The rise and fall of state hospital
By THEO EMERY
Mielke, shown here during a stroll around the
grounds of the Northampton State Hospital, said
he struggled when patients occasionally asked
why they were hospitalized. "Today, I'd
probably have an answer," he says. Mielke
worked in many different jobs at the now-closed
CAROL LOLLIS Photo
NORTHAMPTON - Reaching the end of a pitted,
weed-choked driveway of the Northampton State Hospital,
Robert Mielke said that when patients sometimes asked
why they were hospitalized, he had no answer to give
He turned a deaf ear to the question, he said,
because in many cases there was no good reason for their
confinement. During the many years he worked at the
now-closed hospital - first as a groundskeeper, then on
the wards, and eventually as hospital treasurer - he
didn't have the answer he has now: that thousands of
patients filled the wards, grew old and, in some cases,
died at the hospital simply because society was not able
or willing to care for them in any other way.
In its heyday, the hospital was a town within a town,
he said, as he stood near the edge of the sun-dappled
campus on a September morning. It took more than an hour
for Mielke to amble around the silent buildings
He pointed out the overgrown peach and apple
orchards, the site of the greenhouses, the dormitories
for married couples, and the doors to the honeycomb of
tunnels under the property.
The significance of the decaying structure, now
silent but for the occasional wind-slammed door and the
shriek of rusty air vents, is as sprawling as the
hospital itself. Its legacy, Mielke said, is imprinted
upon every patient who passed through the
hospital doors and, sometimes, asked why they were
"How do you answer people who ask 'why am
I are here?' What do you say?" said Mielke, now 53.
"Today, I'd probably have an answer."
The boom, the bust
More than a century ago, Northampton State Hospital
was in the forefront of reform efforts to improve
conditions for people with mental illness. The hospital
and its nearby sister institution, the Belchertown State
School, boomed together, becoming integral parts of the
area economy by mid-century.
Eventually, they also became emblems of the way
society segregated the ill, the disabled and the
outcast. As medicine and technology advanced, and
attitudes about mental illness and retardation slowly
shifted, both area institutions were caught in a tide of
social change that swept the nation in the 1960s and
interior photograph was taken in 1985, after
this building at the Northampton State Hospital
Gazette File Photo
Those changes focused on emptying such places rather
than filling them, and discharging people with mental
illness and retardation into community settings. The
state shifted care to a new generation of reformers in
the private sector, and boarded up the buildings at both
institutions for eventual sale and development.
The evidence of those changes are visible everyday in
Northampton, Belchertown, and the surrounding towns.
Most care for people with mental illness and mental
retardation has shifted from hospitals and institutions
to private organizations founded upon a vision of
treating these people in the community, as equals.
These agencies and advocacy organizations, with
unlocked doors that open onto neighborhood streets and
downtown hubs, strive to integrate people with mental
illness and retardation into the fabric of society -
rather than banish them to society's margins.
Though Northampton State Hospital and Belchertown
State School eventually came to represent much of what
could go wrong with care for mentally ill and retarded
people, they initially were viewed as humane
alternatives to inhumane conditions.
In 1841, a young Boston school teacher named Dorothy
Dix began teaching religion to jail inmates at Middlesex
County Jail. To her shock, she discovered a "mad
woman" chained to the wall in a basement cell.
Dix gave up teaching and began investigating the
plight of people with mental illness and mental
retardation across the commonwealth. In 1843, she
reported the findings of her town-by-town investigation
to the Legislature. People with mental illness and
retardation were confined in cells and cages in nearly
every community in the state, "chained, naked,
beaten with rods, and lashed into obedience," she
Responding to Dix's stinging report, the state began
funding institutions to care for the people Dix found,
differentiating for the first time between mental
illness and mental retardation. The state's only
hospital for the mentally ill in Worcestor, built in the
1830s, had became overcrowded, and so the state funded
new hospitals for the mentally ill in Northampton and
The Northampton Lunatic Hospital opened in 1858
around the notion that "moral treatment" of
fresh air, hard work and regimented schedules for people
with mental illness would cure them, according to
"The Life and Death of Northampton State
Hospital," a book published by Historic
A publication of the time summed up that optimism.
