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

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.

In a hotel ballroom, somewhere in suburban Chicago, I worked with board members and senior staff from several large behavioral health organizations on how to tell their stories and engage the individuals in the community in their work. "We don't have cute kids or great stories about the arts or impressive statistics about lives changed seemingly overnight," they told me. "Change and progress come slowly for many of our clients, yet we do see real progress. Help us engage the community in what we're doing—we know our work matters!"

These same groups have raised much money but moreover have deepened the awareness and passion of their communities in their work. Year after year, I see these organizations taking their futures into their own hands, realizing that without the community engagement piece, they will go the way of Ypsilanti. With it, they are breaking down the stigma and garnering new advocates for the cause.

Sometimes I wonder, as I see the lines at the soup kitchens, the shanty towns under freeway bridges across America, what have we done, closing down those big awful places. The promise of "community mental health" seemed so exciting back then. Mental illness is no longer as stigmatized as it was 40+ years ago. It seems everyone knows at least one person, including themselves, who is suffering from it.

Maybe just getting people back out in the community helped to demystify mental illness in the general public and to set the stage for greater acceptance. Not so sure about that but I'd like to think those asylums taught us at least a little something.

Please share your story with me here. I know many of you have had similar experiences and, in fact, they are what propelled you to enter and remain in the field.