Authored by Jennifer Honig, MHLAC Senior Attorney
As public state hospitals and schools for people with disabilities in Massachusetts have gradually closed, in many cases the properties have been converted to other uses. In many cases, this development is welcome. As Robert Kirkbride, the descendant of Thomas Story Kirkbride (the designer of many of these American institutions) observed, the idea that these hospitals would appear frozen in time is “a Disney-esque view of history that prevents our public spaces and communal identities from continuing to evolve …These buildings need to find new lives and new purposes.”
Where conversion has occurred, these locations most often are designated for housing, open space, or other community use. However, in some instances, buildings on these grounds are still being used today to keep people confined. In other instances, the properties sit empty, sometimes decaying, usually due to cost concerns. Even demolitions can be expensive due to the presence of asbestos.
In some cases, conversion plans can take a long time to come to fruition. Development of the Metropolitan State Hospital land is a prime example. At one point, the dispute between Waltham and Lexington over the plans became so heated that Waltham wanted to install a gate to deter Lexington residents from using a proposed road through the property. Likewise, conversion of the Boston State Hospital site took several decades.
While exploring reuse of these sites, long-hidden reminders of prior patient lives and deaths, such as anonymous cemeteries, are often exposed. Graves were typically marked with numbered plaques, prioritizing patient privacy over more personal commemoration.
Activist Pat Deegan raised awareness of this history after walking the grounds of Danvers State Hospital in 1997. In February of the following year, she started the Danvers State Memorial Committee, an advocacy group composed of former patients and Danvers town residents, to identify the patients buried in the graves and help preserve two on-site cemeteries. The Department of Mental Health (DMH) responded with a small amount of funding to improve the Danvers’ site.
In 2001, advocates challenged DMH on the practice of labelling graves with numbers and sought to restore names to each marker. Work has since been done at various locations to restore cemeteries and commemorate those buried there. Since its formation in 2005, the Medfield State Hospital Cemetery Restoration Committee has placed granite stone markers with names and dates on each of 841 hospital grave sites. Similarly, historian Alex Green and students at Gann Academy have been working diligently since 2018 researching and honoring the lives of people buried at MetFern cemetery in Waltham, a burial ground for former residents of Metropolitan State Hospital and the Walter E. Fernald Developmental Center. They also have created historical markers for the site.
The advocacy around cemeteries foreshadowed and now proceeds alongside a broader debate about how best to characterize and remember the care provided at state public institutions for people with disabilities. It is a difficult discussion. The facilities have varied histories and those who lived there have had different experiences. A single patient may have vastly disparate impressions of multiple stays at the same facility; changes of time, placement, and staff, as well as changes in the patient, could alter one’s assessment of the experience. Former patients of Medfield State Hospital, for example, describe differences in how they were cared for from one hospitalization to the next. The quality of care seems heavily dependent upon the relationships they had with certain staff. Memories of kind, invested, and creative staff seem to have made the most indelible impressions and are credited with assisting in recovery. Hardships experienced at facilities are recalled as well, and often these also are tied to interactions with specific staff persons.
This is not to suggest that there are no common themes. The reasons for the development of asylums for the care of people with mental illness, the expectations for how they would benefit patients, and all the ways they have fallen short of those expectations was a pattern that would be repeated from facility to facility. This sad progression has been well documented. In the mid-19th century, activist Dorothea Dix campaigned to remove persons with mental illness from prisons and poorhouses and to provide compassionate care instead. Psychiatrist Thomas Story Kirkbride designed hospitals with wings extending from a central building so that patients’ rooms would have air and light. Hospitals were situated in rural areas where patients could work the land and produce their own food.
Massachusetts’ public mental health hospitals exemplify this history. Dix petitioned the Massachusetts Legislature to expand a mental health hospital in Worcester, while expansive Kirkbride buildings were constructed at the public asylums in Danvers, Northampton, Taunton, and Worcester.
Although state hospitals for persons with mental health needs were built with Kirkbride-style specifications in mind, for myriad reasons, they did not offer their patients the serenity that was promised. Many mental health hospitals promoted an environment and “treatments” now understood as damaging, barbaric, and even life–threatening. This is certainly true of our Massachusetts mental health hospitals. Consistent with a national pattern, patients at these facilities suffered at points from overcrowded wards. For example, in the late 1930s, Danvers State Hospital held over 2,600 patients in a building built for 500. Even more concerning, patients were subjected to now-discredited treatments. Among the worst were sedation, cold water packs, shock treatment, straight-jackets, insulin coma therapy, and lobotomy (severing of the frontal lobe).
The Commonwealth’s facility employees used these techniques and, in some cases, such as with psychosurgery, pioneered them. Insulin coma therapy, which in the 1930s was a standard treatment in most American mental hospitals, was used at Boston Psychopathic Hospital, now Massachusetts Mental Health Center, as well as at other state hospitals. Danvers State Hospital has been called the birthplace of the pre-frontal lobotomy for the many operations performed there in the 1940s and ‘50s and the opportunity for “refinement” that that number of surgeries presented. This “massive wave” of Danvers lobotomies “set the stage for the procedure to be spread to other hospitals in the nation.” As our state’s institutions are transformed for other uses, we must find ways to preserve and explore, rather than obscure, this history of good intentions that gave way to appalling abuses.
