To Change the Future, Remember the Past

DHS photo exhibit of state hospital history leaves key parts of the story untold

On October 15, 2007, the Minnesota Department of Human Services celebrated the history of state hospitals and nursing homes by presenting an exhibit of photographs, videos and documents with the theme “Honor the Past, Embrace the Present, Create the Future.” While many of the historical artifacts on display were interesting, what was not shown to the public may hold greater significance when trying to understand this long and frequently shameful chapter of Minnesota history.

Photographs of the institutions stood out because of the sheer magnitude of the buildings. Aerial images captured the vast size of these buildings, with Fergus Falls State Hospital forming an arc about one-third of a mile long and Moose Lake State Hospital stretching out almost as big. However, few pictures of the men and women who actually lived in these imposing structures were on display.

The documents on display included Governor Luther Youngdahl’s statement at a burning of restraints which took place at Anoka State Hospital on October 31, 1949. He said: “As little as eighteen months ago all but one of our mental hospitals used mechanical restraints. Today most are restraint free. The bonfire which I am lighting tonight consists of 359 strait-jackets, 196 cuffs, 91 straps, and 25 canvas mittens.” Newspaper clippings of that era told about how Moose Lake State Hospital received national recognition for ending the use of restraints.

In addition, the Department exhibited a 1967 article about the American Psychiatric Association awarding the Medical Services Division of the Minnesota Department of Public Welfare for the Division’s attack on dehumanization. Dr. David Vail, the Medical Director of the Department, and Miriam Karlins, head of volunteer services at DPW for many years, spearheaded this effort. During his tenure as medical director Vail was a staunch advocate for patient’s rights. The Department appropriately honored these actions and the men and women who worked in the institutions. But we should also remember the men and women, boys and girls and even toddlers who grew up and lived in these institutions.

A complete view of the past would have included heart-rending scenes of children from Faribault State Hospital in the mid-1960s. To Bridge the Gap, a film by Jerry Walsh of the Association for Retarded Children, shows the “saddest scene” he had ever observed in a state institution, a little girl crouched in the corner of a large dayroom. “For the lack of human warmth, she’s huddled up against the cold brick wall, and this is the only comfort she gets so often day in and day out.”

Both To Bridge the Gap and Changes, a film made five years later by Professor Travis Thompson from the University of Minnesota, show what life was like in the Dakota Building at Faribault. Walsh called it “herd care.” Thompson, who was asked by the Faribault administration to work with the men in Dakota Building, recounted the first time he entered that building: “I encountered an odor that was familiar from my childhood. It was a mixture of the smell of urine, feces and antiseptic. It was similar to the smell in my grandfather’s cattle barn north of Milaca, Minnesota…. Men were milling aimlessly around the room, none wore shoes, many had no shirts and some were naked. The nurse told me the 67 men all had severe or profound mental retardation and were non-verbal. Some sat motionless in the lawn chairs, others rocked, flapped their hands, others screamed or shouted but their vocalizations contained no words, only loud uninterpretable sounds. I was struck by how many had what appeared to be cuts, scars, abrasions and scrapes or wounds in various degrees of healing.” These films and Thompson’s comments are on the Minnesota DD Council Web site at www.mncdd.org/parallels2/video-index.html. Comparable scenes from Cottage 7 at Cambridge State Hospital will be on the Web site later this year. These scenes, an important and shameful part of this history, ought to have been part of the exhibit, together with an account of Thompson’s success teaching the men in Dakota Building and the successful work done by Project Teach in Cottage 7.

Dakota Building and Cottage 7 were truly back wards of the worst sort. But cleaner and less crowded buildings were nonetheless still barren and sterile places, with a resident’s life often spent sitting for hours on a staircase or lying on a bare terrazzo floor. This reality, seen in pictures from Cambridge from March 1973, should have been displayed as well.

The exhibit could have included Dr. Vail’s February 1965 Legislative Bulletin in which he acknowledged that “the mental retardation institutions are operating at a stark survival level that is a wrench to the heart.” Vail’s comments may have been prompted by an earlier analysis of levels of patient care done by Dr. H.P. Robb from Brainerd State Hospital. “Survival care” provided the physical care and supervision necessary to preserve life, but did not “reasonably assure residents will not suffer serious injury or physical neglect.” Better than “survival care” was “custodial care,” which could attempt to maintain a resident as he is and to prevent serious injury or physical neglect, but “fosters ‘institutionalization’ and dependency so that the resident cannot learn and grow as he should.” Worse than “survival care” was “presurvival care,” when only another patient was in charge of a ward. In March 1965 Robb wrote that 704 of the residents at Brainerd, almost 60% of them, received only a survival level of care.

The state hospitals of that era could not operate without patient labor. In 1968, Dr. Roger Johnson from Faribault wrote that ten years earlier, higher level patients were doing 80% to 90% of the labor in state institutions. Most of these persons had been discharged. “We need,” he wrote, “many more employees to take care of the 2,000 residents we have today than we needed to take care of the 3,200 we had eight years ago.” In 1968, Johnson said that Faribault residents were paid a maximum of $2.00 a month for work that benefited the institution. Therefore, the full picture of the history of our institutions would have to include reliance upon and exploitation of state hospital residents.

A full account of the history of our institutions would have shown the restraint chair, pictured on p. 1, in use at Brainerd State Hospital in 1980. Despite the awards given Moose Lake State Hospital in 1949 for being restraint free, staff at that hospital placed residents with mental retardation in comparable restraint chairs from the 1970s until the institution was closed in the 1990s. Papoose boards, cuffs on beds, and restraint chairs were used on residents with mental retardation in other institutions as well. A thoughtful presentation of the state hospital history might have considered how Vail’s attack on dehumanization squared with this widespread use of restraint.

The Department did not display photographs of rows of numbered graves in state hospital cemeteries, or the overgrown knoll north of the Fergus Falls State Hospital without any markers at all. Nor did they include the ongoing efforts of Remembering with Dignity to correct this dehumanizing practice. A complete and honest history of the institutions would recognize how the people who lived in them were numbered even after death.

The institutions for persons with mental retardation have closed. Other state institutions have closed or changed. While it is appropriate to respect and to honor the efforts made by people who administered and worked in those institutions, we should not “Honor the Past.” Rather, we should “Remember the Past” to create a better future for the persons the state serves.