California and the Politics of Disability, 1850–1970 3031217136, 9783031217135

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California and the Politics of Disability, 1850–1970 Eileen V. Wallis

California and the Politics of Disability, 1850–1970

Eileen V. Wallis

California and the Politics of Disability, 1850–1970

Eileen V. Wallis History Department California State Polytechnic University Pomona, CA, USA

ISBN 978-3-031-21713-5 ISBN 978-3-031-21714-2 (eBook) https://doi.org/10.1007/978-3-031-21714-2 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Palgrave Macmillan imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

For Arn Tretsven (1968–2022)

Acknowledgments

Thanks must go first to the Historical Society of the Pomona Valley (HSPV) and its members. It was my fellow members of the HSPV’s Executive Board who first introduced me to Spadra (the first “a” is pronounced long, as in “hay”) and to the former Pacific Colony. Particular thanks to immediate HSPV past-President Mickey Gallivan, who graciously shared with me her memories of Pacific’s interactions with the surrounding community, and to current HSPV President Deborah Clifford. Thanks also to Kimberley Erickson and Katie Richardson of the Special Collections and Archives at my home institution, California State Polytechnic University, Pomona (CPP). Special Collections started collecting and preserving research materials on Pacific in 2014 when the transfer of the Pacific property to our university was announced, and today continues to promote the preservation of the site’s history for future generations. Back in 2018, when this book was still just a glimmer in my eye, I had the good fortunate to be accepted to the National Endowment for the Humanities’ 2018 Summer Institute on Global Histories of Disability. The Institute was key in expanding my understanding of disability history in both a national and a global context. Long chats with fellow attendees helped convince me that California and its bureaucracy of disability was indeed a topic worthy of further exploration. The Institute was also a chance for me, as an individual who identifies as disabled, to work through some of my own complicated feelings about my research topic in

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a welcoming and understanding space. Special thanks to Sarah Scalenghe of Loyola University in Maryland, who served as the Institute Director; to Jeff Brune of Gallaudet University in DC, the host institution; and to the National Endowment for the Humanities. The bulk of the primary source research for this book had to be conducted during the global COVID-19 pandemic. I am, therefore, deeply indebted to the librarians and archivists who, while working under extremely difficult conditions, were willing to have long phone and email conversations with me; to scan materials where possible; and to help me figure out how to keep my research agenda on track. These include librarians and archivists at the Bancroft Library at the University of California, Berkeley; the Special Collections Departments at UCLA and USC; the California State Archives; the Huntington Library in San Marino, California; the Lanterman House Archives; the Ronald Reagan Presidential Library and Museum; the Wellcome Collection in London; and the American Heritage Collection at the University of Wyoming. Special thanks to Sarah Kesterson, who conducted research for me by proxy in the AHC collections when I was unable to travel there in person. Thanks also to Joanna Linkchorst, President of the Friends of Rockhaven, who shared with me via email primary sources related to the remarkable history of that facility. In 2020, I won a New York Academy of Medicine Library Paul Klemperer Fellowship in the History of Medicine to spend a month in residence in their extraordinary collections. Although COVID-19 restrictions and disruptions delayed my ability to travel there until 2022, my time at the library was nonetheless incredibly fruitful. Historical Collections Librarian Arlene Shaner’s encyclopedic knowledge of the library’s holdings proved invaluable. She also put me in touch with Nicole Topich, Special Collections Librarian at the Oskar Diethelm Library, part of the DeWitt Wallace Institute at Weill Cornell Medicine’s Department of Psychiatry at New York-Presbyterian. Thanks to Ms. Topich’s assistance, I discovered even more amazing primary sources related to medical history in California. It seems counterintuitive to travel to the East Coast to study disability and medicine on the West Coast, but such are the vagaries of archival collections. Thanks to the members of the Disability Studies and Mad Studies working group at the Consortium for History of Science, Technology, and Medicine for their feedback on a draft of what ultimately became Chapter 8; to Suzanne G. Fox, President of Red Bird Publishing, Inc., in

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Bozeman, Montana, for her invaluable help with editing; Joseph Stuart for his assistance with indexing; and everyone at Palgrave Macmillan. Thanks also to my university, CPP, and particularly to my home college, the College of Letters, Arts, and Social Sciences. The College helped me secure a sabbatical and release time to complete this manuscript as well as providing me with an early opportunity to present my research through its Dean’s Invited Lecture series. As always, the CPP Department of History’s support was and is amazing. No one knows better than my colleagues the tragedies and triumphs of maintaining scholarly productivity at a teaching-focused public university. Finally, thanks to family and friends, who have (mostly) patiently listened to me talk about this topic for years. They have likely learned more about it than they ever wanted or needed to know. And to my very patient dog: we will get caught up on all those walks we missed while I was writing, I promise.

Contents

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1

Introduction

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“Friendless and Homeless:” The Gold Rush to 1870

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“A Sin and a Shame”: Regional Institutional Development in the Late Nineteenth Century

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“Helpless and Delinquent”: The Los Angeles Psychopathic Association

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4 5 6 7 8 9

“The Thankless Task”: Parole, Eugenics, and the Institutionalization of the Addicted

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“Their Responsibility”: From the Great Depression to the Birth of the Community Clinic

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“To Promote Mental Health”: The Bureaucracy of Disability at Midcentury

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“Whistling in the Dark”: California’s Politics of Disability Transformed

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California After the Lanterman-Petris-Short Act

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CONTENTS

Conclusion

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Bibliography

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Index

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List of Figures

Fig. 3.1

Fig. 4.1

Fig. 4.2 Fig. 5.1

Fig. 6.1

Fig. 7.1

The State Insane Asylum at Stockton in 1890. Image from An Illustrated history of San Joaquin County, California: containing a history of San Joaquin County from the earliest period of its occupancy to the present time, together with glimpses of its future prospects; with … biographical mention of many of its pioneers and also prominent citizens of today (Chicago: Lewis Pub. Co.), 1890 Sonoma State Home in 1914. Image by Zan Stark. Courtesy of the California History Room, California State Library, Sacramento, California Detail, “Who’s To Blame?,” Los Angeles Record, October 23, 1915. Interior view of the Los Angeles County General Hospital Psychopathic Department, ca.1925. Courtesy of the University of Southern California Libraries and the California Historical Society “Pacific colony mental hospital classroom,” February 5, 1950. Courtesy Los Angeles Times photographic archive, library special collections, Charles E. Young Research Library, UCLA Patton State Hospital, San Bernardino, California: a psychiatric patient mopping the floor as therapy (Drawing by D. R. Wilder, ca. 1954. Courtesy of the Wellcome Collection)

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LIST OF FIGURES

Fig. 7.2

Fig. 8.1

Fig. 9.1

“Pacific Colony nursery cribs jammed together due to overcrowding,” February 5, 1950 (Courtesy Los Angeles Times Photographic Archive, Library Special Collections, Charles E. Young Research Library, UCLA) Patton State Hospital, San Bernardino, California: a clinical consultation among doctors at which the patient is not allowed to say anything. Drawing by D. R. Wilder, ca. 1954. Courtesy of the Wellcome Collection “California State Mental Health Funds Get $18 Million Boost under Bipartisan Agreement with Governor Ronald Reagan, August 1974.” From left, State Assemblyman Frank D. Lanterman, State Senator Anthony Beilenson, Governor Ronald Reagan, State Senator Alfred Alquist, and Assembly Speaker Leo McCarthy. Courtesy of the Frank D. Lanterman Political Papers, Lanterman House Archives

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CHAPTER 1

Introduction

In 1886, the first group of individuals from Southern California were sent to the Home for the Care and Training of Feeble-Minded Children in Sonoma. At the time, Sonoma was the only state-run institution in California that accepted minors deemed by their doctors, their families, and the courts to be “feeble-minded.” It was a journey of more than four hundred miles. The oldest among them was twenty-nine; the youngest, only nine. Most spent their entire lives, however long or short, in the institution and were ultimately buried on its grounds. Seventy-eight years later, in 1964, all the headstones from the cemetery were removed to protect the privacy of patients’ families and, no doubt, to spare them the perceived stigma of being associated with someone who had been institutionalized. Yet the establishment of the home at its permanent location in Northern California was heralded at the time as a great moral victory for the state, something worthy of celebration. “California has not been behind her sister States in her efforts to give sight to the blind, hearing to the deaf; and speech to the dumb; but, alas, those for whom we plead have eyes, but they see not; ears, but they hear not; tongues, but they speak not; and hearts, but they understand not. Shall we be deaf to their claims and blind to their wants. Heaven forbid,” declared the home’s first superintendent, Dr. Buford T. Woods, in his annual report to the California State Legislature. “Christianity and humanity alike say not, and in

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 E. V. Wallis, California and the Politics of Disability, 1850–1970, https://doi.org/10.1007/978-3-031-21714-2_1

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this great battle with intellectual darkness, California expects ‘every man to do his duty.’”1 This is a book about the state of California and disability that focuses on how ideas and understandings about institutionalization changed over time and how those changes shaped the lived experiences of Californians deemed “mentally disordered” from 1850 to 1970. It uses Los Angeles County as a case study to understand the interplay between state and county (and to a lesser extent, local and federal) governments and how that shaped the rise of institutions for the disabled in the state as well as their eventual decline. “Mentally disordered” was not a socio-medical category, but rather a bureaucratic one. It is, however, still a useful construct for understanding the ways in which California’s politicians, doctors, and reformers lumped together what we would now consider two distinct categories of disability—mental disability and developmental disability—for their own convenience. I focus on these two groups because they were the two populations arguably most vulnerable to institutionalization in this era, as well as the ones least likely to leave primary sources behind. Although their overall numbers in state hospitals were smaller, individuals with substance-abuse problems, whom the state of California also considered to some degree mentally disordered in this era, are also included. It is important to note, however, that until well into the twentieth century, those in control of institutionalized individuals in California regularly blurred the line between mental, developmental, and other forms of disability. The “feeble-minded” (the most used term from the 1910s until the 1950s) might have been so designated due to a score on an IQ test. But many were also presumed to have some other alleged defect (physical, psychological, medical, or moral) as well. As Richard W. Fox notes, California’s “state officials quite consciously advocated this ‘social definition’ of feeblemindedness in preference to the view that limited the concept….The social definition of feeblemindedness made it virtually indistinguishable from insanity: both were labels for irrational or imprudent behavior.”2 It is extremely difficult, and sometimes impossible, to know exactly what people meant historically when they used different terms for disability.3 The time span of this study encompasses the rise of institutions for the disabled in California; the development of their blend of care and custodialism in the nineteenth century; the era of overcrowding, abuse, and crisis; and the ultimate dismantling of most state institutions for the disabled,

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a process that began in the late 1950s and culminated with the passage of the Lanterman Disability Service Act/Lanterman-Petris-Short/LPS in 1969 and the beginning of the era of state-mandated deinstitutionalization. In many ways, it is thus a history of a bureaucracy: in this case, the bureaucracy around mental health and mental health care that California developed over more than a century. American disability policy reflects changing ideas about what disability is and how government should respond to it.4 Even now, the vast majority of the money spent at the state and federal levels is tied to the so-called medical model of disability that frames disability solely as a medical condition to be treated. Policy driven by the medical model in turn largely revolves around work: who can do it and thus support themselves, and who cannot. “In this paradigm, if a person can work, that individual is not disabled.”5 However, disability does not exist in the body—or, more correctly, it does not just exist in the body. It is socially and politically constructed. As Tobin Siebers explains, disability has been a medical matter for as long as human beings have sought to escape the stigma of death, disease, and injury. The medical model defines disability as an individual defect lodged in the person, a defect that must be cured or eliminated if the person is to achieve full capacity as a human being….Unlike the medical approach, the emerging field of disability studies defines disability not as an individual defect but as the product of social injustice, one that requires not the cure or elimination of the defective person but significant changes in the social and build environment.6

Examining the story of Californians with mental and developmental disabilities through the lens of what I term “the bureaucracy of disability” is thus useful for two reasons. First, it allows us to delve into the manylayered systems of power and control California built around disability and then reinforced using all the coercive tools available to it. But this story also acknowledges that power never rested in just one place or person. For example, not all policies about disability and institutionalization flowed from the state legislature, and even those that did were the product of a state government that was itself constantly evolving and changing. Second, this approach creates space to understand the sheer tenacity of that bureaucracy once it was established and why it was so

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difficult to reform California’s governmental approach to disability once it had been created and enshrined in state law.7 It is tempting to reduce this story to one only of California’s bureaucracy of disability and the professionals who represented it using their power to oppress individuals deemed “deviant” (for whatever reason) by the society around them. That would be a morally and emotionally satisfying story to tell. However, as with so many things in history, the reality was far more complex. Reducing what happened in California to a binary of “good” (Californians with disabilities) and “bad” (Californians who organized and managed the state hospitals and their related systems) denies both agency. It also removes many other actors from the story: local communities, county governments, family members, social reformers, federal policy-makers, and so on. Undoubtably, many of them also used the bureaucracy of disability for their own ends. That makes it even more important for us to understand what those ends might have been. As Richard W. Fox puts it when he discusses the role of families in institutionalization, The “helping professionals” and the institutions for incarcerating deviants did take over from the family and the local community the responsibility for caring for troublesome charges but they did not—as is often implied in the literature of “social control”—simply muscle the family or community aside. Those traditional units frequently cooperated in the transformation and reaped some immediate benefits from it.

Recognizing a need to understand the formation of, and the motives behind, the bureaucracy of disability that California built is not, however, the same as justifying it. Over the 120 years covered in this book, thousands of men, women, and children were confined in Californians state asylums and hospitals and frequently treated as criminals, even though the vast majority had never committed a crime. Many did not survive, and many who did suffer long-term physical, emotional, and financial distress from the experience. This was wrong.8 Although I will focus on state hospitals for the mentally and developmentally disabled, I will also cover other forms of care and relief in this study to understand how different systems of care and confinement related to and often mutually reinforced each other. This includes private asylums, sanitariums, and sanitoriums; county hospitals and poor farms; community-based clinics, and so on. Aspects of some of California’s

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other systems of confinement and control, such as prisons and juvenile detention facilities, will be mentioned. However, due to how California government was organized prior to 1970, those institutions for the most part fall outside the scope of this study.9 One of the biggest challenges of writing this kind of history is the source limitations. Although I have, as much as possible, used memoirs and other primary sources created by Californians with mental and developmental disabilities and addictions, they are relatively few, particularly compared to the avalanche of primary source materials churned out by the state’s bureaucracy of disability over 120 years. Government sources present a related problem in that even when the voice of a disabled individual can be “heard” in official records, they are often nearly drowned out by the professional voices around them. As Kirsten Anderberg notes in her work on Camarillo State Hospital, often “the administration and staff have one story, and the inmates/patients have a different story….the ‘official’ stories via administration and staff were the ones documented and circulated.”10 It was also important to me to dig deeper than just asylum reports and government sources to “hear,” as much as possible, not only Californians with disabilities, but their family members, medical professionals, politicians, social reformers, and bureaucrats. Newspapers from around the state and oral histories are thus also used extensively in this project. I use relatively few patient records, and those I do reference are beyond the seventy-five-year limit the state of California puts on such data. This choice is in part due to my awareness of “the coercive means by which many primary sources were created, collected, and maintained.…Many people with disabilities live and have lived in times and spaces where they had no recognized right or access to privacy— privacy of body, privacy of space, privacy of information.” On the other hand, I do agree there is some value to sharing names and stories when possible, particularly those of individuals who have been so marginalized in the state’s history, to “potentially enrich and alter the biography of some disabled individuals.”11 One additional sensitive issue in working with primary sources in this project is the number of minors who were in California’s state hospitals, and particularly in its institutions for the developmentally disabled. Thus minors in this study are not identified by name unless (1) they had already been identified by name in the press or in other publicly available sources at the time and (2) the records about them are beyond the seventy-five–year limit.12

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Over the last twenty years, the historiography of disability in the United States has both deepened and expanded. However, works focused exclusively on California or on the American West as a region remain relatively few. The seminal study of the history of mental health policies in California is that of Richard W. Fox, although that study ends in 1930. Angela Hawk contextualizes California’s nineteenth-century mental health policies within a larger Pacific context. Joel T. Braslow’s study of historical psychiatric treatment in California leans more into medical history, but nonetheless is an important contribution to the field.13 Eugenic sterilization in California is by far the most extensively researched topic within the region’s history of disability, with invaluable work by Alexandra Minna Stern, Wendy Kline, and Natalie Lira. Studies of public policy in California and public policies around health care, broadly defined, are also available, including the work of Miroslava Chávez-Garcia, Kristine Ashton Gunnell, and Natalia Molina.14 Scholarly work on disability history in the United States tends to have either a geographical or a topical focus, such as that of Steven Noll, Susan Burch, and Sarah E. Rose. Research into the intersections between disability and American public policy has also been done, including the work of Edward Berkowtiz and Deborah Doroshow. Studies of the history of madness and mental disability have the longest historiographical tradition, going back, of course, to the work of Michel Foucault. Subsequent scholarly work by Andrew Scull, David J. Rothman, and others have expanded our understanding not just of mental disability, but also of the structures of power and care around it. Likewise, important works are now available on the history of developmental disability in both the United States and Great Britain, such as those of Mark Jackson, David Right, and Anne Digby. Historical scholarship on the Disability Rights movement, including the works of Paul Longmore, is also key to the historiography.15 A quick word about the terminology around disability used in the book. “There is no standard grammatical structure in how people use their chosen disability-specific terms,” Corbett Joan O’Toole explains. I am, therefore, choosing to use the term “disabled” for all disabilities. I use the term “physically disabled” to describe wheelchair users, individuals who employ mobility aids, and so on. “Visually disabled” is used to describe individuals with blind, low, or partial vision, and “hearing disabled” for individuals who identify as D/deaf. I have chosen to use the

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term “developmentally disabled” rather than intellectually disabled/selfadvocate or neurodivergent, and “mentally disabled” or “mad” instead of mentally ill or consumer/survivor. As I have discussed, I will also use “mentally disordered,” a twentieth-century term used to encompass both mental and developmental disabilities. I have chosen to avoid using the terms “patient” and “inmate” when possible in favor of “person/people, “individual/s,” or, ideally, names. I will alternate between using personfirst and disability-first language. My definition of “institution” is drawn from that used by the organization Self Advocates Becoming Empowered: “an institution is any facility or program where people do not have control over their lives. A facility or program can mean a private or public institution, nursing home, group home, foster care home, day treatment program, or sheltered workshop.”16 I recognize we no longer use many terms used historically around disability. However, as a historian, I am choosing not to alter the use of such terms in quoted primary sources. Likewise, “care” and “caring” are concepts with many different meanings that need to be defined for the purposes of this study. Since this is a book largely focused on the development of a state hospital system and the bureaucracy that went with it, the temptation is to embrace only “care” in the strictly medical sense of the word. Doing so, however, would not capture the full scope of activities that occurred both inside and outside of these institutions. To that end, I will use Evelyn Nakano Glen’s definition of “caring”: “the relationship and activities involved in maintaining people on a daily basis and intergenerationally.” She notes that there are really three types of caring labor, all of which are connected. First is direct care, including “physical care, e.g., feeding, bathing, grooming), emotional care (e.g., listening, talking, offering reassurance), and services to help people meet their physical and emotional needs (e.g., shopping for food, driving to appointments, going on outings).” Second is “maintaining the immediate physical surroundings/milieu in which the people live,” such as laundry and cleaning. Third is the “work of fostering people’s relationships and social connections.” Although Glenn’s work is focused primarily on contemporary issues around care, her model is nonetheless useful to understanding what Californians in institutions, politicians, reformers, and medical professionals meant when they spoke of “care” in an institutional context.17 Chapter 2 begins with California gaining statehood in 1850. The gold rush, which had started two years earlier, led to both a population and

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an economic boom in the new state. This in turn accelerated the development of asylums and hospitals in California far ahead of the rest of the region. California’s first political discussion about the need for, and costs of, institutions for the mentally disabled, poor, and disabled is covered here, as is the creation of the first state asylum at Stockton. The chapter ends with an exploration of what that particularly scandal-plagued institution might tell us about the future trajectory of state asylum development. In Chapter 3, the focus shifts to Southern California and the creation of the first systems of care at the local and county levels there, as well as the creation of the first Southern California asylum. California’s quick creation of additional insane asylums in Northern California is covered, as is the move beyond the insane asylum to create additional state institutions, including the first state institution for the “feebleminded” and the first state school for the hearing disabled and visually disabled. All these institutional settings exercised varying degrees of both care and control over the individuals within them. Finally, the chapter examines California’s struggle to create a state-level system of oversight for its growing bureaucracy of disability. Chapter 4 moves beyond the state and county levels to look at community-level activism around creating institutions for the disabled. It uses the Los Angeles Psychopathic Association (LAPA) and its crusade to create the Pacific Colony as a case study to understand how social reformers of the Progressive era came to regard Californians with disabilities not as people, but as patients or inmates; not as individuals with unique needs, but as problems to be solved. Chapter 5 looks at some key developments around disability in the early twentieth century: the creation of psychopathic parole; the embedding of eugenics and sterilization in both California law and in California’s state hospitals; and attempts to solve California’s rising incidence of drug and alcohol abuse through institutionalization. Chapter 6 covers the impact of the Great Depression and World War II, California’s bureaucracy of disability, the growth and expansion of child guidance and community mental health clinics across the state, and the growing involvement of parents and other activist groups. Chapter 7 discusses California’s massive physical expansion of its state hospitals for the disabled and its continued expansion of services at the local level. This chapter uses two different government reports for the era, one state, one county, to illustrate how inpatient and outpatient care were beginning to diverge in the state. Chapter 8 looks at the state’s fully developed bureaucracy of disability at midcentury and the battle to reform it. Led by innovative state legislators, it was a battle

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that ended with the near-wholesale destruction of the legal underpinnings of the California’s old system. Chapter 9 thus takes a look at the implementation of an entirely new and untested bureaucracy of disability that replaced the old system in the 1970s, one that would have long-term consequences for California.

Notes 1. I have chosen not to share the names of these individuals here. Second Annual Report of the Trustees of the California Home for the Care and Training of Feeble-Minded Children, 1886 (Sacramento: State Office, 1886), n.p. On the lack of markers at the Sonoma State Home Cemetery, see https://www.findagrave.com/cemetery/2361837/ sonoma-state-home-cemetery (accessed on October 10, 2022). 2. Richard W. Fox, So Far Disordered in Mind: Insanity in California, 1870– 1930 (Berkeley, CA: University of California Press, 1978), 33. 3. Take, for example, “severely disabled.” In modern research, it means an individual with a disability that lasts for twelve continuous months. But the term was thrown around far more loosely by doctors, politicians, and reformers for most of the twentieth century. On the modern use of this term, see Corbett Joan O’Toole, Fading Scars: My Queer Disability History (Ft. Worth, TX: Autonomous Press, 2015), n16. 4. Richard K. Scotch, “American Disability Policy in the Twentieth Century,” in The New Disability History, ed. Paul K. Longmore and Lauri Umansky (New York: New York University Press, 2001), 386. 5. Scotch, “American Disability Policy in the Twentieth Century,” 386. 6. Tobin Siebers, Disability Theory (Ann Arbor: University of Michigan Press, 2010), 3. 7. As Richard K. Scotch explains, “Public policies not only reflect social status and cultural constructs; they also help create and reinforce them….This active governmental role has especially applied to disabled people whose exclusion from much of mainstream economic life, along with the need by some for accommodation for their impairments, creates a greater need for public services and subsidies. Much of the social construction of disability and its consequences in the past hundred years had come through the medium of public policymaking and policy implementation.” Scotch, “American Disability Policy in the Twentieth Century,” 385. 8. Fox, So Far Disordered in Mind, 163, 181. 9. Paul Lerman, Deinstitutionalization and the Welfare State (New Brunswick, NJ: Rutgers University Press, 1982), xiv. 10. Kirsten Anderberg and Wilma Wilson, They Call Them Camisoles—Revisited: The Story of One Woman’s Four Month Stay as a Committed Patient

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12.

13.

14.

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at Camarillo State Mental Hospital in 1939 (CreateSpace Independent Publishing Platform, 2011), 254. Kim E. Nielsen, “The Perils and Promises of Disability Biography,” in The Oxford Handbook of Disability History, ed. Michael Rembis, Catherine Kudlick, and Kim E. Nielsen (New York: Oxford University Press, 2018), 26. Obviously, identifying data and other information drawn from sources other than patient records are not technically covered by the seventyfive-year rule, but for minors, I have chosen to honor that, nonetheless. Kim E. Nielsen, “The Perils and Promises of Disability Biography,” in The Oxford Handbook of Disability History, 25. Fox, So Far Disordered in Mind, 1978; Angela Hawk, “Going ‘Mad’ in Gold Country: Migrant Populations and the Problem of Containment in Pacific Mining Boom Regions,” Pacific Historical Review 80, no. 1 (February 2011): 64–96; Angela Hawk, “Madness, Mining, and Migration in the US and the Pacific” (Ph.D. diss., University of California, Irvine, 2011); Joel T. Braslow, Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century (Berkeley, CA: University of California Press, 1997). Alexandra Minna Stern, Eugenic Nation: Faults and Frontiers of Better Breeding in Modern America, 2nd ed. (Berkeley, CA: University of California Press, 2016); Wendy Klein, Building a Better Race: Gender, Sexuality, and Eugenics from the Turn of the Century to the Baby Boom (Berkeley, CA: University of California Press, 2005); Miroslava Chávez-Garcia, State of Delinquency: Race and Science in the Making of California’s Juvenile Justice System (Berkeley, CA: University of California Press, 2012); Natalie Lira, Laboratory of Deficiency: Sterilization and Confinement in California, 1900–1950s (Oakland: University of California Press, 2022); Kristine Ashton Gunnell, Daughters of Charity: Women, Religious Mission, and Hospital Care in Los Angeles, 1856–1927 (Chicago: DePaul University, 2013); Natalia Molina, Fit to Be Citizens? Public Health and Race in Los Angeles, 1879–1939 (Berkeley, CA: University of California, 2006). Steven Noll, Feeble-minded in Our Midst: Institutions for the Mentally Retarded in the South, 1900–1940 (Chapel Hill: University of North Carolina Press, 1995); Susan Burch, Committed: Remembering Native Kinship in and Beyond Institutions (Chapel Hill: University of North Carolina Press, 2021); Sarah E. Rose, No Right to Be Idle: The Invention of Disability, 1840s–1930s (Chapel Hill: University of North Carolina, 2017); Edwards Berkowitz, Disabled Policy: America’s Programs for the Handicapped (New York: Cambridge University Press, 1987) and America’s Welfare State: From Roosevelt to Reagan (Baltimore: Johns Hopkins University Press, 1991); Deborah Blythe Doroshow, Emotionally

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Disturbed: A History of Caring for America’s Troubled Children (Chicago: University of Chicago Press, 2019); Michel Foucault, Madness and Civilization: A History of Insanity in the Age of Reason, trans. Richard Howard (New York: Pantheon Books, 1965); Andrew T. Scull, Decarceration: Community Treatment and the Deviant: A Radical Review (Englewood Cliffs, NJ: Prentice-Hall, Inc., 1977), Desperate Remedies: Psychiatry’s Turbulent Quest to Cure Mental Illness (Cambridge, MA: The Belknap Press of Harvard University Press, 2022) and Psychiatry and Its Discontents (Berkeley, CA: University of California Press, 2019); David J. Rothman, Conscience and Convenience: The Asylum and Its Alternatives in Progressive America (Boston: Little, Brown, and Company: 1980) and The Discovery of the Asylum: Social Order and Disorder in the New Republic, rev. ed. (New York: Aldine de Gruyter, 2002); Mark Jackson, The Borderland of Imbecility: Medicine, Society, and the Fabrication of the Feeble Mind in Late Victorian and Edwardian England (Manchester: Manchester University Press, 2000); David Wright and Anne Digby, eds., From Idiocy to Mental Deficiency: Historical Perspectives on People with Learning Disabilities (New York: Routledge, 1996); David Wright, “Getting out of the Asylum: Understanding the Confinement of the Insane in the Nineteenth Century,” The Society for the Social History of Medicine (1997): 137–155; Paul K. Longmore, Why I Burned My Book and Other Essays (Philadelphia: Temple University Press, 2009); Paul K. Longmore and Lauri Umansky, eds., The New Disability History: American Perspectives (New York: New York University Press, 2001). 16. “Self Advocates Becoming Empowered,” position statement on definition of institutions, https://www.sabeusa.org/meet-sabe/policy-statem ents/definition-of-institutions/. As O’Toole notes, “neurodivergent” is used primarily by people who are autistic but may also encompass all neurology-related disabilities. O’Toole, Fading Scars, 37. 17. Evelyn Nakano Glenn, Forced to Care: Coercion and Caregiving in America (Cambridge, MA: Harvard University Press, 2010), 5.

CHAPTER 2

“Friendless and Homeless:” The Gold Rush to 1870

“It is really too bad that the unfortunate insane persons who are found in our city are taken to the station house where they are confined with criminals and in a noise and a din that would almost make a sane man crazy,” San Francisco’s Alta newspaper observed in 1851, just one year after California had become a state. “There are half a dozen of this class confined and several more are running about the street friendless and homeless.”1 No sooner had California become a state than it was confronted with the question of what to do with the mentally disordered living within its new borders. This need was particularly acute in areas that had experienced rapid growth during the gold rush: San Francisco, Sacramento, and, to a lesser extent, Northern California in general, where residents complained to authorities about the sick, disorderly, and disruptive elements in their communities. Compared to the rest of the American West, the gold rush accelerated the development of asylums and hospitals California far ahead of the rest of the region. Indeed, it was the rapid increase in population triggered by the rush that led directly to Californians’ first discussions about the need for, and costs of, institutions for the ill, poor, and disabled. California in 1850 was already several decades behind eastern states in dealing with these issues, and in fact often looked to states like New York and Pennsylvania both as models and as a source of medical staff. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 E. V. Wallis, California and the Politics of Disability, 1850–1970, https://doi.org/10.1007/978-3-031-21714-2_2

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But it nonetheless founded the first insane asylum west of the Mississippi River in Stockton, California, in 1851. The story of institutions for the disabled and of institutionalization was largely a Northern California story for the first twenty years after statehood. It centered on Sacramento as the main legislative seat; San Francisco as the largest population center; and Stockton as the site of the first asylum.2 In creating its first hospitals and asylums, California chose to mimic the structures and beliefs already in place in the eastern United States and in Europe. Expert medical knowledge and expertise in the United States generally flowed from east to west in this period. As we shall see, because it was not formed as an American state until halfway through the nineteenth century, California entered the debate about the care of the mentally disordered at a key moment of transition. Over the ensuing decades, California built one of the largest statewide systems of asylums and mental hospitals in the United States. California embraced mainstream ideas about the care of the mentally and developmentally disabled as part of a larger quest for legitimacy, driven by the state’s doctors and by California’s need to prove itself a state with enough power and resources to create for its residents the kinds of structures of care seen in older, wealthier states and countries. This was to have lasting consequences for Californians with all types of disabilities. No sources have survived that tell us about how disability was handled during the indigenous, Spanish, and Mexican eras of California. Medical care in the missions and pueblos alike was rudimentary at best, and surviving historical records are largely silent on what we would now recognize as disabilities. It seems likely, however, that individuals with intellectual, physical, or developmental disabilities who survived birth and early childhood, as well as individuals suffering from mental disabilities, were cared for within their own communities. Previous studies of other parts of the United States and of Europe have shown that agricultural and ranching communities were often better able to create space for individuals with disabilities to still be active, contributing members of both family and society than industrial ones were. This was due in large part to the home and workspace often being one and the same, thus making it easier to supervise an individual without unduly straining the productive capacity needed for survival. Many generations living under one roof were also more common in those economies and that increased the availability of caregivers overall. Individuals with disabilities thus may not have stood out in a way that attracted the attention and concern of authorities. This

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of course does not mean such care was positive or even humane; it was just different. During the Mexican era of California, there was at least one attempt to create a legal obligation to provide care: in 1837, “the Mexican Congress gave local government officials responsibility for social welfare issues, including caring for the sick and the poor.”3 One of the earliest sources to explicitly mention disability in California is the memoir of Dr. J. Praslow. He was a German physician who moved to California during the gold rush, and he traveled extensively throughout the state, remarking on everything from the weather to the economy to the prevalence of different illnesses and diseases in different corners of the state. In one entry, he observed that “cretinism occurs rather frequently among the Indians and native-born Spaniards; in the neighborhood of Cape Mendocino, I saw six such cases, in one tribe of Indians, in whom the disease was developed to a high degree.” In another entry, Dr. Praslow reported, “I also observed several cases [of cretinism] in the hills of the southern part of the state among the Spaniards.”4 Praslow, however, did have an unfortunate tendency to exaggerate both his observations and his prowess as a physician, and thus any observations he made must be cited with caution. On a visit to Southern California, for example, he claimed that the climate is so healthy that illness I rarely found and one sees many persons who have reached an age of over a hundred years. I saw people here who were from 100 to 115 years old and who were still very active. The fertility of the women is very great and because of this the area was in good repute during the Spanish regime because the women of Old Spain, who had been barren, became fertile after a sojourn in this country. It is still said that women from the United States, who have been married ten or fifteen years and are childless, bear children after being in this area for a time.5

Instead of looking to any local history or traditions, California’s approach to its mentally and physically disabled residents from 1848, when California became part of the United States, on, was heavily influenced by previous developments in the rest of America. Historically in the United States, community aid was only provided to individuals who lived in that community. Colonial Anglo-Americans had brought that belief with them from England, where “warning off the strolling poor” had long been the practice.6 There was, however, no consistency from colony

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to colony or, later, from state to state. Even after the American Revolution, the federal government played little part in giving shape or form to local “poor laws.” Each locality developed its own laws and its own institutions, if any. Ability to provide assistance depended on the community’s own economic health, and “local or private resources, however reluctantly given, were usually all the institution-builders could muster.”7 Both American and European societies in the first few decades of the nineteenth century assumed individuals with what we would now term developmental, physical, or mental disabilities were “incurable.” Thus, the impulse to provide any level of care or support for them was driven by two impulses, neither of which included the idea of treatment. One was the ideal of Christian charity, of caring for the less fortunate in society as a demonstration of Christian faith. The other was a firm belief that individuals incapable of being “productive” should be removed from society for the good of all. The final form such removal took (asylum, jail, poorhouse, etc.) mattered less than the removal itself. As Angela Hawk explains, in this era “insane asylums and jails were a widespread and standard component of what Michel Foucault had termed the ‘carceral archipelago’—a diffuse network of disciplinary mechanisms that normalized ‘containment’ as the primary strategy for addressing social deviancy in the era of industrialization.”8 There was little understanding of disability at the time. For most of the nineteenth and into the early twentieth centuries, as Janice A. Brockley writes, different kinds of disabilities could be hard to separate. “Whether a disability originated in the body or mind could be almost impossible to distinguish. With few ways to measure the brain directly, mental capacity had to be judged by action or communication.”9 People might call individuals with mental disabilities “lunatics,” “mad,” or “eccentrics,” while they might call those with developmental disabilities “cretins” or “idiots” or “fools.” By the early twentieth century, all were often simply lumped together as a single category, the “feebleminded.” Likewise, little attention was paid to the enormous differences in care or support different individuals needed based on the type or severity of disability.10 What was agreed upon was that all such individuals had the potential to disrupt, and that potential had to be addressed. Nineteenth-century America in general had a “deeply held legal-political assumption that community life should be ordered and well-regulated.” It also assumed that it was

