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31 Oct 2004

By Michelle Roberts

The first patients arrived by train, shades drawn, in the dead of night.

Almost 400 people -- their conditions attributed to everything from brain fever to broken hearts -- were shuttled into the Oregon State Insane Asylum under the cover of darkness.

The year was 1883. Despite the secrecy, the hospital's looming J Building, with its red brick and ornate turrets, became the subject of morbid fascination as Salem residents rode trolley cars along Asylum Avenue, now Center Street, to gawk.

Today, the institution -- renamed Oregon State Hospital in 1907 -- is one of the oldest, most dilapidated mental institutions in the United States, a hulking reminder of the state's failure to forge a modern approach to treating people with mental illnesses. Patients still live in parts of the J Building, in renovated wards next to those that have been abandoned.

Oregon first took on responsibility for people with mental disorders in 1843, 16 years before statehood. The provisional government adopted laws and appropriated $500 "for purposes of defraying expenses of keeping lunatic or insane persons in Oregon," according to a 1945 article in the Oregon Historical Quarterly.

By 1861, Dr. J.C. Hawthorne opened a private institution in Portland to care for people with mental illnesses. The state contracted with Hawthorne initially to care for 12 patients. By 1874, the doctor housed 194 patients -- and received 52 percent of the total state budget to do so.

The numbers of patients grew steadily until the state opened its own institution in 1883, when 370 people were transferred from Portland to the J building in Salem.

As decades passed, the numbers of patients grew exponentially. A hospital superintendent complained in 1928 that counties were committing the elderly, alcoholics, the physically disabled and others who didn't belong, just so they wouldn't have to care for them.

Patients sometimes lived four, five or more decades behind the J Building's barred windows, enduring the treatments of the day.

In the 1930s, that meant wet-sheet restraints and insulin-induced comas. In the late 1940s and early '50s, surgical lobotomies were done to cut off the emotions of about 150 patients. At the same time, a crude form of electroshock therapy was used on as many as 50 patients a day.

In 1942, a tragedy at the hospital shocked the nation. A patient, George Nosen, working in the kitchen, mistakenly substituted cockroach poison for powdered milk in the scrambled eggs. Forty-seven patients died; another 400 were sickened.

Nosen remained four more decades at the hospital, dying in 1983 of a heart attack after a fight with another patient.

The hospital's population peaked in 1958, the year the hospital's last lobotomy was performed, with nearly 3,600 patients crowded into identical wards that consisted of tiny, boxlike rooms -- no handles on the doors -- running the length of long, white corridors.

In the late 1950s, journalists and government commissions exposed the dirty, overcrowded and dehumanizing conditions within many state psychiatric hospitals. President Kennedy called for a system that would emphasize community-based care. New drugs such as Thorazine, effective in controlling violent behavior, hallucinations and delusions, made the vision possible.

Congress passed laws that stopped federal Medicaid payments to state-run "institutions of mental disease" in an effort to push states into building community-based mental health centers that would be eligible for federal subsidies.

But the new system never completely emerged.

Oregon, like many states, did not fully reinvest the money it saved by eliminating hospital beds. To this day, community-based services remain underfunded, restrictive and largely inaccessible.

While untold numbers of Oregonians reaped the rewards of deinstitutionalization, thousands of others ended up sleeping on the streets, howling in jail cells or heading back to the hospital in handcuffs.

At a time when many states are shuttering their hospitals, Oregon continues to pour millions of dollars into renovating wards that were deserted in the 1960s.

The hospital is chronically short-staffed, overcrowded and, records show, a place that fosters neglect and abuse of those it was intended to protect.

© 2004 Oregonian Publishing Co. All rights reserved. Used with permission of The Oregonian.