The Ballou's Pictorial Drawing Room Companion proclaimed
in 1956 that the hospital was "an exponent of the
humane feeling that is entering the state government,
replacing the cold and unChristian-like spirit which has
formerly regarded these poor, unfortunate beings."
Those attitudes, in turn, evolved. Pliny Earle,
hospital superintendent from 1864 to 1885, was once an
advocate of such "moral treatment," but by the
time he arrived in Northampton, he had come to doubt
whether it could cure mental illness, and he began to
emphasize work rehabilitation for the patients.
By the close of the 18th century, Northampton State
Hospital - as it was renamed - had became a place not to
cure, but to warehouse poor people who could not afford
psychiatric care, as well as the senile, the elderly and
others who, by today's medical standards, were not
mentally ill at all. There were about 600 patients at
the hospital at the turn of the century; by the 1950s,
that number would increase four-fold, to almost 2,500.
The hospital's heydey
When the hospital reached its peak census in 1955, it
was a booming enterprise that provided some of the
region's best-paying, most stable jobs.
It had also become a nearly self-sufficient entity,
boasting its own gardens, slaughter houses and
canneries. Entire families of employees lived on or near
the campus. There were baseball teams and social events,
and constant traffic down the hill from the hospital to
Shirley Gallup came to Northampton from South
Carolina in 1958, when there were more than 2,200
patients. She expected that her new job as a
psychiatrist for newly admitted women would last one or
two years, she said. She stayed for 28.
When Gallup arrived, the hospital was bulging at the
seams, a small city on a hill above Northampton - and
already ripe for reform.
By that time, the hospital was overcrowded,
underfunded and physically declining. It would be years
later before any legal protections would exist to
prevent people from being involuntarily committed.
The living evidence of that legal void was in the
hospital's back wards and infirmaries. The hospital had
many patients with genuine mental illness. But it also
housed many people with temporary conditions, such as
mothers with post-partum depression, and other who were
simply old, unable to speak English, physically
disabled, deaf, rebellious, or sexually promiscuous.
"I felt, as I saw the patients, that some didn't
need to be in the hospital. Some needed to be in nursing
homes. Six hundred of those 2,300 were geriatric,"
said Gallup. "The older ones - they didn't have the
family to take care of them. They aged there, and they
didn't know anything but institutional life."
It was around this time that two key factors emerged:
anti-psychotic medications that could control depression
and psychosis, and a movement to legally redefine how
patients could be committed to hospitals and what rights
to treatment they had.
It was in the early 1960s that "deinstitutionalization"
efforts began in earnest, pushed by mandates from
President Kennedy on the federal level. During those
years, most of the patients left the hospital, and the
town began to see more of its neighbors from the hill,
according to Robert Fleischner, staff attorney at the
Center for Popular Representation, the Northampton legal
group that advocated on behalf of patients.
"By the time of deinstitutionalization,
Northampton had a high level of tolerance and was used
to seeing people downtown," said Fleischner.
"That's not to say that it was perfect - it wasn't.
But there was a willingness to have people around who
look different and act differently."
Making the case for change
By the 1970s, the anti-institution movement among
parents of children with mental illness and retardation
was swiftly gaining ground. It was fueled by media
reports such as the 1970 "Tragedy of
Belchertown" series in the Union-News of
Springfield and the expose of Willowbrook Hospital in
New York State.
Two short years later, the Belchertown School Friends
Association, spearheaded by Amherst parent Benjamin
Ricci, filed a lawsuit against the state, seeking to
improve conditions at Belchertown State School.