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perfectly acceptable to seize people and send them to a local or state institution, if one existed, for a variety of offenses without “any legal process whatsoever.”11 Some American reformers, however, reemphasized the idea that it was society at large’s Christian duty to care for the poor, sick, and infirm. This slowly evolved into a belief that such individuals could be helped. This did not change attitudes about asylums: indeed, mid-nineteenthcentury reformers and physicians still agreed that, if one was available, the only appropriate place for such individuals was the asylum. If such an individual remained at home, they became “the cause of grief to their friends, and of uneasiness and alarm to the community, that in almost every such case the members of the family are rendered unhappy by the presence of so much suffering, and that often a whole neighborhood are put in fear and apprehension.” It was precisely such individuals’ disruptive potential that required the state to take an active interest in the creation and maintenance of asylums.12 The “help” provided was also sharply limited. Reformers argued that the mentally and developmentally disabled, in particular, were equivalent to children and thus needed to be morally educated and then returned to the larger world. Just as technology in the nineteenth century was moving ahead, so too, reformers thought, was their ability to help those who previous generations of doctors had assumed were unreachable. Many reformers pointed to the advances that were already being made by visually disabled Americans. When technological advances were combined with Christian charity and benevolence, reformers believed, hope could only be on the horizon. “We are indeed living in an age of mental, mechanical, and moral improvements. The advances made in the sciences and the arts within the nineteenth century, improvements are so closely trending on the heel of each other, that one wonder had hardly passed off before we are struck with another,” an American magazine declared in 1847. Even the mentally disabled could, it declared, “in eight cases out of ten,” be cured. “Science has already done so much for several classes of our fellow beings, whom it was once supposed were place beyond its reach; and now it remains to be seen in this country what it can accomplish for the poor idiot.”13 Institutions like asylums were intensely hierarchical worlds, with every facet of life, from meal times to bedtimes to access to the outdoors, regimented and controlled. The most powerful figure within the asylum was the superintendent, who sometimes (but not always) also served as its

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chief medical officer. As Nancy J. Tomes points out, the first generation of asylum superintendents in the United States were “moral entrepreneurs” anxious to establish psychiatry as a field and themselves as a legitimate part of the medical profession. In the first half of the nineteenth century, the asylum “was not an established feature of the social landscape. Its advocates had to convince the public that insanity was a curable disease, best treated in a mental hospital.”14 Thus, superintendents focused much of their time and energy on the physical design of asylums and their management. This was particularly true for private asylums, which had to compete for paying customers by offering the newest treatments and the latest modern conveniences. This approach is probably most associated with Thomas Story Kirkbride, one of the thirteen founders of the Association of Medical Superintendents of American Asylums for the Insane (the present-day American Psychiatric Association) who wrote extensively on asylum design and management.15 Although his work was on seventeenth- and eighteenth-century asylums, Michel Foucault’s observations apply almost as well to asylums of the nineteenth century. He notes the power the doctors heading asylums had. He terms them the “medical personage,” the “essential figure of the asylum.” “If the medical profession is required, it is as a juridical and moral guarantee not in the name of science,” he writes. “A man of great probity, of utter virtue and scruple, who had long experience in the asylum would do as well. For the medical enterprise is only a part of an enormous moral task that must be accomplished at the asylum, and which alone can ensure the cure of the insane.” Authority and order were prioritized over medical care.16 Early nineteenth-century asylum developers like Kirkbride argued not only for the complete authority of the superintendent, but for him also to have in turn complete authority over the staff. An asylum board of managers might be created to have some degree of authority over the superintendent, but they were expected to stay out of the day-to-day management of the institution.17 Strict discipline and obedience, both for the staff and for the individuals living within the asylum, were not just encouraged but expected. The effect was “the establishment of the unwritten rule so characteristic of total institutions in general, the ‘good patients’ enjoy better living conditions and more privileges than ‘bad’ ones.” Worse still, as Christopher Lasch explains,

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the humanizing of the asylum made it possible, as it had not been possible before, to confuse the health of the inmates with the health of the institution itself. So long as the asylum was no more than a place of detention and physical punishment, there was little pretense either of therapy or of efficient administration; administration, in the absence of therapy, being almost totally unnecessary. Once therapy became the object of confinement, however, and once therapy had been defined as learning to submit to moral discipline, efficient administration came to be so closely identified with treatment that in practice the distinction between them was almost impossible to maintain.18

It is vital, however, not to overstate how much power superintendents and chief medical officers exercised outside of the asylum walls by the mid-nineteenth century. The professionalizing psychiatric profession in the United States and Europe did not itself drive the rising numbers of confinements in that century. Instead, as David Wright argues, confinement itself was largely “predicated upon the desires of families to care for and control dependent and violent relatives…as a strategic response of households to the stresses of industrialization.” This also helps contextualize why most asylums had a relatively small resident population but a much larger population of individuals who rotated in and out on relatively short stays. These shorter stays are generally indicative of moments when families who were providing care for an individual decided they could no longer do so. When a family’s ability to provide care improved, and/or an individual recovered to the point to placing less of a strain on their caregivers, they left the asylum. Even within the walls of the asylum, superintendents and chief medical officers (again, often the same individual) did not provide much hands-on care. They were instead “glorified administrators, inspecting the most interesting cases, attending medicopsychological meetings and plotting lucrative futures as proprietors of private licensed homes.”19 Superintendents did, however, largely shape what became known as the “medical model” of disability, one that, as Brent Ruswick and Elliott W. Simon point out, was often in “tension with the lived social experience of disability.” In asylums, poor houses, and hospitals, it was largely superintendents who first defined medically what disability was (a malady or injury of the body and/or mind), and who began to classify individuals by those disabilities. “With this turn towards custodialism and institutional efficiency came new pressures to classify and segregate people by ability.”20

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Although many of the first asylums in antebellum America were private, the downside of that approach, as far as politicians and reformers were concerned, was that they also went to great lengths to exclude the indigent poor. Asylum managers understood that maintaining at least some sense of exclusivity was a critical part of the appeal of private asylums. However, this approach posed challenges for states that had initially hoped private asylums would accommodate at least a few poor individuals in return for a state stipend.21 By the 1850s, rapid increases in population within asylums and institutional schools soon challenged the optimistic assumption that these individuals could be quickly cured and then returned to society. As Steven Noll explains, as more and more of these institutions became publicly funded, it in turn “put pressure on institutional leaders and their claims of helping their patients by curing them.…But high institutional cure rates, often fabricated or exaggerated by superintendents and physicians seeking to improve their reputations and increase funding, were dependent on small numbers of patients, as moral treatment was time consuming and personal in nature. With increasing numbers of admissions, the cure rates for those admitted concomitantly went down….This recognition of lower cure rates for institutions led to problems in funding.” The Civil War further exacerbated these financial difficulties.22 California embarked on the creation of its first asylum at the same time other states in the east were becoming increasingly discouraged about their own and about their ability to create any lasting improvement for individuals in their care. Essentially, California entered into a system already in transition away from care and/or cure and toward custodialism: simply keeping disordered, disruptive, and disabled individuals away from the rest of society. The eastern model of asylum may not have been a good fit outside of the Atlantic seaboard, but it was still the model California and many other states used. This had a direct impact on how California’s first asylum, and all its subsequent asylums, functioned. Richard W. Fox argues “in California, ‘custody’ was paramount from the start” and took precedence over any pretense of care.23 The advent of the gold rush in 1848 triggered rapid population growth in Northern California. From just 14,000 nonindigenous residents in 1848, the population swelled to 255,122 by 1850. In contrast, one of its nearest neighbors, Oregon Territory, had a population of just 13,294 that year.24 This population growth in California was extremely uneven,

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largely bypassing Southern California and focusing on cities like San Francisco, Sacramento, and Stockton and the mining districts to their north and east. In 1850–1852, San Francisco County alone had a population 36,154 (14% of the state’s population), and most of those individuals were in the city of San Francisco (population 34,776). Sacramento County, soon to be the home of the state capital, had 12,418 residents, and San Joaquin County, where Stockton is located, had 5,029.25 Although the southern counties were spared the worst of the upheavals of the gold rush, they were experiencing upheavals of their own. Southern California authorities’ preoccupation in the 1850s was with “lawlessness.” The region was in transition from Mexican to American authority as it moved from a Mexican pueblo to a predominately Anglo-American city, resulting in both cultural and linguistic barriers to a functioning government. This created enormous social and political friction that was compounded by an extremely rudimentary legal system ill-equipped to handle the situation. Nowhere was this more the case than in the largest of the Southern California counties, Los Angeles. Not only was Los Angeles County home to the largest pueblo in the region (Los Angeles), but it was also geographically enormous. In 1851, the county’s boundaries grew to include what is now San Bernardino County. For a time, Los Angeles County stretched from the Tehachapi Mountains in the north to Death Valley and the Mojave Desert in the east. The jurisdiction of the Los Angeles County sheriff, the county’s only official officer of the law, was thus stretched almost to the breaking point, and the sole county jail in Los Angeles was not particularly secure.26 Local authorities thus tended to focus on violent crimes and crimes against property, not poverty, illness, or health care. Assault and horse theft made up the bulk of crimes brought to trial in the county in 1850.27 When it did turn its attention to crimes such as public drunkenness or loitering, the type of crime that frequently brought the mentally ill and disabled to the attention of authorities in the Bay Area, Los Angeles County’s legal system focused its powers almost exclusively on local indigenous peoples. “The crime of loitering was often interpreted by law enforcement in the most general terms,” Ronald Woolsey notes, “and Indians were arrested for no particular reason.” Indigenous residents were in fact frequently the victims of crime in the county rather than the perpetrators, but rarely if ever received justice from authorities.28 So intensely racialized were Anglo authorities’ ideas about who made up the “disordered” elements in the county that when miners did pass through on the way to the gold fields

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or washed up in Los Angeles sick and broke after failing to find gold and made trouble, authorities found themselves ill-equipped to handle them.29 Understanding not just overall population growth but the growth of cities in California is key to understanding how the state approached hospital and asylum creation in the nineteenth century. American doctors, reformers, and sociologists had already noticed that there seemed to be some sort of connection between urbanization and the numbers of individuals committed to institutions of all kinds. This held true “for both sexes, and for all regions, races, and nativity groups.”30 An enormous amount of ink was spilled arguing over what the connection might be. Suggestions ranged from the large populations of immigrants in cities to the deleterious moral impacts of urban life. The actual connections were likely far more prosaic. As Richard W. Fox notes, “There is little evidence to show that urbanization increased the rate at which people exhibited mental problems, any more than it increased the incidence of serious crime. But urbanization in industrializing America did reduce middle-class tolerance for ‘unproductive,’ ‘inefficient’ behavior, such as public drunkenness and loitering, and did promote the establishment of institutions and professions devoted to the control of deviant behavior.”31 The new California State Legislature focused its political attention on those areas of the state with both the largest populations and the most advanced urban development: San Francisco, Sacramento, and Stockton. The last, while considerably smaller than the first two, was connected to both by water, making it a pivotal connection. Those counties with large populations but no real urban development were bypassed in the state’s first round of institution-building. For example, El Dorado County, which bordered Sacramento County, had an estimated population of 40,000 in 1850, making it slightly larger than San Francisco County (population 36,154). But El Dorado County was still a mining area. Residents working in pursuit of gold remained highly mobile, and thus there was little to no stable town development there. Even if there had been, as long as the county was focused on mining, conditions there would have made staffing and maintaining any kind of state institution extraordinarily difficult. A similar calculation also explains why there was no real state attention paid to Southern California’s healthcare infrastructure in the first two decades following statehood. Los Angeles County, by far the largest of the Southern California counties in terms both of size and population, had only 8,329 residents in 1850.32

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The sight of mentally disabled individuals in San Francisco “running about the street friendless and homeless,” as the Alta newspaper had put it, understandably increased anxiety about how the new state was going to handle not just the mentally and developmentally disabled, but also the impoverished and the infirm. There were no existing statewide social and political structures for California to fall back upon. It was, in essence, starting from scratch. Primary sources from the time suggest mental disabilities and disorders were common in California in the 1840s and 1850s, perhaps even more common than elsewhere in the United States at the time. Like the observed but misunderstood connections between cities and mental disability, this phenomenon was also often remarked upon but remained stubbornly unexplained. In his memoir about his travels in California, Dr. Praslow noted that “mental diseases occur not infrequently, and one has opportunities of seeing them among the immigrants who hoped to be [millionaires,] etc., in a few weeks and were disappointed.” Others pointed to the uneven ratio of men to women in the state that might result in celibacy, a state generally regarded at the time as unhealthy for adult men (celibacy was believed to contribute to both spermatorrhea in men and masturbation, both considered potential causes of insanity). The long ship voyage to California, which may have exposed an individual to all sorts of morally damaging ideas and experiences, was another proposed cause. Gambling, alcohol abuse, separation from family, manual labor, and even California’s unique climate were also cited. San Francisco’s climate was believed to be particularly bad for mental health as some doctors argued it overstimulated the nervous system. The American cultural belief that not only did California have more insane than other states, but that there was something about the state itself that contributed to insanity, became so prevalent that doctors were still trying to debunk it fifty years after the end of the gold rush.33 Historians have come up with more grounded possibilities to explain the numbers of mentally disordered in mid-nineteenth-century California. In her study of admissions to Pacific Coast asylums in the 1840s and 1850s, Angela Hawk found that most of the earliest reported cases of insanity in California were actually suicide cases, as suicide and madness were believed at the time to be two sides of the same coin. Arrests for relatively minor offenses such as public drunkenness were also common. Richard W. Fox notes that the relatively high numbers could also reflect that California might have committed more people for more reasons than

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did other states. The connection thus may perhaps be explained by a relatively small percentage individuals who engaged in exactly the kinds of behaviors most likely to draw the attention of authorities (suicidal ideation or suicide attempts and public drunkenness). Then those individuals had been quickly whisked off to jail or, later, the state asylum.34 Whatever the underlying cause might have been, one piece of the puzzle that was well-understood at the time was that most of these mentally disordered individuals were newcomers to the state. They were thus unmoored from traditional support structures (family, church, community) that might otherwise have provided care. Californians did not take kindly to seeing the mentally disordered at large in their communities. Many gold rush migrants came from the eastern United States and from Europe, where the confinement of the mentally disordered was already well established. Although now transplanted to California, they nonetheless still expected their politicians and law enforcement officers to curb disorderly behavior and, if necessary, to remove such individuals from public view. It was a conversation as much or more about containment than care.35 But how was this to be done? The first attempt at a solution came in the form of creating general hospitals. San Francisco’s city hospital was first established in 1850, and, after being destroyed twice by fire, once in 1850 and again in 1852, it was rebuilt in stone with a capacity of 250 to 300 beds. There was also a German Hospital, which was funded by the German Relief Society and took only German patients; a French hospital; and numerous small private hospitals.36 A ship named the Euphemia, originally captured from the British during the War of 1812, was used as floating insane asylum in San Francisco Bay from May 1851 until 1852. It had been abandoned when its crew jumped ship to rush to the gold fields. The two-masted brig had been offered to the city as a place for the insane for free after it was sold; previously, it had served as the city prison.37 To meet the high demand for care, California’s first attempts at creating state hospitals were done by forging municipal contracts with private hospitals, both in Sacramento and San Francisco. In both cases, they proved disastrous for the private hospital operators because the cities often proved unable to repay them for patient care. As a port city with huge numbers of passengers and sailors arriving every day, San Francisco also reached out to the US Marine Hospital Service for aid, and in 1850, Congress authorized the creation of a marine hospital in that city. Located near the bay on Rincon Point, it served sailors of all nations and the

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American Merchant Marine. It opened in 1854, closed after being badly damaged in an earthquake in 1868, and then reopened in 1875. A State Marine Hospital opened in San Francisco as well. It took in sailors and marines, of course, but unlike the US Marine Hospital in San Francisco, the State Marine Hospital there also admitted “persons for whom a bond had been given or hospital money paid; those who had paid five dollars for a year’s care; and patients sent by San Francisco under agreement with the State Marine Hospital trustees.”38 Most of San Francisco’s and Sacramento’s hospitals, perhaps understandably, focused on treating acute illnesses and contagious diseases rather than disability. New arrivals often needed treatment for scurvy after their long trip around Cape Horn. Due to poor sanitation, outbreaks of dysentery, cholera, malaria, and typhoid fever plagued both California’s mining camps and its cities. Syphilis was also common.39 In 1851, the state of California moved to create actual state-funded hospitals in Sacramento and Stockton. The legislature appropriated both state and local funds for them, with the expectation that both would admit the indigent and those able to pay for care. The two hospitals were to serve the entire state, and the Sacramento hospital was also to care for the insane. A ward for the insane with a $15,000 operating budget did indeed open at the new Sacramento State Hospital. However, the Sacramento facility was not secure, and many transfers sent there ended up right back in San Francisco, infuriating local officials. Costs for both hospitals quickly spiraled out of control because many counties that either did not have hospitals yet or did not want to pay for their own patients sent their cases to the state hospitals. Individuals sent to these hospitals also had the bad habit of leaving before their courses of “treatment” were completed. The city of San Francisco was so angry at individuals leaving the Sacramento asylum only to return to San Francisco that in May 1852, it recommissioned the Euphemia for another six months rather than spend the money sending folks back to Sacramento. Up in arms, both a California State legislative committee investigating the situation and the state controller recommended closing the state hospital in Sacramento completely. They recommended keeping the Stockton hospital open, but only as a hospital for the mentally disabled. This transition began in 1852 and was completed in 1853, with the noninsane Sacramento and Stockton patients being sent to San Francisco to be cared for at local cost until the new facility had space for them. Other hospitals

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were not faring much better: the State Marine Hospital, which had also proved extremely expensive, was closed in 1855.40 In addition to hospitals, in large communities like San Francisco, private charities and fraternal orders often helped meet charitable needs through donations. When California became a state in 1850, the first California State Legislature made grants for the relief of both specific individuals in need and for private charities that cared for the aged, the infirm, and the ill. Both practices were later eliminated in 1879, when the state’s constitution was revised, on the grounds that they were too easy to abuse.41 Local private relief was also important because many of California’s early general hospitals refused to serve women and children. Some didn’t even have women on their nursing staffs. Instead, women and children were to go to county infirmaries if they needed care. Unfortunately, the 1860 legislative act that authorized county infirmaries did not make opening one mandatory for all counties.42 In those counties thus far left out of the state’s plans, resentment quickly started to build. In Los Angeles County, the indigent sick were still quite literally at the mercy of strangers. In an 1854 article, the Southern Californian newspaper noted the recent arrival in the pueblo of an American named Humphreys, who fell ill but had no money to pay for care. A local physician agreed to take on his case without charge, the paper noted, and a “Spanish family” took him in, with the lady of the house nursing the stranger until he passed away a few days later. “This lady is worthy the title of saintess [sic], and deserves the respect of every American in the community,” the paper reported. We believe there is hospital fund raised by taxation in this state, but this county has never received a cent’s benefit from it. Why is it? Do we pay this tax altogether for the benefit of foreigners? If this tax is paid, why do not some of our citizens take means to retain it among us for the benefit of the needy in our community. There are a great many persons who take sick in the upper country, and come down here to resuscitate their health, and in many instances without means. They must necessarily suffer for want of proper medical attendance or obtain gratuitous relief from our physicians. However humane our physicians may be they cannot give their services and medicine without some reward. Why not then the state make the same provisions for us that it has for San Francisco, Stockton, Sacramento and other places? We think it no more than right and honest that we receive the hospital fund to which we are entitled, and would urge our officials in whose power it lies, to obtain it for us—to use such efforts as are necessary

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to get it, and have it appropriated for the relief of the sick and destitute amongst us.43

Southern Californians might have grumbled, but they did use the state’s new hospitals. They began to refer to individuals “gone up” or “sent up” to Stockton. Once the new asylum opened, California’s southern counties resented the distance involved, and they particularly resented that state law required all individuals being committed to the new asylum to be transported by a sheriff’s deputy. County governments protested that this practice raised the cost of having anyone committed because counties had to reimburse sheriffs’ departments for their fees and expenses.44 For those counties farthest from Stockton, the costs quickly became problematic. Local newspapers grudgingly reported both the names of individuals transported and the costs involved, which ran as high as $600 to transport a single individual, a veritable fortune for the relatively poorer Southern California counties. In San Diego County in 1855, the San Diego Herald newspaper reported that several individuals had been examined by the courts and found to be suitable subjects for the State Lunatic Asylum, and were remanded to the custody of the Sheriff, to be conveyed to Stockton but from some cause—lack of funds, perhaps—they are still at large, and likely to remain so. If there is no provision made by law, for cases of this kind, for God’s sake let the people assemble en masse, and petition the Legislature to pass the necessary enactment, and in the event of their refusal to do so, let us refuse to pay our taxes into the State Treasury, and bide the result. There is no other remedy left us. We have been oppressed long enough.45

Perhaps in response to complaints from the southern counties, in 1855, California passed the Poor Law of 1855, which made the county boards of supervisors responsible for relief of the indigent sick in their own areas, up to and including hospital care. To help cover the costs of providing care, the Poor Law gave counties the power to levy either a poll tax or a small ad valorem duty on all real and personal property. In Los Angeles County, the Board of Supervisors’ Committee of Health began to reimburse doctors, pharmacists, and boardinghouse keepers who cared for the sick for approved expenses on a quarterly basis.46 The passage of the 1855 Poor Law also funded the creation of additional general hospitals in larger

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communities up and down the state, although not all counties immediately built them. In 1860, the legislature revised the law to allow these new county general hospitals to also care for “the blind, lame, old, and all those so disabled as to need public assistance.” Bond issues helped pay for additional hospital construction in Los Angeles, Sacramento, and San Francisco. By 1871, there were twenty-four county general hospitals and almshouses. In California, these were most often called county homes or poor farms or county farms. Some of them were operated by private contractors on behalf of the county. The quality of care in both these early county hospitals and the county farms was generally poor. However, since it was the only option available, the sick, the aged, and the disabled, were often all crowded together under one roof. In most California counties, the county hospital served as a county farm as well. Only in San Francisco, Los Angeles, and Santa Clara Counties were the almshouses functionally separate from the county hospitals. A statewide vagrancy act followed in 1872, which under the state’s penal code allowed for any person to be charged with disorderly conduct if they were found lodging in a public or private place without explicit permission. This pushed more people into county farms.47 As Frances Cahn and Valeska Bary point out, one of the distinguishing features of California in the era, particularly compared to older states in the east, is the rapid increase in the number of almshouses and county hospital farms at a time when they were already disappearing elsewhere. In Cahn’s and Bary’s analysis, this did not reflect a shortage of benevolent sentiment from Californians themselves. Indeed, they argue, “state subsidies to private institutions were far greater [in California] than in eastern states, and although city and county subsidies were less, the number of persons in private benevolent institutions [in California] who received some type of public aid represented a larger proportion of the total inmates than was general for the country.” They attribute the number of county farms to the need for California to provide a substitute for “home life.” The gold rush had created a population that, even by the late 1860s, was still heavily male. Those men were either single or lived far away from their families. This occupational pattern of single men worked well in mining, and it was becoming common in California agriculture as well. “Thus,” Cahn and Bary conclude, “agriculture as well as mining threw upon the cities during the winters large numbers of men, only partly employed, who supported themselves while their money lasted and fell back upon the community when ill or destitute.” In their analysis of the

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US census of 1880, the first one to give separate figures for almshouses, Cahn and Bary find that while in the country as a whole the gender balance was roughly even in almshouses and county farms, in California, it leaned heavily male. California’s numbers, they also note, show the foreign-born making up over three-fifths of the population in almshouses and similar institutions, even though the foreign-born accounted for only a quarter of the total state population at the time. This is yet another reflection of how many Californians were dislocated and thus isolated from family and support structures in the years after the gold rush.48 To control costs, California’s state legislators agreed that aid or any kind of care or assistance the state might create should only be provided to residents of the state. Communities like San Francisco that were already beginning to experiment with providing some level of services on the local level did the same.49 The fear that individuals from outside the state might become dependent on it was a recurring one. By 1852, California had become fearful enough about dependent migrants that they enacted a passenger act. Modeled on laws in Massachusetts and New York, the law required shipmasters to either “provide a bond of five hundred dollars or pay five dollars in head money to the state of California for the entry of each passenger.” Any passenger deemed to be “lunatic, idiot, deaf, dumb, blind, cripple, or infirm”; who had been a pauper in another country; or who seemed likely to become a public charge due to sickness or disease required an additional $1,000 bond. A governor-appointed commission of emigration was placed in San Francisco to oversee the enforcement of the act. The law lasted only until 1857, when it was overturned by the California Supreme Court. However, this was not the last time California attempted to restrict who could access services in the state. In 1870, for example, Judge Wright in San Francisco declared that only citizens could be committed to the state asylum. He was pointed to the existing state law, and it appears he quickly dropped the assertion. Similar arguments continued to crop up as late as 1886, when, in the Stockton Asylum’s annual report to the state legislature, its superintendent complained that there were an estimated 140 mentally disabled Chinese individuals in state asylums at state expense. “The expatriation of mentally defective immigrants is, in other places a well-established custom,” he groused. “Less than one half the amount annually expended for their care and maintenance here would charter a vessel and return the whole number to Hong Kong, whence they came.”50

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The successful transition of a general hospital into the State Insane Asylum at Stockton, the first asylum in the state, must have seemed to California legislators, at least momentarily, like a triumph. California had successfully survived the destabilizing effect of the gold rush and asserted its own political legitimacy by creating some of its first state-funded and state-operated institutions. It was also responding to residents’ demands to deal with the disorderly and disruptive plaguing respectable society by replicating the same structures of care and control found in the eastern United States. What could go wrong? California passed its first law about mental disability, a “lunacy law,” in 1853. It allowed a county judge, “upon the application of any person under oath and after the examination by two reputable physicians,” to order an individual be placed in an insane asylum. Those who could pay were expected to do so, but if they could not, confinement was to be at state expense. The following year, the law was amended to require the judge holding the commitment proceeding to inquire specifically into the financial wherewithal of the individual being committed. Commitment requiring the testimony of two doctors was becoming common across nineteenth-century United States as both states and reformers tried to develop means for making sure no sane people were forced into asylums by unscrupulous friends or relatives. The court-appointed “two respectable physicians” were expected to examine the individual and provide a judge with their diagnosis and recommendations. If the judge found the individual in question to be “insane,” admission to a state hospital could be ordered.51 With Stockton’s hospital now rechristened as California’s first State Asylum, the path from commitment to institutionalization had been cleared. California’s State Asylum at Stockton remained the only such institution west of the Mississippi River until 1871.52 By creating a state, rather than county or local, institution for the mentally disabled, California bucked the national trend in asylum creation. In other states at this time, such care was usually considered a local matter, although asylum reform activists, including Dorothea Dix, were working to change that at both the federal and the state levels. From its very beginnings as a state, “California established the policy of caring for its insane with state money instead of forcing the counties to pay a part of the cost and the state appropriating the remainder.”53 While transitioning from general hospital to asylum, the Stockton asylum remained

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in the old hospital building at El Dorado and Market Streets. Twentyone individuals were sent from the Sacramento Hospital to Stockton before additional accomodations could even be built for them there. Sixteen more individuals from San Francisco followed in November 1852. Of those sent to Stockton in the early years of its operation, all but one were male. They were a racially and ethnically “remarkably diverse” group, reflecting the polyglot, multicultural nature of post-gold-rush California.54 There was some discussion in the state legislature about the “healthfulness” of the site at Stockton due to proximity to the region’s many rivers and marshes, but ultimately, financial concerns ruled the day, and Stockton remained the state’s choice. In 1853, the asylum moved to a new location further from downtown.55 Two years later, the asylum at last received a state appropriation of $30,000 for the construction of new buildings56 The asylum grew one building at a time: a row of wooden buildings called the Cottage Ward was added in 1869 to accommodate an additional 160 individuals, and a women’s wing and a new central wing were finished in 1874, adding 325 additional beds. Construction at Stockton was not complete until 1884, when a new building for men (known locally as “the bricks”) opened with 530 beds.57 As stated, admission to asylums like Stockton’s was at least as much about removing threats to the public order from society as about any semblance of successfully treating the individual. Capitalism and industrialization required the removal of those who could not be productive from the economy and the movement of caregiving into institutions to free up families’ time, energy, and attention, and societal norms required order and peace, even if it was only achieved by removing the disorderly.58 In the eyes of the state, California seemed to bring out the crazy in people, and since said individuals might risk their own life or the lives of others, this required intervention from the state.59 California newspapers routinely played up the presence of such disruptive individuals and stressed the need for authorities to “deal” with them. When authorities and newspapermen extended any grace at all to the mentally disordered, it was only to stress the need to distinguish the “mad” from the criminal.60 In his study of late nineteenth-century San Francisco commitment records, Richard W. Fox found that in “at least” six out of ten cases, “it was the presence of socially inappropriate behavior that constituted the actual grounds for commitment, although such commitment was contrary to a strict reading of the commitment law.”61 Chronic alcoholism was also grounds for admission to the state

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asylum, as both doctors and the general public regarded it as a moral failing in need of a “moral” cure, rather than as a disease.62 There were likely some Californians institutionalized simply because other Californians did not want to see them. In 1867, San Francisco passed its first so-called ugly law, prohibiting any individual “diseased, maimed, mutilated, or in any way deformed” from begging or simply appearing in public. Those convicted were expected to pay a fine. If they could not do so, they were shunted off to the city’s new almshouse. The first person arrested under the new law was a former Union soldier.63 Individuals often cycled between different institutions over several months or years. Most did not emerge, if they emerged at all, from their encounters with such facilities “recovered” or “rehabilitated.” At best, such carceral institutions merely provided a respite (shelter on a cold night, regular meals, rudimentary health care) for individuals who for whatever reason did not have access to them in their own communities.64 Stockton fancied itself an institution that, like its Eastern counterparts two decades earlier, promoted the so-called “moral treatment” to restore individuals to sanity. The reality, however, was that the time for this idea had already passed when Stockton reopened its doors. The result was that “whereas many eastern hospitals were thought by contemporary observers and subsequent historians to have ‘declines’ from therapy to custody, California asylums underwent no such apparent transition,” Richard W. Fox explains. “From their very beginnings in the 1850s they were clearly understood to be not simply treatment facilities for the mentally disturbed, but also detention facilities for ‘imbeciles, dotards, idiots, drunkards, simpletons, fools,’ for ‘the aged, the vagabond, the helpless.’ The efforts for superintendents in the 1850s to establish a humanitarian ‘moral treatment’ regime—modeled after earlier eastern efforts—was futile from the start.”65 This was not an issue confined to the American West: even Thomas Kirkbride’s own asylum, the Pennsylvania Hospital for the Insane, often failed to live up to the promises it had made and struggled with overcrowding and upkeep. “The tendency of hospital life,” as Nancy J. Tomes notes, “was ever towards disorder and disintegration.”66 Most of California’s doctors in this era, including the ones who staffed the Stockton asylum, had received their training in the eastern or midwestern United States or in Europe and had come to the state seeking to further their careers. Formal medical training only become

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available in California in 1864 at the Toland Medical School, which eventually became the medical department of the University of California. The state was slowly building its own medical infrastructure, such as the 1870 creation of the California State Board of Health. The board initially served as just an advisory body to the state on matters of hospitals, private and public alike, collecting data and conducting inspections. It had no direct involvement with the state asylum. Thus, as Esther Pond and Stuart Brody explain, Stockton and California asylums that followed it were each “a relatively independent entity run by its board of trustees who exercised almost complete control over the superintendent and the hospital’s employees.”67 Life in an asylum like Stockton came with a set of expectations. Judges and doctors alike expected appropriate behavior from individuals confined to these institutions. Individuals were to acknowledge that they were “ill” and acquiesce to whatever treatments the doctors prescribed. However, in asylums across the country, oftentimes “patients refused to be orderly and content. They grew bored, fought with their ward mates, and complained almost endlessly about hospital life. By suicide, escape, and destruction, they continually expressed their resistance to the therapeutic regimen of the asylum.” Yet resistance in any form was often presumed to be yet another symptom of mental disorder itself. It could result in anything from a lengthening of time an individual had to stay institutionalized (unlike prison sentences, commitments were open-ended) to physical violence at the hands of attendants, nurses, and doctors. The only “treatments” available were tonics, stimulants, sedatives, and narcotics, physical restraints, and, in some cases, water therapies. Staff turnover was constant. Individuals in the asylum were expected to work: to wax and mop floors, cook, help tend others, and so on. This not only helped ease the strain of not having enough staff to perform needed labor, but was in and of itself considered by doctors a form of treatment, a sort of “occupational therapy” before the term had ever been coined. The idea of having individuals inside institutions contribute to it through their labor was not new, of course. As early as the mid-seventeenth century, European institutions were combining the repressive function of confinement with a demand that those confined “contribute to the prosperity of all.” In its official report to the California State Legislature in 1855, the Legislative Hospital Committee declared that Stockton “would do credit to any similar Institution in any of the older States,” but expressed hope that soon the individuals there would have “an opportunity to employ themselves in

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the tillage of the soil, which in similar institutions has resulted in great good in restoring invalids to health.”68 Such labor, whether performed inside or outside the asylum, doctors believed, prevented “brooding” while simultaneously making the individual “useful.” As with refusing treatment, refusing to work was often interpreted as a symptom of illness rather than a protest.69 During the first ten years, it was in operation, the more than 2,000 individuals confined at Stockton reflected California’s gold rush-driven demographics. They were relatively young (75% were between the ages of twenty and thirty-nine); overwhelmingly male (men outnumbered women five to one); and largely foreign-born (53% of the men at Stockton were foreign-born, even though they accounted for only 39% of the overall state population at the time). Forty percent of these individuals were discharged within six months (“restored to usefulness,” as Superintendent Robert K. Reid put it in the asylum’s first annual report). Reasons for admission ranged from madness to developmental and physical disabilities to alcohol abuse to epilepsy. The latter became a particularly contentious issue among doctors, as “epilepsy had always created an institutional as well as a medical problem for the superintendents (what constituted an epileptic condition itself was not well defined)….Some seizures had clear neurological origins, but other appeared to be associated with various forms of lunacy.” Other individuals were simply old and/or ill and had nowhere else to go. Whatever the reason for admission, the population at Stockton quickly ballooned. By the end of 1853, the California State Asylum at Stockton housed 102 people; by 1864, 301. Not only was it still the only such institution west of the Mississippi, but it was also among the largest such facilities in the country. Asylums in New York State, Illinois, Philadelphia, Pennsylvania, and Washington, D.C. were the only ones with larger populations in a single facility. Moreover, most states operated more than one state-run asylum by 1864: New York State took the lead, with six of them. California still had just the one. By 1871, the State Insane Asylum at Stockton housed 1,090 individuals. Not until the 1871 opening of the state’s second insane asylum in Napa County was there any relief on the population strain.70 Even had overcrowding not bedeviled the institution from the start, the Stockton asylum would still have proved itself to be a deeply troubled institution. Although originally believed to be the best possible site for an asylum (“Los Angeles is too warm and San Francisco is too cold and changeable to be favorable,” one doctor opined at the time), the site

