I think the "S" after the room number stands for "south."

I've worked with many individuals who lived much of their lives institutions where the patient population included people with mental retardation as well as people with mental illness. Nearly all of them had what we called "institutional behaviors" that stemmed from their experiences in the hospital. There was a preoccupation with coffee and cigarettes, as those two items provided a good deal of the structure of the hospital day, and because there were staff who used the next coffee break or smoke break to control a patient's behavior ("you have to get dressed before you can have coffee," for example, or "calm down if you want your next cigarette"). Except in very rare and specific cases, in community placements we could not use cigarettes as a reinforcer for behavior plans. We had to try every other reinforcer first. Of course we encouraged people to quit smoking, but for many it was a decades-long habit. There has also been some research which showed that patients with schizophrenia may be self-medicating when they smoke, because there is apparently something in nicotine that acts on the parts of the brain affected by the illness. Other institutional behaviors included eating very rapidly and eating with one arm wrapped around one's plate, both done to protect the individual from those at the table who would otherwise steal their food. We also saw people who would carry their most valuable possessions (often coffee, cigarettes, sugar) with them everywhere they went because that was the only way they could be sure someone wouldn't take them while they were out of the room. Some people wore many layers of clothing even in the summer for the same reason. Other behaviors came from the large doses of antipsychotic medications they had been given, such as the "Haldol" shuffle and tardive dyskensia.

Kirkbride's proposal for psychiatric hospitals specified that corridors be 12 feet wide, and that ceilings be 12 or 13 feet high. In the center building the main corridors were to be 16 feet wide, with ceilings of 18 feet. In some places, the corridors were used as sitting rooms. The alcoves were also a feature of his plans, with the recommendation that they be on the sunnier side of the building (if only on one side) to get as much natural light as possible.

Kirkbride's original specification for psychiatric hospitals was gas lighting, because (at that time) it was the "safest, neatest, and most convenient."

These photos are so illustrative of depression--the being alone, face hidden, back turned on the world, the emptiness, loss of hope, wanting to get away from the pain...and yet, reaching, struggling to get out, with the wings symbolizing a purity of spirit and remnants of faith. When I imagine the pictures that represent my own battle with depression, this is what I see. I also see mental health from a social work perspective, and sense the attempts to connect with the patient, to restore some trust in life and people, to guide the person back to health.

I'm not defending any real abuse or brutality, but a good deal of past treatment that we consider abusive today, was considered "state of the art" in its time. These hospitals were founded with the intent of helping people, not dehumanizing and warehousing them. But then the "system" (which is ALL of us), with its lack of financial support, took over.

Yes, the screens were put there for safety reasons, for protection from accidental falls and deliberate pushes or jumps. They were probably installed after a change in the building code prohibited open stairwells. Buildings were sometimes closed after codes required elevators and other mechanisms to increase accessibility because it was cheaper to close the building and move the people living or working in it than to make the required modifications.

Usually (or at least I thought so until seeing this and other photos on this site) one of the big questions a state has to answer when closing down at institution is where to store all of its records. Then every social worker/psychologist/nurse etc. has to try to keep track of where the state has Hospital X records this year (they tend to move them around as other institutions shut down, or departmental space is re-allocated). That's why I always asked for a copy of a person's entire institutional record upon discharge, and when the DD center here was being closed I requested the records of any person we served who had ever been there.

I wonder if any of the agencies serving people with developmental disabilities near where this facility is located know about all this equipment that has just been left here. If they do know, I wonder if they have asked the state about acquiring it. Sometimes all it takes is someone asking for it, or letting advocates know about it, and letting them work to get it to the people who need it.