By 1976, the patient census at the Northampton State
Hospital had fallen sharply, to 536. But the pace of
change was not fast enough for legal advocates of the
mentally ill. Documenting patients' behavior on the
wards, they came to believe that patients who could
easily live healthy, productive lives had assumed
"institutional behaviors" that made them
appear sicker than they were.
In other words, the hospital was not curing patients,
but making their conditions worse, according to
Taking a page from the Belchertown School Friends
Association suit and other groups like it, the lawyers
who later formed the Center for Public Representation
filed a class-action suit in 1976 on behalf of a state
hospital patient named David Brewster and others there.
Two years later, that lawsuit against the
commonwealth of Massachusetts would be settled in what
became known as the Brewster Consent Decree. That
agreement, overseen by U.S. District Court officials,
promised to reduce the hospital census to about 50
patients and to discharge the rest into the community,
according to Fleischner.
"It was revolutionary to think of putting people
into group homes of eight or nine people," said
Raymond P. Brien,
regional director of the Department of Mental Health
from 1976 to 1979, said those years were "very
emotional" for everyone involved. Because he has a
sister with mental retardation, he entered the social
work field in the 1960s - just ahead of the regional and
nationwide sea change in attitudes.
"On both the mental retardation and mental
health side, I got to know people who were pioneers who
had profound beliefs that most of the people in those
institutions didn't need to be there," said Brien.
"It was the first region in the country that closed
both its state hospital and the state school without
dumping the patients."
Dr. Jeffrey Geller served as medical director of the
state hospital from 1979 until 1984. He helped draft the
the lawsuit, and then joined the hospital staff the
year after the consent decree to help implement it.
Even today, some people involved with the hospital
believe that the need remains for inpatient hospitals to
treat mental illness, and Mielke and Geller are among
them. Though Geller's view has shifted since that time,
he felt a "tremendous excitement" in the
aftermath of the decree, he said.
The original timeline for the decree's implementation
was set for 2 ½ years. Instead, it took 15, and ended
in a conclusion that even Brewster's lawyers had not
originally foreseen: The state opted to close the
On Aug. 26, 1993, Northampton State Hospital
discharged its last 11 patients, and, with the van door
slammed behind the ex-patients, Northampton's hospital
for the mentally ill became a piece of history.
Not everyone shared the enthusiasm for
deinstitutionalization. In the early 1980s, as new
community programs opened and spread in Northampton,
some residents - including then-Mayor David Musante -
feared that Northampton was becoming a "mental
health ghetto," as one prominent piece of graffiti
in downtown Northampton proclaimed at the time.
Several incidents involving former patients,
including fires set at halfway houses, reinforced that
impression and led to efforts to rein in the spread of
Rebecca Macauley was one of those who sought to
confront fear about deinstitutionalization.
Even today, she has constant reminders of her past:
Out the kitchen window of Macauley's Old South Street
house, through a dip in the tree line, she can see a
copper-domed spire atop Building G, a hospital ward
where she was once a patient.
Macauley said that for years, people associated with
the hospital carried "anti-resumes" they only
shared among themselves - lists of all the places they
were hospitalized, all the treatments they received, the
experiences they endured. The anti-resume she
accumulated after the death of her husband included five
hospitalizations at Northampton and five at the
Department of Veterans Affairs Medical Center in Leeds.
Macauley said that during the early 1980s, there was
a "terrible stigma" associated with being a
hospital patient. She eventually "came out" in
a letter to the Gazette, saying there was a "witch
hunt" afoot in Northampton that sought to blame the
mentally ill for all of the city's problems.
She got into a public exchange with Musante in the
newspaper's pages, and eventually arrived in his office
unannounced for an angry showdown. Instead, the two
became fast friends - an example, she said, of the
healing that can, and must, take place in the long
shadow the hospital casts over Northampton.
"It was great, we had a great conversation. We
became good friends after that. I knew what he was
saying, I knew what those fears were," said
Macauley. "Northampton State Hospital is an example
of failed social policy. It seemed like a good idea at
the time, but no one looked far enough down the road to
see what it would become. And now, we're living with