The rise and fall of state hospital

Robert Mielke, shown here during a stroll around the grounds of the Northampton State Hospital, said he struggled when patients occasionally asked why they were hospitalized. "Today, I'd probably have an answer," he says. Mielke worked in many different jobs at the now-closed hospital. CAROL LOLLIS Photo

NORTHAMPTON - Reaching the end of a pitted, weed-choked driveway of the Northampton State Hospital, Robert Mielke said that when patients sometimes asked why they were hospitalized, he had no answer to give them.

He turned a deaf ear to the question, he said, because in many cases there was no good reason for their confinement. During the many years he worked at the now-closed hospital - first as a groundskeeper, then on the wards, and eventually as hospital treasurer - he didn't have the answer he has now: that thousands of patients filled the wards, grew old and, in some cases, died at the hospital simply because society was not able or willing to care for them in any other way.

In its heyday, the hospital was a town within a town, he said, as he stood near the edge of the sun-dappled campus on a September morning. It took more than an hour for Mielke to amble around the silent buildings overlooking Northampton.

He pointed out the overgrown peach and apple orchards, the site of the greenhouses, the dormitories for married couples, and the doors to the honeycomb of tunnels under the property.

The significance of the decaying structure, now silent but for the occasional wind-slammed door and the shriek of rusty air vents, is as sprawling as the hospital itself. Its legacy, Mielke said, is imprinted upon every patient who passed through the hospital doors and, sometimes, asked why they were there.

"How do you answer people who ask 'why am I are here?' What do you say?" said Mielke, now 53. "Today, I'd probably have an answer."

The boom, the bust

More than a century ago, Northampton State Hospital was in the forefront of reform efforts to improve conditions for people with mental illness. The hospital and its nearby sister institution, the Belchertown State School, boomed together, becoming integral parts of the area economy by mid-century.

Eventually, they also became emblems of the way society segregated the ill, the disabled and the outcast. As medicine and technology advanced, and attitudes about mental illness and retardation slowly shifted, both area institutions were caught in a tide of social change that swept the nation in the 1960s and 1970s.

This interior photograph was taken in 1985, after this building at the Northampton State Hospital was emptied. Gazette File Photo

Those changes focused on emptying such places rather than filling them, and discharging people with mental illness and retardation into community settings. The state shifted care to a new generation of reformers in the private sector, and boarded up the buildings at both institutions for eventual sale and development.

The evidence of those changes are visible everyday in Northampton, Belchertown, and the surrounding towns. Most care for people with mental illness and mental retardation has shifted from hospitals and institutions to private organizations founded upon a vision of treating these people in the community, as equals.

These agencies and advocacy organizations, with unlocked doors that open onto neighborhood streets and downtown hubs, strive to integrate people with mental illness and retardation into the fabric of society - rather than banish them to society's margins.

Good intentions

Though Northampton State Hospital and Belchertown State School eventually came to represent much of what could go wrong with care for mentally ill and retarded people, they initially were viewed as humane alternatives to inhumane conditions.

In 1841, a young Boston school teacher named Dorothy Dix began teaching religion to jail inmates at Middlesex County Jail. To her shock, she discovered a "mad woman" chained to the wall in a basement cell.

Dix gave up teaching and began investigating the plight of people with mental illness and mental retardation across the commonwealth. In 1843, she reported the findings of her town-by-town investigation to the Legislature. People with mental illness and retardation were confined in cells and cages in nearly every community in the state, "chained, naked, beaten with rods, and lashed into obedience," she told lawmakers.

Responding to Dix's stinging report, the state began funding institutions to care for the people Dix found, differentiating for the first time between mental illness and mental retardation. The state's only hospital for the mentally ill in Worcestor, built in the 1830s, had became overcrowded, and so the state funded new hospitals for the mentally ill in Northampton and Taunton.

The Northampton Lunatic Hospital opened in 1858 around the notion that "moral treatment" of fresh air, hard work and regimented schedules for people with mental illness would cure them, according to "The Life and Death of Northampton State Hospital," a book published by Historic Northampton.

A publication of the time summed up that optimism. The Ballou's Pictorial Drawing Room Companion proclaimed in 1956 that the hospital was "an exponent of the humane feeling that is entering the state government, replacing the cold and unChristian-like spirit which has formerly regarded these poor, unfortunate beings."

Those attitudes, in turn, evolved. Pliny Earle, hospital superintendent from 1864 to 1885, was once an advocate of such "moral treatment," but by the time he arrived in Northampton, he had come to doubt whether it could cure mental illness, and he began to emphasize work rehabilitation for the patients.

By the close of the 18th century, Northampton State Hospital - as it was renamed - had became a place not to cure, but to warehouse poor people who could not afford psychiatric care, as well as the senile, the elderly and others who, by today's medical standards, were not mentally ill at all. There were about 600 patients at the hospital at the turn of the century; by the 1950s, that number would increase four-fold, to almost 2,500.

The hospital's heydey

When the hospital reached its peak census in 1955, it was a booming enterprise that provided some of the region's best-paying, most stable jobs.

It had also become a nearly self-sufficient entity, boasting its own gardens, slaughter houses and canneries. Entire families of employees lived on or near the campus. There were baseball teams and social events, and constant traffic down the hill from the hospital to the town.

Shirley Gallup came to Northampton from South Carolina in 1958, when there were more than 2,200 patients. She expected that her new job as a psychiatrist for newly admitted women would last one or two years, she said. She stayed for 28.

When Gallup arrived, the hospital was bulging at the seams, a small city on a hill above Northampton - and already ripe for reform.

By that time, the hospital was overcrowded, underfunded and physically declining. It would be years later before any legal protections would exist to prevent people from being involuntarily committed.