In my state, and I would think in most other states too, the law mandating the closure of the institution contained specific procedures for the community placement of the residents. We were required to ensure that the community placements included all services at least equal to the services the people were getting in the institution. There was a court monitor and very close follow-up after each person's discharge until all services had been in place for 18 consecutive months after discharge from the institution. The state provided start-up money to the community agencies. In some cases people were moved to vacancies in existing homes, but in most cases we set up new 3-person homes for them. I think when institutions for psychiatric patients were closed or downsized, there was a lot less planning and follow-up, and people may have been just "pushed out." There was so much planning and oversight for the resident of institutions for the developmentally delayed because most of them had very intense medical and behavioral needs and very involved families (the people who were "easy" to place in the community were discharged in most cases between 1975 and 1988).

When I was involved with the closure of an institution for people with developmental disabilities, we were allowed to take the pieces of equipment used by the individuals we were moving to community group homes. So we got their wheelchairs, shower trolleys, and other pieces of positioning/mobility equipment, which helped reduce our start-up costs. Whatever was not being used by the last individuals living in the institution, or what was being used but was not wanted/needed by the community agencies, went to state surplus property and is probably still sitting in a warehouse somewhere 11 years later. The facility itself was turned into a prison, and it made me so angry to see how, on my last few visits there, all the maintenance that had been "deferred" while the disabled lived there was now being done by the Dept. of Corrections, even before the facility was closed for good.

When I would get a new person on my caseload, I would request all of his/her records and complete a new comprehensive social history. For people who had been in the system for decades, this was boxes and boxes of info and hours--sometimes days--of work, but it was worth it. It was amazing to rediscover things that at one time had been known about the person but had been "lost" or "forgotten" in the intervening years, had come to be considered (and documented) as "unknown," but really it was there in the record all along. It just hadn't been brought forward appropriately, and then it became easier to assume that it was unknown than to search for it. Sometimes the lost information explained lots of aspects of a person's behaviors.(I have some compulsive tendencies and always wanted to know all there was to know about each person with whom I worked, so I dug until there was no digging left to do.)

I can't speak for this facility, but at all the places I've worked with people with developmental disabilities, the doctors and dentists prescribed whatever sedation the patient needed, whether that was a benzo before the appointment, nitrous, IV sedation, or some combination. However, as these were considered "chemical restraints," we also had to implement a dental desensitization program, which is great in theory but not if a person needs immediate dental treatment and doesn't have the several months or more that it might take for him/her to get comfortable with dental treatment. I think that the dental clinic in the institution also had some means of physical restraint to use when required, called a "papoose board" if memory serves me. this would be used only in emergencies, not for routine care.

Toys were considered "demeaning" because they were not "age appropriate," meaning appropriate to the person's chronological age, not his/her mental age. There were ways around this, such as having a "collection of model cars" rather than "toy cars" or using large-piece jigsaw puzzles of animals instead of preschool puzzles of cartoon characters. It's mostly about respecting each person as an individual and offering choices. Sometimes the rules change from day to day and it all seems very arbitrary.

One of the most poignant conversations I had was with the mother of a middle-aged woman who had mental retardation. She had taken care of her daughter alone for years after her husband's death, then let her move to a group home so that she could live with people closer to her own age, rather than just with her mother, and so that it wouldn't be so hard for her if her mother died or became too sick/weak to care for her. The mother still picked her up every Friday and took her home until Monday morning. She was included in all family events. Her mother never really trusted that anyone else would properly care for her if Mom wasn't around to make sure Daughter was treated right, and said that she wanted her daughter to have as long and happy a life as possible, but that she prayed that Daughter would die just one minute before Mom did, so that Mom would never have to know that fear of leaving her disabled child alone in the world. As it turned out, Daughter became physically ill, had to have surgery in the hospital, and had to go briefly to a nursing home before she was well enough to return to her group home (thanks to Medicare restrictions on hospital stays and only a certain number of days being allowed for a given diagnosis). Complications rapidly developed, within a couple of days she was back in the hospital, and shortly after that she died with Mom and family at her side (and group home staff, too). A few months later her mother died, at peace. The impossible choices some of us are forced into...

All old (maybe pre-WWII?) fixtures had separate hot and cold faucets. I guess mixer faucets (not sure if that's the correct plumbing term) are a relatively modern invention. My grandma's bathroom had a sink with faucets like this and still does, as far as I know.

