A short distance from the Waterbury complex, across the train tracks and up a steep hill, lies a cemetery where some of the first patients of the Vermont State Hospital are buried.
"There's somewhere between about 20 and 24 folks -- they were some of the very earliest patients at the state hospital who didn't have a home town or family to claim them so they ended up here," said Rep. Ann Donahue. Long forgotten, the unmarked graves were re-discovered in the early 1990's. Northfield Rep. Ann Donahue has been a long time advocate on mental health issues and at one time was treated herself for depression. She says paying tribute to these early patients is important. "These were folks that were in our care -- the care of the state, so I think we have a responsibility to make sure it's a protected site that always has the appropriate honor," she said.
From shortly after it opened in 1891 up until the late 1960's, the state hospital was constantly adding new patients and struggling to find places to house them. Originally built for the criminally insane, the asylum's mission soon expanded to treat a range of problems including epilepsy, depression, alcoholism, syphilis, senility and tuberculosis. "Chronic overcrowding, chronic under funding, and yet when push came to shove they eventually would have to add more space," said Vermont State Curator David Schutz.
By 1936, the patient population had mushroomed to more than 1,700 patients, and there still wasn't enough space. Every ward in the complex was stuffed to capacity. Even the network of dungeon-like tunnels underneath the asylum was put to use.
From early treatments like cold water baths, the understanding of the causes and treatment for schizophrenia, depression and other mental illness had not advanced remarkably. "There was not a sense of treatment that was aimed toward recovery. Some people recovered, but probably not because of the specific medical interventions that were offered. And some people spent many decades in institutional settings," said Robert Pierattini, Chair of the University of Vermont Department of Psychiatry.
The first psychologist on hospital staff wouldn't arrive until 1948. In the 30's Neurology was still an emerging field, but it didn't stop practitioners from trying some bold, aggressive forms of treatment -- like insulin shock therapy and lobotomies. "The primary driver may well have been the desperation of not having anything to do -- and people tried things and there was nothing really to stop them," Pierattini said.
In insulin shock, schizophrenic patients received injections of insulin over the course of months, causing violent seizures and coma. Doctors believed the treatment somehow jolted patients out of their mental illness.
Beginning in 1936, Washington D.C. neurologist Dr. Walter Freeman began conducting lobotomies, a brain operation intended to reduce the severity of psychotic symptoms and that often made patients docile and childlike. In later years Freeman would go on summer tours to state hospitals across the country. Using an ice pick and a hammer, he transformed his signature trans-orbital lobotomy into a 10 minute outpatient procedure. Freeman's journals don't indicate he ever worked in Vermont, but his methods became widespread. "It is a tragedy, but its a tragedy that's on a long list of medical and surgical interventions that caused more harm than good," Pierattini said. Despite their mixed results and growing controversy, both insulin shock and lobotomies continued to be performed at the Vermont State Hospital up until 1956.
Electro-convulsive therapy, better known as shock treatment, was first used at the hospital in 1945. "The discovery was that spontaneous seizures sometimes helped with major illness, and then that led to the idea of inducing the seizure artificially. And the safest way -- there were many ways to do that -- turned out to be to do it electrically," Pierattini said. While used considerably less often today, It's the only form of treatment from that era that is still used for severe symptoms of depression.
The late 1930's up until the end of World War II were trying times at the hospital. The hospital suffered from severe staff shortages and those on the job were often inadequately trained. At the same time, the patient population continued to grow, at times reaching 45 percent over capacity -- a familiar theme since its establishment. Conditions were -- as one witness in 1944 described it -- "Deplorable." Some wards were infested with head lice, bedbugs and rats.
The conditions in Vermont were not unique. In 1946, Life Magazine published "Bedlam," a groundbreaking expose on the deteriorating conditions at state mental hospitals in Ohio and Pennsylvania. Author Albert Maisel reported that:
"...Hundreds are confined in 'lodges' - bare, bed-less rooms reeking with filth and feces - by day lit only through half-inch holes in steel-plated windows, by night merely black tombs in which the cries of the insane echo unheard from the peeling plaster of the walls..."
The article prompted outrage around the country. "There was a building view that large institutional warehousing of people with illness was increasingly inappropriate," Pierattini said.
"For many people it's a painful, ugly history. For many other people it's something where they gave a huge part of their lives to try to help other people's lives be better," Rep. Ann Donahue said.
A reform movement led by Vermonters in the way that patients were treated and re-integrated into the community would soon be underway.
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