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Historic Asylums: Ypsilanti State Hospital--How Far Have We Come?

August 5, 2013
by Terry Axelrod
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The promise of community mental health.

I took a little trip down memory lane yesterday, courtesy of the Internet. I was trying to remember the name of the very inspiring medical director of Ypsilanti State Hospital, when I worked there back in the late 1960s. I never found his name but I found some pretty terrifying photos—befores and afters—on a site called, sadly, Historic Asylums. You might want to check it out.

I did my first-year field placement there as an MSW student in Ann Arbor. My "patients" had been in the institution an average of 40 years. Their permanently discolored fingers from incessant chain smoking, their soft padded hospital slippers and hospital gowns, rows of human beings sitting in straight-backed chairs lined up around the perimeter of the enormous empty "day room" in the "locked unit"—it all came back to me when I watched this video, taken several years after I left there, before they closed the place down in the early 1990s.

I had remembered my rodent-infested cement office, the bars on the windows, the dim lighting, but what I had forgotten were the sounds of the place: jangling keys on massive key-rings sported by the wardens, the heavy metal doors slamming and echoing all the way down the dark underground corridors, the faint whimpers and occasional profane outbursts from the patients who might have refused to take their daily Thorazine or were headed back from an unspeakable treatment.

A year and a half later, I began my first job post-MSW back at the same "asylum." But by now the walls were coming down. We were starting a whole new era—community mental health! People with mental illness were going to live out in the community now. We were sending them home from the state hospital (aka, the start of homelessness).

I had been hired to set up the new admitting unit and to site and staff the first halfway houses in the town of Ypsilanti. We had to get people in, diagnosed, "treated," and back out into the community within 48 hours max. Forty-eight hours versus forty-eight years! I remember that the hardest job was cajoling the new residents to want to live in these pristine halfway houses.

As a newly minted social worker, someone must have figured, naively, that they could trust me with real patients. I remember several young men in my caseload. One committed suicide within his first days there; another (still in the long-term unit) was my age and had been there since childhood. I was particularly upset when I was assigned to work with a young mother who seemed pretty sane to me. Her diagnosis was for a character disorder because she wanted to have her children go to live with their father while she sorted her life out. I was told that any mother who wanted to do that must be insane.

Fast forward to last week.

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I am an architect who specializes in psychiatric facilities. I find it interesting that we keep recycling the same words every few decades about making these facilities more "humane" or "non-institutional" etc. These are usually in regard to the latest trends in the design of these facilities.

Even though the rhetoric does not change, the images of the facilities do change dramatically over time. The Kirkbride buildings of the late 1800's were a gigantic leap forward and credited as being the first buildings to actually participate in the healing of mentally ill patients. They also provided light and fresh air ventilation to all patients, which had not been the case previously.

Now we see these buildings as horrible and oppressive. They are being abandoned all over the country in favor of "new" buildings which provide a "much more humane environment". I am personally aware of psychiatric hospital buildings that were built in the 1950's that were abandoned in the 1980's because they were too oppressive and depressing to be fit facilities in which to house these patients.

I am very glad that the images are continuing to evolve, even though the words stay the same.

I have quite a bit of information on the history of mental health facilities if anyone is interested.

Thanks for sharing your unique perspective, Jim. Seems to me that the buildings reflect the prevailing approach and funding available for the care of the mentally ill or other residents at the time they were designed and built.

For example, many of the groups we work with that serve people with intellectual and developmental disabilities have now even moved away from the recently popular group homes to more of a private family foster care model, which has closed down many custom designed group homes, and caused (and solved) major financial challenges for their owners.

As you probably know, there are great innovations in nursing home design, focusing on small group interaction and more of a home-like feel.

It will be interesting to see what's next for behavioral health when it comes to facilities.

Did you by any chance know my mom, Gloria Chen; she was a music therapist at Yorkwoods, YRPH and finally the Center for Forensic Psychiatry. She passed away a few years ago, and I have been trying to research where she worked to get a better sense of what her life was like.

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Terry Axelrod

CEO, Benevon

Terry Axelrod

@terryaxelrod

www.benevon.com

Terry Axelrod is founder and CEO of Benevon. She has more than thirty years of experience in the...