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itself created a host of problems for the institution. The natural drainage of the land was so poor that farming was often done in the mud, a situation made worse by the hard clay soil. There was no reliable source of clean water for irrigation and no money to dig an artesian well, leading J. B. Saul, the asylum’s farmer and gardener, to irrigate with “sewerage” (waste) water. California’s legislators had expected the Stockton asylum to grow most of its own food as a cost-saving measure. Saul, however, found that many of the staple crops most needed to feed the asylum population (particularly potatoes) not only wouldn’t grow properly at the site, but likely wouldn’t grow in the Stockton area at all. Graves in the onsite cemetery were often filled with water within a few hours of being dug. The asylum had no way to carry sewage away from the building until 1861: before that, cesspools dotted the yards, “subject to overflow, contaminating the air and producing a horrible or sickening stench.”71 California had also chosen to make the position of superintendent at Stockton a political appointment, and thus the men in that position were frequently replaced. Every time political power in the state shifted from one governor to another, a fight over the superintendency might ensue. That decision alone set up the asylum for years of turmoil that often left even supportive Californians shaking their heads in dismay.72 While such kerfuffles might easily be dismissed as mere political infighting, they are significant because each scandal inadvertently shed light on very real issues at California’s Asylum for the Insane at Stockton. The problems began with the appointment of Stockton’s very first superintendent, Dr. Robert K. Reid. Like so many other Californians, Reid had originally come to California to mine, but he soon gave up that enterprise to return to the stability of his medical practice. Reid had been at Stockton since 1851, when it had been a general hospital. At that time, the hospital was so small, with only ten or twelve rooms, that he housed some of his own patients on a brig, the Suzanne, moored in Stockton Slough. He stayed on during its transition to an asylum, thus becoming both resident physician and superintendent at the age of thirty-one. Reid and a set of male attendants (initially called “keepers”) oversaw the men, while a female matron, Mrs. Mathilda Masters, and a set of female attendants oversaw the women. Reid’s approach to mental disability reflected the standard medical beliefs of the day, that “insanity is a corporeal disease; that the brain is the instrument of mind an organic part of the system; that it is generated and nourished, becomes diseased and is cured, as any other organ of the body.”73

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In April 1856, the California State Legislature attempted to fire Reid, a Democrat, and replace him with Dr. Samuel Langdon, a Republican, at the behest of California’s newly elected Governor Neely Johnson, also a Republican. Stockton’s trustees, however, refused to remove Reid purely for the sake of political expediency. It ultimately took an order from California’s State Supreme Court confirming the governor’s power to make such appointments at his discretion to force Reid out. To justify his removal, local newspapers that supported Langdon’s appointment quickly splashed details about Reid across their pages. He had been a poor financial manager, they argued, racking up bad investments and debts that had already left him destitute by 1855.74 The state legislature launched an investigation into Reid’s management of the asylum that ran, in fits and starts, for the next two years. Reid was accused of still paying some asylum employees after they had left their positions and of removing from his former office “a cabinet, containing above one hundred species of birds, fifteen species of animals, and a fine collection of reptiles, shells and minerals” that had been collected at state expense. Buried in the back and forth, however, was a far more serious charge: that Reid had been deliberately undercounting the number of deaths at the state asylum to paint a rosier picture in official state reports. Official asylum records and reports to the state legislature counted sixty-five deaths between when Reid took office and October 1, 1856, when he officially stepped down. But the sexton of Stockton’s City Cemetery, a Dr. Bond, said that thirty-one individuals from the state asylum had been buried there, which should have left only thirty-four interments in the cemetery on the asylum grounds. Yet there were sixty-one graves in the on-site cemetery. State Assemblyman Edwin G. Waite, who served on the Joint Special Committee investigating the allegations, reported that he and other committee members who had attended exhumations at Stockton had seen “several graves open, and in all but one there were two coffins or boxes in and in each of the four top boxes were found the remains of two persons, placed heads and points.” Waite added: These facts can be attested by at least fifty citizens of the city of Stockton. Those graves, it is not denied, were made during the administration of Doctor Reid, and the whole appearance of the graves, the boxes and seem to preclude the possibility of a design on the part of any one to deceive the committee. Dr. Reid, in his. sworn statement in regard to this point, adds the number sworn to by Mr. Bond to the number called for in his

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report—thus impeaching the accuracy of his own reports to the Legislature; for, if both Doctor Reid’s reports and the account of Mr. Bond be true, then at least thirty of the insane have been buried alive—a proposition too monstrous to be seriously entertained. In conclusion, the undersigned would say that abundant material is at hand to make a longer and more forcible report, but the limited time allowed him to write a minority rereport, compels him to be brief. He, however, refers to evidence fallen by the committee, which ought to be published. It is important that the people should know how an institution on which the State has expended over one half million dollars, has been managed. Respectfully submitted. E. G. Waite.”75

Waite was in the minority. Four other members of the committee drafted a majority report that exonerated Reid of all charges. The Nevada (County) Journal, reflecting on this outcome, expressed discomfort with the decision of the state not to act. The author or authors of the anonymous newspaper article were not all that troubled by the accusations about excess payments or the removal of state property. “These offences, however, as the times go, may be classed among the venial and trifling ones. Swindling the State is not altogether without precedent in California, even in high places,” they concluded. “We have known men to do that thing, and be considered none the less entitled to ‘great credit’ afterwards” What did trouble them, and rightly so, were the discrepancies in the burial records: There is evidently rank perjury in this matter somewhere. If Dr. Reid’s report was correct, there has been a fearful conspiracy against him. for which we cannot see any adequate motive. If it is erroneous he has been guilty of gross deception, for the purpose of enhancing his reputation for skill, or concealing his lack of it. But this is not the worst. The poor unfortunates who are forced to seek the shelter of that institution, are the most utterly helpless and defenseless creatures in the world. They are entitled to the warmest sympathy and kindness. The State, with a creditable liberality has taken them under its protection and should see that the commonest decencies 496678_1_Enof humanity at least, are exercised towards them, living or dead. If, as is shown by the report of Mr. Waite, the deaths of so many of these patients have been concealed, and their bodies thrust into the ground, with as little respect or decency as those of wild beasts, we cannot see how a majority of the committee could award the meed [sic] of praise to the resident physician. The matter should be more thoroughly investigated. P. S.—Since the above was written, Senator Fiske has laid before the Senate,

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the affidavit of one Frank Wilmesmeier, who swears that he has been keeper of one of the wards of Asylum under Dr. Langdon; that, acting under the orders of Dr. Langdon, he removed the numbers and names from the graves at the Asylum the day before the Legislative Committee arrived, and that in several instances, he had buried two or three bodies in one grave, acting under the same authority. This gives a different color to the whole affair, but renders a thorough investigation still more necessary.76

There was indeed an affidavit from Frank Wilmesmeier available to the investigators. It, too, was damning. Wilmesmeier, a veteran of the Mexican–American War who had settled in California in 1852, was trained as a baker, but went to work as a “keeper” (asylum attendant) under Dr. Langdon in October of 1856. He reported that he was still a keeper when the committee visited Stockton. I was present when the graves were opened by order of Dr. Langdon; I opened three graves myself, by the same order; found only one coffin in each grave; most of the graves were opened by insane patients; did not see them all opened. The day before the Committee came to the Asylum, Drs. Langdon and Frey ordered the numbers and names to be removed from the graves and put away until the Committee left, and then to be replaced, and I was ordered to keep still and say nothing about it till the Committee left; was ordered to dress the patients and prepare the Asylum for the inspection of the Committee; some of the patients were badly clothed; either eleven or twelve died on my hands while I was keeper; 1 buried all who died in my ward. I placed three coffins in one grave and two coffins in one grave, in three instances; 1 buried three in one grave in October. One patient died while I was digging the grave —two others died. I was then ordered to enlarge the grave and we put all three together in the same grave.77

Wilmesmeier’s testimony put a new, even darker spin on the story. It suggested that the new asylum superintendent was complicit in the continued cover-up of deaths at the State Insane Asylum. The Joint Special Committee did not, however, choose to follow up on any of his accusations. Wilmesmeier had also testified that he had never been paid for his five months of work at Stockton, so perhaps he was written off as a disgruntled employee with an ax to grind. Reid was, after all, already gone; Langdon was the person the governor wanted in place, and he was in place; and all the trustees expressed confidence that, despite the scandals, their political appointments were also secure. They were proved correct in their assessment. “Take it by and large,” the Placer Herald

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newspaper wrote dispiritedly of the affair, “it is what might fairly be termed a muddle.” Because the families of those confined to Stockton and other asylums often could not or would not claim individuals’ bodies for private burial, the practice of burying (and later, cremating and inurning) those who died in state asylums on site, and of marking those individuals, if at all, only with numbers and not names, continued well into the twentieth century.78 Dr. Langdon, the Republican, had indeed taken the position of superintendent. But he quickly found himself at odds with the staff at the asylum, many of whom still felt loyalty to Reid. Reid’s assistant physician, who had remained in his post, proved a particularly hostile colleague. The dispute between the two men came to a head when the two men fought a duel on the asylum’s grounds. Langdon got a bullet wound in the knee for his troubles. After all the trials and tribulations to get into the position, he stepped down after serving for little more than a year. His successor, Dr. W. D. Aylett, seems to have provided the institution a few years of relative stability. He increased the number of attendants as well as their salaries; introduced games of dominos and chess for the individuals living in the asylum; and even promoted co-educational dances as recreational therapy. But he, too, was soon under suspicion by some members of the state legislature. It began with a tragedy. A blacksmith named Otis Brett, who had left his large family behind in the eastern United States to work in one of the southern mining counties, in January of 1859 exhibited what one newspaper called “religious excitement.” He was, they said, “a raving maniac.” He was taken first to the county jail in Sonora, California, and then was sent on the long journey to the State Insane Asylum. It was a cold January, and Brett made the journey loosely manacled. Although the details remained in dispute, sources suggest that immediately before or during the trip, his feet suffered an unknown injury. He was then confined in a cell in the asylum for nine days, which, everyone later agreed, seemed to have returned him to sanity. His brother, “one of the most respected citizens of Marysville,” found him there, sane again, and immediately had him removed to a Stockton hotel, where he received medical care. Doctors found that Brett’s feet appeared to have lost circulation some days before, either through frostbite or another means. By February, both of his feet had to be amputated. After recovering him from the asylum, Brett’s brother John Brett promptly launched a lawsuit for $50,000 in damages against the asylum and the state of California on his behalf. The

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case quickly made news all over the state. In some California newspapers, this was yet more evidence of ongoing poor management at the state asylum. “If this is the manner in which the State Insane Asylum is managed,” the Daily National Democrat sniffed, “it is time that the present incumbent were removed from his position.”79 This time, the California State Legislature acted quickly to get out in front of the story. At the end of January, when the tenth session of the California State Legislature officially opened, the possibility of another investigation was discussed frankly and openly. It had already put together a Joint Standing Committee on Hospitals, and that committee was already investigating what, exactly, might have happened to Otis Brett while he was at the state asylum. After all, committee members pointed out, Brett was no longer a patient at Stockton, and Superintendent Ayelett had already appeared before the committee. They pleaded with their colleagues to let the process play out. Others, however, demanded the immediate creation of another investigative committee, one that would not only investigate the Brett case but also potential financial mismanagement at the asylum. In fact, it quickly became apparent that Brett’s case was simply a vehicle to get at what many legislators felt were excessive expenditures at Stockton: buildings that always seemed to cost more than had been originally proposed and high prices for foodstuffs. In February, by which time articles documenting every side of the debate had appeared in newspapers across Northern California, a legislative special committee was formed, separate from the hospital committee, to visit the asylum yet again. As had been the case in 1857, the investigators did not find any major issues at Stockton. There was a great deal of speculation as to the underlying causes of Brett’s madness and how his behavior while in custody (stripping off his clothes, tearing up his bedding, etc.) might have exacerbated what reports were now claiming may have been a pre-existing problem with the circulation in his feet. However, no malice or deliberate neglect was charged against the doctors at the state asylum. Indeed, in the majority report, the investigators opined that Ayelett and the other doctors on staff had done everything they could for Brett’s feet. Even the special committee’s minority report was limited in its criticism, suggesting only that the younger, more inexperienced doctors on staff had perhaps not understood the full gravity of Brett’s injuries when they released him to the care of his brother and the private physicians.80 Nor was any fiscal impropriety found. The state legislators looked over the recent construction they had authorized to both the male and female

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wings and to asylum infrastructure, ranging from adding a bakery to the kitchen wing to adding a water tower and tank to ensure a steady supply of water, and found all of it necessary. All had been built via contracts that went to the lowest bidders. The men serving on the committee also largely blamed themselves for the asylum having to turn to outside vendors to purchase food stuffs. California had been in a state of financial precarity for several years and had not been able to meet the increased needs of the many individuals living in the state asylum. “Great thanks are due to many or the citizens of Stockton,” the investigators concluded, “who then in its time of need furnished it the necessary supplies at charges but little above cash prices, trusting to the honor of the State for payment.” They recommended increased state appropriations for the following year.81 Following yet another gubernatorial election, Ayelett voluntarily stepped down from his position in 1861 in favor of a new political appointee, Republican Dr. W. P. Tilden.82 The State Insane Asylum operated relatively quietly until 1865, when a new dispute broke out. This time, it was between Superintendent Tilden and the asylum’s board of directors (sometimes also called the board of trustees). On May 1, 1865, the board turned Tilden out and took possession of the institution. Tilden argued that he was being pushed out of his position earlier than the August 1 date his contract called for and thus what the board had done was invalid. The board of directors, on the other hand, identified a whole host of issues with Tilden’s management of the asylum and argued they had been right to force him out. These issues ranged from Tilden having arbitrarily dismissed staff to spending too much on potatoes to falsifying the causes of death of individuals who died in the asylum. Tilden in turn accused the board of taking forceable possession of the institution and of encouraging the staff to turn against him to keep their own positions. On one memorable occasion, he confronted a staff member he had dismissed who refused to leave the grounds with a derringer. News of the infighting soon reached newspapers in Stockton and San Francisco. In 1866, everyone involved was hauled before yet another special joint committee of the California State Senate and Assembly to explain themselves.83 As it had twice before, much of the testimony before the committee involved mundane matters such as asylum expenses and Tilden’s many absences from the premises. But just as before, the investigation also forced darker matters into the light. As we have seen, ever since the

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asylum had opened, there had been scattered reports of mistreatment and deaths at the asylum. The joint committee seized on the opportunity of the hearing to dig deeper into such reports. This time, one death at Stockton caught the attention of both the state legislators and the press. She was Catherine Adams, just twenty-eight when she died there. Perhaps it was because Adams was a relatively young white woman, a wife and a mother, that her death attracted so much attention, even though she had died three years before the latest investigation was launched. She had been born in Ireland and lived with her family in San Francisco. A judge in San Francisco committed her on September 4, 1863, and she arrived at Stockton on September 6. Her commitment record indicates she was married with two children, the youngest only a year old. Her illness had come on suddenly only the week before and consisted first of delusions about harming herself and her children, which then escalated into actual attempts. She was lucid enough upon admission to tell doctors that her grandmother had been insane. The doctors who committed her to Stockton judged her to be “not filthy or destructive in her habits…had no peculiarities, was temperate; has not suffered from disease of injury so far as known; no change in health since the attack only loss of appetite had not been restrained; cause thought to be heredity; treatment, anti-spasmodic.” The next day, Adams was dead.84 It was common practice to bathe people and have them change clothes as soon as they arrived at the asylum, likely to minimize the chance they would carry lice or other pests into the institution. The baths were cold because there was still no warm water available on-site. This bathing practice was different from the use of water therapies on some Stockton patients, a common “treatment” in asylums at the time.85 On admission, Mrs. Adams refused to be bathed. The next day, September 7, 1863, asylum staff insisted upon it. After that bath, she died. According to some of the former staff members who subsequently testified in 1866, even at the time, the death had seemed suspicious. Superintendent Tilden had been absent from the asylum on the day Mrs. Adams died. Asylum clerk John A. Vance testified to the joint committee in 1866 that the cause of death was listed in asylum records as “congestion of the brain.” In fact, Vance testified, Tilden had often insisted that be listed as the cause of death no matter how the person actually died. Assistant Physician Thorndike testified that he had been in a meeting of the asylum’s medical staff in which Catherine Adams’ death came up, and that Tilden said, “Congestion of the brain should be listed as the cause of death.”

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Thorndike also remembered Tilden saying that “Such cases, or similar cases, might happen, which should not be known to the outside world.” Adams’ case thus seemed to be exactly the kind of alteration of records the board of trustees were citing as part of their crusade to remove Tilden. Assistant Physician Clark went one step further in his 1866 testimony, testifying that although he himself had not witnessed Mrs. Adams’ death, upon Tilden’s return, he had reported to his superior that “the attendants were more or less culpable.” There were even unsubstantiated rumors that no less a personage than California Governor Frederick Low had already known about the circumstances of Mrs. Adams’ death and that the governor had agreed it was best to keep it quiet. It was confirmed that in October 1863, just a month after her death, Governor Low had accompanied the two visiting physicians assigned to the asylum, Drs. Morse and Whitney, on a visit to Stockton. While there, J. F. Morse testified in 1866, they had heard the whole story from Clark. Clark’s tale was this: two female attendants had stripped and forced Mrs. Adams into a bath; Adams had fought back; and the two attendants forcibly held her under the faucet until she stopped moving. The attendants immediately pulled her from the water, but Adams was already unconscious and died a few minutes later. As Dr. Morse later recalled, it was represented to us as a melancholy affair, and was stated for consultation as to what was best to be done about it, and also as an evidence of the unfitness of the Matron for the position she held. Doctor Clark further stated to us that he had immediately discharged the two attendants who had administered the bath It resulted in all coming to the conclusion that, for the benefit of humanity, and for the purpose of saving the feelings of the husband, the cause of death should be suppressed but that it should be used as one of the means for adopting a more stringent system for the management of the institution.

According to the published version of the 1866 testimony, this was the practice for suicides that occurred in the asylum as well as with more suspicious deaths. One of the two attendants who had administered Mrs. Adams’ bath, and who had lost her job because of it, was next brought in to testify before the joint committee. She, however, continued to insist that Mrs. Adams had never been forced under the water and that she had died from some unknown cause. For his own part, the governor continued to insist he had not heard this story when he visited the asylum

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and, if he had, he certainly would have acted on it. No criminal charges were filed.86 Although not recounted in such harrowing detail, numerous other cases of abuse and neglect appear in the 1866 testimony. Employees came forward with stories of finding female patients locked in the woodshed; of attendants who were known to physically abuse their charges; and of at least one patient, a man known only as Lilly, who after his death had been found to have broken ribs and a broken sternum consistent with being kicked or beaten. As in the Adams case, the individual suspected of having administered the beating had already left or been dismissed from the asylum. He was eventually tracked down by the joint committee to testify. He insisted he had nothing to do with Lilly’s death, and it appears no charges were filed against him.87 Although he himself was never charged with any crimes, the tide had clearly turned against Tilden. Later in 1866, Dr. G. A. Shurtleff was promoted from Stockton’s board of trustees to take over as its superintendent. It was a job he held for eighteen years, providing a level of administrative stability at Stockton. During that time, he reduced the use of drugs at Stockton, and after the scandals of the previous years, “even shower baths were tabu” [sic]. Shurtleff eventually moved on to become professor of mental diseases at the first University of California (later the University of California, Berkeley). He was the last of the Stockton asylum’s politically appointed superintendents.88 What is perhaps most remarkable about this pattern of scandal followed by damning revelations (or what should have been damning revelations) is how little it did to change the day-to-day functioning of the State Insane Asylum or the oversight, such as it was, provided by the California State Legislature. The legislators who had authorized the creation of the state’s first asylum seemed quite content to let the superintendents run the asylum as they saw fit so long as neither press nor public outcry drew attention to it. Their trust in the wisdom and rightness of nineteenthcentury American medicine, as it was demonstrated in the care provided at Stockton, was absolute. Save for the infighting over political appointments to the position of superintendent, investigations were cursory at best. None resulted in any formal charges against doctors or staff for abusing or possibly even killing the individuals in their care. This speaks to the role the Stockton asylum played in the state. California now had a reliable place to put those it deemed disruptive, deranged, drunken, disheveled, or disorderly. Individuals placed there were off the streets,

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out of the sight of “respectable” citizens, and, sadly, largely forgotten unless a family member complained or the state legislator roused itself for some cursory investigation. Moreover, by functioning as much as an almshouse as an insane asylum, “by providing custody, relief, and care at state expense,” California’s cities did not have to do much to provide care and relief in their own communities. County officials also had little incentive to develop their own institutions. It was a system that served everyone—except those who needed care.89 Speaking of nineteenth-century American asylums more broadly, David Rothman asks, the asylum was a success or failure as judged by what? By reformers’ dreams, or by families’ needs, or by what might have come in its stead, or by the practices it actually replaced? If the question is whether the asylum lived up to the expectations of its founders, the answer is an unequivocal no. But, then one must immediately ask why the failure persisted, why the asylum lived on long after the dream turned into a nightmare. The likely answer is that it was fulfilling the needs of those outside, if not inside, its walls. Their wish was to be rid of the deviant and dependent, to put them out of sight and out of mind, and in that regard the asylum was a notable success, functioning ever so effectively.90

For California’s politicians, the state asylum at Stockton and other state institutions remained a source of great pride. At a railroad exposition in 1869, California Governor Henry Haight found much to celebrate in what California had accomplished. In his speech, Haight asked, What is our present? But little more than twenty years have gone and what has been accomplished ? Look around you, and see these philanthropic and benevolent institutions which now constitute your highest praise. Sanctuaries representing every form of religions belief—Gentile and Hebrew —Protestant and Catholic. A Public School system, well organized and endowed, growing every year in efficiency, placing instructions, within the reach of all. A University, furnished with ample means for growth, in addition to private institutions of learning. Hospitals, private and public. Asylums for the insane; for the deaf, dumb and blind, and for the orphan; Benevolent Associations to relieve the wants of the distressed and suffering, of every creed and nationality. A public press which for enterprise and devotion to the public interests, is certainly not inferior to that of any Eastern State. Thousands of comfortable homes in the best sense of the word, with troops of rosy-cheeked children.…The day is near at hand when

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a more splendid civilization than any which has preceded it will arise upon these distant shores.91

In keeping with this vision, California’s legislators had an eye on expanding the state asylum far beyond the sole facility at Stockton. Indeed, over the next decades, California built one of the largest statewide systems of asylums and mental hospitals in the United States. Shortly after statehood, California had embraced mainstream ideas about the care of the mentally ill and disabled as part of a larger quest for legitimacy, driven by the state’s doctors and by the California’s need to prove itself. By replicating the structures of care found elsewhere, the state of California thus simultaneously positioned itself as a major player in American medicine and as the single biggest arbiter on the care of mentally ill and disabled Californians for the next century.

Notes 1. Alta (San Francisco), April 3, 1851. 2. Hawk, “Going ‘Mad’ in Gold Country,” 73. 3. In her study on the Menominee Nation and other indigenous groups and the Canton Asylum in South Dakota, for example, Susan Birch found that caregiving in the community was interdependent, with multiple generations living under one roof and sharing responsibilities for the sick, the elderly, and the disabled. Susan Birch, Committed: Remembering Native Kinship in and Beyond Asylums (Chapel Hill: University of North Carolina Press, 2021), 40–43; Penny L. Richards, “‘Beside Her Sat Her Idiot Child’: Families and Developmental Disability in Mid-nineteenth Century America,” in Mental Retardation in America, eds. Steven Noll and James W. Trent, Jr. (New York: New York University Press, 2004), 65–86; Gunnell, Daughters of Charity, n107. 4. Praslow did not attempt to explain what he meant by “cretinism,” nor does he provide any further details. In the mid-nineteenth century, the term was used to describe what is now is known as untreated congenital hypothyroidism. If left untreated, it can impair both physical and mental development. Praslow may also have been describing some other form of developmental or congenital disability. J. Praslow, The State of California: A Medico-geographical Account, trans. Frederick C. Cordes (San Francisco: J. J. Newbegin, 1939), 12–13, 44–48, 74, 84; Sonia Salisbury, “Cretinism: The Past, Present and Future of Diagnosis and Cure,”

2

5. 6.

7.

8. 9.

10. 11.

12. 13. 14.

15. 16. 17. 18.

19.

20.

21.

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Paediatric Child Health 8, no. 2 (February 2003): 105–106, https:// doi.org/10.1093/pch/8.2.105, https://www.ncbi.nlm.nih.gov/pmc/art icles/PMC2791432/. Praslow, The State of California: A Medico-Geographical Account, 12–13, 44–48, 74, 84. Steven Noll, “Institutions for People with Disabilities in North America,” in The Oxford Handbook of Disability History, eds. Michael Rembis, Catherine Kudlick, and Kim E. Nielsen (New York: Oxford University Press, 2018), 312. Theda Skocpol, Protecting Soldiers and Mothers: The Political Origins of Social Policy in the United States (Cambridge, MA: The Belknap Press of Harvard University Press, 1992), 92–93. Hawk, “Going ‘Mad’ in Gold Country,” 69–70. Janice A. Brockley, “Martyred Mothers and Merciful Fathers: Exploring Disability and Motherhood in the Lives of Jerome Greenfield and Raymond Repouille,” in The New Disability History, 294. Noll, Feeble-minded in Our Midst, 2. William J. Novak, The People’s Welfare: Law and Regulation in NineteenthCentury America (Chapel Hill: University of North Carolina Press, 1996), 154–155. “State Lunatic Asylum,” Monthly Traveler, February 1, 1838, 78–80. “Instruction of Idiots,” Christian Palladium, September 18, 1847, 327. Nancy J. Tomes, “A Generous Confidence: Thomas Story Kirkbride’s Philosophy of Asylum and Construction Management,” in Madhouses, Mad-Doctors, and Madmen: The Social History of Psychiatry in the Victorian Era, ed. Andrew Scull (Philadelphia: University of Pennsylvania Press, 1981), 122–124. Tomes, “A Generous Confidence,” 122–124. Foucault, Madness and Civilization, 270. Tomes, “A Generous Confidence,” 136–137. Christopher Lasch, “Origins of the Asylum,” in The World of Nations: Reflections on American History, Politics, and Culture (New York: Alfred A. Knopf, 1973), 11–12. Wright, “Getting out of the Asylum,” 137, 139, 143–144, 154; Mark Finnane, “Families and the State,” in History Workshop, no. 20 (Autumn 1985): 134–136. Fox, So Far Disordered in Mind, 15–16; Brent Ruswick and Elliott W. Simon, “Industry, Improvement, and Intellectual Disability: Finding the Hopes and Fears of Parents and Superintendents at the Pennsylvania Training School,” The Journal of the Gilded Age and the Progressive Era, 17 (2018): 145, 149. Andrew Scull, “The Discovery of the Asylum Revisited: Lunacy Reform in the New American Republic,” in Madhouses, Mad-Doctors, and Madmen, 157.

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22. Noll, “Institutions for People with Disabilities in North America,” 308– 309, 312. 23. Fox, So Far Disordered in Mind, 17–18. Steven Noll, for example, notes that this eastern model was a particularly bad fit in the American South, a region “beset by endemic poverty and mired in a caste-based system of racial separation” that made addressing both mental and developmental disabilities even more complex than they were elsewhere. Nonetheless, the eastern institutional model was still imported to and implemented there. Noll, Feeble-minded in Our Midst, 1. 24. California’s other closest neighbors, what would be Nevada Territory and Arizona Territory, were not part of the 1850 census because they had not yet been officially created. “Gold Rush Overview,” https://www.parks. ca.gov/?page_id=1081; The Seventh Census of the United States: 1850: Territories (Washington, DC: Robert Armstrong, Public Printer, 1853), 993. 25. The Seventh Census of the United States: 1850, 966–982. 26. Ronald C. Woolsey, “Crime and Punishment, 1850–1856,” Southern California Quarterly 61, no. 1 (Spring 1979): 79–80, 93. 27. Woolsey, “Crime and Punishment, 1850–1856,” 81. 28. Woolsey, “Crime and Punishment, 1850–1856,” 84. 29. By 1853, the situation was so fraught that a citizen’s police force was organized, followed by a local police force, the Los Angeles Rangers. Violence and lynching became commonly used tools to combat crime in the region. Without the economic lure of gold, however, the population remained small. Woolsey, “Crime and Punishment, 1850–1856,” 89–90. 30. Fox, So Far Disordered in Mind, 5. 31. Fox, So Far Disordered in Mind, 7. 32. San Diego County in 1850 had only 2,817 official residents, and Santa Barbara County, only 1,525. San Bernardino County (1853), Kern County (1866), and Orange County (1889) were later carved out of Los Angeles County; Imperial County (1907) out of San Diego County; Ventura County (1872) out of Santa Barbara County; and Riverside County (1893) out of both San Bernardino and San Diego Counties. The Seventh Census of the United States: 1850: California, 966–982; “A History of California’s Counties,” PublicCEO (https://www.publicceo. com/2017/01/the-history-of-californias-counties/). 33. Dr. Praslow claimed to have been appointed city physician and quarantine officer in charge of vaccination, but no evidence of his appointment exists. Praslow, The State of California, ix, 84; Kenneth Thompson, “Early California and the Causes of Insanity,” Southern California Quarterly 58, no. 1 (Spring 1976): 47–49, 52, 56–57; John W. Roberston, “The Prevalence of Insanity in California,” The American Journal of Insanity 60 (1903–1904): 75–88.

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34. Before the creation of the state asylum and the poor house, many such arrestees were sent on to the San Francisco Marine Hospital, city hospital, or the local station house. Angela Suzanne Hawk, “Madness, Mining, and Migration in the U.S. and the Pacific” (Ph.D. diss., University of California, Irvine, 2011), vii, 26, 30, 33; Fox, So Far Disordered in Mind, 18–19. 35. Hawk, “Madness, Mining, and Migration,” 28. 36. Praslow, The State of California, 22. 37. Official brig records were lost when the ship burned in 1851, but it was estimated that twenty-seven cases of insanity were housed in the ship, initially alongside prisoners. No attempts at treatment were made. Hawk, “Madness, Mining, and Migration,” 1, 26; The Story of Stockton Development Center, dir. Frank L. Gardner (Sacramento: California Department of Developmental Services, 1997). 38. Frances Cahn and Valeska Bary, Welfare Activities of the Federal, State, and Local Governments in California, 1850–1934 (Berkeley, CA: University of California Press, 1936), 138–139. 39. Praslow, The State of California, 44–48, 74. 40. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 139; Hawk, “Madness, Mining, and Migration,” 43–44, 46, 51. 41. Floyd A. Bond, Ray E. Baber, John A. Vieg, Louis B. Perry, Alvin H. Scaff, and Luther J. Lee, Jr., Our Needy Aged: A California Study of a National Problem (New York: Henry Holt and Company, 1954), 39–40. 42. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 143. In 1869, no less a personage than Dorothea Dix, who happened to be on a visit to Northern California, visited and publicly praised the charitable institutions in San Francisco, including the Protestant Orphans Asylum, as well as public institutions, including the local schools. She did not visit the Stockton Asylum. “Miss Dix,” San Francisco Chronicle, March 30, 1869. 43. The Southern Californian, October 12, 1854. 44. Doctors and asylum superintendents soon began to protest that this practice frequently further traumatized the individual being transported. According to Richard W. Fox, the San Francisco sheriff’s department may well have been the only official agency that approved of this practice, as they collected a fee of $5 per days for transporting individuals and protested vociferously any time reforms were suggested. The practice thus continued in California well into the twentieth century. Fox, So Far Disordered in Mind, 182–183, n30; Los Angeles Star, September 5, 1868, July 25, 1868. 45. San Diego Herald, January 13, 1855; Los Angeles Star, November 6, 1869, March 15, 1856.

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46. Most such grants never exceeded $1,000. Bond, Baber, Vieg, Perry, Scaff, and Lee, Our Needy Aged, 39–40; Gunnell, Daughters of Charity, 63. 47. In San Diego, a newspaper complained, “We have a Hospital Fund in the hands of the County Treasurer, but to our shame be it said, there is no officer in the County who is willing to act in the matter.” Bond, Baber, Vieg, Perry, Scaff, and Lee, Our Needy Aged, 40–41; Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 142–143, 147; San Diego Herald, January 13, 1855; “Homelessness and the California Vagrancy Act,” Foundations of Law and Society, December 5, 2018, https://foundationsoflawandsociety.wordpress.com/ 2018/12/05/california-vagrancy-law-cal-penal-code-section-647-e/. 48. For 1880, the United States had 35,564 men and 30,639 women in almshouses. California had 1,377 men, but only 217 women. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 145. 49. Noll, “Institutions for People with Disabilities in North America,” 312. 50. As Hidetaka Hirota notes, the Passenger Act was used primarily against Chinese immigrants to California. Hidetaka Hirota, Expelling the Poor: Atlantic Seaboard States and the Nineteenth-Century Origins of American Immigration Policy (New York: Oxford University Press, 2017), 88–90; Los Angeles Star, April 23, 1870; Biennial Report of the Directors and the Thirty-Third and Thirty-Fourth Annual Reports of the Superintendent of the Insane Asylum of the State of California (at Stockton) for the Two Years Ending June 30, 1886 (Sacramento: James J. Ayers, Superintendent of State Printing, 1886), 14. 51. “Miss Dix,” San Francisco Chronicle, March 30, 1869; “Report of Department 54 (Psychiatric) Superior Court of Los Angeles County,” August 1, 1955, to July 31, 1957, J. Howard Ziemann, Judge, quoted in the Welfare Planning Council of the Los Angeles Region, The Mental Health Survey of Los Angeles County, 1957–1959: A Project of the Welfare Planning Council of the Los Angeles Region (Los Angeles, 1960), 107; Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 157; Fox, So Far Disordered in Mind, 38. 52. Hawk, “Madness, Mining, and Migration,” 76. 53. This would only be the case until 1897. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 157. 54. Angela Hawk’s analysis of the journals of Dr. Robert K. Reed, first superintendent of the Stockton asylum, found that patients admitted represented a staggering twenty-nine different nationalities. Hawk, “Madness, Mining, and Migration,” 2, 22, 52–53. There is some variation in the exact numbers of patients and which institutions they came from. See also The Story of Stockton Development Center. 55. Hawk, “Madness, Mining, and Migration,” 62, 64.