We are quick to denounce the institutions, but I started in the field 20 years ago, during one of the big pushes for deinstitutionalization in my state. We wanted to set up a 6-person group home (now that's considered too large, but at the time it was considered optimal) with 24/7 staff. We went door-to-door in the neighborhood, talking to each household individually, then had a public meeting to share our plans. We explained that these people had mental retardation--they were not psychotic, sexual predators, drug addicts, or dangerous. In fact, most of them used wheelchairs and were not independently mobile. Several were blind and/or deaf. Staff would ALWAYS be with them. After this presentation, an educated man, with a high position in a local corporation, still stood up and said (and was quoted in the newspaper the next day), "What if IT (emphasis mine, but his actual word) gets out and rapes one of our women?" A few years later, in another neighborhood, our plans to open a home for a similar group were met by a local coalition who distributed fliers decrying "the cancer spreading through our neighborhood."

OK, I know these comments are a year old, but some of this is deliberate sensationalism at worst and unknowing misunderstanding at best.
These institutions were originally set up because it was thought they would help people...then they were overwhelmed by the enormity of the needs and lack of will to expend the resources needed to meet them.

As in any other profession, there were a few cruel and sadistic staff, others who "snapped" momentarily due to overwork and exhaustion, and the vast majority who came day after day to thankless jobs, doing the best they could, finding joy in a patient's tiniest achievement, taking patients home for holidays so they would have some semblance of a family.

But these were NOT death camps. Private experiments were not done just on some doctor's whim. We have forgotten the huge public health threat that so-called chidhood diseases used to be. My ex-husband nearly died of measles just 50 years ago. His older brother did die of measles. Many children ended up in places like these because of the high fevers and resulting brain damage that went with measles, meningitis, etc. So developing vaccines was imperative, and we have a very false sense of safety today.

Lobotomies were surgical procedures that doctors hoped would help mentally ill patients. In some cases, they may have. For too many, there were untenable side effects. I can't recall ever hearing of a patient, whose only problem was mental retardation, having a lobotomy. They did NOT involve cutting off the top of the person's head and taking out parts of their brain to see which were essential! (although they were horrific procedures--but then what brain surgery isn't pretty horrific, at least to the layperson?) And now brain surgery is done for some patients with severe seizure disorders, surgery that seems in some ways similar to the principles behind lobotomy. In medicine there are many advances that come only after tragic errors.

I have worked with more than a few people who did die very sad deaths...but not until they had lived much longer, in comparatively good health given their underlying disabilities, than doctors ever predicted they would, thanks to the hourly attention and meticulous care provided by the staff too many of us are too eager to condemn.

Sorry so long.

I have worked with older adults whose teeth had all been pulled during long years of living in state mental institutions. Some of my co-workers were of the opinion that their teeth were pulled because they had repeatedly bitten staff at the hospital. This may have been true, although I tend to believe that the extractions were due to the severity of decay in their mouths. This was before widespread fluoridation of water in rural areas, and when poor people did not have access to regular dental care. In a "normal" patient, with financial resources, perhaps a skilled dentist could have restored at least some of the teeth. But in an uninsured, nonpaying, combative, disturbed patient, extractions were easier (and probably all the state would pay some minimal amount for). And as sad as it is to not have teeth, I have seen people whose general physical health, behavior, entire persona changed for the better after their teeth were pulled. In an ideal world, there would have been intervention long before it got to that point, but unfortunately we do not have an ideal world, and most people DO do the very best they can, with the resources they have, in the situation they're in.

If one chooses to see this photo as representative of horrific events, that is what one will see. I see an institutional-looking bathroom in an old abandoned building. Just as I can imagine a staff person abusing a resident here, I can also imagine a staff person patiently working with a resident, day after day, trying patiently to teach the resident to rub the soapy washcloth just once on his/her arm, to take one little step toward greater independence, and celebrating every little achievement. While there may have been a few voyeurs among staff, who found gratification in watching residents bathe, most staff would have been teaching, protecting, and providing care.