While time has passed since the first of these facilities for people with disabilities was redeveloped, the need to address these properties’ histories in a substantial and comprehensive way suddenly seems more urgent. While past uses of these buildings or grounds had gone unquestioned or perhaps just unnoticed, recent proposed uses have triggered a need to describe and honor the historical significance of these places.
The evolution of this thinking can be seen in recent events following a film screening on state hospital grounds. Multiple movies have been filmed at state properties, including Danvers and Medfield State Hospitals, without much attention to actual patient experiences. In fact, Massachusetts welcomed such use as a way, in conjunction with tax credits, to bring film production revenue into the state. However, in 2020, when the Coolidge Corner Theatre screened one of these films, Shutter Island, on Medfield’s grounds, an attorney from the Disability Law Center took notice. Concerned that the film sensationalized a fear of mental health patients and that attendees might not be aware of the experiences of patients at the hospital campus, she approached the person hired by the Town of Medfield to restore and maintain the Medfield Hospital campus. The lawyer and caretaker, who has become an expert on the history of the hospital, agreed to work together to develop resources for those who attend future tours of the facility so that visitors could learn about patient life through personal accounts.
Uses of another former site, however, have been more unsettling. The unrestored Fernald Developmental Center, which had served people with developmental disabilities, was the site of carnivals hosted by the Waltham Lions Club in 2017 and 2018. This winter, the same non-profit used the Fernald property for a fundraising holiday light show. The event provoked widespread protests. Interestingly, a holiday lights display this year at a restored site, Medfield, did not raise the same level of concern. The differing reactions might be explained by Fernald’s particular history. Between the late 1940s and early 1950s, an MIT professor conducted nonconsensual and dangerous experimentation on 74 Fernald boys, feeding them oatmeal tainted with radioactive iron and calcium and injecting the boys with radioactive calcium.
But the difference also may be explained by what has become of the two properties. Fernald was neither fully demolished nor restored. Holiday lighting that dresses up an untransformed location may seem to minimize the institution’s history of tragedy and neglect. By contrast, Medfield has been carefully restored; a light show may signal a recognition of the healing that is supposed to happen in such places and is, therefore, seen as more acceptable.
But why do townspeople want to use these locations for holiday celebrations in the first place? For Halloween celebrations, one could imagine that people are drawn to the haunting quality of these sites. Some people, aware of the trauma experienced by former residents and patients, may even find these places satisfyingly frightening.
It is more difficult to explain why these campuses are chosen for winter lights celebrations. While there are practical advantages — these are large, vacant spaces where a stream of cars will not generate resident complaints – the emotional relationships to the place are more ambiguous. There are some possible explanations. For some, a former facility for the care of people with disabilities may evoke feelings of altruism. Such a facility may also appeal to a nostalgic conception of treatment – where a patient could go off to a bucolic setting and be cured – rather than struggle in a harsh, industrial world. Townspeople also may peer into a restored campus such as Medfield’s and see a pristine, old-fashioned place where a simpler, less materialistic Christmas can be celebrated.
In contrast, former patients and their advocates often see something less benign when they return to these locations. They may revisit the horrible experiences suffered by patients in the name of treatment. Yet, it is not only the knowledge of intrusive and bizarre “treatments” that forms activists’ views of these facilities. These individuals do not see these facilities as merely historical artifacts. For many, modern psychiatry continues to rely upon the same paternalistic, coercive approaches that were used in hospital settings. For this reason, these individuals recoil at a romanticized conception of these places. Instead, they seek to recall that people with disabilities experienced not just coercion and paternalism, but also institutionalization, medicalization, sexism, classism, racism, segregation, isolation, and loss of liberty.
We need to do more to preserve this history in Massachusetts. Advocates started with the tangible — with cemeteries and the histories of those interred. Green and his students are also collecting oral histories “on disability history relating to institutions.” They are now trying to hold the mayor of Waltham to her 2018 commitment to them to create a museum to honor institutionalized people with disabilities.
We must expand upon this work, starting with efforts to assemble stories of mental health patients. Few accounts of patients’ experiences at Massachusetts state mental health hospitals are easily accessible. One exception is the writing of Dorothy Dundas, who recounts her experiences, including at Westborough State Hospital. Jeffrey Geller and Maxine Harris’ Women of the Asylum: Voices from Behind the Walls, 1840-1945 also collects patient accounts, but this book is not easily available on the internet.
To remedy this dearth of available history, the Mental Health Legal Advisors Committee (MHLAC) is beginning to collect and publish the personal histories of former residents of state mental health facilities. We welcome people to be in touch with MHLAC to discuss this project. Please contact Jennifer Honig at jhonig@mhlac.org to share your stories or for more information.