinics to help determine mental deficiency in children. When originally opened it was called the “State Lunatic Hospital at Danvers”, housed 450 patients suffering from various mental illnesses, was considered a one-of-a-kind facility, and was considered a leader in humane treatment.  The patients’ regimen involved exercise and the creation of elaborate gardens as well as a patient-run farm that produced large harvests used in the institution’s kitchen. By the late 1930s and 1940s over 2,000 patients were being housed here and overcrowding had become severe with little increase in staff and resources creating improper staffing and supervision. In the 1890s the superintendent declared mechanical restraint unnecessary and harmful in cases of mental illness. In response to the problem of destruction by disturbed patients, the hospital reacted with better segregation of patients, the use of special garments and the use of bed care for denudative patients, occupational therapy, and sedative forms of hydrotherapy which they then reported a considerable reduction in destruction. As a result of increased emphasis on alternative methods of treatment, during the 1960s the inpatient population started to decrease due to de-institutionalization and community-based mental health care. 

http://historyofmassachusetts.org/history-of-danvers-state-hospital/

http://www.danverslibrary.org/archive/?page_id=1096

https://www.danversstateinsaneasylum.com/history

http://www.asylumprojects.org/index.php?title=Danvers_State_Hospital