Another walk at the state hospital
We took another walk at Northern State Recreation Area yesterday. One of the luxuries of being retired is being able to follow paths without knowing exactly where they are leading. The map of the hiking trails in the area are less than precise and the paths we had previously followed were all loops, so we kept expecting this particular trail to lead back to another path, but it did not. It led to a dead end and then we had to walk back on the path to get back. We added about two miles to our usual walk of two miles, so all-in-all walked 4.33 miles. It caused no problem. We had the time. We enjoy being together. The exercise is good for us. My loving partner has learned over the years that I am prone to taking “long cuts” when we are exploring.
The walk gave me more time to think about the history of Northern State and the history of state institutions for mentally ill persons in general. Those institutions were born out of genuine concern for the victims of mental illness. They needed places where they could be safe and secure. In addition to those suffering from mental illness, most of those state institutions housed individuals who had cognitive disabilities. Before such disabilities were understood, it was common for a child born with Down Syndrome, for example, to be removed from her or his family and housed in an institution. Now we understand more about Down Syndrome, we understand that those who are born with an extra chromosome can grow to be productive adults and participate fully in life. Back then it was thought that such individuals would never be able to learn the basics of talking, self-care or ever gain skills that made them employable.
The institutions tried to separate those who had violent tendencies from others and, for the most part, did a good job of keeping innocent victims from violence. They provided a way of life that supported persons as they went through their lives and often people lived the remainder of their lives in the institutions, which developed areas for senior care and end of life care.
Northern State had its own cemetery. The remains of nearly 1,500 persons are buried there. We visited the cemetery yesterday. It is a large field, kept mowed, with a single marker in memory of all who are buried there. No individual graves are marked. There are no headstones. There was no way to distinguish individual graves.
I wondered about the stories of individuals as we went on the rest of our walk. Some of them, I presume, were cut off from their families by the process of institutionalism. I know that some state hospitals discouraged and even forbid families from visiting. The visits disrupted the normal flow of the days for individuals. Some people became upset when family members had to leave and were disruptive in their expressions of their grief. Some care givers mistakenly thought that it was best for the individuals not to receive visitors. They were institutional residents now. The institution was their family.
Families grieved when their loved one was admitted to the hospital and then they went on with their lives. Parents died before children and there were residents of the institution who had no one but the institution to care for them when they died. As the size of the institution grew, so did the number of deaths. If you take the number of deaths and divide by the number of years the institution operated, it comes to about 30 deaths per year. Those deaths must have resulted in grief for residents and staff, but I know virtually nothing about how grief was handled in the institutional setting.
By the mid-1970’s the attitude of society towards mental illness and disability was shifting. One pioneering family in the town where I grew up decided not to allow their daughter to be institutionalized. They kept her at home and raised her in the love and warmth of their family and the concern of a caring community. She grew to become an important member of the community and lived a full and productive life. This was happening all across the country. Advances in medical research, especially new discoveries of psychotropic drugs transformed the treatment of mental illnesses. That, combined with the high and ever-increasing costs of running state hospitals resulted in a fairly sudden depopulation of institutional care. Group homes replaced larger institutions. Dispersed care became a more popular model. States closed institutions.
The result was that today we have a significant population of persons with mental illness who have no place to turn. They become homeless because they lack the ability to pay for housing. They experience episodes that sometimes become violent. In place of the large state hospitals, county jails are used for incarceration when other alternatives cannot be found. The reality is that we still lock people up as a result of their illnesses. Many go without the treatment that they need in our for-profit medical system.
My career roughly lines up with the time of deinstitutionalization. Over the course of my career I have been involved with many families who have a family member who suffers from mental illness. Our communities lack the resources to assist families with their care. I have known cases where a family is in a crisis. Perhaps an individual poses a threat to themselves or to other persons. Their only option is to call the police. Sometimes the individual is incarcerated, which provides no treatment. Sometimes there simply is no treatment option available nearby. I know cases of families who had to transport a family member hundreds of miles just to find a safe place for the individual to sleep.
We can look back at the large state hospitals and understand that they were less than perfect settings, but when we look at our communities today we know that we are still failing to provide adequate care for those who suffer from severe mental illness and for many who have cognitive disabilities.
Much work remains for us.