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56. Henry Harris, California’s Medical Story by Henry Harris; with an Introduction by Charles Singer (San Francisco: Grabhorn Press for J. W. Stacey, 1932), 117. 57. After the turn of the century, Stockton expanded again with the purchase of farmland to create the state farm for growing food and raising animals. The Story of Stockton Development Center. 58. Novak, The People’s Welfare, 154–155. 59. Hawk, “Madness, Mining, and Migration,” 31; Fox, So Far Disordered in Mind, 138. 60. Hawk, “Madness, Mining, and Migration,” 24–25. 61. Fox, So Far Disordered in Mind, 151. 62. An understanding of the biological and psychological mechanisms of addiction was still many decades in the future. Fox, So Far Disordered in Mind, n4. 63. Susan M. Schweik, The Ugly Laws (New York: NYU Press, 2009), 2, 26, quoted in Roddy Slorach, A Very Capitalist Condition: A History and Politics of Disability (London: Bookmarks Publication, 2016), 99. 64. See, for example, Angela Hawk’s case study of James “Scotty” Brown in “Going ‘Mad’ in Gold Country.” 65. Michael T. Savino and Alden B. Mills, “The Rise and Fall of Moral Treatment in California Psychiatry, 1852–1870,” Journal of Insanity 60 (July 1903): 81, quoted Fox, So Far Disordered in Mind, n2 and 17–18. 66. Tomes, “A Generous Confidence,” 139. 67. The state’s medical second school, Cooper, later becomes the nucleus of Stanford University. There were also two small medical societies formed that decade, one in Sacramento and one in San Francisco. State of California Department of Public Health, California’s Health, 1870–1970: Centennial Issue (Berkeley, CA: State Department of Public Health, 1970), 12; Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 143; The Story of Stockton Development Center; Esther M. Pond and Stuart A. Brody, Research Monograph No. 3, Evolution of Treatment Methods at a Hospital for the Mentally Retarded (Sacramento: Department of Mental Hygiene, 1965), 9–10; Hawk, “Madness, Mining, and Migration,” 76. 68. “Report of the Hospital Committee, submitted March 28, 1855, Document No, 20, Session 1855” (Sacramento: B. B. Redding, State Printer, 1855), 5–6. 69. For the ways in which these ideas about cooperation with care still linger, see, for example, Fox, So Far Disordered in Mind, 73 n15, 176–177, 181; The Story of Stockton Development Center; Myra Samuels Himelhoch and Arthur H. Schaffer, “Elizabeth Packard: Nineteenth-century Crusader for the Rights of Mental Patients,” Journal of American Studies

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70.

71.

72. 73.

74.

75. 76. 77. 78.

13, no. 3 (December 1979): 344–345; Tomes, “A Generous Confidence,” 139; Foucault, Madness and Civilization, 51; “Report of the Hospital Committee, submitted March 28, 1855, Document No, 20, Session 1855” (Sacramento: B. B. Redding, State Printer, 1855), 5–6. As the Civil War still raged, this study did not factor in any asylums “in States now in rebellion.” “Statistics of American Asylums for the Insane,” American Journal of Insanity 20, no. 4 (1864): n.p.; Hawk, “Madness, Mining, and Migration,” 77; Warren F. Webb and Stuart A. Brody, “The California Gold Rush and the Mentally Ill,” Southern California Quarterly 50, no. 1 (March 1968): 47–49; Annual Reports of the Officers of the Insane Asylum of the State of California for the Year 1854 (Sacramento: B. B. Redding, State Printer, 1855), 16; Trent, Inventing the Feeble Mind, 90. California Legislature Joint Committee to Investigate the Affairs of the Insane Asylum at Stockton, Testimony Taken Before the Joint Committee of Senate and Assembly to Investigate the Affairs of the Insane Asylum at Stockton (Sacramento: O. M. Clayes, State Printer, 1866), 42–44, 86. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 9–10. Reid later married Masters. History of the Association of Medical Superintendents of American Institutions for the Insane, from 1844 to 1884, Inclusive (Warren, PA: E. Cowan and Co., 1885), 207; The Story of Stockton Development Center; “Dr. Robert King Reid,” findagrave.com (https://www.findagrave.com/memorial/121083741/robert-king-reid?_ gl=1*1f65m8g*_ga*OTY0NjUxMjgzLjE2NTMwNjc4NDM.*_ga_4QT 8FMEX30*MTY1OTMxNzExNy44LjEuMTY1OTMxNzE2OS4w); Annual Reports of the Officers of the Insane Asylum of the State of California for the Year 1854, 20. History of the Association of Medical Superintendents of American Institutions for the Insane, from 1844 to 1884, Inclusive, 207; The Story of Stockton Development Center; “Dr. Robert King Reid,” findagrave.com. “Mr. Waite’s Minority Report,” San Joaquin Republican, March 7, 1857. “The State Insane Asylum,” Nevada Journal, March 13, 1857. “The State Insane Asylum,” Placer Herald, March 14, 1857. “The State Insane Asylum,” Placer Herald, March 14, 1857. As the Stockton Weekly Mail newspaper explained about how the Stockton Asylum handed its dead in 1898, “as is often the case, those to whom word is sent [of a death] are often too poor to bear the expense of shipping the body or even paying for a burial…It is generally conceded a misfortune and not a disgrace for any poor mortal to be compelled to end his days in a madhouse, yet there are those who would no move a finger towards defraying the expenses of a decent funeral even for one who is part of their flesh and blood for fear the incident may become

2

79.

80.

81. 82.

83. 84.

85.

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public property, thereby causing them a little humiliation.” “Burying the Asylum Dead: Where the Poor Unfortunate of the State Hospital Go,” Stockton Weekly Mail, March 12, 1898. At this time, newspapers still regularly reported, by name, individuals being sent to the state asylum and why they were being sent there. Sacramento Daily Union, January 5, 1859; “A Horrible Tail,” Daily National Democrat, January 26, 1859. The state legislature later passed a relief bill intended to aid Brett. Although its exact contents are unknown, it was likely monetary. The lawsuit appears to have been dropped, perhaps in response. Although Otis Brett is difficult to trace in historical records, he may have returned to his family in Massachusetts. An Otis Brett appears in the federal census for 1860 in Stowe, where he worked as a blacksmith while living with his wife and seven children. In the column about disability, the census enumerator wrote “(sickness) insane.” If this is indeed the same person, it suggests his psychological troubles did not end when he left California. “California State Legislature 10th Session,” Sacramento Daily Union, January 29, 1859; “California State Legislature, 10th Session, Forty-Sixth Day,” Sacramento Daily Union, February 29, 1859; “Insane Asylum Minority Report,” Daily National Democrat, March 4, 1859; San Joaquin Republican, April 12, 1859; “Otis Brett,” United States Census Bureau (1860), United States Federal Census for 1860, retrieved from Ancestry.com (https://www.ancestry.com/discoveryui-content/ view/9434148:7667?tid=&pid=&queryId=f814cb6415c54cf333b8382e 95427c23&_phsrc=Pac19&_phstart=successSource). “California State Legislature 10th Session,” Sacramento Daily Union, January 29, 1859. History of the Association of Medical Superintendents of American Institutions for the Insane, from 1844 to 1884, Inclusive, 207; The Story of Stockton Development Center. California Legislature Joint Committee to Investigate the Affairs of the Insane Asylum at Stockton, 1–13, 87. “Catherine Adams,” Stockton State Hospital, Commitment Registers, vol. 3–4, 1862–1870, California, U.S., State Hospital Records, 1856–1923, retrieved from Ancestry.com (https://www.ancestry.com/discoveryuicontent/view/26173:9206?tid=&pid=&queryId=3961be022436c508e0 76ddb911d23192&_phsrc=Pac20&_phstart=successSource); California Legislature Joint Committee to Investigate the Affairs of the Insane Asylum at Stockton, 36–37, 39, 41–42, 51–53. As Michel Foucault notes, “the practice of immersion reaches far back into the history of madness.” Originally rooted in ideas about purification and rebirth as much as in the perceived need to “cool” frenzy and mania, by the end of the nineteenth century, the practice had shed much of

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86.

87. 88. 89. 90. 91.

its mystical roots but was still in common use in asylums in the western world well into the twentieth century. Foucault, Madness and Civilization, 166–172. Baths upon admission, as well as two hydrotherapy techniques, the “wet pack” and the continuous bath, remained the most frequently used forms of hydrotherapy in California’s state hospitals well into the twentieth century. California Legislature Joint Committee to Investigate the Affairs of the Insane Asylum at Stockton, 36–37, 39, 41–42, 52–53; Braslow, Mental Ills and Bodily Cures, 39. California Legislature Joint Committee to Investigate the Affairs of the Insane Asylum at Stockton, 47–48, 55–60. Harris, California’s Medical Story, 118–119. Lerman, Deinstitutionalization and the Welfare State, 33. David J. Rothman, The Discovery of the Asylum: Social Order and Disorder in the New Republic, rev. ed. (New York: Aldine de Gruyter, 2002), xlvii. Los Angeles Star, May 15, 1869.

CHAPTER 3

“A Sin and a Shame”: Regional Institutional Development in the Late Nineteenth Century

“The prosperous cluster of counties that forms the southern portion of the State send their insane mainly to this asylum, about fifty patients a year from Los Angeles County alone,” the superintendent of Stockton observed in his 1888 annual report. “The expense to the State of transporting patient. Sheriff, and often Sheriff’s assistant, over a distance of five hundred miles, is a consideration of some weight. But a more serious objection is the injury so long a journey is liable to inflect upon a patient. In the early stages of brain disease, more than in any other form of bodily ailment, quietude, rest, and freedom from excitement are of first importance,” he added. “The remoteness of the southern portion of the State enforces a severance of the natural ties of affection which, to a humane people, should speak in forceable tones for nearer asylum facilities. To the poorer classes it works a distinct hardship; the distance and the expense of travel present an impassible barrier; and lay an embargo on the natural expression of the feelings. They cannot visit their friends, no matter how eagerly they may long to do so,” he lamented. “The construction of an asylum to hold seven hundred patients should not be delayed. The transportation of the insane of San Bernardino and San Diego Counties, a distance of six hundred miles, equal to a journey from Beaufort, North Carolina, to New York, is a cruel, wasteful, and barbarous proceeding,” he concluded.1

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 E. V. Wallis, California and the Politics of Disability, 1850–1970, https://doi.org/10.1007/978-3-031-21714-2_3

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As the 1870s dawned, California had found itself at a crossroads. There was one state asylum, the one at Stockton, for the indigent as well as for families that could only afford a public asylum. Individuals with a bit more money, although perhaps not enough to enter a private hospital or sanitarium, could become “pay patients” in the state asylum for $40 a month and receive in return better accommodations, meals, and service than the regular patients paying only $15.2 For Californians who could afford what was (they hoped) better care and more privacy, there were also numerous small private asylums, including Alameda Park in Alameda and Langdon and Clarke’s in Woodbridge. Although no state or local entity was keeping track at the time, it is likely many other Californians were being cared for by family members or, if their families were wealthy enough, private nurses. Most patients in Stockton from the 1850s through the 1880s continued to come from the Bay Area and the Sacramento Valley. This was likely due to both the high costs involved in transporting individuals from Southern California northward and to families’ reluctance to send loved ones so far from home.3 But this was soon to change. Not only did California quickly add additional insane asylums in Northern California, but in the 1880s, it also created the very first state asylum in Southern California. It also moved beyond the insane asylum to create additional state institutions, including the first state institution for the developmentally disabled and the first state school for the hearing disabled and the visually disabled. All these institutional settings exercised varying degrees of both care and control over the individuals within them.4 Finally, as these systems rapidly expanded, the state legislature struggled to create a state-level system of oversight for its growing bureaucracy of disability. Politicians up and down the state were reassessing what they knew, or thought they knew, about mental and developmental disabilities. As California’s society and economy moved ever further away from the disruption and instability of the gold rush, politicians found they could no longer blame all cases of madness and disability on outsiders passing through the state.5 Just as mobility had marked the 1850s and the creation of the Stockton asylum, the next three decades saw California grappling with how to deal with the same issues from within its own population. Its solution was to rapidly expand its institutional system to add asylums for the mentally and developmentally disabled and schools for the hearing disabled, visually disabled, and delinquent. This expansion mirrored developments in the rest of the United States toward the end of the nineteenth century. As Nancy Gallagher documented in

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her study of the state of Vermont, “The gradual shift in responsibility for the supervision and care of the ‘social problem group’ from the towns to state and private institutions and the growing demand for these services contributed to an apparent need to expand the existing facilities or construct new ones. The demand for more institutional space provoked anxiety over the apparently growing population of dependent, delinquent, and disabled persons and the rising costs of their care.” The state of California continued to insist that its asylums were sites of treatment, rather than just confinement. This expansion, however, necessitated ever larger staffs: not just doctors, but nurses, administrators, custodians, and more, swelling the ranks of state employees ever further and driving state costs ever upward.6 Once in motion, the political, economic, and social drive to create ever more institutions to confine the demented, disabled, and disruptive often became near-unstoppable juggernauts, often with devastating results for those caught up in it.7 As part of California’s informal self-assessment of its provisions for the disordered, in 1873, the state of California’s Commissioner in Lunacy, Dr. E. T. Wilkins, made a formal report to the governor. He had been commissioned with visiting asylums in both the United States and Europe to “compile all accessible and reliable information as to their management, the different modes of treatment, and the statistics of insanity.” Wilkins noted that “we have not gone forth with the expectation or even the hope of originating anything upon the subject, but rather to collect the accumulated truths gathered by the wisdom and experience of other men in other lands, that we might bring them home to California.” For whatever reason, he chose not to visit any of the other asylums that were just starting to be established west of the Mississippi River, but he did travel to asylums and hospitals along the East Coast of the United States and in the American South, Europe, and Canada. He also brought back a number of books, reports, and essays related to his research for the collections of the California State Library.8 Wilkins’ report is worth examining in some detail because it not only provides a snapshot of the field of medicine in the 1870s, but also was created in large part to serve as a sort of blueprint or road map to where California should go next. Wilkins noted that the medical profession was grappling with trying to understand mental illness and disability as biological processes but was forced to do so within the limited medical frameworks available at the time. Psychology was not taught in most American medical schools then, although the Association of Medical Superintendents of American

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Institutions for the Insane recommended its adoption into curricula. This lack of knowledge, he argued, led to delayed or incorrect diagnoses by general practitioners, and thus delayed care. Even doctors who testified at commitment hearings might find that “the lawyer knows more about the subject than himself.”9 Recognizing that no physician had yet offered a satisfactory explanation of what insanity was, Wilkins drew on the work of Dr. David Skae of the Royal College of Surgeons in Edinburgh, who in 1861 had defined insanity as “‘a disease of the brain affecting the mind.’ We accept this definition as the best of all, because it is the most simple,” Wilkins wrote. “It makes but little difference how the brain becomes diseased, whether primarily or by reflex action from the disease of some other organ of the body, so the fact as stated true that the brain must be diseased ere the mind is affected.”10 As was typical of medical men at the time, Wilkins classified an enormous variety of illnesses and disabilities under the blanket term “insane.” Insanity, medical conditions, such as epilepsy, and both congenital and acquired disabilities were discussed as if they are interchangeable.11 Insanity and “feeble-mindedness” were also often spoken of in the same breath because both were seen as creating individuals who would be dependent on the state. “If there is a responsibility of different degree resting on the State to provide for its idiotic and insane, what shall constitute the difference?” one reformer asked in 1884. “If insanity is a disease, why shall the Commonwealth endeavor to effect a cure in this rather than in other classes of disease? If the feeble-minded children of the State are susceptible to improvement by culture, why shall the educational benefits bestowed upon more favored minds be denied them, in a scale adapted to their comprehension? It is surely only justice that we pleased for in the right of one class to education as of the other to cure. The question of the cost cannot be logically nor justly pleaded in one case and denied in the other.”12 This collapsing of what now are recognized as very distinct illnesses and disabilities (and in some cases no longer considered illnesses or disabilities at all) is critical to understanding how states like California approached and institutionalization over the next several decades. For doctors like Wilkins, institutions, be they general hospitals or asylums, were the only logical answer to the problem and were as much a social necessity as a medical one. These were spaces of treatment, he hoped, but they were also critical in relieving families of the “burden”

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of insane, ill, and/or disabled family members. Without asylums, families risked disaster because the insane would “drag all down to poverty and misery with themselves.” Even families that wanted to care for a loved one at home, he noted, would likely be unable to do so, either because the individual was violent, or because they wandered, or because they were destructive, or because the individual had the temerity to refuse treatment. “The sequestration of the insane in public or private asylums,” Wilkins argued, “is, at the same time, a measure of public order and of personal safety. The lunatic is a sick person who has the right, by very reason of the special disease with which he is afflicted to special care; he is also a being dangerous to those around him; in presence of this terrible scourge, the most prepossessed minds cannot refuse to admit it, family devotion is, for the most part, fruitless; they are exhausted by vain efforts; the most generous sacrifices result only in cruel deception; they are obliged, sooner or later, to adopt the serious measure of placing in an asylum the patient whom they can neither protect nor take care of at home.”13 This was a common attitude in the medical profession at the time. As a contemporary physician from Kansas put it, rather than forcing the families of insane or disabled individuals to choose between caring for them at home or leaving them to the care of an almshouse, state asylums could meet them halfway by providing affordable care. This would then take from these families “the heavy end of the burden, lifting to a higher and better grade the imbecile himself, emancipating groups of brighter children from the tyranny of rule prescribed in almost any home where a blighted one dwells, and releasing exhausted mothers for the untrammeled care of their households.”14 In Wilkins’ report, we also see clearly the economic rationale behind what California was doing. Institutions were more cost-effective, it was believed, due to the efficiency brought by caring for many people under one roof, Wilkins wrote. If they were indeed able to restore an ablebodied, young individual to health, and thus to the workforce, asylums could also be of economic benefit to the entire state. “So much is gained by restoring an insane laborer twenty-five years old,” Wilkins cheered. “It would have been less if he had been older, with a prospect of fewer years before him; it would have been more if he were a mechanic or man of business, with power to earn more if in health. The cost [to the state for keeping one person for one year in the Stockton asylum], only one hundred and ninety three dollars, is neutralized by the consideration that it would have been as great for his support if no attempt had been made to

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restore him.”15 This attitude and approach to disability, and the focus on institutionalization almost exclusively, characterized California’s approach to these issues for decades to come. In his report, Wilkins tried to calm the fears of those who believed that American society in the late nineteenth century was somehow creating evermore cases of insanity. On paper, the number did indeed seem to be trending upward: from an estimated one in every 738 Americans in 1850 to one in every 623 Americans in 1870. California was perhaps uniquely anxious about this perceived increase and the damage such information might do to the reputation of the newly minted Golden State. Nevada, for example, Wilkins noted, was already blaming all but two of their own reported cases of insanity on California, even though Nevada had sent its insane and “deaf and dumb” citizens to be cared for in California’s institutions. To Wilkins’ mind, there was a risk other Western states might try to offload their own cases to California. Indeed, such arrangements do not seem to have been unusual in the nineteenth-century American West. Within the next few years, Nevada did remove its residents from the Stockton asylum, likely at California’s behest, and sent them instead to the private Langdon and Clarke’s Asylum in Woodbridge, California, with Nevada then footing the bill for their care.16 California in 1870, Wilkins noted, had a population of just over 560,000 people. With only one asylum in the state to study, and that asylum having a population of just 1,146 individuals, he extrapolated that one in every 489 Californians was insane, and that one in every 6,439 could be classified as “idiots.” Wilkins found the insane in California to be disproportionately white, male, and foreign-born, likely the lingering effects of gold rush migration to the state. Indeed, to his mind, California was to be complemented rather than condemned, as it had “never refused admission to a single person who has sought to enter her asylum, notwithstanding it is a well-known fact that among those received there have been and still are many citizens of other countries, who have not claimed California as a home, but who have come here hoping to better their fortunes and enrich themselves at her expense, and then return to their own homes and country; but failing to realize their dreams of wealth, give way to despondency, break down in health, or enter upon a course of reckless dissipation that leads them to insanity and to our asylum, either to be cured by our treatment or maintained through life at the expense of the State.”17

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He pointed out that his counterparts in other nations were seeing the same spike and that it was most likely attributable to doctors getting better at identifying and diagnosing such cases, rather than an increase in cases themselves. “It is exceedingly interesting to trace this apparent increase of insanity in the various countries of the world,” he wrote, “and easy to show how much more rapidly the increase has been brought to light in those countries where the most humane and liberal provisions have been made for their accommodation…[insanity] has always and everywhere come forth from its recesses and hiding places whenever suitable hospitals for the reception of its victims were provided.”18 Wilkins was honest enough, however, to admit that very often, the cause of a particular case of insanity could not be known, and that in most cases, doctors were simply providing the best explanation they, as physicians, could come up with at the time of commitment.19 As had happened during the gold rush, Wilkins blamed the foreignborn for the high numbers of insane in California. This declaration likely had both racial and political appeal. First, it implied there was nothing wrong with white, native-born Californians, and second, it suggested the problem of insanity in the state would ease over time as the foreignborn left, died off, or assimilated. Wilkins included a section in his report assuring his readers that there is no reason to think that the American-born children of foreigners would have the same issues with mental health. Of course, nowhere in his report did Wilkins dig down into possible underlying causes of the high statistical frequency of the foreign-born appearing in asylum records. The phenomenon is likely better explained by the fact that the foreign-born in nineteenth-century California were more likely to be economically marginalized than whites and thus may have been more vulnerable to mental health issues and less likely to be able to access care. This omission seems deliberate, since elsewhere in his report Wilkins does acknowledge an apparent connection between poverty and diagnoses of insanity. The foreign-born were also more likely to lack familial and community support structures that might have otherwise eased the impact of mental disabilities and were more likely to end up in the hands of state and local authorities in the first place due to language difficulties and cultural differences.20 It was a bitter pill for California’s doctors and politicians to swallow in the early twentieth century when the demographics at last shifted, with the numbers of native-born Californians steadily going up as predicted. But so, too, were

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the number of commitments to the state’s asylums. At that point, California willingly adopted even more radical explanations for, and solutions to, the “problem” of mental disability. Wilkins also squeezed criticism of the conditions at the Stockton asylum into his report. Although he noted that its superintendent, Dr. Shurtleff, and his staff were doing the best they could under difficult circumstances, expansion was desperately overdue. Overcrowding there, he argued, had become a crisis, with 1,100 individuals crammed into space intended for only 600 or 700. “These wards are poorly ventilated, low, and uncomfortable in the extreme, and should be erased from the face of the earth and the memory of man,” he wrote. “They never were fit receptacles for any human being and have been tolerated altogether too long.” He saved most of his ire for the state legislature for not acting sooner: “let any member of the Legislature visit these wards at bedtime, and if he does not conclude that it is a sin and a shame not to do something for their immediate relief , we will be willing to acknowledge that we ourselves have lost our reason and our heart” [emphasis his]. He particularly pushed for the completion of the north wing of the Female Asylum at Stockton, then still under construction. Wilkins also urged the state to think about what would be needed in the years to come. Based on his research into asylum construction and growing need, he argued that California place “the next asylum” in the Bay Area to serve San Francisco. After all, of the 523 individuals admitted to the Stockton asylum in 1870–1871, 300 had come from the counties bordering on the Bay of San Francisco, and 222 had come from San Francisco itself. “When we suggest that another asylum will be necessary in the northern and still another in the southern portion of the State, ere many years shall have elapsed, it is in obedience to the dictates of the same ideas and natural laws.” He also suggested the state think about creating separate, not-forprofit asylums for those individuals able to pay for their care. The state could then put any savings it made on those asylums into making all other asylums completely free for any California resident who desired care.21 As both a working physician and, at the time of his report, a state bureaucrat, Wilkins was aware of the constraints under which care for the mentally and developmentally disabled operated. For example, one of the reasons California shouldered this burden at the time is that little to no assistance for the ill, disabled, or elderly came from the federal government. This is not to say that the federal government in this era had no role to play at all in charitable relief. Civil War benefits, for example,

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were offered by federal, state, and even some local governments. Theda Skocpol argues that “from the 1880s through the 1920s, federal veterans’ pensions became the keystone of an entire edifice of honorable income supplements and institutional provisions for many northern Americans who were longstanding citizens.” Such pensions were, in effect, an oldage pension and a disability payment rolled into one. Roughly one quarter of federal government spending in those years went to pensions for former soldiers, their widows, their dependent children, or their orphans. Many lived at federally funded veteran’s homes. This form of aid, however, was “openly defined in opposition to demeaning provisions for paupers. The point was to keep these deserving men and those connected to them from the degrading fates of private charity or the public poorhouse.”22 For everyone else, though, options were few. In the nineteenth-century United States, two forms of relief ultimately evolved: institutional care (in an asylum, a county poor farm, etc.) and outdoor or home relief, which usually permitted an individual to remain in their own community but still receive assistance. California did not completely shun the idea of providing outdoor relief to certain people in certain situations. For example, California developed a so-called Pioneer Pension given to individuals who had arrived during the heady days of 1848–1849 but who had, by the 1870s and ’80s, fallen on hard times. Legislators justified those payments on the grounds that the economic development the ’49ers had helped launched had been an invaluable contribution to the state. For most Californians in need, however, there were few other reliable sources of aid at the county, state, or federal level.23 Adding to the complexity, the state’s revised constitution of 1879 further changed how California provided aid to its residents. It allowed the state to give financial assistance to institutions caring for “halforphans, minor orphans, abandoned children, or needy aged. Such assistance was to be proportional to the number of inmates at the various institutions, with a large share of the responsibility for the administration of the funds being placed in the hands of the county boards of supervisors.”24 The County Government Act of 1883 further expanded the powers of county boards of supervisors, which led to many counties creating their first outdoor relief systems, except in San Francisco and Solano. Those two counties depended solely on private charity for a few more decades. Fortunately for California’s counties, by the 1880s, the expansion of the state’s asylums was already underway. Thus, the costs and responsibilities of providing county-level care did not overwhelm county

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governments as it might have had this law been passed twenty or thirty years earlier. A subsequent state law, the 1901 Indigent or Pauper Act, further clarified the responsibilities of California counties. This act explicitly made the county responsible for the care of the “indigent sick, the aged, the blind, and those otherwise physically disabled.” By excluding any mention of the mentally and developmentally disabled, it implied those individuals were still the responsibility of the state. The Indigent Act redefined residency as the place of work or, if an individual did not or could not work, their home. An individual had to have lived in a county for at least three months to be eligible for aid there. If they applied for aid in a county in which they were not eligible, the law decreed they be removed to their last county of residence and the county that sent them had to be reimbursed.25 Adding to the difficulties, in the handful of California counties that offered county-funded outdoor relief, it was for the most part “poorly administered, unstandardized, and inadequate.” Most counties required an individual in need to petition their county board of supervisors to get an allowance every month. If they were approved, they were placed on a county indigent list. County supervisors often tried to, but usually failed at, finding family members of the indigent person who could be charged for their care. County officials could also sell off any real or personal property the indigent person possessed to cover costs, and, if the person died, deduct any costs from their estate before the remainder went to any surviving relatives.26 Outside of the asylums, demand for aid in California tended to be cyclical, peaking in the winter months. This was attributed to able-bodied individuals finding summer employment in agriculture or mining but no work in the winter and to the need for shelter changing as the weather grew cold.27 Outdoor relief remained rare in California until the federal New Deal of the 1930s. The consequences of this policy decision for Californians with disabilities and their families were harrowing. It encouraged institutionalization because that was the only way many disabled individuals who were not self-supporting could access medical care and financial support. It frequently forced families, who might prefer to keep an aged or disabled family member at home but could not afford to do so, to have that individual committed. This in turn created overcrowding within asylums because state appropriations for building and expansion failed to keep pace with population growth.

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The California State Legislature deliberately chose a site in the Bay Area for the second state asylum. Construction of the elaborate Kirkbridestyle facility, budgeted for $600,000, quickly ballooned to $1.75 million, triggering a minor scandal in Sacramento and in state newspapers. The first patients, all from San Francisco or the Stockton asylum, arrived in the winter of 1875–1876. The first superintendent, Dr. Edwin Bentley, remained in the position for less than a year; the second was Dr. E. T. Wilkins. The nearest town was Imola, California, and the asylum also had access to a wharf on the nearby Napa River for transporting people and goods. Like Stockton, Napa had a farm, garden, and dairy, as well as an arboretum, with most of the labor done by the individuals committed there. Like Stockton, there was a morgue, and unclaimed bodies were buried in unmarked graves on the property. Initially, the asylum encompassed 209 acres, but soon it had to be expanded to 2,062 acres to accommodate all the daily operations and to provide enough fresh water for the population.28 By the time the state’s second insane asylum opened, the population of individuals at Stockton had grown so much that transfers to the new institution offered little relief. In 1885, the California State Legislature responded by passing “An Act to Prevent the Overcrowding of Asylums.” It authorized the creation of a third state asylum for the insane, while also calling for all individuals currently in state asylums who suffered from “idiocy, imbecility, chronic mental unsoundness, or acute delirium tremens, or insane person who are harmless” to be returned to the counties “from whence they had been committed.” However, the act does not appear to have contained any provision for funding such a shift, or even an enforcement mechanism, and generated no real change in where Californians were being sent. Asylum superintendents were also aware of just how unevenly the burden of responsibility had been spread statewide. “If San Francisco took care of its own insane,” an 1888 report from Stockton lamented, a great deal of burden could be taken off the state’s shoulders. The state of California was by now reimbursing counties for the cost of transporting individuals to asylums, but “if the expense of transportation was placed where it belongs, on the county, there would be less inducement for the authorities of county hospitals and almshouses to unload their helpless and bedridden cases on us.” The need to shift more financial responsibility back to California’s counties to free up funds for the care of those people already in state institutions became a recurring theme in California asylum management over the next several decades. Even with

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a third asylum in the planning stages (Agnews in Santa Clara County, which opened in 1889), Stockton’s superintendents continued to lament how overpopulation constrained both the day-to-day functions and the care available at state asylums. By 1888, Stockton had 500 more beds than it had been built for, straining the asylum nearly to the breaking point. “Happily, our climate is such that there is hardly a day when the most crowded wards cannot be almost entirely emptied of their occupants and thrown open for purification; a fortunate circumstance when, besides the bedroom and the dormitories, the floors of hall, corridors, and doorways are nightly used as sleeping apartments. To overcrowd the insane is to impair the usefulness of the asylum and subvert good management….The failure of this great State to fulfill its duty towards its helpless wards, the insane, cannot be viewed without concern.” Recognizing that many individuals entering state asylums were doing so to access financial support as much as, if not more than, medical care, reformers and state asylum superintendents alike continued to push for the creation of county and state almshouses as alternative destinations for the aged, impoverished, and infirm who were not mentally or developmentally disabled. Asylum superintendent increasingly pushed back against courts that, in their view, were using state hospitals as dumping grounds for people who were sane but whom the courts didn’t otherwise know what to do with. “In almost every community are persons to be found who are odd, eccentric, or more or less annoying than their neighbors, but beyond this quite harmless,” Stockton Hospital Superintendent Dr. H. N. Rucker wrote in 1892. “The temptation is strong, and the effort easy under our present system, to land such people in the asylums.” Such pleas went unheard. For many Californians who needed help, a state asylum, with the state picking up all or most of the costs, remained their only option (Fig. 3.1).29 There was also at least some concern that some individuals were ending up in state asylums who did not belong there at all. The year 1893 saw the founding of the California Association for the Protection of Persons Charged with Insanity in San Francisco. Modeled on the original New York State branch, it was an organization devoted specifically to making sure individuals could not be railroaded into local asylums. In response to the publicity, a superior court judge ordered that all commitment proceedings were to be held in open court so friends, family, and the public could observe what was happening and intervene if necessary. Although no statistical data about wrongful commitments survives from this era, individuals often claimed in the press that business partners or

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Fig. 3.1 The State Insane Asylum at Stockton in 1890. Image from An Illustrated history of San Joaquin County, California: containing a history of San Joaquin County from the earliest period of its occupancy to the present time, together with glimpses of its future prospects; with … biographical mention of many of its pioneers and also prominent citizens of today (Chicago: Lewis Pub. Co.), 1890

current or former loved ones were threatening them with commitment to some other end. During a particularly ugly divorce from her second husband, M. Adrian King, in 1910, for example, Fanny Briggs Carr was told to appear before a judge in a Los Angeles court and “show cause why she should not be declared mentally incapacitated, and a guardian appointed for her person and property.” Fortunately for her, Carr, who had made a fortune selling cucumber-infused skin preparations from her Southern California home, had the financial resources and social acumen to hit back. She produced a raft of lawyers and character witnesses who not only attested to her sanity, but who successfully convinced the court that the whole thing was an underhanded attempt by King to seize control of the business and fortune she had built up before their marriage.

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The commitment attempt was quashed, and Carr successfully obtained her divorce.30 Changes were underway for California’s physicians as well. They were moving to further professionalize their field and solidify their claims on health care in the state, both inside and outside institutions. On April 22, 1870, California became only the second state in the country to have a state board of health. Although the law authorizing its creation had provided little direction, the board focused its energies initially on sanitation, disease prevention, investigations of epidemics, and the general public health.31 This was a time when American physicians were preoccupied with how to best maintain both the physical and the mental health of the nation. The developing discipline of psychiatry was centered in America’s asylums because that is where the expertise lay.32 Gilded Age physicians and alienists were increasingly advocating for “mental hygiene,” a focus on preventing mental illness and promoting mental health. Unlike later generations of mental hygiene enthusiasts, however, at the end of the nineteenth century, doctors used the term in a strictly medical context. The thrust of such advice, Barbara Sicherman, explains, “was clearly toward self-restriction—of emotional attachment and expression, aspiration, imagination, creativity, and even individuality.” Such advocates spoke out against excess in general and expressed “fears of going too far, having too much or too little, and losing control.” Only by limiting one’s ambitions, they argued, could one stave off the anxiety of potential disappointment and the potential mental breakdown such disappointments might engender.33 As Theresa Richardson explains, “at the end of the nineteenth and beginning of the twentieth century, medical science provided a major rationale for social as well as public health reform.” She points to the inherent contradiction of mental hygiene claiming to be both a scientific movement, concerned with “discovering absolute principles and systematically applying them as solutions to problems” while at the same time it wanted to be a humane movement intent on ameliorating human suffering. At times, these two goals were incompatible, but those contradictions lie at the heart of much of North American social policy in this era.34 Moreover, as Richard W. Fox notes, “medical opinion and popular attitudes [in this era] were in flux.”35 Were mental diseases biological? Were they a form of illness that, by definition, could thus be treated? Increasingly, physicians were interested in distinguishing between “mental illness” (a huge category, but one believed to be treatable) from insanity.

