In an earlier post, I scratched the surface of the complex history of Northern State Hospital (NSH), which was the largest mental health facility in Washington state. It was finally shut down in 1973. In this post, I’ll be discussing its philosophy of occupational therapy, in theory and in practice.
There was ample opportunity for occupational therapy from this institution’s very inception. NSH was built on the backs of its patients. But I sincerely believe that NSH was created with the best of intentions.
In the early 1900’s, Western State Hospital, another state asylum, was becoming overcrowded, so it was decided that an additional facility had to be built. This one was to be a working farm, and patients (called inmates, and you’ll find me using those words interchangeably in all these posts, along with the word residents) would be sent there to work and learn valuable life skills.
After a diligent search, they decided to start this farm in the town of Sedro-Woolley, and to say that the locals were thrilled is putting it mildly. NSH was the area’s primary employer throughout its history. The townspeople protested for 5 years upon hearing that it was to be shut down.
Originally, the place was called Western State Hospital Farm for the Harmless Insane. It was 700 acres of undeveloped land, and it was to be turned into a working facility by inmates from Western State Hospital. 101 men were sent there. Their diagnoses didn’t seem to matter as much as their size and strength. More than half of these men were immigrants who most likely shouldn’t have been institutionalized in the first place, but mental hospitals had quickly turned into dumping ground for people with no other prospects, so there they were.
These men lived in tents for what appears to be about 3 years, while they cleared the land and built the barns and first buildings, some of which still stand (but barely) to this day. The first death in this endeavor was a man named Hugh Gariety, in 1911, when a temporary building that had been erected for the workers collapsed on top of him.
Over the years, NSH grew to the point where it was, in essence, its own city. In the 60’s it had gotten so big that it got its own zip code (98284) and it had its own railroad spur for the delivery of those supplies that couldn’t be produced on site. The train stop was called Norlum, for “Northern Asylum”. In the early days, when families sent mail, they often used Norlum as the “city” part of their mailing address instead of Sedro-Woolley, even though Norlum wasn’t ever incorporated. The mail arrived either way.
These images include aerial views of the main campus today, and some of the farm buildings, which are deteriorating rapidly.
For the most part, NSH was self-sustaining. That was only possible because, with the exception of medical staff and administration, the patients did most of the work. They would work very long hours and not get paid for their efforts. Their labors were simply considered to be what had to be done to maintain the facility. If any of their work produced money, such as the building of rocking chairs or the making of various crafts for sale, that money was promptly deposited in the patient activity fund. I suppose that means that they benefited from that money, but not in any way they could personally control.
At its height, NSH had a prize-winning dairy herd, a piggery, a sheep ranch, a cannery, a laundry, a kitchen, pasture and farmland, various wards and administration buildings, staff housing, greenhouses, a gymnasium, a bakery, a commissary, a post office, a hospital, a print shop, an assembly hall/chapel, a power house, a crematorium, a cemetery, a reservoir, a warehouse, a mansion for the superintendent complete with an in-ground swimming pool and a horse stable, a carpentry shop, a plumbing and tin shop, a machine shop, a paint shop, a sewing and weaving shop, a mattress factory, a blacksmith shop, a shoe shop, a basket factory, and a beauty shop.
From maids at the mansion to groundskeepers to farmers, every bit of this work fell on the shoulders of the patients. They even made the very clothes they wore. They worked hard, and one can assume that there was considerable pressure to do so, because otherwise it would be impossible to keep the Titanic-sized ship that was NSH afloat.
Consider this: In the laundry, in 1947, the daily wash loads included 1764 sheets, 360 pillowcases, 130 spreads, 400 face towels, 1030 hand towels, 400 tea towels and aprons, and 1079 dresses. That’s a lot of fluffing and folding.
In addition to all that occupational therapy, the patients had to wax all the floors every single day. They did this by using blocks of wood covered in carpet and attached to long mop handles. Patients used to get into fights because they had “favorite blocks”. It didn’t occur to anyone to cut them to standard sizes to avoid these altercations until 1932.
I’m quite sure that some of the patients were happy to have things to do. It was most likely preferable to crushing boredom, and it may have given them a sense of purpose, a source of pride and a way to get off the wards. And it’s true that some of them gained skills from this work, which would have been valuable if you were one of the lucky ones who got released.
Some of the work assignments were supposedly to kill two birds with one stone. For example, if a doctor ordered that a patient with aching hands was to soak them in warm water, that patient was assigned to wash dishes. It’s difficult to know if that person’s aches were due to arthritis, but if they were, then dishwashing would have been a horrible idea.
Some patients were farmed out to work in the community. For example, one farmer asked for 5 patients a day to work his fields. In exchange, he’d feed them lunch and dinner and return them to NSH each evening.
Given NSH’s reliance on its residents for its very existence, it’s easy to see how this occupational therapy, in the wrong hands, could become like the forced labor camps in Nazi occupied territories, or the slavery system of the American south. Could an inmate call out sick? Did he or she get days off? How did they handle discipline? Did the administration monitor community employers to ensure that they weren’t being abusive? Were patients forced to work if they didn’t want to, or forced to do jobs that they didn’t want to do? (I struggle to imagine someone volunteering to do the laundry every single day, for example.) It’s hard to know, these days, because all we have to rely on are personal narratives, which are bound to be biased one way or the other. I could locate no official reports that give any details on this topic.
But there was one issue that concerns me above all others. For the bulk of NSH’s existence, patients who already had certain skills were placed in jobs that fit those skills. Others, who demonstrated the ability to catch on quickly, were also retained in certain jobs. But because of this, a lot of patients were kept at NSH for longer than they otherwise would have been. In some cases, they were kept for decades longer.
It wasn’t until Dr. Charles Jones became superintendent in 1950 that this system was altered. He was, in my opinion, the best superintendent that NSH ever had. I’ll be writing more about him in a subsequent post. But for now, I’ll tell you that he did away with the old system. In its place he implemented the Resident Training Program, which had the goal of aiding in the patient’s recovery. Patients were assigned jobs suited to their interests, and they were (in theory) no longer retained simply due to their utility value. They no longer had to be particularly good at their job in order to keep it. The focus was on their education and enrichment and improvement, rather than on their production.
As with so many policies at NSH, occupational therapy may have started off with the best of intentions, but if you delve deeper, you find darker elements as well. Negative aspects are bound to creep in when one group of people has complete power over another, and/or when an organization becomes extremely large. We see that in our prison system to this very day.
Northern State Hospital is a prime example of how most things are neither black nor white. This institution was all about shades of grey. I think much about the place can be extrapolated to the wider world, especially in the present day, when power appears to be prized over compassion.
I hope that you are finding this topic as fascinating as I do, Dear Reader, as there will be more posts to follow.
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