I think everyone agrees that large institutions are not desirable. However, one thing they have/had "going for them" was an economy of scale. The individuals with developmental disabilities whose needs could be met at lower cost in the community were discharged from institutions 20-30 years ago (if they were ever in institutions at all). The individuals in institutions today or who have been discharged in the last 12 or so years have multiple serious problems--the mental retardation itself, inability to walk, lack of intelligible communication, often orthopedic complications, feeding difficulties, various medical problems, seizures--and very intense needs. Ten years ago I worked on setting up community placements for the last 12 people who were still institutionalized from my agency's region of the state. The usual cost of their community placements was above $12,000 per person per month, well over twice the cost of their care in the institution. Community homes are cheaper in the aggregate, but not necessarily in any particular individual case. Some services also became much harder to access. The institution had a dentist who was used to working with these patients. It was very difficult to find a local dentist (the community placements were of necessity two hours away from the institution because the closure agreement specified that each person be returned to his/her "home" community) willing to take the time necessary to treat them.

Almost all of the mechanical restraints I have seen used have been used to protect individuals from their own self-injurious behaviors. I have seen people pick at sores until bone is visible. Or an eye or lip destroyed. Or head-banging until stitches are needed because what the person seeks is the attention given in a hospital emergency room.

Two aspects of moving these residents to the community were especially hard. One was reassuring the staff at the institution that we would provide the same loving, considerate care they had provided for the thirty or forty years the person had been with them. I know abuses happened, but I don't think abusive staff were the ones insisting on coming to the new home with the person to make sure it was everything we had promised in the discharge planning meetings, and who made videos for us showing how they handled mealtimes, baths, transfers, and all the other little aspects of the person's day, as well as making sure we knew favorite foods, favorite music, etc.

The other especially hard thing was the families of the individuals. Forty years ago we**the "experts"**had told them that the right thing to do was to place their child in the institution, because they would get special care by people who knew how to help them, it was best for everyone, etc. Now we were coming back to them, after they had either finally made some kind of peace with that placement or were still agonizing with guilt over it, and telling them, no, the institution isn't the right place, we were wrong. It was the only home most of them had ever known, they were with staff who had been there for years in a small town where they were part of the community, but the LAW said they had to leave there and come live among strangers who didn't know them. And yes, we had been wrong before, but this time, the families were supposed to trust that we really DID know, and that this would be better. For some, probably most, families, it was. For others, I'm not so sure.

in regard to babies at institutions...yes, some children were admitted very early in life (I am speaking in general terms, not specifically about Pennhurst). Sometimes when a clearly disabled baby was born, the doctor advised the parents to not get attached, to "put the baby in a home," and have another (hopefully normal) child. Sometimes the parents already had several older children, or had another child or two in quick succession after the disabled child, and felt that they could not provide for all their children, and that the disabled child would be better off at the state school where he would get "special" education and training (this is when there was no special education in public schools for severely delayed children and no community support services to help families keep their children at home).
Also, many developmentally delayed children are very small for their chronological age as a result of the syndrome that caused their disability. Some children the size of an average three year old may be seven or eight years old...so they might have been considered "babies" for a long time.
One of the things my work with adults who grew up in institutions taught me is that the real miracle is that so many babies are normal. Just one tiny defect on one microscopic part of one chromosome can change the person's entire life, yet the vast majority of the time, everything goes right.

I know of cases where, as part of a consent decree in a class-action suit brought on behalf of patients at institutions like Pennhurst, certain sections of buildings (or entire buildings) were so far out of compliance with standards for active treatment and patient care that they were ordered permanently closed. Because of the deficiencies, any services that did take place in such areas could not/would not be paid for by Medicaid, which was the funding source for most patients. In some cases it would have cost too much to renovate the area to bring it into compliance, in other cases it was concluded that no matter what was done, the area could not be brought into compliance, and it was sealed off to ensure that no one had access to it.