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“The ‘insane’ were those ‘mentally ill’ persons who were completely incapable of functioning in the community, who were unable to unwilling to cooperate in their treatment, and who therefore still required indefinite confinement in locked asylums.”36 Examiners often erred on the side of commitment, believing that even if an individual did not seem particularly ill at the moment, a clearer diagnosis and, if the individual should enter a sharp decline, prompt treatment, would be had at an asylum or a state hospital.37 American neurologists had begun to challenge the psychiatrists who, since the creation of the Association of Medical Superintendents of American Institutions for the Insane in 1844, had dominated the field. Unlike psychiatry, American neurology was largely a product of medical treatments developed during the Civil War to treat nerves damaged by gunshot wounds. It focused “on the diagnosis and treatment of organic disorders,” often in an outpatient setting. Neurologists quickly realized, however, that they had little to contribute when it came to understanding, let alone treating, mental disabilities. Their involvement does seem to have encouraged asylum superintendents to refocus their energies on reform and on “searching aggressively for new and useable scientific theories. This new approach is reflected in the renaming of the Association of Medical Superintendents of American Institutions for the Insane to the American Medico-Psychological Association in 1895 (and, eventually, to the American Psychiatric Association).” Similar trends were underway more broadly in American medicine. It was at this time that the American Medical Association was reorganized in a way that made it “a confederation of state associations (which in turn were confederations of county associations) thus unifying physicians under one umbrella and making the AMA the authorized voice of the profession.”38 Although the Southern California counties had been complaining about having no state asylum for the better part of two decades, now that Wilkins’ report to the state had proposed one, residents expressed some hesitancy. California’s towns and cities in general seem to have been torn between the possible economic benefits of an asylum, particularly for creating jobs, and the potential for stigma and for encountering mentally and developmentally disabled individuals in the community. Dr. Portia Belle Hume, born in 1901 in Napa, California, and later a prominent psychiatrist in the state hospital system, remembered that local community members attended events held at the Napa State Asylum. Her own parents, she recalled, “courted each other at the state hospital dance.” Individuals believed to be dangerous were kept behind bars inside the

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asylum, but others “were allowed to go to the dances and be out on the grounds occasionally. I’ve had contact with mental patients from the time I was a baby,” she remembered, “because they would work for the superintendent. The head of the hospital would have them work in his house and we would be served by a patient.…They did the work for the staff there; they did babysitting, cooking, housecleaning.” One of her maternal uncles, she reported, learned drawing and painting from an individual committed to Napa. “I never got any feeling from my upbringing of the townspeople having prejudices against these patients,” she mused.39 Hume, however, proved to be in the minority. Los Angeles, as the largest community in Southern California, had slowly been developing its local healthcare system.40 The first hospital created during the American era, the Los Angeles Charitable Institute, had been founded by the Catholic Daughters of Charity in 1856. It was followed in 1858 with the Los Angeles Infirmary. Operated in partnership with, and funded by, the Los Angeles County Supervisors, it cared for the city’s poor and needy residents. In the 1850s, many of those were former gold miners who had failed to strike it rich and had drifted down to Los Angeles in search of work and milder weather.41 “To ensure they retained control of the institutions and its policies,” Kristine Ashton Gunnell notes, only Daughters of Charity could sit on the hospital’s board. The daughters provided their labor for free, but charged the county for “food, bedding, and medical supplies for those admitted as charity patients.” Charitable hospitals of the era often turned away individuals with contagious and incurable diseases, venereal diseases, and alcoholism. Catholic hospitals, however, were somewhat less likely to turn away such cases. This appears to have been true for cases of mental disability as well. An 1868 article in the Los Angeles Star noted that the sisters had “for a long time” been caring for an “unfortunate Frenchman…afflicted with the extraordinary disease which causes him to scream in a frightful manner.” Even he, though, was eventually sent to the Stockton asylum.42 Several benevolent societies in Los Angeles also opened hospitals for their members by the end of the 1860s, and a Los Angeles Free Dispensary opened in 1877, providing outpatient care for the city’s poor. In the meantime, however, county costs for the Los Angeles Infirmary quickly spiraled upward. In her research, Kristine Ashton Gunnell found that in one year alone, from 1868 to 1869, costs doubled from $4,684 to $9,195. The Los Angeles Board of Supervisors increasingly pushed for

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the state of California to pick up more of the costs on the grounds that most of the individuals being treated were not county residents. It was, they declared, the state’s responsibility to care for migrants, not the county’s. It also began to explore creating an almshouse. In 1876, the Los Angeles County Board of Supervisors tried to get state approval for the construction of a new hospital but failed.43 It did, however, open a county general hospital and farm along the same lines as the ones in San Francisco and Sacramento Counties. The supervisors hoped that such an institution at the county level would help control costs for care, thus keeping taxes down for county residents. As in many institutions of the time, including the state asylums, individuals placed there were expected to work in return for assistance and to grow as much of their own food as possible to ease the financial burden on the county. The Los Angeles County Poor Farm opened at its original site in 1878, which consisted of thirty acres about a mile from the heart of Los Angeles. The Los Angeles County Board of Supervisors recognized that the county farm could also fulfill another need by providing a place for medical students to train. Indeed, offering clinical experience to students somewhere was an essential precondition of establishing the University of Southern California’s College of Medicine, the first medical school in the region, in 1885. After all, “funding public health,” as Natalia Molina notes, was yet another way communities could preserve “an essential bulwark against social chaos and spiraling economic costs.” The county farm, as it was usually simply known, moved to a new site in 1888. With the real estate boom of the 1880s, the land the old site sat upon had become too valuable, and there was no room to expand the farming operations the county wanted to make the facility as selfsufficient as possible. A new site, just outside the small town of Downey in an area known as Los Nietos Valley, was ultimately selected. Individuals lived in tents and temporary housing until the new facility was completed. Just as in the state asylums, separate buildings were constructed to keep men and women as segregated from one another as possible. As in the state asylums, the individuals living at the county farm did the bulk of the work to keep it operating, including nursing, sewing, and laundry. Those willing to work on the farm could receive a stipend of a dollar a month and an extra ration of tobacco.44 Although the state laws at the time made the indigent and sick the charges of California’s counties and the mentally and developmentally disabled the charges of the state, the division between the two systems

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was never quite that cut and dried. In her magisterial history of the Los Angeles County Poor Farm, Colleen Adair Flieder found that among the early residents of the farm, there were indeed former’49ers, many of them now elderly, alone, and in need of care. Individuals with respiratory problems, including tuberculosis, were also represented. Many residents were individuals with physical disabilities, either congenital or from accidents, including former miners who had lost limbs in mining mishaps. But there were also individuals listed in records as suffering from “partial imbecility,” epilepsy, insanity, and alcoholism. Individuals were often sent to the farm specifically to await openings in the county hospitals or a state asylum. However, there were no specialized wards for different individual needs at the farm. Thus, “an old man in relatively good health might have had a bed next to a fifteen-year-old boy with tuberculosis or a blacksmith with lobar pneumonia or tuberculosis. An elderly woman with rheumatism might be sandwiched between a forty-five-year-old woman who had become mentally deranged from menopause and a feeble-minded young woman.” The population at the farm was, however, statistically older than either the population in the state asylums or the surrounding community. By 1901, the majority of the estimated 165 individuals living there were over sixty and in need of medical care. In 1918, the Los Angeles County Hospital also transferred all “long-term bedridden patients” to the farm.45 However, a county hospital and poor farm was one thing: an asylum, something else entirely. But the state of California was determined to proceed. A gubernatorial commission had been put together to select the proposed site for the Southern California Asylum for the Insane. There was no serious discussion of placing the asylum in or even close to Los Angeles, even though that was far and away the largest population center in the region. Instead, a 360-acre site north of the city of San Bernardino was chosen. There were persistent rumors that the San Bernardino site was chosen because Governor Robert W. Waterman secretly owned the proposed site, although no one was ever able to prove it. In fact, its distance from Los Angeles seems to have been part of the attraction. The new asylum was close enough that regular trains connected San Bernardino and Los Angeles, and eventually San Bernardino to the asylum, but it was far enough away that Angelenos did not have to see or think about it or its residents or even its employees, most of whom had to live on-site. It opened in 1893 as the Southern California State Asylum for the Insane but was sometimes also called the

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Highland State Asylum. While the idea was for this to be a Southern California asylum for Southern Californians, all the individuals transferred there initially were from the Stockton, Napa, and Agnews asylums, no doubt to relieve overcrowding.46 Sara Ramsey never forgot her first glimpse of the massive stone edifice of the Southern California State Asylum. Ramsey, and the man she regarded as her husband in the eyes of God, James, were street preachers in Los Angeles. That alone was likely enough to attract the attention of local authorities. But the two were also living together as man and wife despite still being legally married to their previous spouses. Sara was also pregnant with a son that, according to her, God had ordained should be called Jesus Christ. On December 17, 1912, plainclothes officers arrested both Sara and James and took them to jail by streetcar, and then to “the psychopathic ward of the old, malodorous hospital.” The next day, she went before a local judge named Hutton. She described the experience thusly: The court room had a number of spectators, the judge, officers, and I suppose a few attaches of the law, but no jury. I was seated on entering the room, opposite the judge. He was a large, handsome man, with big, soft, kind-looking, dark eyes, and black, wavy hair… The judge asked me just one question. “Do you claim this man James to be your husband?” I did not call him “your honor” when I gave him my answer. “Yes, I do. And what God hath joined together, let not man put asunder!” Mark 10:9. He spoke one more word to me. “Committed!”47

The pair, each accompanied by guards, were transported by train to San Bernardino and then by cart to the asylum. Sara recalled that “the place was set at the foot of the mountains, and towering high above the others, one great mountain looked down silently, grimly, as if aware of the drama enacted before its unmovable face. Its face was always watching but never joyful.…There were great stone lions, one at each side of the entrance, as on guard. Their solemn faces, their colossal forms, man-made, a symbol of the power of the beast in men—evil power. They seemed to say, ‘There is no escape for you. We are on guard here.’” Sara remained in the asylum for several more months; James was there for three years before finally being released. The couple did eventually legally wed.48

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As with most such institutions in California, the Southern California State Asylum went through multiple name changes. It became the Southern California Hospital for the Insane and Inebriates in 1895; the Southern California State Hospital in 1897; and Patton State Hospital in 1927. For many years, the treatments Highland provided were all homeopathic. It also sought to combine the work needed to keep the asylum operational with at least the illusion of occupational therapy: a dairy, piggery, chicken ranch, fruit orchard, and vegetable gardens were all located there, with the individuals confined there doing much of the labor. “Farm work and food processing were principal therapies,” as one official history politely puts it. For her part, Sara Ramsey maintained that the individuals in the asylum never benefitted from all the food grown around them: “with all the bountiful crops of fruits and vegetables of every kind at that place, it was incredible that we were never given any of them. There were great fields of potatoes, corn, beans green and lovely, peas, vegetables of every kind in great abundance, and all kinds of fruits. Oranges, lemons, grapefruit, peaches, and olive orchards, pomegranates, too many to mention. But, none for us.” Worse still, the superintendent, who “had a wife and two young children living nearby,” regularly used “‘patients of the better sort [as] his ‘free’ domestics.” “There was a large dairy; there were herds of cattle for meat, some sheep and many hogs. We had none of that meat. There was butter made daily, none for us. There was an ice factory, electric plants, shoe factory, mattress factory, laundries, all kinds of industries,” she explained, “kept up by the work of slaves.”49 The founding of Southern California’s first asylum occurred against a backdrop of regional economic development, much of it focused on the promotion and maintenance of health. Southern California’s boom of the 1880s had Los Angeles at its epicenter. It was driven by the completion of multiple railroads connecting in the city that, for the first time, made it practical and affordable to travel to the region. White Anglo-Americans and their money flowed in, triggering land speculation and business growth while swamping the Californio population. In Los Angeles, one 1880s publication bragged, “intelligent and enterprising families, from all parts of the country, are centering there; churches and school-houses are being established and everything tends to make agreeable social society and homes of contentment.” The boom ended in the winter of 1888. Although “it signaled the end of the greatest period of speculation, it also permanently reshaped southern California. Most notably, Los Angeles County’s population, which had increased some thirty percent

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between 1860 and 1870 and then doubled the following decade, now more than tripled during the 1880s—all this despite the subtraction of some thirty thousand citizens with the creation of Orange County in 1889.” Los Angeles also found itself home to a growing economic sector providing health care and related services to individuals who came west by train in search of milder climates and warmer weather to treat various ailments, chief among them tuberculosis. Doctors did a flourishing business there, as did sanitariums and hotels that catered to sickly travelers. Nineteenth-century-style “alternative” medicine also flourished there, with physicians (some real, some fake) offering “electro medicines,” homeopathic treatments, and more.50 When it came to mental and developmental disabilities, however, doctors, nurses, and families still looked to the state asylums. This may have been because, given the medical limits of the time, these disabilities were not likely to be improved, and certainly not cured, easily and thus were not something most doctors wanted to attempt to treat outside of an institutional setting. For individuals with money, or who came from wealthier families, care at home or in a private asylum or sanitarium was the best they could hope for. The Sisters of Charity had left their public–private partnership with the city of Los Angeles in 1878, retreating instead to the private medical market with a new hospital under their sole control.51 Both the city and the county of Los Angeles continued to develop their healthcare infrastructure. The city of Los Angeles had its own board of health and public health officer by the 1880s.52 In 1915, Los Angeles County centralized its own work in a county department of charities office. At the top was a superintendent of charities who answered to the county board of supervisors. Outdoor relief was one division within the department, along with the county hospital, county farm, Olive View Sanitarium for tuberculosis, and the county cemetery. There was also a Bureau for the Handicapped within the outdoor relief division that provided training in trades for visually and physically disabled residents of the county. The county department of charities took as its motto “Service with a Heart.”53 In addition to creating additional asylums for the mentally disabled, California in this era tackled the question of institutions for the developmentally disabled. Although, as noted, the mentally and developmentally disabled were often confined together in asylums on the grounds both were exhibiting some form of mental disorder, some doctors and reformers now argued that the two populations were sufficiently distinct that they should be separated for their own good. Eastern states, again,

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had been working on this issue for decades. Initially, much of the concern there had been about the developmentally disabled outside of institutions. In 1846, for example, an appointed commission in Massachusetts carried out a study of individuals in 171 towns within the state to ascertain how many residents had been identified as “idiots.” The commission reported to the state legislature they had come up with a number, 543, out of population of more than 345,000. Moreover, the report continued, it had observed that those in the care of more “intelligent” caregivers were healthier, more industrious, and thus more useful to society. “If persons having only common sense and common humanity, but without the advantage of experience or study, can so improve the condition of idiots, how much could be done by those who should bring the light of science, and the experience of wise and good men in other countries, and the facilities of an institution adapted to the training of idiots—how much, we say, could be done by such persons, towards redeeming the minds of this unfortunate class from the waste and desolation in which they now lie!”54 That same year, an article in the American Journal of Insanity noted that in New York State, doctors had presented a report to the state legislature calling for the creation of schools along the lines of those recently created in Europe for individuals classified as “idiots.” “Are there no wealthy individuals in our country,” the article demanded, “who are willing to appropriate a part of the fortune with which they are blessed to the permanent relief of this most pitiable class of our fellow creatures? We know not of an enterprise of benevolence more worthy of such support and patronage.”55 American reformers and physicians were particularly interested in the educational and training opportunities offered at the Bicêtre in Paris. Formerly one of the grimmest European insane asylums, in the 1790s, the hospital had slowly been transformed by its Superintendent Philippe Pinel into a still carceral but less physically cruel institution. Numerous reports of the ongoing work there filtered into American newspapers and journals in the 1840s.56 In 1848, Massachusetts created the Boston School for Idiots and Feeble-minded Youth. Most of the patients were drawn from existing state institutions, but parents seeking to place a child could apply directly to the governor via their local representatives. Its founder and greatest champion was reformer Samuel Gridley Howe. Characteristically of mid-nineteenthcentury American reformers, Howe believed that “mental weakness” was “a manifestation of the principle of the sins of the fathers being visited upon the children unto the third and fourth generation.” Moreover,

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the “mentally weak” “represented an earlier stage of man, more like a monkey than the average Homo sapiens.”57 Despite his often-appalling beliefs, Howe was nonetheless dedicated to physical and academic training for developmentally disabled children. Reading was a particular focus at the Massachusetts School. When New York followed in the 1850s by creating its own such institution, the Massachusetts newspaper The Liberator somewhat smugly noted that the state nonetheless remained ahead of its rival “in the race of benevolence.” Much of the early education for children with developmental disabilities was shaped by Edouard Seguin, who had emigrated from France to the United States in 1850. While in France, he had worked with these children and young people and had learned that with careful training and coaching, most were quite capable of developmental, physical, and emotional progress. His regime focused on drills and physical exercise.58 Americans were beginning to recognize the need to separate children from adults within institutions. Prior to 1880, mental hospitals in the United States were disproportionately filled with adults, with an average age of 43.5. As Theresa Richardson notes, “seventeen percent were over the age of sixty years. A great number of those incarcerated as insane were alcoholics or were suffering from the debilitating effects of advanced syphilis. The mentally disordered ended up in county farms and almshouses almost as often as they ended up in asylums, and there were no restrictions on the age of admission.”59 But by the 1870s, the first generation of California’s children who had been placed in asylums were starting to reach adulthood. Yet many were finding that even if they had living relatives, they were often unable or unwilling to accept them back. This put institutions in a quandary. The assumption had always been that childrens’ presence in an institution was temporary. Now, however, more and more insane asylums found themselves acting as custodians for adults with developmental disabilities as well as for developmentally disabled children. This put enormous staffing, financial, and space strains on facilities that had not been designed with lifelong care in mind. As an official report from the Stockton asylum explained: This asylum has, from an early day, carried along on its reports a large contingent, drawn from all quarters, of chronic incurable dements, of imbeciles, dotards, idiots, drunkards, simpletons, fools; a class, in fact, of harmless defectives, usually found in poorhouses elsewhere. In the absence of county charitable institutions, it was necessary to send them here; there

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was no other place for them; but by classing them as insane an error has been fostered. and an aspersion cast upon our people. In other States a large proportion of them would have been relegated to almshouses and would not figure in insanity statistics at all. There is no institution specially for the reception of idiots in the State. If an idiot becomes intractable or dangerous at home, what shall be done with him? There is no alternative. Public safety demands that he be sent to the asylum and taken care of.60

In 1876, doctors interested in the causes and treatments of feeblemindedness founded the Association of Medical Officers of American Institutions for Idiots and Feeble-Minded Persons in the wake of the Centennial Exposition at Philadelphia. It was a place for doctors to discuss the causes and treatments of feeble-mindedness, but its secondary purpose was specifically to promote the creation of institutions.61 As with the insane asylums, by the time California created its first facilities for the developmentally disabled, institutionalization was already the forgone conclusion. In the creation of California’s first institution devoted specifically to care of the developmentally disabled, the state of California was initially outmaneuvered by private activism. Two wealthy women from the Bay Area, Mrs. F. H. Bentley and Mrs. Julia M. Judah, both of whom had developmentally disabled children, had in 1882 traveled to New York to visit its state School for Idiots in Syracuse. Impressed by what they saw, the two women determined to create something similar back home in California. They collaborated with Warring Wilkinson, principal of the State Institution for the Deaf, Dumb, and Blind in Berkeley (discussed below), to gain support for their project. They held an organizational meeting for the proposed facility in San Francisco’s elegant Palace Hotel in 1883, where a committee was appointed to draft a plan of organization. Soon a board of directors was appointed that included a veritable “who’s who” of 1880s San Francisco, including former governor Leland Stanford and San Francisco Mayor (and future California governor) Washington Bartlett.62 In May 1884, the school opened at the White Sulphur Springs property in Vallejo. The school was never on a firm financial footing, however, and within six months, the trustees appealed to the State of California to take over the financial responsibility for it. It did so by act of the legislature in March 1885, initially calling it “the California Home for the Care and Training of Feeble-minded Children.” Children between the ages of five

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and eighteen were eligible, but that was soon increased to age twenty-one, and in 1901, all age limits for admission were removed.63 The act also specified who was eligible for admission to the institution: “all imbecile and feeble-minded children between the ages of five and eighteen who had been residents of California for one year and who were incapable of receiving instruction in common schools.” Interestingly, then-Governor California Stoneman refused to sign the bill until he was assured that the facility would admit “idiots” (considered the lowest rank of the developmentally disabled) as well as higher-functioning children. The school moved temporarily to Alameda before a new site in Santa Clara was chosen, where it reopened in 1885 with twenty children in residence. In 1887, it received a funding allocation that allowed for the construction of a separate cottage for epileptics. It housed seventy-five individuals.64 The sojourn in Santa Clara also turned out to be temporary, however, and in 1891, the school reopened yet again, this time in Sonoma County. The railway station and post office closest to the site chosen were soon renamed after one of the two governor-appointed individuals who had been charged with helping select a site, Oliver Eldridge. Thus, the institution was known officially as the California Home at Eldridge but was often referred to just by its location, “Sonoma.” The new site had 1,670 acres, enough room to allow for cultivating fruits and vegetables and raising livestock and poultry, most of which was used to feed the population. Farming was also a key part of the “therapeutic” side of the institution.65 Although rarely discussed publicly, the large numbers of individuals committed to state hospitals and asylums remained pivotal to their day-to-day functioning: “their time and service to the State,” as one unusually honest 1873 report put it.66 Progressive-era doctors repeatedly used the metaphor of a beehive to describe the idealized communities they sought to create in these institutions. They also often used the term “colony,” an apt description indeed at a time when America was engaged in colonialism from Puerto Rico to Hawaii and beyond.67 In the face of persistent demands from parents and doctors, in 1897, the California State Legislature expanded the facility’s original mandate, allowing individuals with epilepsy and “paralytics” to be admitted or committed there.68 Perhaps in part because of its changing mission, the California State Legislature changed its name in 1909 to the “Sonoma State Home,” simultaneously also removing the stigmatizing term “feeble-minded” from the official title.69 The state of California

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initially paid all the expenses for children at Sonoma. As the population grew, however, and costs soared, the law in 1897 was revised so that each county had to pay monthly for every child it committed to the institution.70 Often, the wait for an available space in Sonoma had terrible consequences for an individual. In San Francisco in 1899, the Society for the Prevention of Cruelty to Children found eight-year-old girl Amelia Tarentino chained in her family’s basement. “The light of reason has never entered her mind,” the San Francisco Call newspaper wrote about the child. Feeble of mind and destructive by an irremediable propensity of nature, she crawls up and down on the floor, like some uncanny and unclassified animal. The child grovels in the dirt, devouring the filth that lies within her reach. Strange sounds issue from her mouth, and her face too twisted and contorted in ugly grimaces. Being of a destructive bent, her mother has chained her to the wall, allowing about five feet of tether to the child, who spends the hours of daylight cuddled up in a corner or groping about for something to pull and tear.

Interviewed by the newspaper, the child’s mother said she was divorced from her ex-husband, who was still in Texas, “mad with religious fervor” and unable to help support her or their five children. Speaking of Amelia, “at night I wash her and put her to bed, and she sleeps soundly until morning,” the mother vowed. But once the mother had to leave the house for work, leaving only the family’s oldest child in charge, the mother claimed she had to chain her eight-year old to the wall to stop her destructive tendencies. “For the last two years I have tried to place her in a home for the feebleminded, but without success,” the mother told reporters. One other child in the family, a boy, was already before the city’s Insane Commissioners, who were considering his case. “I would be happy if the children could be placed in some home where they would be properly cared for,” Mrs. Tarentino said. “I must provide for all, and it is hard with this poor girl, who cannot receive the proper attention.” With the society now pushing the family’s cases through the system, within five months, both children had been committed to institutions, the boy to Mendocino State Asylum in Ukiah (opened in 1893), and the girl, now nine years old, to Sonoma in Glen Ellen.71

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In classifying its residents, Sonoma and, eventually, other state institutions, adopted a system developed by Dr. Isaac N. Kerlin that focused on an individual’s organic brain development, activity level, and trainability. Although scientists and social scientists are now well aware of the dangers of the cultural biases inherent in such testing, there was no such idea at the time. Instead, investigators were convinced they were detecting real “inherited and genetic” differences. The “idiot” was at the bottom of Kerlin’s scale and was further subdivided into “unteachable” and “teachable.” “Idio-imbecile” occupied the middle of his scale, who, while unable to succeed in academic settings, were “often capable of self-help and light work.” The highest level were imbeciles, subdivided into low, middle, and high grades. Individuals with epilepsy were not included on Kerlin’s scale. In fact, they were considered a class unto themselves and a danger to the more “docile” patients. They were often housed on separate wards if possible, and administrators urged again and again that a separate facility be created for them.72 For California’s institutions for the developmentally disabled, the initial focus was on teachers as the pivot point upon which any hope of rehabilitation rested. The teacher had an “all-inclusive” responsibility: for academic instruction, moral uplift, and social responsibility. Nurses and the matron helped patients dress and eat and generally watched over them, for which, as of 1885, they were paid $20 to $33 a month, with the matron earning $50 a month. Most staff worked twelve-hour days, six days a week. Physical abuse or cruel treatment of a child was explicitly forbidden by the board’s by-laws.73 Unfortunately, this wasn’t enough. In 1901, a new medical superintendent was appointed by the board, Dr. W. M. Lawlor, a former prison doctor and a trustee of the home. Once he took over, he instituted a series of “reforms” evidently learned from his time working in California’s prison. These included physical beatings, the use of restraints, and bread-and-water diets lasting for days. When the story went public in the summer of 1902, it was met with so much public outrage that Governor Gage assembled an investigative committee that charged Lawlor with cruel treatment and recommended his removal. Lawlor resigned before he could be removed. In October of that year, however, he evidently changed his mind and petitioned the board to withdraw his resignation and reinstate him. The board investigated and exonerated him from the charge of cruelty. They did not, however, choose to reinstate him. Two months later, they discovered Lawler and another former trustee had also absconded with $3,000 from the trust fund of

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an individual in the Sonoma institution. Fortunately, as Esther Pond and Stuart Brody note, the state was ultimate able to prosecute the two men and recover the money.74 Sonoma replaced Kerlin’s scale in 1914 with intelligence tests and the revised Stanford-Binet classification of developmental disability. The terms “idiot” and “imbecile” were retained but given different meanings. An “idiot” was now someone who at maturity reached a mental age up to two years; an “imbecile” had a mental age from two to seven years; and a “moron,” from seven to eleven years. Economic productivity was tied to each of these new categories. Imbeciles and idiots were not able to earn their own living. Morons could “under favorable circumstances,” but were not able to compete on equal terms with nondisabled individuals or manage their own affairs “with ordinary prudence.”75 Creation of the concept of the so-called moron in 1910 led to a new wave of national anxiety for politicians and reformers because there were assumed to be so many of them moving freely about in society and thus able to reproduce. It’s at this point we see a shift from just life-long institutionalization being enough to impede the growth of that population to restrictive marriage laws in some states and sterilization. The fear was that “they were out there among us, as they were doing bad things,” James W. Trent explains. “Though the superintendents used the threat of the moron to enlarge existing institutions and build new ones, they also abandoned their dream of institutionalizing all feeble minded…the menace of the feeble-minded had to be fought on several fronts.”76 Physical and mental health were not the only issues of day, however. California also further developed its institutions related to juvenile delinquency in this era. As with the insane asylums, much of the initial impetus for their creation had come from San Francisco. Fearing the impact that city’s large number of homeless children might have, in 1858, California had authorized the creation of the San Francisco Industrial School, which admitted homeless boys and girls under the age of eighteen. County officers throughout the state had the power to arrest children who fled the institution and return them to it. Facing growing outcry that children and teenagers convicted of crimes were being sent to county and state prisons, California also created its first official reform school in Yuba County in 1861, but closed it in 1868 due to financial problems. In 1874, reformers in San Francisco organized a Boys and Girls Aid Society, which evolved in 1920 into the Boys Aid Society and eventually became part of San Francisco’s Community Chest agency. The California State Legislature

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also passed a Juvenile Probation Law in 1883 that allowed juveniles to be placed in the care of any nonsectarian society devoted to reform and made provision for the state to reimburse those organizations. Six years later, it passed additional legislation creating both a state reform school in Whitter and the Preston School of Industry at Ione. While the state legislature’s original intent behind creating two separate institutions remains opaque, scholars have suggested the intent was to send younger children to Whittier and older ones to Preston.77 In 1859, the California State Legislature had briefly taken up the issues of creating a school for the “deaf and dumb,” but quickly decided the population was so small, it was “inexpedient” to appropriate state funds for such a school.78 Unwilling to wait for Sacramento to act, in March 1860, a group of women in San Francisco founded the Society for the Instruction and Maintenance of the Indigent Deaf and Dumb and the Blind. While the state legislature had balked at the idea of creating such a school just the year before, they evidently did not object to letting someone else have a go at it: the ladies quickly received a $10,000 appropriation from the legislature to construct a building on the corner of Mission and Sparks Streets in San Francisco. While it was being constructed, the school opened in a rented building on Tehama Street. The first students were hearing disabled. Admission of visually disabled students was delayed for several more months until “alphabets and books adapted to their peculiar necessities” arrived from the eastern United States. The school became known as the California Institution for the Instruction of the Deaf and Dumb, and the Blind. In what was clearly a dig at the state legislature’s failure to act, the school’s board in their first annual report noted that “it had been considered by some, that an Institution of this kind was premature, the State being too young to have a sufficient number of these unfortunate classes to establish a school….The California Institution opened with three pupils, and increased during the first six months to twenty-two, and will, in all probability, before the present year elapses, increase to a number equaling the first ten years average of the New York Institution.” Most pupils were not able to pay the full cost of attending the school, and the board recognized charitable donations from Californians would only go so far. “Although the public of this State are noted for their liberality in support of all charitable objects, it is not reasonable to suppose their proverbial generosity will prove adequate in this great work. We must, therefore, look to the State for such assistance as will remove all impediments and enable the

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Society to progress in the good work of enlightening the minds of these children of silence and darkness.” Likely due to geographic distance, all the students were from the Bay Area until 1869, when the first student from Southern California, a resident of the city of Anaheim, made the long journey north to attend the institute.79 In 1861, California passed its first laws calling for the education of the “indigent deaf, dumb, and blind” at state expense, later amended to provide for a maximum of five years of education for young people between the ages of eight and twenty-five whose parents were residents of California. Now, admission was done through county judges who checked these criteria and ascertained a family’s ability to pay.80 As with the asylum at Stockton, other Western states that lacked similar schools quickly began to send their residents to the California Institution. Institute reports from the 1860s through 1900 routinely show enrolled students from Oregon, Utah, Wyoming, and Nevada.81 The California Institute struggled to find qualified teachers, particularly to teach what it called “the sign-language.” It successfully hired its first sign-language teacher in 1865.82 In 1867, the legislature revised the previous laws around the institution, clarifying the roles of the directors, providing them compensation for their work, and increasing the annual state appropriation to $25,000 dollars. With the increase in funds, the school moved out of its cramped quarters in San Francisco to a new site in Berkeley, close to what was then known as just the University of California. An 1875 fire destroyed the institute’s main building, but thankfully there was no loss of life, and it was quickly rebuilt.83 By 1902, the school had 260 students, of whom 184 were hearing disabled and 76 were visually disabled.84 To meet community demand for services for visually disabled adults, in 1885, California created the Industrial Home for the Adult Blind in Oakland, the first school of its kind in the United States.85 Although it was initially under the same legislative management and funding systems as the state’s asylums, from the beginning, the California Institute chaffed at any comparison to them. Its management, teachers, and pupils understood, in ways the state legislature did not, the dangerous social assumptions about, and stigmas directed at, charitable institutions and, particularly, at anything termed an “asylum.” Principal Warring Wilkinson declared in his report to the State in the 1890s,

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It seems proper to correct a misapprehension on the part of many people concerning the status of this Institution. The idea is quite prevalent that the Institution is an asylum—an eleemosynary establishment where the deaf and blind are house and supported because of their helplessness….Nothing could be further from the truth. This Institution is a school, a legitimate and necessary part of the education system of the State. The Institution has no place among other charities and reformatories of the State. Its pupils are neither sick nor insane, nor idiotic nor criminal…They comes from all ranks of life: the rich, the well-to-do, the poor. None are exempt by right of birth. There is no blood spot upon the lintel of any household to warn away the scourge of scarlet fever, spinal meningitis, or the various instrumentalities of disease and accident by which deafness or blindness is caused. No one knows how soon he may need for his own loved offspring the beneficence which this Institution offer to its pupils, and to put the stigma of charity upon the parents of children thus sorely afflicted is unjust.86

To Wilkinson’s ongoing complaints, the new State Board retorted that his school “is an institution…for…the education of the deaf and blind. To accomplish this buildings are constructed, providing for housing and feeding these pupils. As long as this is done at State expense, the Institution must be charitable as well as educational.”87 They did, however, vow to scrub any use of the word “asylum” in conjunction with the school and with any other institutions in the state. Although he continued to crusade for the reclassification of the institute within the state’s bureaucracy, Wilkinson took this as a victory, reemphasizing how important it was to clarify that this was an educational institution and thus part of the educational system of the state. The official change, he wrote, would “relieve the school of a misnomer, and the disabuse the public mind, if possible, of the idea that the Institution is an asylum, a name which is misleading and inappropriate to the last degree. Deaf or blind boys and girls come to Berkeley from all parts of the State to obtain and education and for no other purpose. The parents are no paupers; the pupils are not vicious, nor insane, nor criminal, nor diseased….To call a school of this kind an asylum was an injustice to the pupils and an offense to their parents and relatives.”88 In 1913, oversight for the newly renamed California School for the Deaf and Blind was at last shifted from the California State Board of Charities and Corrections to the California State Board of Education.89 Back when it was still the California Institute it had also discussed possibly creating separate schools for “deaf-mutes who are of a low order of

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intellect” on the grounds they would hold the other pupils back, but Wilkinson did not agree. He argued that separate classes might be necessary, but that allowing young people of all levels of ability to mix on the playground would “brighten and elevate” all. By then, it was also engaged in its first real discussions about separating into two separate schools, one for the hearing disabled and one for the visually disabled. This ultimately occurred in 1922.90 Perhaps in a move to forestall repeats of the scandals of the 1860s and 1870s, the California State Legislature also moved to create centralized control over its asylums and vest power over them in Sacramento. The state passed a new version of its Insanity Law in 1897. Parts of the new law were unremarkable: it officially removed “asylum” from the names of all state hospitals, and it stressed the need for the Commission in Lunacy (authorized in 1887, but until then existing only on paper) to oversee all state hospitals. More problematically, it gave doctors what many had been clamoring for: near total control of the commitment process. The new law got rid of open court hearings and eliminated the examination by a judge that had been a feature of the previous law. Two physicians could examine an individual for possible commitment without even informing them of why they were being examined on the grounds that doing so would only make an individual that much more resistant to treatment. The California Supreme Court disagreed, throwing out the 1897 Lunacy Law in 1901 by a vote of four to one and reverting to the previous commitment procedure.91 California’s State Commission in Lunacy, however, was allowed to continue. While all state hospitals continued to have superintendents or the equivalent position, the State Commission in Lunacy at last provided one set of rules and one voice for the management of all state hospitals for the mentally and developmentally disabled. In 1909, for example, the California State Commission in Lunacy attempted to codify what it regarded as best practices in state hospitals and the Sonoma State Home. The prevention of abuse was a recurring theme. The medical superintendent had to “make every possible effort to prevent ill treatment or abuse of patients” and to investigate any reported abuses; staff suspected of abuse were not to leave the institution until the superintendent had taken a statement from them and determined what, if any, future action would be taken against them. A matron and assistant matron were to look after the health and well-being of women in the institution, and a supervisor oversaw training all male employees in how to extinguish

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fires. Individuals were not to perform labor for anyone outside of the asylum without the permission of the superintendent and were not to do the work of attendants and nurses for them. Attendants and nurses were strictly prohibited from using any force or violence against patients. A new rule book explained the difference: The word “force” as used in these rules, means the overcoming of the active resistance of a patient using superior strength without violence. It is not intended to include those exhibitions of slight strength that are frequently necessary to induce movement in certain obstinate and mildly resistive patients. The word “violence” as here used, means the exercise of such great or undue force as is contrary to reason and moderation; blows, kicks, choking, and kneeing will always be considered violence. Where it is necessary to use force an attendant or nurse must always seek assistance before laying hands on the patient, except in cases where force is immediately needed for the protection of a patient or property or self-protection. Choking, kicking, or striking patients will not be permitted under penalty of discharge.

