Housing the Mentally Ill

Years ago the mentally ill who could not take care of themselves were housed in government facilities, and, as this story from the Wall Street Journal notes, that perhaps provided more good than bad.

An excerpt.

To say I didn’t know my great-uncle, Wolfe Levine, would understate things. Though my grandfather and I were close, for years I didn’t know he had a brother. In retrospect, it’s clear Wolfe was simply unmentionable. We’d write it off today as the stigma of mental illness.

Wolfe’s story is tragic, dating from an era of large public asylums that America has sought to forget. His journey to the Lima State Hospital for the Criminally Insane in Lima, Ohio, began in 1910 with a criminal conviction: one to five years in a reformatory for pickpocketing. Six years before, Wolfe had immigrated to America at age 14. Theft was not a shocking charge for a young man in Cleveland, living on a block of ramshackle frame houses with his widowed mother and her three other children. Once convicted Wolfe would never again be a free man

After less than two years in the reformatory—later made famous as the setting for “The Shawshank Redemption”—he exhibited “persecutory delusions” and “auditory hallucinations.” That’s how he wound up in Lima, where the conditions were so bad that by 1974 a federal judge chastised Ohio for failing to ensure “dignity, privacy and humane care.”

My great-uncle was still there. He died in custody in 1982, at 92, and was buried near Toledo, the costs covered by a fund for indigents supported by a local Jewish federation. Wolfe had spent 72 years in institutions. In the language of reformers, he had been “warehoused” for his entire adult life. His aspiration to be a playwright, the occupation he listed when admitted to the reformatory, would prove a dark irony for someone formally diagnosed with dementia praecox—schizophrenia, as it later came to be called.

Yet the story is not so straightforwardly bleak as it seems, and it casts light on how far America has come—and not come. Are we treating the severely mentally ill better today than we did a century ago?

Wolfe did not do well at the reformatory. In a year’s time, more than 300 days were added to his sentence for misbehavior. This almost certainly reflected an onset and worsening of his mental illness. The family may have been involved in the decision to transfer him to the hospital. My great-aunt, now nearly 100, recalls my grandparents discussing what to do with Wolfe. “Dave and Ethel were just starting their own family,” she says. “They just couldn’t take care of him.” Nor was his extended family well-off. My grandmother’s immigrant father was still making deliveries on Cleveland’s East Side with a horse-drawn wagon well into the 1920s.

Thus did Wolfe arrive at Lima in 1915. Little information exists on daily life there, but census records portray an institutionalized American melting pot. My great-uncle was listed as a “Russian Jew”; his neighbors—all of whose occupations were listed as “patient”—included natives of Alabama, Indiana, Germany, Bohemia, Hungary, England and Italy. The hospital was enormous, with 17 wings for 1,400 patients. It was considered the largest poured-concrete structure in the world until the Pentagon.

The nationwide hospital system was the product of a 19th-century reform movement, led by Dorothea Dix and Horace Mann, outraged by the imprisonment of so many of the mentally ill. By 1940, America had institutionalized 450,000 patients. Though the care given was far from perfect, it aspired to be therapeutic.

A little-known book provides a remarkable window into the era. In 1931, a 52-year-old journalist named Marle Woodson checked himself into Eastern Oklahoma Hospital in an attempt to kick his alcohol problem. As he dried out, he wrote “Behind the Door of Delusion,” which did not describe a quiet warehouse: “About me the daytime activities of the hospital hummed. All the work was done by the patients. There was little detailed supervision by the attendants, although they were here, there, and everywhere all the time.” A “floor gang” polished and shined, and a crew for making up beds did its work “with a neatness which would shame many of the maids in good hotels.” Patients worked in the “art department, bakery, the store, or other departments of the institution.”

There was darkness, too. “I was to learn,” Woodson wrote, “that a patient who apparently is in sound mind most of the time can suddenly suffer a paroxysm of wild hallucinations and become thoroughly and irresponsibly insane or even dangerously violent, then, after a period, return to an apparently normal state.” Straitjackets were used, as were opiates or barbiturate sedatives.

My great-uncle may have been restrained or sedated. Such were the limited tools then available. They did not change Wolfe for the better. For decades he was seemingly a shell of a human. Yet he also may have found satisfaction in helping with the chores, perhaps while mentally composing plays that would never be produced. He may have been comforted by visits from a Toledo rabbi. He was, without doubt, kept safe and warm through the cold Ohio winters

Instead of investing in such facilities when the level of care deteriorated, the movement toward “deinstitutionalization” shut them down. Today people like my great-uncle end up in prisons and jails. The Bureau of Justice Statistics once estimated that 365,000 adults with serious mental illnesses are behind bars. They are often kept isolated because of the risk of disruption or suicide.

About David H Lukenbill

I am a native of Sacramento, as are my wife and daughter. I am a consultant to nonprofit organizations, and have a Bachelor of Science degree in Organizational Behavior and a Master of Public Administration degree, both from the University of San Francisco. We live along the American River with two cats and all the wild critters we can feed. I am the founding president of the American River Parkway Preservation Society and currently serve as the CFO and Senior Policy Director. I also volunteer as the President of The Lampstand Foundation, a nonprofit organization I founded in 2003.
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