The living evidence of that legal void was in the hospital's back wards and infirmaries. The hospital had many patients with genuine mental illness. But it also housed many people with temporary conditions, such as mothers with post-partum depression, and other who were simply old, unable to speak English, physically disabled, deaf, rebellious, or sexually promiscuous.

"I felt, as I saw the patients, that some didn't need to be in the hospital. Some needed to be in nursing homes. Six hundred of those 2,300 were geriatric," said Gallup. "The older ones - they didn't have the family to take care of them. They aged there, and they didn't know anything but institutional life."

It was around this time that two key factors emerged: anti-psychotic medications that could control depression and psychosis, and a movement to legally redefine how patients could be committed to hospitals and what rights to treatment they had.

It was in the early 1960s that "deinstitutionalization" efforts began in earnest, pushed by mandates from President Kennedy on the federal level. During those years, most of the patients left the hospital, and the town began to see more of its neighbors from the hill, according to Robert Fleischner, staff attorney at the Center for Popular Representation, the Northampton legal group that advocated on behalf of patients.

"By the time of deinstitutionalization, Northampton had a high level of tolerance and was used to seeing people downtown," said Fleischner. "That's not to say that it was perfect - it wasn't. But there was a willingness to have people around who look different and act differently."

Making the case for change

By the 1970s, the anti-institution movement among parents of children with mental illness and retardation was swiftly gaining ground. It was fueled by media reports such as the 1970 "Tragedy of Belchertown" series in the Union-News of Springfield and the expose of Willowbrook Hospital in New York State.

Two short years later, the Belchertown School Friends Association, spearheaded by Amherst parent Benjamin Ricci, filed a lawsuit against the state, seeking to improve conditions at Belchertown State School.

By 1976, the patient census at the Northampton State Hospital had fallen sharply, to 536. But the pace of change was not fast enough for legal advocates of the mentally ill. Documenting patients' behavior on the wards, they came to believe that patients who could easily live healthy, productive lives had assumed "institutional behaviors" that made them appear sicker than they were.

In other words, the hospital was not curing patients, but making their conditions worse, according to Fleischner.

Taking a page from the Belchertown School Friends Association suit and other groups like it, the lawyers who later formed the Center for Public Representation filed a class-action suit in 1976 on behalf of a state hospital patient named David Brewster and others there.

Two years later, that lawsuit against the commonwealth of Massachusetts would be settled in what became known as the Brewster Consent Decree. That agreement, overseen by U.S. District Court officials, promised to reduce the hospital census to about 50 patients and to discharge the rest into the community, according to Fleischner.

"It was revolutionary to think of putting people into group homes of eight or nine people," said Fleischner.

Raymond P. Brien, regional director of the Department of Mental Health from 1976 to 1979, said those years were "very emotional" for everyone involved. Because he has a sister with mental retardation, he entered the social work field in the 1960s - just ahead of the regional and nationwide sea change in attitudes.

"On both the mental retardation and mental health side, I got to know people who were pioneers who had profound beliefs that most of the people in those institutions didn't need to be there," said Brien. "It was the first region in the country that closed both its state hospital and the state school without dumping the patients."

Dr. Jeffrey Geller served as medical director of the state hospital from 1979 until 1984. He helped draft the the lawsuit, and then joined the hospital staff the year after the consent decree to help implement it.

Even today, some people involved with the hospital believe that the need remains for inpatient hospitals to treat mental illness, and Mielke and Geller are among them. Though Geller's view has shifted since that time, he felt a "tremendous excitement" in the aftermath of the decree, he said.

The original timeline for the decree's implementation was set for 2 ½ years. Instead, it took 15, and ended in a conclusion that even Brewster's lawyers had not originally foreseen: The state opted to close the hospital completely.

On Aug. 26, 1993, Northampton State Hospital discharged its last 11 patients, and, with the van door slammed behind the ex-patients, Northampton's hospital for the mentally ill became a piece of history.

Early questions

Not everyone shared the enthusiasm for deinstitutionalization. In the early 1980s, as new community programs opened and spread in Northampton, some residents - including then-Mayor David Musante - feared that Northampton was becoming a "mental health ghetto," as one prominent piece of graffiti in downtown Northampton proclaimed at the time.

Several incidents involving former patients, including fires set at halfway houses, reinforced that impression and led to efforts to rein in the spread of group homes.

Rebecca Macauley was one of those who sought to confront fear about deinstitutionalization.

Even today, she has constant reminders of her past: Out the kitchen window of Macauley's Old South Street house, through a dip in the tree line, she can see a copper-domed spire atop Building G, a hospital ward where she was once a patient.

Macauley said that for years, people associated with the hospital carried "anti-resumes" they only shared among themselves - lists of all the places they were hospitalized, all the treatments they received, the experiences they endured. The anti-resume she accumulated after the death of her husband included five hospitalizations at Northampton and five at the Department of Veterans Affairs Medical Center in Leeds.

Macauley said that during the early 1980s, there was a "terrible stigma" associated with being a hospital patient. She eventually "came out" in a letter to the Gazette, saying there was a "witch hunt" afoot in Northampton that sought to blame the mentally ill for all of the city's problems.

She got into a public exchange with Musante in the newspaper's pages, and eventually arrived in his office unannounced for an angry showdown. Instead, the two became fast friends - an example, she said, of the healing that can, and must, take place in the long shadow the hospital casts over Northampton.

"It was great, we had a great conversation. We became good friends after that. I knew what he was saying, I knew what those fears were," said Macauley. "Northampton State Hospital is an example of failed social policy. It seemed like a good idea at the time, but no one looked far enough down the road to see what it would become. And now, we're living with that legacy."