Ward attendants in California’s state hospitals at this time made from $30 to $40 dollars a month, but with it came a working day that lasted from six in the morning until nine at night. They received a half day off each week and one full day off each month.92 With the number of state charitable institutions still rapidly increasing, and with a hodge-podge of relief efforts taking place in California counties, in 1903, the state reassessed its organization and created a State Board of Charities and Corrections. Here again, California was playing catch-up: most other states had had something similar since the 1880s. The State Board of Charities and Corrections was responsible for the day to day management of multiple institutions in the state, including (at least for a time) the California Institute and the California Home at Eldridge/Sonoma.93 The question, however, was exactly how much practical control the state board could exercise. Understandably, the California State Legislature wanted the state’s county hospitals, county almshouses, and county farms under the State Board of Charities’ oversight. After all, by 1904, there were fifty-nine such county-level institutions, with 1,950 Californians in them, and by 1914, population growth in the state had increased that number to sixty-two institutions with a whopping 3,645 Californians in them. The board also sought to take a more direct, day-to-day role in

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state hospitals and state prisons. However, county boards of supervisors, asylum administrators, the commission in lunacy, and the State Board of Prisons successfully fought off most of the state board’s attempts to establish direct bureaucratic control, rightly seeing it as a threat to their own power. As a compromise, the California State Legislature gave the new State Board of Charities and Corrections the power to investigate and report on all penal, correctional, and charitable institutions in the state, both at the state and at the county level. However, it had no direct control over any of those entities, as each had its own administrators and boards of governors. Instead, the state board was largely supervisory. California also hoped the state board could help better coordinate relief activities. In 1911, the law authorizing the State Board of Charities and Corrections was amended to extend its supervision over county outdoor relief as well, and in 1917, it was amended again to require all counties to keep records and other documentation for every individual. The state board ultimately had to develop a simplified version of its record-keeping systems for county use, and even then, the job was so overwhelming that most large counties ended up delegating that job to someone else. Los Angeles and Alameda Counties, for example, created their own welfare boards to administer and then keep track of cases. Yet the creation of a county-level paper trail for the first time in the state’s history had a seminal effect on California’s grasp of charitable need in the state.94 During the 1916–1918 legislative session, California reorganized its system yet again. This time, it created a new Board of Public Welfare specifically to oversee the care of all dependents in the state. This was followed in 1921 by the creation of a State Department of Institutions. The Board of Charities and Corrections continued to oversee supervising county hospitals, outdoor relief, and all private institutions for children. Further reorganization came in 1925, with the State Board of Charities and Corrections becoming the State Department of Public Welfare, renamed again in 1927 as the Department of Social Welfare.95 With the creation of new institutions in both the northern and the southern halves of the state, commitments in California again spiked upwards. With institutions now closer to home, attitudes on institutionalization itself shifted. “The people who sent a few patients to the distant institutions now sent many to the hospital which was brought to their neighborhood,” one doctor noted.96 Another California doctor argued that putting so many Californians in state asylums and hospitals was a sign of the state’s enlightenment, not its oppression. “California believes

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that, in place of allowing irresponsible individuals to wander, a care of their friends, a menace to society, or a burden to some particular community.…all such should be gathered up in her great institutions and at least be humanely cared for,” Dr. John W. Robertson, former superintendent of the Napa Asylum and current superintendent of the private Livermore Sanitarium, argued. “She certainly deserves praise for not only shouldering the entire responsibility not only for those mentally disordered, but for the helpless and incompetent who have flocked here in such numbers.”97 In California, doctors and politicians set the terms of the debate, with individuals and their families having little or no voice in the proceedings. After the turn of the twentieth century, however, social reformers became an increasingly influential pressure and lobbying group on the form state provisions for disabled Californians should take.98 The next chapter examines this in detail by looking at the campaign to create the Pacific Colony in Southern California.

Notes 1. Biennial Report of the Directors and the Thirty-fifth and Thirty-sixth Annual Reports of the Superintendent of the Insane Asylum of the State of California (at Stockton) for the Two Years Ending June 30, 1888 (Sacramento: J. D. Young, Superintendent State Printing, 1888), 15–16. 2. In San Francisco, a month-long stay at a private hospital cost around $100. Fox, So Far Disordered in Mind, 117. 3. The Alameda Park Asylum was originally located at the intersection of Central Avenue and Park Street before it was moved to another location. See, for example, “Eustace Trenor, M.D.,” Alameda Daily Evening Encinal, November 27, 1869; “Dr. Trenor Drops Dead,” San Francisco Call, September 18, 1896. 4. Trent, Inventing the Feeble Mind, 271. 5. Hawk, “Going ‘Mad’ in Gold Country,” 67. 6. Lasch, “Origins of the Asylum,” 10. 7. Nancy L. Gallagher, Breeding Better Vermonters: The Eugenics Project in the Green Mountain State (Hanover, NH: University Press of New England, 1999), 52. 8. California Commissioner in Lunacy, Insanity and Insane Asylums: Report of E. T. Wilkins, M.D., Commission in Lunacy for the State of California, Made to His Excellency H. H. Haight, Governor, December 2ns, 1871 (Sacramento: T. A. Springer, State Printer, 1872), 1–3, 6. On the role

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9. 10. 11.

12.

13. 14. 15. 16.

17. 18. 19. 20. 21.

distance played in asylum commitments, see M. D. Edward Jarvis, “Treatise on the Influence of Distance from and nearness to an Insane Hospital on Its Use by the People, prepared for the State of New York,” quoted in California Commissioner in Lunacy, 109. Many of the first lecturers on psychology available to medical schools were superintendents of asylums. California Commissioner in Lunacy, 215. California Commissioner in Lunacy, 8. For example, he cites apoplexy, palsy, consumption, epilepsy, and masturbation as potential causes of incurable insanity. California Commissioner in Lunacy, 56, 195. Isaac Newton Kerlin, Provision for Idiotic and Feeble-minded Children, and H. M. Greene, The Obligation of Civilized Society to Idiotic and Feeble-minded Children: Two Papers Presented at the Eleventh National Conference of Charities and Correction, St. Louis, October 16, 1884 (Boston: Press of George H. Ellis, 1884), 25. California Commissioner in Lunacy, 68, 214–215. Kerlin, Provision for Idiotic and Feeble-minded Children and Greene, The Obligation of Civilized Society to Idiotic and Feeble-minded Children, 5. California Commissioner in Lunacy, 220–221. California Commissioner in Lunacy, 220–221. It does not appear to have been unusual for Western states without institutions to depend on those that had them. It happened with both asylums for the insane (since those were usually the first institutions built) and then with specialized schools and other facilities. Nevada sent individuals both to California’s Stockton Asylum and to its School for the Blind and Deaf in Berkeley. Oregon also sent individuals to California’s School of the Blind and Deaf. Washington State sent individuals to the institution for the feeble-minded in Vancouver, British Columbia, until they built their own institution. California Commissioner in Lunacy, 66, 209–211. Nevada Legislature, Appendix to Journals of the Senate and Assembly of the Eighth Session of the Legislature of the State of Nevada, Vol. 1 (Carson City: John J. Hill, State Printer, 1877), n.p. On Washington, see Dr. J. C. Carson, “Review of the Legislation for Defectives in the United States for the Year 1905,” Journal of Psycho-Asthenics 11, nos. 1–4 (September and December 1906 and March and June 1907): 38. California Commissioner in Lunacy, 30–31, 209. California Commissioner in Lunacy, 56–57; 66. California Commissioner in Lunacy, 34–35. California Commissioner in Lunacy, 52–53, 210. In insisting that “no person should profit by [the] operations save and except the patients who paid for the privilege,” Wilkins admitted he knew this idea was “in advance of American notions of propriety” but insisted

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22. 23. 24. 25.

26.

27. 28.

29.

30.

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the idea was based on “sound policy.” California Commissioner in Lunacy, 134, 159, 212–213, 222. Skocpol, Protecting Soldiers and Mothers, 7, 65, 150. Bond, Baber, Vieg, Perry, Scaff, and Lee, Our Needy Aged, 39–40, 44. Bond, Baber, Vieg, Perry, Scaff, and Lee, Our Needy Aged, 41. Bond, Baber, Vieg, Perry, Scaff, and Lee, Our Needy Aged, 39–40, 44; Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 146. This system, too, was rife with potential for corruption. There were regular accusations that placement on the list had been tied to securing votes. Occasionally, authorities would respond to public outcry by purging the lists. Then the application and approval process would have to begin anew. It is likely many vulnerable people fell through the cracks in the system in the meantime. Bond, Baber, Vieg, Perry, Scaff, and Lee, Our Needy Aged, 44–46. Bond, Baber, Vieg, Perry, Scaff, and Lee, Our Needy Aged, 50. Burying unclaimed bodies in unmarked graves became the standard practice at California’s state hospitalsv for the mentally and developmentally disordered. Patricia Prestinary, Napa State Hospital (Charleston, SC: Arcadia Publishing, 2014), 9, 11, 34–35. 64, 119. Richard W. Fox points out that this essentially “socialized” mental and developmental disabilities in the state. Fox, So Far Disordered in Mind, 44, 97; Bond, Baber, Vieg, Perry, Scaff, and Lee, Our Needy Aged, 42; Dr. H. N. Rucker, “Report of the Medical Superintendent,” Thirty-ninth and Fortieth Reports of the Stockton State Insane Asylum (Sacramento, 1892), 29, quoted in Fox, So Far Disordered in Mind, 42; Marysville Daily Appeal, April 1, 1885; Biennial Report of the Insane Asylum of the State of California [at Stockton], 1892 (Sacramento: State of California, 1892), 29; Biennial Report of the Directors and the Thirty-fifth and Thirty-sixth Annual Reports of the Superintendent of the Insane Asylum of the State of California (at Stockton) for the Two Years Ending June 30, 1888 (Sacramento: J. D. Young, Superintendent State Printing, 1888), 14; Henry Harris, California’s Medical Story, with an Introduction by Charles Singer (San Francisco: Grabhorn Press for J. W. Stacey, 1932), 199–120; On the need to redistribute more responsibility to the counties, see Biennial Report of the Directors and the Thirty-fifth and Thirty-sixth Annual Reports of the Superintendent of the Insane Asylum of the State of California (at Stockton), 16. “Asylum Censor,” San Francisco Call, September 22, 1893; “A Humane Work,” San Francisco Call, October 15, 1893. The Carr-King divorce was extensively covered in the press at the time. See, for example, “Hubby Tells His Version,” Los Angeles Times, September 23, 1910.

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31. The first was Massachusetts. Allegedly, a California Medical Society briefly existed in 1859, only to dissolve in a scandal after a member delivered a paper claiming some of the women in California were “diseased” (i.e., had venereal disease). “The society was later reestablished,” the State of California Department of Public Health said. State of California Department of Public Health, California’s Health, 1870–1970: Centennial Issue (Berkeley, CA: State Department of Public Health, 1970), 2, 16, 28. 32. Noll, “Institutions for People with Disabilities in North America,” 313. 33. Barbara Sicherman, “The Paradox of Prudence: Mental Health in the Gilded Age,” in Madhouses, Mad-doctors, and Madmen 218, 224–225. 34. Theresa R. Richardson, The Century of the Child: The Mental Hygiene Movement and Social Policy in the United States and Canada (Albany: State University of New York Press, 1989), 3–4, 16. 35. Fox, So Far Disordered in Mind, 15. 36. Fox, So Far Disordered in Mind, 16. 37. Fox, So Far Disordered in Mind, 9. 38. Bonnie Ellen Blustein, “‘A Hollow Square of Psychological Science’: American Neurologists and Psychiatrists in Conflict,” in Madhouses, Maddoctors, and Madmen: The Social History of Psychiatry in the Victorian Era, 241–242, 265; Glenn, Forced to Care, 40. 39. “Portia Belle Hume,” “Earl Warren and the State Department of Mental Hygiene: Frank F. Tallman, M.D., Dynamics of Change in State Mental Institutions,” and “Portia Belle Hume, M.D., Mother of Community Mental Health Services,” interviews conducted by Gabrielle Morris in 1973, Governmental History Documentation Project, Regional Oral History Office, The Bancroft Library, University of California, Berkeley, Berkeley, California, 5–6. 40. As Kristine Ashton Gunnell points out, such cost savings rarely materialized, at least not immediately. Gunnell, Daughters of Charity, 125–129. 41. Colleen Adair Fliedner, Centennial: Rancho Los Amigos Medical Center, 1888–1988, ed. G. Maureen Rodgers (Downey, CA: Rancho Los Amigos Medical Center, 1990), 7; Gunnell, Daughters of Charity, 17, 20–22, 33, 58–59. 42. The Los Angeles Infirmary was also known as County Hospital or Sisters’ Hospital. The Daughters of Charity had a formal union with another Catholic organization, the Sisters of Charity, from 1850 on, which likely explains why both names are used almost interchangeably in conjunction with the organization in Los Angeles. The Daughters of Charity also founded an orphanage, the Los Angeles Orphan Asylum, in 1869. Gunnell, Daughters of Charity, 17, 20–22, 33, 58–59; “Gone Up,” The Los Angeles Star, September 5, 1868; Fliedner, Centennial, 13. 43. Gunnell, Daughters of Charity, 90, 105–106, 123.

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44. Molina, Fit to Be Citizens?, 54, 102; Fliedner, Centennial, 2, 14, 18–21, 25, 34. 45. Fliedner, Centennial, 44–47, 55, 97. 46. Patton Remembered: A Pictorial History of Patton’s First One Hundred Years, 1890–1990 (San Bernadino, CA: Patton State Hospital, 1990), 2–3. 47. Dorothy Ramsey, And What Is Hell? A True Story: Exposing the Dark Secrets of “The Insane Asylum,” As Told by Sara Ramsey, ed. Michael Miller (Las Vegas: Pyramid Press, 2015), loc. 257, loc. 352, loc. 380, loc. 352, loc. 402, loc. 1349, and loc. 2524 of 2684, Kindle. 48. Sara’s son, whom she indeed named Jesus Christ, was born inside the asylum. He lived there for three weeks, with nurses periodically bringing the baby to Sara so he could nurse, before Sara’s friends came to take charge of the boy until she was released. Ramsey, And What Is Hell?, loc. 257, loc. 352, loc. 380, loc. 352, loc. 402, loc. 1349, and loc. 2524 of 2684, Kindle; The Los Angeles Record, December 20, 1912. 49. It was renamed for Board of Trustees Member Harry W. Patton. Patton Remembered, 2–3; Ramsey, And What Is Hell?, loc. 2040–2045 and loc. 549 of 2684, Kindle. 50. Molina, Fit to Be Citizens?, 22. 51. The new hospital they founded eventually became St. Vincent Medical Center. Semi-tropic California 3, no. 1 (January 1880), 4; Eileen V. Wallis, Earning Power: Women and Work in Los Angeles, 1880–1930 (Reno: University of Nevada Press, 2010), 12–15; Gunnell, Daughters of Charity, 26–27, 81. 52. United States Public Health Service, Report of a Survey of the City Health Department of Los Angeles, California, April–August 1939 (Sacramento: California State Printing Office, 1940), 43, 386–395, 404–405. 53. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 175–176; Fliedner, Centennial, 80–81. 54. The Massachusetts commission did explain how it determined one caregiver was more “intelligent” than another. “Asylums and Schools for Idiots,” American Journal of Insanity, July 1, 1847, 76–79. 55. “Asylums and Schools for Idiots,” American Journal of Insanity, April 1, 1846, 392–393. 56. See, for example, “Education of Idiots,” Littell’s Living Age, November 27, 1847, 423–425. For more on Philippe Pinel, see D. B. Weiner, “Philippe Pinel’s ‘Memoir on Madness’ of December 11, 1794: A Fundamental Text of Modern Psychiatry,” American Journal of Psychiatry 149, no. 6 (June 1992): 725–732. 57. Harold Schwartz, Samuel Gridley Howe: Social Reformer, 1801–1876 (Cambridge: Harvard University Press, 1956), 140–145. 58. Seguin worked briefly at New York’s school in 1854 and later opened his own school in Orange, New Jersey. Edward Shorter, The Kennedy

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59. 60.

61.

62. 63. 64. 65. 66. 67. 68. 69.

70.

71.

Family and the Story of Mental Retardation (Philadelphia: Temple University Press, 2000), 2–3, 8, 13; Schwartz, Samuel Gridley Howe, 140–145; “The Boston School for Idiotic and Feeble-minded Youth,” The Liberator, April 30, 1852. Richardson, The Century of the Child, 12. Biennial Report of the Directors and the Thirty-third and Thirty-fourth Annual Reports of the Superintendent of the Insane Asylum of the State of California (at Stockton), 16; Shorter, The Kennedy Family and the Story of Mental Retardation, 13. Association of Medical Officers of American Institutions for Idiotic and Feeble-minded Persons, Proceedings of the Association of Medical Officers of American Institutions for Idiotic and Feeble-Minded Persons, Session: New Haven, Conn., 1895 (Faribault, MN: The Institute for Defectives, 1895), 239. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 1–5. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 127. Trent, 90; Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 11, 17, 22. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 11, 17, 22. Second Biennial Report of the State Board of Health of California (Sacramento, 1873), 68, quoted in Fox, So Far Disordered in Mind, 46. Kim E. Nielsen, A Disability History of the United States (Boston: Beacon Press, 2012), 118. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 6–9. By 1911, 110 of the 865 children at Sonoma had some form of paralysis. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 11; Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 127; W. J. G. Dawson, “A Few Remarks on the Different Forms of Paralysis with their Complications,” The Journal of Psycho-Aesthenics 15, nos. 3–4 (March and June, 1911): 98. Initially, the cost was $10 per child per month; in 1921, it was increased to $20 per child. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 127. The spelling of the family’s surname varies from source to source. It does not appear the mother was ever prosecuted or even investigated for her treatment of her daughter. “She Passes Her Days Chained to the Wall: Strange Life of Amelia Tarentino, a Child of Feeble Mentality,” The San

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72.

73. 74.

75.

76. 77.

78. 79.

80. 81.

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Francisco Call, September 19, 1899; “The Torontino Family,” The San Francisco Call, January 9, 1900. Isaac N. Kerlin, quoted in California Home for the Care and Training of Feeble-Minded Children, Institution Bulletin (Sacramento: State Printing Office, 1893), 7–8; Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 18; ChávezGarcia, State of Delinquency, 5. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 16, 20, 55. Board of Trustees, California Home for the Care and Training of FeebleMinded Children, Book of Minutes, 1902, quoted in Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 20–21. In 1914, using this new scale, Sonoma classified 281 of its residents as idiots; 389 as imbeciles; and 155 as morons. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 22, 29; Fox, 178n20. Trent, Inventing the Feeble Mind, 165. The San Francisco Industrial School operated until 1891, when all of the young people there were transferred to the Whittier State School in Southern California. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 46–55. Sacramento Daily Union, January 29, 1859. “First Annual Report of the California Institution for the Instruction of the Deaf and Dumb, and the Blind, to the Legislature of the State of California for the Year 1860,” Reports (from One to Eleven Inclusive) of the Boards of Directors of the California Institution for the Education of the Deaf, Dumb, and the Blind, for the Fifteen Years Ending June 30, 1875, rpt. 1890 (Berkeley, CA: Pupils of the Institution, 1890), 7–8, 11– 12; “Ninth Report of the Board of Directors and Officers of California Institution for the Education of the Deaf and Dumb, and the Blind, for the Twenty-two Months Ending July 31, 1871,” Reports (from One to Eleven Inclusive), 28. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 114–115. See, for example, “Fourth Annual Report of the Board of Trustees and Managers of California Institution for the Instruction of the Indigent Deaf and Dumb, and the Blind, to the Governor of the State of California for the Year Ending December 31, 1863,” Reports (from One to Eleven Inclusive), 11. Getting Nevada to pay the bill for students it sent to California soon became a problem. “Ninth Report of the Board of Directors and Officers of California Institution for the Education of the Deaf and Dumb, and the Blind, for the Twenty-two Months Ending July

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82.

83.

84.

85. 86.

87.

88.

89.

90.

91. 92.

31, 1871,” Reports (from One to Eleven Inclusive), 14; Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 114–115; “California State Legislature 10th Session,” Sacramento Daily Union, January 29, 1859. “Fifth Annual Report of the Board of Trustees and Managers of California Institution for the Education and Care of the Indigent Deaf and Dumb, and the Blind, to the Governor of the State of California for the Year Ending December 31, 1865,” Reports (from One to Eleven Inclusive), 8. “Seventh Report of the Board of Directors and Officers of California Institution for the Education of the Deaf and Dumb, and the Blind, for the Two Years Ending September 30, 1867,” Reports (from One to Eleven Inclusive), 11. Twenty-fifth Report of the Board of Directors and Officers of the California Institution for the Education of the Deaf and the Blind, for the Twenty-four Months Ending June 30, 1902 (Sacramento: A. J. Johnston, Superintendent of State Printing, 1902), 1. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 153. “Report of the Principal,” Twenty-second Report of the Board of Directors of the California Institution for the Education of the Deaf and Dumb, and the Blind, for the Twenty-four Months Ending June 20, 1896 (Sacramento: A. J. Johnson, Superintendent State Printing, 1896), 11. California State Board of Charities and Corrections, Second Biennial Report, 1904–06, 70–71, quoted in Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 116. “Report of the Principal,” Twenty-seventh Report of the Board of Directors and Officers of the California Institution for the Deaf and the Blind, for the Twenty-four Months Ending June 30, 1906 (Sacramento: W.W. Shannon, Superintendent of State Printing, 1906), 21–22; Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 118. As part of this transition, the board of trustees was done away with in 1921. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 116, 123. “Report of the Principal,” Twenty-fourth Report of the Board of Directors and Officers of the California Institution for the Education of the Deaf and the Blind, for the Twenty-four Months Ending June 30, 1900 (Sacramento: A.J. Johnston, Superintendent of State Printing, 1900), 8. Fox, So Far Disordered in Mind, 53–54, n21. California State Commission in Lunacy, Rules and Regulations of the State Commission for the State Hospitals for the Insane and Sonoma State Home (Sacramento: W. W. Shannon, Superintendent State Printing, 1909), 4, 8–9, 10, 12–13; Prestinary, Napa State Hospital, 26.

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93. As part of the shift, Sonoma was allowed to keep its board of trustees until 1921, but it had essentially been defanged. It was now purely advisory and answerable to the state commission in lunacy. There had been rather ugly infighting at Sonoma between employees who sought to unionize and the board of trustees, as well as accusations of abuses. Pond and Brody suggest this is likely what convinced California to bring the home under the same control as the insane asylums. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 10; Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 115–116. 94. The state had authorized the counties to create county welfare boards in 1915, but not all did so. Bond, Baber, Vieg, Perry, Scaff, and Lee, Our Needy Aged, 46–50; Fox, So Far Disordered in Mind, n21. 95. Bond, Baber, Vieg, Perry, Scaff, and Lee, Our Needy Aged, 51–52. 96. Jarvis, “Treatise on the Influence of Distance from and nearness to an Insane Hospital on its Use by the People,” 109. 97. Dr. John W. Robertson, “Prevalence of Insanity in California,” American Journal of Insanity 60 (July 1903): 77, 86, 81, quoted in Fox, So Far Disordered in Mind, 45. 98. Richardson, The Century of the Child, 191.

CHAPTER 4

“Helpless and Delinquent”: The Los Angeles Psychopathic Association

“Five-year-old girl is declared insane,” blared the 1903 headline in the San Francisco Call newspaper. As the nineteenth century slowly gave way to the twentieth, California newspapers continued to regularly publish the names of individuals sent to state asylums, just as it did for those arrested for crimes or picked up for loitering or public drunkenness.1 Then again, in her short life, this particular child had already experienced much worse. She had been found as a nameless, abandoned infant, wrapped only in newspaper, and taken to the San Francisco Foundling Asylum. They were the ones who named her after where she had been found on Harriet Street. Harriet had a congenital cleft palate that prevented her from communicating verbally. It may well have been her frustration at this that drove her behavior. “She has shown signs of violent insanity and has frequently attacked her companions at the asylum,” the article reported. No longer wanting to shelter Harriet, the Foundling Asylum tried to get her admitted to the state’s only asylum for the feeble-minded in Sonoma County. But although that institution had been open at its permanent home for less than two decades, it already had a long waiting list for admission. Instead, the Foundling Asylum had Harriet adjudicated insane so she could be sent to Stockton. Her commitment record declared, “child acts irrationally. Attempts to jump out windows and plays with fire. Makes peculiar noises. Sits and sways. Her manner is peculiar for hours

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at a time.” She lived at the Stockton asylum for two years until she was declared “improved” and transferred to the Sonoma County facility.2 As it entered the Progressive era, the United States continued to be plagued by “anxieties surrounding the state of public education and worker productivity in an industrial economy.”3 It was also an era focused on identifying and removing developmentally disabled individuals from public schools. The prevailing belief was that those individuals would somehow transfer their “poor habits” to developmentally typical children. This was true inside institutions as well: if space was available, superintendents segregated students by ability for the same reason. This also explains why doctors were careful not to admit too many severely disabled individuals into asylums.4 Racial change in communities in California as the state’s economy grew also fed into ideas about both reform and health.5 Women, particularly white women, played a key role in this work. As Jennifer Koslow explains, “because public health did not reach maturity as a distinct profession until the 1930s, it offered a forum for women with disparate interests but a common concern for the public’s health to engage in reform. They concocted systemic solutions to coping with life in a modern city” on issues as diverse as “public health nursing, housing renovation, birthing services,” venereal disease treatment, and clean food and milk.6 “Huge maternalist associations, organized as local clubs tied into state and national federations, sought to extend into civic life and public policymaking the caring values of the separate ‘domestic sphere’ culturally ascribed to the female gender during that time.”7 Progressives, in particular, believed strongly in the need for bureaucratic, regulatory entities as the only bulwark against the kind of corruption, much of it based in political patronage systems that had marred much of post-Civil War and Gilded Age America.8 In 1912, founding member of the Los Angeles Psychopathic Association Mrs. W. S. James explained the origins of the association two years earlier. She, along with a coalition of doctors, social reformers, and sympathetic laypeople, had organized it “for legislative purposes and also to improve the condition of those mentally afflicted. The doctors,” she added, “do an immense amount of gratuitous work that the public hears little about as the doctors do not reveal the sorrows of those to whom they minister.”9 The Los Angeles Psychopathic Association (LAPA) was the first Southern California-based organization focused on the care and treatment of individuals with disabilities and addictions. In its day, it

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was arguably one of most powerful lobbying groups working on medical issues in the region. Its most notable success (if one wishes to term it as such) was the creation of California’s second state institution for the developmentally disabled, the Pacific Colony, founded in the early 1920s. As discussed in Chapter 3, educators founded the first American schools for individuals with disabilities in the early 1800s. However, after the Civil War, such institutions increasingly shifted from education to the segregation of individuals with disabilities from an industrialized society.10 “Pupils” soon gave way to “inmates.” Increasingly, both doctors and families assumed that individuals in such institutions would likely remain under custodial care for life.11 At the same time, the professionalization and standardization of medical training in the United States gave physicians “diagnostic control, and thus treatment control” over their patients, particularly if those patients could not advocate for themselves.12 In 1915, the Committee on Provision for the Feeble-Minded was founded in New York City to coordinate and disseminate information on “the practical care, treatment, and prevention of feeble-mindedness.” The committee drafted and circulated a wide range of bulletins and pamphlets on the “menace” of feeble-mindedness and what might be done about it, and committee members traveled to different states to interface with state governments and other policymakers.13 In a parallel to institutions for the mentally disabled, institutions for the feeble-minded, advocates argued, could make even the most disabled of inmates productive by having them contribute labor to the institution itself. These arrangements, not coincidentally, also allowed large institutions to provide what Sarah Rose calls “care on the cheap.”14 Residential institutions were often the only resources available to individuals with disabilities unless they or their family could afford private nursing care.15 “Coming from the world of the college, the settlement house, and the medical school, the Progressive reformers shared optimistic theories that at once clarified the origins of deviant behavior and shaped their efforts to control it. They marched under a very appealing banner,” David Rothman writes, “asking citizens not to do less for fear of harm, but to do more, confident of favorable results.”16 By the end of the nineteenth century, both Los Angeles City and County were running out of space to contain the region’s drunk, disabled, disorderly, and disruptive individuals. The asylum in San Bernardino County was not large enough, and the city and county jails were themselves rapidly expanded. The county jail, an adobe building built in 1853,

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was replaced in 1886 with a new jail with room for 160 and then was replaced again in 1904. The first Los Angeles City Jail opened in 1881 with space for forty prisoners, but by the end of the decade, it had expanded to accommodate several hundred people. That one was quickly outgrown and replaced in 1896 with a new jail at a new site on First Street, but by 1903, Los Angeles’ chief of police was once again lobbying for a new, larger jail.17 The 1886 county jail had a small psychopathic ward attached to it, one that Dr. H. G. Brainerd, the attending physician for the ward, called “totally unfitted for the care of the mentally sick.” In 1910 or 1911, the Los Angeles County Board of Supervisors made plans to once again expand the psychopathic ward at the Los Angeles County Hospital that, it was hoped, would relieve some of the overcrowding at the State Hospital for the Insane at San Bernardino. There was a waiting list for admission to the state home in Sonoma, and it was estimated that 28 percent of the young men and boys at the Whittier School of Correction were “mentally defective” and would be better served at a different institution, should one be created in Southern California, or even a specialized facility at the Whittier site.18 To help close this gap, in 1909, the state of California began allowing counties to pay for the care of dependent and/or delinquent children who had been committed by the juvenile court in licensed, private boarding homes or orphanages. The state of California opened a second asylum in southern California, Norwalk/Metropolitan in 1916, seventeen miles southwest of downtown Los Angeles. Like Stockton fifty years earlier, the site was plagued with water issues. Local oil wells had contaminated much of the groundwater, so much so that eventually, closing the facility was discussed.19 This brings us back to the Los Angeles Psychopathic Association.20 As discussed, in California in the late nineteenth and early twentieth centuries, “in both professional and popular usage there was considerable overlapping between” the concepts of developmental and mental disability. Indeed, many physicians of the day believed that there was often a direct correlation between the two. “The question is sometimes asked,” a doctor mused in 1891, “whether the feeble-minded person is not an insane person—whether idiots and imbeciles are not classified as insane. I think in a legal sense they may be, but not in a medical sense.”21 Richard Fox calls this a “social definition” of feeble-mindedness. He argues that California state officials consciously used it because it made it easier to sell the public on the need for institutionalization. This extremely broad “social definition” of disabilities helps explain what now seems like the

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very odd choice to use “psychopathic” as part of the Los Angeles Psychopathic Association’s name: at the time, “psychopathic” was simply one term among many used to describe mental disability.22 The membership of the association and the arguments they used in favor of creating the Pacific Colony for the Feeble-Minded shed light on the role nonstate actors played in the development of California’s ever-expanding system of institutions. We do not know what initially brought the men and women who founded and served in the LAPA together. However, an analysis of their lives indicates two main sources of membership: the medical profession and the city’s larger Progressive reform movement. Given what we know about the connections between the professionalization of medicine and the rise of institutionalization, it is not surprising that doctors formed the core of the LAPA’s membership. Of all the board members, Dr. Henry Brainerd had the most direct experience treating mental and developmental disabilities. He was the first psychiatrist to practice in Los Angeles, having arrived in 1887. Before that, he had been superintendent at the Iowa Hospital for the Insane. For twentytwo years, he was chair of neurology at the Medical College of Southern California, the forerunner of USC’s School of Medicine. His colleague at the medical college, Dr. Ross Moore, also served on the board of the LAPA.23 Fellow board member Dr. Charles Whitman was a superintendent of the Los Angeles County Hospital and, by 1915, president of the Los Angeles County Medical Association.24 The California Academy of Medicine elected LAPA board member and neurologist Dr. Thomas Orbison vice president in 1915. A clear portrait of the doctors who served on the board of the LAPA is easy to assemble. They were mostly male, all white, professionally trained, and well respected in their fields. They were also already in positions of power in the medical community. This raises interesting questions. How much of that “gratuitous work the public hears little about” that Mrs. James talked about was driven by altruism? How much was driven by the need to maintain the regional medical community’s authority over former, current, and future patients’ bodies? The Progressive reform movement, broadly defined, was particularly strong in Southern California. One thread connecting Progressive reformers and the LAPA was an interest in juvenile justice. Californians had long had a particular interest in the possible connections between juvenile delinquency and mental deficiency.25 Curtis Wilbur, one of the founding members of the LAPA, was a Los Angeles superior court judge

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with a particular interest in the juvenile courts.26 Board member Mrs. Oliver P. Clark was a member of the probation committee of the juvenile court. Another thread connecting Progressives to the LAPA was the middle- and upper-class women’s club movement in the city. Mrs. Clark was also a former president of the largest and most influential women’s club in the city, the Friday Morning Club.27 William Lamb was a Congregational minister and had formerly served in the state legislature. Before his wife Mary Proctor Lamb passed away in 1914, she had been a member of the LAPA and director of both Los Angeles’ Florence Crittenden Home for unwed mothers and its McKinley Home for Boys.28 All the LAPA board members spoke the language and understood the tactics of Progressive era social reform. Only one LAPA member appears to have had any personal experience with mental or developmental disabilities.29 The LAPA wanted a state “psychopathic” hospital for the mentally disabled in Southern California, one closer to the main population center in Los Angeles. As previously mentioning, bowing to the pressure, in 1912, California authorized the creation of a new state hospital in Norwalk, twenty miles from Los Angeles. It wasn’t large enough to take population pressure off Patton, the county hospital, or, indeed, the county farm, which had been forced to begin transferring individuals from its insane ward to its general ward just to find enough beds for everyone being sent there. A new smaller insane ward exclusively for women was quickly constructed at the county poor farm, and the older insane ward was designated for men only.30 The association also lobbied for the creation of a “municipal farm for inebriates,” what newspapers at the time inelegantly called a “drunk farm.” One newspaper asked Mrs. James if addiction was not outside the LAPA’s wheelhouse. She responded that the LAPA found a natural overlap between alcohol abuse and mental disability.31 In 1914, the LAPA formed a “Committee on Unusual Children” and launched its own investigation into feeble-mindedness. Their target was the city schools. Los Angeles’ school superintendent gave the committee permission to visit the grammar schools in the city. Based on these visits, the committee estimated that there were approximately 300 feebleminded children in Los Angeles’ classrooms who, to its mind, should not have been there. The LAPA lobbied the next meeting of the California State Legislature, asking that it set aside part of Southern California’s Whittier State School for the care of these so-called “defective children”. When that proposal went nowhere, they planned in 1916 to introduce

