Rustic Dreams, Human Nightmares

The important lessons learned on Long Island at three of America's largest mental institutions came at an awful price

By Jamie Talan | Staff Writer

IN 1889, 40 men with long histories of chronically odd behavior headed east from New York City to a new home in the country. The men would settle into three makeshift dwellings on an undeveloped 800-acre site in Central Islip, set aside as part of an experiment to ease overcrowding at the New York City Asylum for the Insane on Ward's Island.

At the time, it was thought that the open space and country calm would ease these turbulent souls. And though they were called inmates, they were soon working as farmers, successfully planting more than 1,000 fruit and shade trees at the site.

But while all that sounds bucolic enough, social historians now say the construction of this facility, then known as the Branch Lunatic Asylum at Central Islip, was only the first step in the eventual establishment of Long Island as home to three of the largest mental hospitals in the country -- in Central Islip, Kings Park and Brentwood. Ultimately, historians say, all three would fall under the bureaucratic aegis of New York State, housing more than 30,000 people a day at their peak in a time when overcrowding was considered a neccessary evil and treatment options were limited.

At that point, in the late 1940s and early 1950s, "the conditions were just horrendous," said David Rothman, a professor of social medicine at Columbia University in Manhattan. "They were massively overcrowded, and nobody blew the whistle."

Kings Park was created one year after Central Islip, for patients transferring from Brooklyn asylums. And 41 years later the state built the Pilgrim Psychiatric Hospital in Brentwood, which eventually would become the largest individual mental hospital in the United States, with a peak population of more than 15,000 patients a day.

Being a a psychiatrist then "was a tough job," recalled Dr. William Turner, now 91, who worked at Central Islip. "We didn't have much to offer. Once you got in, it was hard to get out."

Still, experts say, the three large facilities did serve one key function early in their history. They were important in research being done nationally on potential psychiatric treatments, including the first antipsychotic drug, Thorazine, which was extensively tested at all three hospitals.

They also helped provide information on non-psychiatric problems. In 1912, for instance, pathologists at Central Islip discovered the organism Spirochaeta pallida in the bodies of patients who had died with syphilis, a finding that helped research into treatments.

And even today, with Central Islip and Kings Park closed and Pilgrim much reduced in size, the ancient charts from all three are being used in ongoing research. For instance, doctors at Pilgrim recently have been convinced to reconsider treatment options for schizophrenia after completion of a landmark study suggesting that many schizophrenic patients also suffer from subtle thinking disorders that require something other than the standard anti-psychotic medicines.

Initially, though, the hospitals were set up to offer little more than a healthful retreat from New York City.

Written reports from the turn of the century show that Central Islip had a library of 200 books, played weekly baseball, organized a musical band and ran a farm that by 1945 had grown to include 118 cattle and 330 pigs. One-third of the vegetables, milk and eggs in the patients' diet came directly from their own work, labeled therapy by the hospital's staff.

"The most popular prescripton for the chronic patient is occupation and oxygen, rest and recreation," a report filed in 1900 said. And at the time, hard work, relaxation and binding contraptions that might seem medieval today were about all that doctors had in the way of treatments for mental illness.

But therapy was changing even as the hospitals grew at what experts now say was an astounding rate.

In 1903, for instance, Dr. Adolf Meyer, director of the Pathological Institute in Manhattan (now the New York State Psychiatric Institute) visited Central Islip for the first time to provide doctors there with a range of new treatments, including things like hot vapor baths followed by a scotch douche to help promote sleep for women patients. He also showed the staff how to take detailed case histories of behavior and symptoms to track patients' progress.

As the inmate population grew in Central Islip, a similar asylum commute was under way a stone's throw away in Kings Park. These patients, primarily from Brooklyn, also helped clear the land for the facility, built the roads in and around it, and farmed the soil.

Soon, Central Islip and Kings Park would become hospitals in their own right, not just rural branches of city asylums. And, in 1927, the state approved plans for the largest mental hospital in the world to be built in Brentwood.

At the time, Ward's Island was to become a city park, and Gov. Alfred E. Smith envisioned a hospital that could withstand what was becoming serious overcrowding at the other two facilities, and then some.

The first patients arrived in Brentwood in the fall of 1930.

Eventually, Pilgrim had an eight-ward building, for each type of shock therapy being offered at the time and records show that 12 to 20 patients would be escorted into special rooms every hour for such therapy in almost assembly-line fashion. At the time, doctors suggested that the therapy seemed to help about half of the patients. But inevitably, many would return and, historically, the therapy was proven to have little long-term value.

By 1949, the Pilgrim census would peak at 15,000 patients. But changes were ahead that would soon help address the overcrowding.

In 1955, the anti-psychotic drug Thorazine would become widely available for the first time; it was followed by the first generation of antidepressant medicines. "Widespread drug therapy brought order to disturbed wards," historian Leland Bell noted in his 1980 book, "Treating the Mentally Ill: From Colonial Times to the Present." And the "need for shock treatments, physical restraints and seclusion lessened."

Additionally, the new drugs allowed some people to remain at home or be treated in small, local facilities, helping, for the first time, to decrease the populations at larger facilities.

In 1954, New York State passed the first Community Mental Health Act and, by the late '60s, the public -- concerned about stories of abuse and overcrowding at the hospitals, and eyeing their huge tax cost -- turned to new community-based mental heath centers as a possible solution. A number of government programs accompanied this movement, with many even calling for complete shutdowns of the state hospitals.

A second factor decreasing public dependence on large hospitals like the three on Long Island was passage of Medicaid in 1965. According to historian Gerald Grob, half of all mental patients between 1900 and 1950 were elderly. When Medicaid began paying the bill to send elderly patients to nursing homes instead, the patient population at the bigger hospitals dropped precipitiously.

Thus, deinstitutionalization was born, and by the early '70s Long Island mental hospitals for the first time had so many empty beds that whole buildings -- and eventually whole hospitals -- would close.

According to Bell, an average 33 percent decline occurred between 1955 and 1970, and some states were showing a 50 percent drop in patient numbers.

New York State figures show that in the 1930s there were, on average, about 75,000 patients in the system. By 1955, the state facilities peaked at 93,600 patients. By 1966, however, 2,000 patients a year were being released from the state hospitals, and the number of patients had fallen by two-thirds.

Today, about 1,400 patients remain at Pilgrim, while Central Islip and Kings Park have been closed.

The effects of deinstitutionalization remain controversial. Half of the homeless population on Long Island suffers from psychiatric illness, studies show. Several doctors have suggested that many of those people aren't getting the out-patient treatment they need to function.

"Deinstitutionalization led to a lot of stuff, but the misery may not have been substantially different than the misery that was kept behind the walls," said Columbia's Rothman. "You can't evaluate the sins of deinstitutionalization unless you reckon with how bad the institutions were."