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a bill to the California State Legislature to create a brand-new facility at a new site. In the same report, three female LAPA members, including Mrs. Oliver and Mrs. James, lamented, “they could recall cases where some able-bodied member of a family was deprived of means of a livelihood on account of having to devote their time to caring for a defective child and this attention was often misdirected.”32 Instead of moving on that proposal, the California State Board of Charities and Corrections in 1916 brought together members of the State Board of Education, the State Board of Health, the Commission in Lunacy, and the State Board of Control to discuss the issue. Out of this meeting emerged a State Joint Committee on Mental Defectives tasked with investigating and reporting to the state its findings.33 What is striking about this committee’s report in retrospect is how quickly the idea of feeble-mindedness being a contributing factor in admission to any state institution had infiltrated the thinking of both state and nonstate actors by 1916. The joint committee immediately landed on the idea of investigating feeble-mindedness in San Quentin Prison; in existing state children’s institutions; and in the public schools of an unidentified county in the state. The investigators were all already part of the apparatus of the state; indeed, they were likely chosen for exactly that reason. Dr. Lewis M. Terman of Stanford University did the work on San Quentin and on the public schools; Dr. J. Harold William of the Whitter State School investigated orphan children and unwed mothers in state charitable institutions and maternity homes; and Dr. Grace M. Fernald, head of the Department of Psychology at Los Angeles State Normal School, conducted “mental examination” of seventy-five children at an unidentified home. At moments in each of the three reports, investigators acknowledge the difficulty of the task before them and how slippery the abstract idea of “feeble-mindedness” really was. Terman himself pointed out in his report on San Quentin that “there is no simple standard…which can be accepted as an infallible criterion of an individual’s fitness to be at large. Ability to ‘get on in the world,’ ‘to manage one’s self and one’s affairs with ordinary prudence,’ etc., depends upon many things besides intellectual ability. It depends in part upon emotional traits, health, looks, bearing, muscular strength, inherited wealth, sympathetic friends, economic and industrial conditions, the prevailing level of intelligence among those with whom one must compete, etc.”34 Yet, investigators still used the standardized tools of the era, including the Stanford Revision of the Binet-Simon Intelligence Scale, the Yerkes-Bridges Point Scale,

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and the Vineland Psycho-Anthropometric Tests to quantify the individuals they were studying. Like many of their Progressive era brethren, they saw no contradiction in using standardized tests to measure what they had just admitted was inherently unmeasurable. Indeed, Terman was the author of the Stanford Revision test. On Terman’s test, individuals with a score of ninety and above were “normal” (90–110); “superior” (110–120); “very superior” (120–140); and “genius” (140 and above). Individuals who scored between 80 and 90 were “dull,” but not feeble-minded. Those who scored between 70 and 80 were borderline feeble-minded, and anyone with a score below 70 was feeble-minded. Among individuals classified as feeble-minded, there remained three subcategories: “morons” (50–70), “imbeciles” (20–50), and “idiots” (below 20).35 The 1916–1917 investigations echoed many of the same ideas that Dr. E. T. Wilkins’ study of American and European asylums had forty years earlier. At San Quentin, Terman found a correlation between foreign birth and feeble-mindedness, concluding that although the foreign born made up only 24.5 percent of the small sample of individuals he studied, they accounted or 40.4 percent of the feeble-minded in the prison. “Something like this had been found to be the case at the Whittier State School also,” he wrote, “and it indicates that California has drawn a large proportion of immigrants of an undesirable type.” The reported results of the four studies were also profoundly racialized and classist. After insisting that his study of the public schools in “X” county had corrected for issues that might be caused by English being a child’s second language, Terman still reported a correlation between feeble-mindedness and race or ethnicity. To prove his point, he cited as one example “studies” from Whittier that showed “the Mexican population in southern California is of extremely low mentality.” According to the cited studies, feeble-minded children were far more likely to come from families whose fathers came from lower occupational categories (such a laborers, farmers, and tanners) and the “lower social classes” in general. However, Terman attributed this to heredity defects in a handful of families that had confined them both to less desirable occupations and to (eventually) producing feebleminded children. Williams and the staff at Whittier also argued that individuals who were either orphans or who had been born to unwed mothers were more likely to be feeble-minded. Here, the connection was believed to be a mix of heredity and “undesirable” home conditions prior to institutionalization. “Desertion, separation, divorce, disease, and immorality among members of the family are not uncommon. Poverty is

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less common than we had expected to find, but it is sometimes a factor.”36 Although the study never mentioned LAPA, one of its formal recommendations was that California create a hospital for the feeble-minded to serve Southern California, just as the Sonoma facility served Northern California.37 In 1917, the California State Legislature duly authorized the creation of such a new institution. The East Coast-based Committee on Provision for the Feeble-Minded, upon request, provided the California Department of Engineering with suggestions for planning the new institution. The committee’s executive and field secretaries gave numerous public addresses around the state, often in conjunction with Mrs. C. P. Bryant, vice president of California’s Board of State Charities. California Governor William D. Stephens appointed three trustees to direct the affairs of the proposed Pacific Colony. One was clubwoman Mrs. J. Powers Flint, who had been active with the LAPA.38 While LAPA might not have received any immediate credit, they were, for the moment, content. They had achieved their goal. The Pacific Colony opened in 1921, thirty miles from Los Angeles. The lands had been part of Rancho San Jose and by the early twentieth century were part of the Sterns ranch. The closest two settlements were Spadra and Walnut Station. The closest town of any significant size was Pomona. Spadra in 1874 had become a railroad stop, and it played a key role in connecting the stage routes from the east with Los Angeles. While Spadra was considerably closer to Los Angeles than San Bernardino, the distance of some thirty miles was no accident. Asylum and institution builders and reformers at the time still had a distinctly antiurban bent. The idea was to get individuals as far away from the hustle and bustle of dirty cities and their myriad temptations to better promote peaceful rest. No doctors at the time reasonably expected any sort of recovery for the feeble-minded, but it was hoped a soothing, semirural environment might still promote health and quality of life.39 The physical plans were ambitious. Architectural design ideals for asylums and other state institutions had evolved considerably since the 1860s and 1870s. The old Kirkbridian ideal of housing everyone under one roof—sometimes called the congregate system—was giving way to a segregated system, often called the cottage plan. This shift had been gradual, but as far as doctors and reformers were concerned, the cottage system held some key advantages: “doctors could reuse old houses, use structures with a variety of plans; and cluster small buildings around preexisting linear hospitals.…Wooden houses could be built

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Fig. 4.1 Sonoma State Home in 1914. Image by Zan Stark. Courtesy of the California History Room, California State Library, Sacramento, California

less expensively than fireproof masonry hospitals, and small buildings did not require the complicated heating and water technologies of a linear asylum.” Often resembling a small village, with accommodations designed to mimic the home, the cottage plan created the illusion of communitybased care at a time when, as Carla Yanni puts it, actual “community care was a bridge too far.”40 The Sonoma Home already followed such a design; advocates expected Pacific to do so as well (Fig. 4.1). Physicians and reformers alike played down the removal of individuals from their families into these institutions and played up the potential benefits of such a move. “Home” is of course a loaded term, and the individuals sent to Pacific came from many different types of households and communities. But nonetheless, reformers repeatedly assumed “home” for a disabled individual must have been substandard and the institution thus preferable. “In the light of what had been learned concerning the influence of heredity and environmental conditions, it is difficult to see that a well-equipped, sanitary institution, providing three wholesome meals each day and minus the daily contact with quarrelsome, immoral, or abusive parents, is a much better place for children than some homes could ever become,” the joint committee argued. “That home should be a place

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of love, co-operation, and devotion is a strange revelation to many children.…There is no doubt that whatever shortcomings some institutions may have (especially some of those of several years ago, now for the most part improved or eliminated) they are superior to the homes from which many of their children come.”41 Dr. George L. Wallace from the Wrentham State School, a facility for children with developmental disabilities in Massachusetts, came to California specifically to consult on the design of the project.42 With buildings only taking up 125 acres of the 1,326-acre site, there was room for orchards and vegetable gardens, and the hope once again was that individuals placed there could engage in “light farm work” and “similar employment” that would help make the institution selfsupporting. Everyone assumed the facility would develop further over time; the vision was to eventually have it designed as a giant “T,” with recreational grounds and athletic fields surrounding the administration, housing, and educational buildings. When built out, it was supposed to be able to house 2,000 residents, both male and female, and provide jobs for an estimated 300 teachers, doctors, and attendants.43 That this site selection also continued the practice of geographically and physically segregating the residents of Pacific from much of the rest of the region was not openly discussed. This was, however, likely considered a feature, not a bug. The Pacific Colony thus followed the “cottage plan” to a T. “It is no historical accident,” Kim Nielsen writes, that such a plan became popular during the era of US imperialism abroad and Jim Crow at home. “Epileptics and the feebleminded…remained segregated within their own geographical places, literally called a colony, and removed from larger society.”44 The state of California appropriated $259,000 for the facility, and it opened with a sixty-bed capacity. Nineteen men and boys from the Sonoma Home were sent to live at the site along with a small staff. By the next year, there were thirty-three residents and fourteen staff there. However, a chronic shortage of water plagued the site. Although the members of the board of trustees were not initially informed about the water shortage, plans for any further development quickly ground to a halt. The state scrambled to find a solution to the water issues but soon decided there was no cost-effective way to do so. In this, they were aided by the Pomona Chamber of Commerce, which sent a formal statement to the governor agreeing with a closure due to current conditions but

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promising him that the land was still valuable for its agricultural potential.45 The state closed Pacific in 1923, after barely two years in operation. It paroled as many individuals as it could to the care of family or friends and transferred the rest back to Northern California. By 1924, when construction had not yet begun on a replacement facility at a new site, the LAPA sprung back into action.46 They resumed their lobbying efforts to make sure the state did not renege on the commitment it had made for a Southern California institution. This time, a tragedy helped further sway public opinion. On the night of May 31, 1924, a fire swept through the Hope Development Home, a private home for girls with developmental disabilities in Southern California. Twenty-three people died, most of them residents. The youngest victim was only five years old.47 It was soon revealed that the State Board of Charities and Corrections had denied the home a license to operate, specifically because the facility was an old, all-wood hotel that the state feared was unsafe. The board had been trying, without luck, to find a better facility for the school. As George H. Hutton, president of the Los Angeles County Public Welfare Commission, explained in the fire’s aftermath, “There was no other place to send the children. The Eldridge [Sonoma] School was full to overflowing and could not possibly care for many more. We simply had to make the best of the situation.” “All social welfare workers know that there had been a deplorable lack of proper facilities for the care of defective children in this part of the state,” Margaret Sirch of the Board of Charities told investigators. The school had been given only a temporary permit by the County Public Welfare Commission, and even that had only been granted with the expectation that the school would soon be moving elsewhere. “There was no institution in the county where these children could have been sent if the Hope School had been closed,” another commission member testified.48 Although investigators at first suspected an accident and a grand jury investigation had been unable to agree on the fire’s cause, one of the surviving girls soon confessed to setting it. Newspapers up and down California had no qualms about publicly identifying her by name. Not only did articles about sixteen-year-old Josephine Bartholemy appear that speculated about her intelligence, her culpability, and the exact nature of her disabilities, but they included photographs of her. Bartholemy was an orphan. She had four brothers, but none was able or willing to care for her. After repeatedly running away from a foster home, she

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had been committed to Hope Development Home. Other small fires had been reported at the home that predated her admission, so whether she was indeed the culprit, or just a convenient scapegoat, may never be known. “If her confession is substantiated, what to do with her becomes a problem,” the Los Angeles Times mused. “She is believed; and there is testimony to confirm her story; but legally it has no weight for all of it comes from girls of her own class—morons.” Bartholemy ultimately was sent to the Sonoma Home in Eldridge. She was to be detained there until she reached her majority, after which the courts were to decide what would happen to her.49 The grand jury investigation also soon discovered a long list of safety violations that had contributed to both the fire and the loss of life: locked exterior doors; no fire escapes; nonfunctional fire extinguishers; and more. Outraged, the public demanded to know why these girls had not been in a state institution instead of a private one, assuming that oversight would have made a state facility at least nominally safer. Governor Richardson sent the state fire marshal to Los Angeles to investigate all the hospitals and schools in Southern California. The Los Angeles City Council moved to eliminate all wooden hospital buildings.50 In their final report, the grand jury excoriated both Los Angeles County Welfare Commission and the state of California: It is the opinion of the grand jury that the State of California is primarily responsible for this terrible catastrophe because of the fact that it has not provided a home for these children, either with monies it may have at its disposal for this purpose or in taking steps thoroughly to acquaint the public with the situation and to obtain sufficient funds to make sure provision. That the members of the County Welfare Commission were sadly negligent in the performance of their duties in allowing the children to be placed in a building which had been condemned by them as unfit for this use….Investigation also proves that the present plan of caring for these children is impractical and does not properly provide for their safety, health, happiness, and opportunity to develop. [A disaster such as this] means more than this horrible incident of itself. It weakens confidence in the machinery of the community and State supposed to function for society’s benefits and safeties. This confidence must be restored. The greatest thing in human living is the regard we have for our offspring. No business office or personal ambition is greater than a little child. In probably twothirds of instances feeble-mindedness is of hereditary origin—is the result of defective family stocks.51

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Mrs. W. S. James sent a telegram on behalf of the Psychopathic Association to Governor Richardson making exactly that point: “The board of directors of the Psychopathic Association of California in conference with federal and county officials today passed resolutions urging you to take immediate action to relieve the deplorable conditions that now preclude the adequate care of the helpless and delinquent feeble-minded in southern California, as exemplified in the recent holocaust in Playa del Rey.” Doubtless to assuage any concerns the governor might about spending money on a new hospital, James also pointed out that there was still $140,000 of the original appropriation “lying idle in the State Treasury” for the Pacific Colony.52 At the same time, Los Angeles County once again picked up its old argument that it was not getting the full benefit of state institutions for the disabled because so many of them were so far away. County Supervisor Prescott Cogswell gave a speech to the local University Club in the summer of 1924 making exactly this point. Although the county, he said, “paid more than one quarter, and only a little less than one third, the cost of maintaining various State reformatory, medical, and welfare institutions in some of them the number of inmates from this county is altogether disproportionate.” The Sonoma Home housed less than one hundred individuals from Los Angeles out of a population of 2,000, and had taken only twelve from Los Angeles in 1923–1924, hardly surprising, Cogswell pointed out, considering it was more than 600 miles away. “In the California School for Girls at Ventura,” he added, “there is not one inmate from [Los Angeles] county.” At the same meeting, William Harriman, superintendent of the Los Angeles County Poor Farm, explained that his facility had taken in 400 people turned away from state hospitals but who were “not fit associates for others at the farm. The government cannot continue long to care for these unfortunates without building a separate institution, whether it be done by the state or the county.”53 In response to the outrage over the deaths at the Hope Development Home, Los Angeles County’s frustration, and LAPA’s revived lobbying, Governor Richardson vowed that California would and could do better. “Southern California should have an institution for feeble-minded children,” he now proclaimed. He stressed that the closure of the Pacific Colony had taken place before he had assumed the office and blamed it on the Board of Control: “[T]his false move can be charged to a politician who poses as a humanitarian. There must not be a second failure.” However, he stressed that although the Hope Development Home fire

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had been a tragedy, “the State is no more responsible for the disaster than it was for the gun explosion at San Pedro of the blowing up of the Maine. The responsibility for the care of all children rests upon parents and guardians. The responsibility for educating children rests with the counties and school districts, and the State advances many millions each year for this purpose.”54 California moved ahead with plans to rebuild the Pacific Colony. It decided to use not the original site, which by then had stood abandoned for two years. Instead, the new version was built on a 200-acre site on the south side of Pomona Boulevard that had been part of the original purchase but was yet unused. California State Director of Institutions Wagner vowed that this time wells on the site had been tested and a steady future supply of water assured. “I can say positively that your troubles in regard to Pacific Colony are over,” he vowed to the Los Angeles Psychological Association. “Everything will be built right; every building will be fireproof.” In addition to two buildings that could house a total of eighty individuals, the new site also had agricultural provisions including a dairy, barns, a poultry plant, and piggeries. This site was also much closer to the tracks of the Southern Pacific Railroad, a key supply line. The state legislature authorized the Board of Control to sell off parts of the original site as needed to purchase additional lands closer to the new one. However, the state had not given up on the original site entirely. The Pacific Lodge, an institution for wayward boys, became the first of several other organizations and institutions that would use the original hospital grounds. It was followed by an early version of the California State Narcotic Hospital and, eventually, Mount San Antonio College, which occupies the site today.55 Continued overcrowding at and a long waitlist (now estimated to range somewhere between 500 and 2,000) for admission to the Sonoma State home continued to fuel urgency to reopen Pacific. As the California State Board of Charities and Corrections, the entity charged with overseeing the state homes, put it at the time, “growth in population as well as a greater understanding of the significance of the problem of feeblemindedness have greatly complicated the question of admissions; both factors have driven home the need for study and readjustment.…We are inclined to be so discouraged by the immensity of a problem and its ramifications that often we consider certain of them almost beyond solution. With the lapse of time the difficulties become more complicated. Just so had it seemed for many years in meeting the demand for admission to state homes.” The colony reopened in 1927 at its new site in the town

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Fig. 4.2 Detail, “Who’s To Blame?,” Los Angeles Record, October 23, 1915

of Spadra (present-day Pomona). Unlike in its previous incarnation, this time, the colony admitted both males and females, most of them from either the Sonoma Home or the Whittier State School. The idea that the opening of Pacific would solve the state’s overcrowding issue was soon proven false, however: within a few months, Pacific, too, had a waiting list for admission (Fig. 4.2).56 Due to the lack of space, children with developmental disabilities continued to be committed to private boarding homes and orphanages.57 Reflecting on institutions like Sonoma and Pacific, Steven Noll argues that they were “viewed by some state officials as prisons for lowfunctioning offenders, by others as training schools for retarded people to learn the life skills necessary for reintegration back into society, and by still others as permanent homes for those unable to function outside the walls, institutions never developed a coherent function. By attempting to fulfill all those roles simultaneously, these facilities and their managers struggled to succeed at providing any one of these functions.”58 Indeed, California’s two institutions for the developmentally disabled became increasingly custodial as the 1920s wore on. The state had already, for

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example, added a “colony” at Sonoma for “delinquent, defective” girls infected with syphilis during World War I.59 By 1932, California authorities were so pleased with what they had accomplished that Norman Fenton of the California Bureau of Juvenile Research proposed a so-called “Pacific Colony Plan,” which emphasized the need for the right blend of individuals there so doctors could treat the most severely disabled but still have enough moderately to mildly disabled individuals to handle much of the day-to-day labor at the site. It also stressed the need to train and release the least disabled so they could return to being productive in the larger economy.60 The Progressive-era doctors and reformers who lobbied so actively for a Southern California institution were in many ways repeating the state politicians’ tendency to regard Californians with disabilities not as people, but as patients, not as individuals with unique needs, but as problems to be solved. More Californians were paroled from state hospitals, but for reasons of economic efficiency rather than because they had recovered. This approach in turn helps explain the expansion of eugenics in the state of California, which became one of the most notable features of state hospitals in the 1920s, as well as the battle over the institutionalization of Californians affected by addictions to drugs and alcohol. It is to these topics we now turn.

Notes 1. Richard W. Fox argues that this only began to change in the early twentieth century when disability came to be perceived as a medical, not a legal, matter. Fox, So Far Disordered in Mind, 40. 2. There is no indication in surviving records that there was ever any attempt to teach the child sign language or any other form of non-verbal communication. “Five-Year-Old Girl Is Declared Insane,” San Francisco Call, April 25, 1903; “Harriet Street,” Stockton State Hospital, Commitment Registers, vol. 13–14, 1899–1904, California, U.S., State Hospital Records, 1856–1923, retrieved from Ancestry.com (https://www.anc estry.com/discoveryui-content/view/54834:9206?tid=&pid=&queryId= eccb6edc471eaf65e84059704ed31631&_phsrc=Pac23&_phstart=succes sSource); “Harriet Street,” Sonoma State Hospital, Personal Description List, Females, 1900–1913, California, U.S., State Hospital Records, 1856–1923, retrieved from Ancestry.com (https://www.ancestry.com/ discoveryui-content/view/50544:9206?tid=&pid=&queryId=eccb6edc4 71eaf65e84059704ed31631&_phsrc=Pac24&_phstart=successSource).

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3. Brent Ruswick and Elliott W. Simon, “Industry, Improvement, and Intellectual Disability: Finding the Hopes and Fears of Parents and Superintendents at the Pennsylvania Training School,” The Journal of the Gilded Age and the Progressive Era 17 (2018): 145. 4. Brent Ruswick and Elliott W. Simon, “Industry, Improvement, and Intellectual Disability: Finding the Hopes and Fears of Parents and Superintendents at the Pennsylvania Training School,” The Journal of the Gilded Age and the Progressive Era 17 (2018): 145–146. 5. Miroslava Chávez-Garcia, State of Delinquency: Race and Science in the Making of California’s Juvenile Justice System (Berkeley, CA: University of California Press, 2012), 7–8. 6. Jennifer Lisa Koslow, Cultivating Health: Los Angeles Women and Public Health Reform (New Brunswick, NJ: Rutgers University Press, 2009), 157. 7. Skocpol, Protecting Soldiers and Mothers, 10, 528. 8. Skocpol, Social Policy in the United States, 24. 9. “Wellborn Outlines ‘Drunk Farm’ Plan,” Los Angeles Herald, October 23, 1912. 10. Trent, Inventing the Feeble Mind, 39, 50–51. 11. Trent, Inventing the Feeble Mind, 60. 12. Nielsen, A Disability History of the United States, 66. 13. Committee on Provision for the Feeble-minded, Report of the First Year’s Work (Philadelphia: The Committee on Provision for the Feeble-minded, June 1916), 2–3. 14. Trent, Inventing the Feeble Mind, 73; Sarah F. Rose, No Right to Be Idle: The Invention of Disability, 1840s–1930s (Chapel Hill: University of North Carolina Press, 2017), 75. 15. Janice Brockley, “Rearing the Child Who Never Grew: Ideologies of Parenting and Intellectual Disability in American History,” in Mental Retardation in America: A Historical Reader, 132, 139. 16. David J. Rothman, Conscience and Convenience: The Asylum and its Alternatives in Progressive America (Boston: Little, Brown, and Company: 1980), 5. 17. Kelly Lytle Hernandez, “Hobos in Heaven: Race, Incarceration, and the Rise of Los Angeles, 1880–1910,” Pacific Historical Review 83, no. 3 (August 2014): 430–432. 18. “Need Imperative for New Psychopathic Ward,” Los Angeles Times, September 15, 1911; “Psychopathic Association: Help for Defective Children Grave Need,” Los Angeles Times, October 19, 1914; “To Heal Minds of Deficient,” Los Angeles Times, February 26, 1915.

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19. State of California Department of Mental Hygiene, Biennial Report for 1950–1952 (Sacramento: California State Printing Office, 1952), 89; “State Hospital Faces Closing,” Los Angeles Times, February 5, 1931; Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 128. 20. It sometimes also went by the Psychopathic Society or the Psychopathic Association of Southern California. “Wellborn Outlines ‘Drunk Farm’ Plan,” Los Angeles Herald, October 23, 1912. 21. Association of Medical Officers of American Institutions for Idiotic and Feeble-minded Persons, Proceedings of the Association of Medical Officers of American Institutions for Idiotic and Feeble-minded Persons Session, 161. 22. Fox, So Far Disordered in Mind, 33, 42. 23. The two men were already working to reform the way the city dealt with mental health issues. For example, they successfully lobbied to have patient confinement hearings moved from the old Broadway Courthouse to the somewhat less stressful environs of the county hospital. George L. Cole, Medical Associates of My Early Days in Los Angeles (Los Angeles: 1930), 25–26; George H. Kress, A History of the Medical Profession in Southern California, 2nd ed. (Los Angeles: Times-Mirror Printing, 1910), 82. 24. “Dr. Whitman to Head Medical Association,” Los Angeles Herald, December 16, 1915. 25. Los Angeles had founded a separate justice and juvenile court system for children and young adults in 1909. Stern, Eugenic Nation, 92–93. 26. By 1921, he was an associate justice of the supreme court of California. “Go North to Take Part in Conference of Charities,” Los Angeles Herald, September 27, 1908; “Wilbur, Curtis D.” in 1921 Los Angeles City Directory (Los Angeles: Los Angeles City Directory Company, 1921), 2636. 27. She was also at various times vice president of the Women’s City Club and secretary of the Woman’s Progressive League, as well a member of the Los Angeles Psychopathic Society. “Mrs. OP Clark Named on Probation Committee,” Los Angeles Herald, November 2, 1911. 28. The couple’s daughter, Ellen Augusta Lamb, followed her parents’ example as the member of the LAPA who actually traveled to Sacramento to lobby on behalf of the organization. “William A. Lamb,” A History of California and An Extended History of Los Angeles and Environs, Biographic, vol. III (Los Angeles: Historic Record Company, 1915), 881. 29. Local newspapers openly discussed a “nervous collapse” Dr. Charles Whitman had suffered in 1916. When he died in June 1917 at the age of sixty-three, the Los Angeles Examiner noted that he had, a month earlier, taken a leave from the county hospital “to make a fight for his life.” Evidently, it was a fight he lost. “Dr. Whitman, County Hospital Head,

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31. 32.

33.

34. 35.

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Dies,” Los Angeles Herald, June 14, 1917; “Dr. Charles H. Whitman and Lee C. Gates Dead,” Los Angeles Herald, June 14, 1917. Sadly, because individuals in the farm’s general wards were allowed to move freely around its many acres, several mentally disabled individuals wandered onto the nearby railroad tracks and were killed. “Doctors Outline Hospital,” Los Angeles Herald, March 25, 1911; “Asylum Decision Today,” Los Angeles Herald, October 13, 1913; Fliedner, Centennial, 99,–100. “Wellborn Outlines ‘Drunk Farm’ Plan,” Los Angeles Herald, Number 19, October 23, 1912. “To Ask Legislature for Children’s Home,” Los Angeles Herald, May 20, 1914; “Home Project Well Advanced,” Los Angeles Times, October 29, 1916. California State Joint Committee on Defectives, Surveys in Mental Deviations in Prisons, Public Schools, and Orphanages in California under Auspices of the State Joint Committee. Brief Description of Local Conditions and Need for Custodial Care and Training, Dependent, Defective, and Delinquent Classes (Sacramento: California State Printing Office, 1918), 5; Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 129. California State Joint Committee on Defectives, Surveys in Mental Deviations in Prisons, Public Schools, and Orphanages in California, 5. California State Joint Committee on Defectives, Surveys in Mental Deviations in Prisons, Public Schools, and Orphanages in California, 5; Lira, Laboratory of Deficiency, 43; Stern, Eugenic Nation, 18–20, 92–93. The emphasis on “immorality” applied, of course, to the unwed mothers. What strikes the modern reader about the case studies in the report is how many of the young women may have been victims of assault or abuse that had resulted in pregnancy. One twenty-one-year-old, identified by the study as a “high-grade moron,” had been picked up by a man, taken to a picture show, and then drugged, only to wake up the next morning in a public park. The assault resulted in a pregnancy. Another young woman who investigators claimed “will pass for average-normal in any community” had been working as a domestic servant in a private home, only to be impregnated by her employer while his wife and children were away. None of this potential trauma, or its possible influence on the standardized test results, was addressed in the 1916–1917 report. Indeed, in the twenty-one-year-old’s case, the report only commented that “the affair could never have happened had this girl been placed in a training school, where she would have been useful and happy.” California State Joint Committee on Defectives, Surveys in Mental Deviations in Prisons, Public Schools, and Orphanages in California, 14, 35–36, 53, 62, 65, 75.

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37. Hugh Kohler, “Pacific State Hospital, 1921–1965,” Pomona Valley Historian 8, no. 1 (January 1972): 2. 38. The others were Newton W. Thompson of Alhambra, a former state senator, and Dr. Mary Roberts Coolidge of Berkeley, who had previously directed the South Park Social Settlement in San Francisco. “Trustees Named for New State Hospital Former Senator Thompson on Board of Pacific Colony; Home of Feeble Minded,” Sacramento Union, October 23, 1917; Committee on Provision for the Feeble-minded, Report of the First Year’s Work (Philadelphia: The Committee on Provision for the Feeble-minded, 1916), 6. 39. Carla Yanni, The Architecture of Madness: Insane Asylums in the United States (Minneapolis: The University of Minnesota Press, 2007), 102, 105; “Trustees Named,” Sacramento Union, October 23, 1917; “Pacific Colony Site Selected,” Los Angeles Times, September 18, 1919; “Spadra’s Past Woven into History of Valley,” Los Angeles Times, May 17, 1959. 40. Yanni, The Architecture of Madness, 79–80. 41. California State Joint Committee on Defectives, Surveys in Mental Deviations in Prisons, Public Schools, and Orphanages in California, 78. 42. “Fix Pacific Colony Site,” Los Angeles Times, November 11, 1918. 43. “Rush Big Development,” Los Angeles Times, December 9, 1919. 44. Nielsen, A Disability History of the United States, 100. 45. “Epileptic Home Closing Fought,” Los Angeles Times, March 25, 1923; “History of the Establishment and Growth of Lanterman Developmental Center,” Lanterman Developmental Center Collection, Special Collections Department, California State Polytechnic University, Pomona, Pomona, California. 46. Assembly Bill 932 and 1003 sought to repeal the 1917 act that had created the institution. The Psychopathic Association, understandably, fought the bill. “Seek to Keep Moron Colony,” Los Angeles Times, March 14, 1923; “Pacific Colony Project Urged,” Los Angeles Times, December 10, 1922; “Feeble Minded Colony Ends,” Los Angeles Times, January 18, 1923; Kohler, “Pacific State Hospital, 1921–1965,” 4–6. 47. “Home Fire Inquiry Closed,” Los Angeles Times, June 20, 1924; “Twentytwo Deaths in Home Flames Stir Four Inquiries,” Los Angeles Times, June 2, 1924. 48. Technically, the state’s lunacy law put the management of institutions like the Hope Development Home under the state department of institutions, but since that department had no office in Southern California, the responsibility was delegated instead to the board. “School Denied License for Fear of Calamity,” Los Angeles Times, June 2, 1924; Grand Jury Called in Fire,” Los Angeles Times, June 4, 1924.

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49. Bartholemy cannot be definitively tracked through surviving records, but it appears she may have eventually been released back into the community. “Girl Incendiary Offer Puzzle,” Los Angeles Times, June 19, 1924; “Eldridge to Get Pyromaniac Girl,” Healdsburg Tribute, June 26, 1924; Grand Jury Called in Fire,” Los Angeles Times, June 4, 1924. 50. “Spotlight on ‘Homes,’” Los Angeles Times, June 3, 1924; “Twenty-two Deaths in Homes Flames Stir Four Inquiries,” Los Angeles Times, June 2, 1924; “Grand Jury Called in Fire,” Los Angeles Times, June 4, 1924; “Rigid Anti-fire Act Looms,” Los Angeles Times, June 11, 1924. 51. “State and County Scored for Playa Del Rey Fire,” Los Angeles Times, June 16, 1924. The county welfare commission held its next elections at the end of July 1924, but no mention of the fire or the grand jury’s conclusions appear to have made. “Welfare Body Heads Elected,” Los Angeles Times, July 31, 1924. 52. Why James refers to the organization here as the association “of California” may signal a political strategy, or it may just be the psychopathic association once again being inconsistent with its name. “Asks Governor Aid Defectives,” Los Angeles Times, July 5, 1924. 53. It is unclear from the news coverage of this speech if Harriman meant the state hospital at Stockton or the Sonoma home; given the context, however, he likely was referring to the Sonoma home. “Asks Governor Aid Defectives,” Los Angeles Times, July 5, 1924. 54. “Home Fire Inquiry Closed,” Los Angeles Times, June 20, 1924. By “the gun explosion at San Pedro,” Richardson may have been referring to the June 12, 1924, explosion in a gun turret on the USS Mississippi just south of Los Angeles that killed forty-eight sailors. It had occurred only a few days before and thus may have been at the forefront of Richardson’s mind. See Cecilia Rasmussen, “The Scarred History of Turret No. 2,” Los Angeles Times, June 6, 1999. 55. A subway was eventually dug out to allow residents and staff safe passage under the tracks. “Pacific Colony Will Be Reborn,” Los Angeles Times, May 8, 1925; “Spadra Colony Bill Approved,” Los Angeles Times, May 15, 1925; “Lanterman Developmental Center History”; “History of the Establishment and Growth of Lanterman Developmental Center”. 56. Kohler, “Pacific State Hospital, 1921–1965,” 7–8. On conditions at Sonoma, see Report on Survey of Sonoma State Home Waiting List, Made by the State Board of Charities and Corrections of the State of California (Sacramento: California State Printing Office, 1925), 5; “History of the Establishment and Growth of Lanterman Developmental Center”. 57. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 130. 58. Noll, Feeble-minded in Our Midst, 156.

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59. These women and girls were institutionalized because they were considered a “menace” to soldiers in the military camps. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 11, 35. 60. Lira, Laboratory of Deficiency, 61, 65–67.

CHAPTER 5

“The Thankless Task”: Parole, Eugenics, and the Institutionalization of the Addicted

Alma Rubens and Wilma Wilson were two very different women. Rubens, born in California in 1897, was a relatively successful silent film actress before her career was derailed by drug addiction. Wilson, born in California in 1908, bounced from job to job: waitressing, dancing, swimming in motion pictures and water ballets, and doubling for feature players in films. By the time she was in her twenties, she was, she openly admitted, an alcoholic. Rubens and Wilson did not know one another, and although both worked in Hollywood, it is unlikely their paths ever crossed. But they did have a few things in common. Both were young, attractive, and white. Both had very close relationships with their mothers, and both had partners who, at least for a time, did their best to help them battle their addictions. Both women also had firsthand experience with California’s growing bureaucracy of disability, and both left behind them memoirs providing firsthand accounts of both Los Angeles’ and California’s systems for containing and committing the disorderly.1 As state hospitals became, once again, overcrowded, legislators, doctors, and bureaucrats sought ways to treat individuals as quickly and as permanently as possible so they could be released back into society. The economics behind this new emphasis on parole decisions are quite clear. It was exponentially cheaper to have an individual out on parole, perhaps holding down a part-time or even a full-time job, and pay a social worker to supervise them than to care for an individual around the clock in a state © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 E. V. Wallis, California and the Politics of Disability, 1850–1970, https://doi.org/10.1007/978-3-031-21714-2_5

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facility. Even developmentally disabled individuals who had no family to return to but who could not live independently could live with and work for a “foster family” and earn their own room and board.2 Parole from state institutions for the disabled became a regular occurrence, although, as we will see, not every institutionalized Californian had equal access to it: access was usually shaped by race, class, gender, and the nature of the disability itself. Certain individuals, particularly white, middle- and upper-class women, could avoid state institutions entirely. Within the state hospitals, eugenic sterilization became one of the most frequently used tools to “treat” Californians with disabilities and thus prepare them for release. Eugenics served two goals. First, it allowed the political and social elites of California to decide who in the state was to be considered damaged, deviant, defective, and/or dangerous. Second, it allowed those same elites to arrange society in a way that isolated those individuals as much as possible before they could “contaminate” the eugenically “fit” populations. And it was all seemingly backed up by science. Soon, “ideas about the dangers and costs of hereditary degeneracy pervaded California government and culture.”3 At the same time, California once again expanded its definition of who should be placed in state hospitals, this time to include alcohol and drug addicts on a scale never attempted. Here again, the California State Legislature was happy to pass laws and then trust the bureaucrats in its employ to carry them out however they saw fit. The best scientific minds, both inside and outside of California’s state government, truly came to believe that if it could just get the right policies in place, the state could be rid of the disorderly and “defectives” once and for all. This new attitude was reflected in the widespread adoption of “mental hygiene” as the term of choice to describe California’s efforts, both inside and outside of the state hospital system.4 By the early twentieth century, the commitment procedure in California for individuals with mental or developmental disabilities followed a well-worn path. First, a petition for commitment was made to the court and a prepetition inquiry conducted. The commitment could be initiated by just about anyone: a family member; a member of law enforcement; a doctor; even an employer. In his study of commitments in San Francisco from the 1910s to the 1930s, Richard W. Fox found that relatives made up 57% of petitioners, with doctors at 21% and police at 8%. Moreover, the number of police accusations dropped over the years covered in his study. Law enforcement continued to apprehend individuals on the grounds of possible mental disability and bring them to local hospitals,

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but they increasingly handed off the task of actually determining whether an individual was insane to professionals.5 While the courts and doctors decided the ultimate fate of an individual, many were held in city- or county-level detention facilities or local hospitals if they would take them, for days or even weeks. This was often an exceptionally grim experience. Even though the 1897 state lunacy law explicitly forbade confining those deemed mentally disordered with those deemed criminal, it happened all the time. Cities and counties simply did not have the space to effectively segregate the two groups while each waited for the hearings that would determine their fates. As late as 1920, twenty-nine of the fifty-eight counties in California still confined the two groups together, which in practice meant iron bars, locks on the doors, and indifferent and often brutal treatment at the hands of jail staff.6 Depending on the outcome of the court’s investigation into the circumstances surrounding the petition for commitment, an examination or even detention, if the individual was deemed to be a danger to themselves or to others, could be ordered. A court hearing then followed. The judge could decide to dismiss the matter. They could decide to release the person into the care of a relative. In a few counties, including Los Angeles, they could commit the person into the custody of a so-called “psychopathic parole officer” (discussed below). In counties where this option was available, judges chose it frequently when they deemed an individual “mentally disordered” but not “dangerously ill.” The parole officer had the leeway to place the individual in a rest home, sanitarium, or other care facility. If the individual being committed had means, they or their relatives were expected to pay for said care; if not, the county in which they were resident paid the bill.7 The flaws in this approach were well-known, even at the time. What, exactly, constituted “mentally disordered” but not “dangerously ill”? Even the court’s most ardent supporters recognized that individual judges often answered that question very differently. The worse outcome was, of course, the judge ordering commitment in a licensed private sanitarium or hospital (if the individual could afford one); to a Veteran’s Administration hospital (if the individual qualified for admission to one); or to the State of California for placement in a state facility.8 For the individual labeled insane who had been committed, but who was determined to fight the order, their best hope was a jury trial. Within ten days of the order, they, their friends, or family members could demand one to determine if the person was mentally disordered. Courts usually

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granted such requests, but they also often ordered the person into a ninety-day institutional stay pending the jury trial, assuming that even a few weeks of care might resolve whatever issues had brought the individual before the court in the first place. If the jury should find the individual mentally disordered, a writ of habeus corpus was their remaining legal option.9 Asking ordinary jurors to adjudicate someone as mentally ill or not was, everyone acknowledged, problematic for obvious reasons. It was an imperfect tool, but as someone at the time noted, “the best legal and medical thinkers have been unable as yet to devise and gain acceptance of a substitute procedure which will remove all need for retaining a jury trial as a kind of ultimate guarantee that every citizen will have the fullest opportunity to safeguard his legal rights and liberties.”10 As part of an attempt to address overcrowding at state hospitals, more and more city and county hospitals across the state were creating or expanding their own psychopathic wards. California’s more than fifty counties had, of course, a direct fiscal interest in pushing problematic individuals into the state institutions as quickly as possible, so the county would not be responsible for the cost of care. However, this was not always possible, and thus other solutions had to be created.11 For example, the Los Angeles County General Hospital had first expanded its insane or psychopathic ward in 1905, but soon once again ran out of room. It continued to rely on the county farm to take the overflow. By 1907, there were nearly fifty individuals at the farm identified as having some kind of mental disability. That year, the farm at last was able to construct a new building specifically for its insane ward. Men and women were once again segregated in different parts of the building. Unlike at the state hospitals, each had their own room, although all were locked out of their rooms during the day to encourage them to go outside into fenced courtyards for fresh air. Violent individuals, however, were not tolerated and were transferred to state hospitals as quickly as possible.12 Counties may also have had an idea that, by attaching these acute wards to local general hospitals, individuals could thus avoid the stigma that came with a stay in a city or county jail and commitment to a state institution. Psychopathic wards could, advocates argued, also take individuals who, however odd or deviant their behavior, were not deemed mentally disabled, thus freeing up space in overcrowded state hospitals.13 Another innovation of the Progressive era, psychopathic wards were specialized hospital wards designed to hold individuals for only a few days at most, until they could be examined by physicians. The physician would then

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make the decision of whether a patient needed to be sent on to an institution (and, if so, which one) or whether they could go home.14 These were usually part of regular urban general hospitals and thus did not require the construction of additional specialized facilities. The goal was to create an intermediate step between initial contact with authorities (voluntary or involuntary) and commitment. Richard W. Fox argues that these wards were doctors’ attempt to “establish their own professional control over the commitment system, a system subject, in their view, to intolerable obstruction from laymen.”15 They were also popular with city and county governments seeking to show they were making an effort to address the disabled, disordered, and diseased in their communities, particularly as waiting times for admission to state hospitals grew longer and longer. 1917 saw the founding of the California Society for Mental Hygiene in San Francisco, which lobbied for the creation of a psychopathic ward in the city itself. Clinics also often provided access to social workers, since it was “assumed that mental disorder stemmed in most cases from unhygienic conditions at home.” In 1923, a psychopathic ward was created at San Francisco Hospital.16 However, in a 1930 study of the five urban California counties that had psychopathic wards (Alameda, Fresno, Los Angeles, San Diego, and San Francisco), a researcher found that only in San Diego and San Francisco were the wards doing anything resembling treatment. The others were just metaphorically sitting on individuals pending commitment to a state hospital, sanitarium, or other facility. Fox also argues that the advocates for creating these psychopathic wards had not only exaggerated the contribution such wards could make in treating mental disabilities in California, but also that they either did not understand or did not acknowledge that these wards were simply becoming yet another dumping ground for Californians regarded as problems. “Although medical professionals had won the authority to decide for or against long-term commitment without overt lay interference, they did not have the power, sought by specialists in diseases of the mind, to strictly limit admissions to persons with ‘well-defined’ mental disorders,” he writes. “Local community authorities could still see to it that the psychopathic ward, the state hospitals, and the physicians that manned them, remained dedicated to the broader, traditional goal: the confinement of individuals who, whether mentally ill or not, seemed to threaten family stability or public tranquility.” Moreover, he adds, “the establishment of psychopathic wards—the partial result of public demands for easy access to psychiatric treatment—made it easier at the same time

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for physicians to commit the insane to state hospitals. Not only did the psychopathic ward in practice eliminate the court hearing, but it offered clinically authoritative judgements that non-experts were in no position to doubt.”17 California’s shifts in care were accompanied by a rather unique historical twist. When the state codified its laws around “lunacy” in 1913, it included a new optional provision. It allowed any county in the state, if they chose to do so, to create the office of psychopathic probation officer.18 Individuals serving in this capacity were nominated and appointed by a judge of the superior court and served at their discretion. In a county that chose to create such a position, the psychopathic probation office became involved in any case brought before the court involving an individual deemed to be mentally disordered. Only two positions for psychopathic probation officers could be created in each county. An unlimited number of deputies could be appointed, but they served without pay. The job called for the psychopathic probation officer to “inquire into the antecedents, character, family history, environment, and superinducing cause of the mental sickness or insanity of every allegedly mentally sick of insane person brought before the court.” They were then expected to report to the judge, in writing or verbally, all they had learned. Each psychopathic probation officer also had all the same powers as a peace officer and could, for example, bring any person in their “care” back before the courts at any time they deemed necessary. The position of psychopathic probation officers was a mechanism for the courts to deal with those “not dangerously insane” without committing them to a state hospital. The officer held enormous power over the ultimate fate of each individual: the court could release an individual to the “care and custody” of a psychopathic probation office who would then decide if they could return home under supervision or be sent to a private sanitarium or rest haven, again, under the continued supervision of the officer. Only two counties created these positions: Los Angeles and San Diego.19 Los Angeles County then added a special court dedicated to dealing with all aspects regarding the mentally disabled and with commitments for county residents deemed to be “mentally deficient.” On occasion, the court met within the county general hospital itself. (Fig. 5.1). California’s Welfare and Institutions Code gave this court the power to commit any “persons not mentally responsible.” It could also operate as a juvenile court when needed. In 1928, a Juvenile Hall Psychiatric Clinic

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Fig. 5.1 Interior view of the Los Angeles County General Hospital Psychopathic Department, ca.1925. Courtesy of the University of Southern California Libraries and the California Historical Society

was added to Los Angeles’ courts to provide psychological and psychiatric evaluation of young people moving through system. Although only an estimated 10% of children were screened under this system, it quickly developed a backlog that often resulted in longer stays for juveniles in detention as they waited to be examined and for the results to make their way to a probation officer. The awesome power of the county’s specialized court was well understood: “within the total range of community services for the mentally ill, this court occupies the key position. No other local agency wields such extensive powers.”20 Judges served one-year renewable terms and were chosen based on feedback from an advisory mental health committee within the superior court. A bailiff, court secretary, court reporter, and court clerk rounded out the staff. The result was that most petitions for commitment in Los Angeles County ended up before this court.21 On rare occasions, the individual threatened with commitment ended up in the same room with the psychopathic probation officer, the judge, the doctors, and the person attempting to have them committed as

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attempts were made to decide their fate. In 1936, for example, photographers captured Margaret Fillmore, the sister of actress Mary Miles Minter, across the table from her mother, Mrs. Charlotte Shelby, as the latter tried to have her daughter committed for “habitual” intoxication. Fillmore was also an actress, although not nearly as successful as her sister. However, the family had obviously learned about the power of publicity. It was extremely rare to have cameras present in psychopathic court hearings, yet we have still images of this one. This suggests either Fillmore or her mother wanted them to be there. In this case, at least, the commitment attempt failed.22 Whether an individual landed in a city or county jail as the first step to commitment, the experience seems to have been universally horrible. Of her brief stay in a Los Angeles jail back in 1912, Sara Ramsey recalled that “the rotten beef…stank so it nauseated me, the bread without butter, the simulated coffee, the beans, the dry boiled potatoes, there is no need to elaborate,” she said. For an intensely religious woman like Ramsey, the other women around were an additional source of distress. “The language was such as I never heard from human lips, certainly not from animals. Blistering oaths, sewer, obscene, filthiness. I could not go away from it, for I was locked in with it. One, just a girl,” she remembered, “and nearing the birth of her baby, said she wanted beer and sang and danced. How horrible she looked with her swollen face and distorted body.” Ramsey herself was also pregnant at the time, but that clearly did not mean she was able to muster any sympathy for those around her. Wilma Wilson ended up in the system after her mother, who had tried every solution she could think of (“nauseous remedies in my coffee…quack sanitariums where they indubitably shorten one’s life span by trying a series of ‘cures,’ from making one bulge with strong drink followed by drastic enemas, down to leeches,” Wilson wrote) resorted to trying to have her daughter committed. Wilson went first to Los Angeles’ city jail and then, after a judge ordered her held for observation for sixty days, to Los Angeles General Hospital’s Prison Ward, where the addicted as well as the mentally and developmentally disabled were all confined together. “Once seated in the midst of these poor demented, a still more horrible thought shook me,” she later wrote. “‘These people,’ I whispered, ‘think they are sane—I think I’m sane—Oh God!” The care provided there was indifferent at best. In her memoir, Wilson recounts how one young woman had an epileptic seizure while there, and no one was able to find a nurse. Fortunately, one of the other women under observation,

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Rose, had been a nurse and knew what to do. “The child recovered,” Wilson reports. This time, Wilson was lucky: the Psychopathic Court judge refused to commit her, although she did end up having to serve a short sentence in Los Angeles’ Lincoln Heights jail for a previous infraction. After that, she was placed on a year’s parole, as long as she did not drink, and returned to her mother. She didn’t make the year. During an alcoholic binge, she was picked up by two deputy sheriffs and returned to the psychopathic ward. This time, the judge sentenced her to four months in Camarillo State Hospital, one of the newest in the state system (opened in 1936). Alma Rubens, with her relatively higher class and economic position, as well as the fact that she was addicted to narcotics rather than alcohol, never spent time in jails or psychopathic wards as part of her commitments. Instead, she was allowed to directly enter sanitariums and state hospitals from her home or from another institution.23 As Rubens’ case suggests, race, class, and gender all played a role in determining the ultimate outcome for an individual caught up in these systems. In Los Angeles County, for example, a new organization made up largely of clubwomen, the Psychopathic Parole Society, formed to put this new idea of psychopathic parole to what they regarded as its best use. They assumed that women (or white women, at least) needed special assistance in navigating their recovery from mental disability. This belief widely reflected the prevailing gender assumptions of both doctors and the public at the time. Women, or at least white Anglo American women, were assumed to be more emotional and thus more liable to falling prey to ailments of the nervous system than men. Doctors argued that women were essentially at the mercy of their reproductive systems, hence the idea of hysteria. This biological vulnerability could exacerbate any existing emotional or nervous strain. This was not just a profoundly gendered and racialized argument, but a class-based one as well. The nervous strain on working class and poor women was at least as detrimental, if not more so, to their health, but reformers still focused most of their energy on white, middle- and upper-class women. Women’s clubs at both the local and the state level supported the work of the organization, including the California Federation of Women’s Clubs.24 The society recognized that women without any ties in the community and elderly women were uniquely vulnerable to institutionalization.25 It was also somewhat easier for women to be granted parole in the first place. They are disproportionately represented in surviving records of parole from California’s state institutions, although they made up a minority

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of the commitments. Of course, “parole is not the same as discharge; nor did it represent a ‘cure.’ It meant simply that a relative was willing to care for the individual for a period of weeks or months. It is not surprising that relatives should have been more willing to care temporarily for female insane persons, who would probably appear easier to ‘control.’ Hospital superintendents would probably for the same reason have had fewer scruples about granting parole to female patients than to male patients.”26 Two of the most unique institutions that accepted women diverted from the state hospitals by the Psychopathic Parole Society were Resthaven Sanitarium and Rockhaven Sanitarium. Resthaven (also sometimes written “Rest Haven”) had been founded in 1912 by “a group of far-sighted citizens who visualized the vast human rehabilitation of mild mental and nervous cases.” Initially, it focused on diverting women from Patton State Hospital or in giving women who had been committed to Patton a more restful, home-like environment in which, it was hoped, they would recover. A doctor, a trained nurse, and a matron staffed it, but it operated out of a private home and the women there were called “guests” rather than “patients.” Resthaven was open only to women between fifteen and fifty-five and only if the individual had been deemed a good case for “complete rehabilitation.” Los Angeles County paid a small stipend for every woman placed there, but until the 1940s, it was mainly supported by charitable organizations. Regular fundraisers were held, and for $2 a year, one could become a member. The one surviving study of Resthaven was not done until 1949, by which time the local Community Chest helped support it financially. That study notes that of the fifty women living there at the time, most were working- or middleclass. Most had indeed been able to return to work and to their families, although a few were sent on to the state hospital. This study did not note the race of the women staying there: however, it seems likely that most, if not all, were white.27 Rockhaven, located in the Crescenta Valley just north of Los Angeles, was the brainchild of Agnes Richards. An immigrant from Germany, Richards had been widowed in 1905. Looking for a way to support herself and her young son, she worked as a servant at the Nebraska State Hospital for the Insane and then as an attendant at the Independence State Hospital in Iowa. In 1922, she became a registered nurse, and she and her second husband moved to California, where they both worked at Patton State Hospital. After a year, she changed jobs to the Los Angeles General Hospital. Her years of work in hospitals had

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convinced her that women were uniquely vulnerable: not just vulnerable to being committed, often by unscrupulous husbands, but also vulnerable to sexual abuse once inside an asylum. Leaving public hospital work, in 1923 she opened a private, woman-only facility she named Rockhaven Sanitarium. Initially, six individuals lived in a stone house (hence the name “Rockhaven”) with an all-female staff to assure their safety. Like most private sanitariums, Rockhaven focused on milder forms of mental disability such as depression, nervous disorders, and anxiety, although it did occasionally accept residents with more serious disabilities such as schizophrenia and dementia. Employees handled the day-to-day work so individuals sent there could focus on rest and recovery. Staff were forbidden from calling them “patients.” Instead, they were “ladies” or “residents.” Eventually, Rockhaven grew to encompass fifteen buildings and at its peak in 1950 had one hundred female residents. Richards strove to keep her rates reasonable, but most residents were white and middle or upper class. Her facility ultimately gained something of a reputation as a place of retreat for women from the entertainment industry, including actress Billie Burke and Marilyn Monroe’s mother Gladys.28 Individuals could also be directly paroled from the state hospitals. These paroles were usually indefinite, and the individual on parole was expected to work. Wilma Wilson noted that many of the women she met in Camarillo who were paroled were sent to “arduous” jobs in sanitariums “for very small pay, usually fifteen or twenty dollars a month and board. But it was one way to get out of the institution.”29 Although its ideas were not entirely new, American eugenics as a movement had begun to flourish in the 1890s. Eugenicists increasingly emphasized the permanence of developmental and physical disabilities and mental disabilities and thus saw themselves as ringing an alarm bell about the dangers such individuals could pose to the rest of American society. Worse still, they employed “half-cocked” genetics to argue that such conditions were inheritable, and thus society needed to not only worry about individuals but also entire families that might be passing down “defects” to the next generation. Lurking behind all of this was Social Darwinism, which held that “in the community only the strongest individuals had the right to survive. Indeed, said the Social Darwinists, nature herself had preordained this triumph of the strong as part of the process that Darwin called natural selection.” Individuals who were weak due to illness or disability, they argued, were “useless people, they had no contribution to make to society and should simply be warehoused

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until weeded out by premature death.”30 The physical, mental, and moral health of the individual was increasingly linked to the physical, mental, and moral health of the nation. For eugenicists, it was only then a short jump to considerations about the economic health of the nation as well. Thus, lurking beneath the sound and fury of the eugenics movement and its language of defectives, mongrels, and misfits is a set of brutal yet recognizable beliefs about the kind of lives people on the margins deserve. Thinking of eugenics more broadly as a world-building enterprise has helped me understand how a quest for economic purity was just as important to eugenicists as racial and genetic purity were. If the eugenicists were successful, they figured the rate of return on their actions would be enormous. It would relieve the burden on prisons, institutions, and welfare offices and end the need to help engineer the survival of people who had no right to be alive and yet were.31

Tragically, given their emphasis on “social burdens,” eugenicists completely missed the possibility that, with proper support, most mentally disordered individuals were quite capable of living fulfilling and enjoyable lives, and many might even had been able to live on their own and be self-supporting had they been allowed to do so.32 For many American physicians, the “cult of curability” of the postCivil War era had given way to a far more skeptical view of the possibility of recovery and a hardening view that mental disorders were caused by hereditary factors that were immutable and thus, incurable.33 “Eugenic thinking filtered into philanthropic organizations through the publications of professional organizations involved in corrections, child welfare, and mental health.… Social reform groups also organized legislative committees to bring their agendas before the state legislature in the interest of legal reform of public services.”34 As early as 1895, medical officers from institutions for the developmentally disabled around the United States were beginning to discuss the need to not just treat it, but also to prevent it. Much of this seems to have been driven initially by a recognition that all the other interventions nineteenth-century doctors had attempted, using the best technology and medical understandings of the age, didn’t seem to have made any appreciable difference in the numbers. In his annual address to the Association of Medical Officers of American Institutions for Idiotic and FeebleMinded Persons, the organization’s president, Dr. A. W. Wilmarth of

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Pennsylvania, noted glumly that “the brilliant results that at one time appeared possible from surgical measures have failed to materialize.” Doctors around the country had been experimenting with craniectomies to treat microcephaly, he noted, but in most cases, such surgeries were proving to be “worse than useless.” Attempts to find an effective pharmaceutical treatment for epilepsy were not faring much better. He vowed to his audience of fellow doctors that he believed “the future promises much in the medical prevention and arrest of juvenile mental disease,” but that they did not know enough about the underlying causes to attempt cures via surgical and other aggressive interventions. And since there were no medical interventions to “cure” the feeble-minded, he told his audience, then surely prevention through prohibiting “marriage of the unfit” was the way forward. The American public, however, stood in the way. “Year after year,” he complained, “we have asked the public attention to this evil, have cited case after case until we ourselves are heartsick from the misery and wrong we recite, but public opinion, hardened by constant contact with this condition, becomes educated with most discouraging slowness, and we have but to continue the thankless task of arousing the public mind by continued recital of precept and recital of examples.”35 The vast majority of sterilizations in the United States took place inside institutions, and the institutional heads themselves often became leaders in a “crusade” to establish eugenic sterilization as “a viable and legal method of ameliorating problems associated with feeble-mindedness” and madness.36 In the face of a rising eugenics movement, some superintendents began to question the purpose of what they had been doing: “if the hereditarian doctrine was in fact true, they asked themselves, could education and skill training really be so important?” One superintendent in Minnesota in 1898 even argued that teaching children with developmental disabilities to read and write was pointless, as it only made them crave greater contact with an outside world they would not be allowed to connect with or participate in.37 In California, the rise of the bureaucracy of disability made it easy for able-bodied people and even the legislators who passed the laws to ignore the very real impact these shifts had on the minds and bodies of their fellow Californians. For decades, the state and the counties had done their best to socially and geographically isolate the mentally and developmentally disabled. If they were thought of at all, it was more as objects of charity and pity.38 The profoundness of this isolation matters, because the further disabled Californians were from the public eye, the easier it was to

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ignore them save in cases of scandal and the occasional budgetary crisis. The rest of the time, Californians outside of institutions seem to have been perfectly happy to let the state bureaucracy operate unimpeded. Alexandra Minna Stern has identified several key trends in California’s historical development that may explain why its residents were so enthusiastic about eugenics. The Anglo Americans settlers who had come to the state post-gold rush had viewed it as a “fertile yet underutilized terrain,” one ripe to be transformed into an American region through science, particularly “maxims of heredity and biology.” This was visible in everything from large-scale agriculture to citriculture to the “better baby” contests that were popular community events in the years before World War II. Stern also points to the intense racism and nativism that first developed during the gold rush years and continued to be interwoven into California society well into the twentieth century. Discrimination against and resentment of indigenous Californians, the Chinese, Mexican and Mexican Americans, African Americans, and immigrants of every kind were easily harnessed to support eugenic policies in the state. Finally, California, unlike, say, Washington or Oregon, already had a critical mass of state and non-state organizations ready and willing to do the work of implementing eugenic policies statewide.39 By the 1920s, California was also a decade or two deep into a shift to custodial care rather than treatment, particularly for developmentally disabled children. Many who had been institutionalized in the 1880s and 1890s had now grown up but could not return or were not welcomed back to their home communities. This, combined with the belief that feeble-mindedness was hereditary, also helped fuel eugenic sterilization. Institutions like Sonoma and Pacific were increasingly dealing with sexually mature developmentally disabled adults as well as children and were extremely anxious about it. After all, in the popular American imagination, “the dark obverse of the [developmentally disabled individual’s] child image was the primitive, violent, sexual child’s mind in an adult body.” These beliefs in turn often became tangled further by larger societal assumptions about race and ethnicity. In the case of individuals who were developmentally disordered (or suspected of being so) and of Mexican or Mexican American ancestry, it intertwined with “already existing beliefs about the inferiority of Mexican bodies, behaviors, and minds and their unfitness for citizenship of social membership in the state.”40

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California passed its first eugenic sterilization law in 1909, becoming only the third American state to have such a law on its books. The 1909 version of the sterilization law, interestingly, said nothing about heredity or the protection of future generations as a factor in sterilization decisions. When California revised the law in 1913, however, the new version was much more explicitly eugenic.41 It was amended in 1917. As the law stood in 1929, it allowed for “sterilization before discharge, with or without consent, of ‘any person who has been lawfully committed to any state hospital for the insane or the Sonoma State Home and who is afflicted with mental diseases which may have been inherited and is likely to be transmitted to descendants, the various grades of feeblemindedness, those suffering from perversion or marked departure from normal mentality, or from disease of a syphilitic nature.’”42 It also allowed officials to use it against “certain recidivists in the state prisons who are also moral or sexual degenerates or perverts” if an official decided it would benefit their “physical, mental, or moral condition.”43 Any “idiot or fool” could be sterilized free of charge if their parent or guardian requested it.44 Pacific is not mentioned in this law only because a provision for sterilization there was already in the original act calling for its creation. The life-changing decision of whether to sterilize a Californian rested almost entirely in the hands of hospital administrators, although family members and guardians could also request the operation be performed.45 The law’s connection to the larger goal of the maintenance of California’s social order was clear: an estimated three-quarters of the women sterilized in California, for example, were labeled either prostitutes or sexual deviates.47 California’s eugenic sterilization law was remarkably noncontroversial at the time, likely because eugenics writ large was a relatively popular idea in the state and the country. California drew on eugenicist thought from across the United States and around the world to support and justify what it was doing. The Los Angeles Times even ran a regular column on eugenics through the 1930s.48 Victoria Nourse points out that by the 1930s, there was a long history of American politicians on both the left and the right supporting sterilization, and “by the 1930s, eugenics attracted a large and diverse political following, from Junior Leagues and school principals and the Kiwanis to prohibitionists and birth control advocates and anti-miscegenationists.” As Miroslava Chavez-Garcia explains it, “the work of H. H. Goddard, the director of

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the Vineland Institute in New Jersey and major proponent of the BinetSimon intelligence test in the United States, for instance, had piqued the curiosity of state officials working with delinquents in California, as did the studies carried out by Charles Davenport and Henry Laughlin of the Eugenics Records Office [ERO] in Cold Spring Harbor, New York.”49 The Catholic Church was arguably the only notable group that stood in opposition to eugenic sterilization. Eugenics may also have seemed acceptable to Americans because at this time, it was largely couched in the language of health, not of human rights or bodily autonomy.50 The Committee on Provision for the Feeble-Minded, for example, had been quite clear about its stance on eugenic sterilization. The committee’s explicitly stated object was to “disseminate knowledge concerning the extent and menace of feeble-mindedness and to suggest and initiate methods for its control and ultimate eradication from the American people.”51 In early publications, it was cagey about exactly how this was to be done, but was already hinting at eugenics as the solution, even if it did not yet employ that term. One of the reasons it stressed dissemination of information about the feeble-minded, one pamphlet explained, was that “public sentiment must give its consent and especially so in the case of the feeble-minded where the rights of procreation may be denied.”52 The 1918 California Joint Committee spoke in similar terms. Having already identified feeble-mindedness as a “menace” to the state, it is hardly surprising that they predicted “disastrous consequences” if the state did not act. The state’s public schools would be overwhelmed, they predicted, and the feeble-minded would end up public burdens as “a delinquent, criminal, prostitute, pauper, or vagabond.”53 Lewis Terman, in his conclusion to the study of San Quentin inmates, opined, all the findings of this study emphasize the necessity of bringing a larger proportion of our defectives under social surveillance and restraint. The present huge cost of feeble-mindedness to the state can only be reduced by preventing as far as it is possible to do so, the reproduction of degenerates....It will be necessary to resort to more widespread control of defective matings or to the building of an enormous number of colonies if the problem is to be solved. To both methods there will doubtless be many objections offered. The colony methods, if permanent segregation is provided, is the better of the two.54

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The Human Betterment Foundation was founded in Pasadena in 1928, also with an explicitly eugenic orientation, albeit one carefully couched in the language of both science and reform. It explained its mission thusly: the “first major problem is to investigate the possibilities for race betterment by eugenic sterilization, and to publish the results. When the public is familiar with these facts, some other major subject will be substituted. The scope of the Foundation is as broad as its name indicates. It is restricted only to conservative, preventative, work for humanity as distinguished from ordinary charity relief work or patch work.” Perhaps more than any other California-based organization, the Human Betterment Foundation gave legitimacy to eugenic sterilization. It did so by couching sterilization in the language of science and statistics and by circulating its findings around the world.55 Like many California eugenicists, Ezra Seymour Gosney had come to human eugenics through agriculture: he was a citrus grower who had developed an interest in plant and animal breeding. He served as director and hired biologist (and former student of David Starr Jordan) Paul Popenoe as the secretary. The Human Betterment Foundation’s board of directors also helped launch California branches of the American Eugenics Society and the American Institute of Family Relations. Popenoe had already carried out extensive research in California’s state institutions for the mentally disordered, which became the basis for pro-eugenics articles and pamphlets. The Human Betterment Foundation also had a close relationship with eugenicists in Germany in the years leading up to the birth of the Nazi regime.56 In the meantime, California had added criminality to its eugenic sterilization laws. Three classes were subject to potential sterilization under the law. The first was anyone who had been committed to a state prison at least twice for rape or seduction, or at least three times for any other crime who “shall have given evidence while an inmate” of being a moral or sexual degenerate or pervert. The second was any person serving a life sentence who “exhibits continued evidence of moral and sexual depravity,” and then was anyone found guilty of carnal abuse of a female under the age of ten. But no one in a position of power seemed exactly sure what the ultimate point of such a law should be. Even Paul Popenoe, in a rare moment of reflection, admitted as such in a public address on the subject. Was it penal? Eugenic? Therapeutic? A mixture of all three? Criminality was not considered hereditary, although it did “tend to run in families,” Popnoe explained. Low intelligence and mental illness were believed to be linked to criminal behavior, but then again, no one was

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exactly certain how. “It is obvious that the possession of a certain amount of intelligence is a prerequisite for the commission of most felonies,” Popnoe mused. “The California law applying sterilization to criminals is therefore unsatisfactory in many ways.” Popnoe’s concern, however, was not with the rights of the incarcerated who were potentially subject to these laws. Instead, he saw the lack of clarity expressed as giving unnecessary ammunition to those opposed to sterilization through what he characterized as “prejudice, ignorance, or any other motive.”57 Popnoe and his Human Betterment Foundation, based in Pasadena, also sought to quantify the result of eugenic sterilization in California in a 1938 report. Even from the one-sheets inserted into the front of many editions of their report, it is clear Popnoe and his co-author Ezra Gosney were on the defensive. They insisted the policy had only one effect: to prevent parenthood. There was, according to the authors, no stigma or humiliation attached to having been eugenically sterilized because it was “a protection, not a punishment.”58 Indeed, “parents and their families are among the best friends of sterilization. They know by experience what its protection means to them.”59 Since the passage of the first state law in 1909, sterilization had kept patients out of state institutions where they might otherwise have spent their lives, thus preventing individuals from becoming “public charges” and “thus increasing the efficient care for more defectives without increasing the cost to the tax-payer.”60 For Popnoe and Gosney, sterilization was a boon to “handicapped persons” as it enabled many to marry whose “marriage without sterilization would be unwise if not disastrous. Conservatively and sympathetically administered, it is a practical, humane, and necessary step to prevent race deterioration.”61 The numbers they reported are staggering. Between 1909 and January 1, 1937, the state of California had sterilized 11,484 individuals (5,933 men and 5,551 women). Authorities at the time insisted that only a small percentage of the mentally disordered were subject to sterilization. The Human Betterment Association argued it was really only used on those individuals likely to return to the community and that it was unfair to calculate based on total admissions in the state. It was also unfair, they claimed, to factor in individuals who were too young or too old to be of reproductive age. Instead, they argued, the likelihood of sterilization should be calculated using only those individuals who left the hospitals. Using those numbers, the Human Betterment Foundation arrived at an estimate of one in four. California’s laws about the sterilization of convicts

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were still not being used, although men in San Quentin could request the procedure on a voluntary basis. Evidently, 200 convicts in San Quentin requested voluntary sterilization, although of course just how “voluntary” anything can be in the context of a prison is an open question. Courts could get around parental objections to institutionalizing or even sterilizing their children by declaring these parents unfit, in which case, the state assumed control of the minor.62 Popnoe and Gosney frankly argued for using a medical procedure (sterilization) to solve a political problem (the shortage of beds in state institutions). The public feared the mentally deficient, and particularly the mentally disabled, they wrote, and thus “such patients.…are given institutional care, for their own protection and for that of others.”63 This drive by governments to “remove” the mentally disabled from public spaces led to overcrowding in hospitals in every state. “In California,” they wrote, hospitals “contain 40% more patients than they were built to accommodate. Cots are crowded side by side; mattresses are laid on the floor in hallways.”64 The situation was even grimmer for the developmentally disabled because fewer institutions were devoted to their care. The best use for the limited number of institutions for the developmentally disabled was, to Popnoe and Gosney, their use not as custodial homes but as “training schools,” after which they could then be returned to the community as “self-supporting” individuals. “At the present average rate of official sterilizations in the state homes for the feebleminded and hospitals for the developmentally diseased, in California, for a period of twenty years, the state will save more than $2,000,000 per year,” they vowed. “This money saved, of course,” they conceded, “goes into the care of other defectives, who take the places of the sterilized, who have made good adjustments outside of the institutions and are discharged.”65 California had not yet opted to track all developmentally disabled state residents through a central registration bureau (as Nebraska and Southern Dakota were doing). Popenoe and Gosney thus argued that the only way to make certain that individuals released from state institutions into the larger community did not produce offspring was to, in effect, prophylactically sterilize those individuals. Even individuals who would be taking only short holidays from institutions into their communities, Popenoe and Goseny suggested, should perhaps be sterilized lest “a holiday result in the pregnancy of a defective girl. She may not even be safe from her own relations.”66

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Eugenic sterilization was being sold to the people of California, in part, as a way the state could save money in the long run by providing less institutional care yet also still profit from the individual labor of the mentally disordered. “The boy of lowest intelligence can help around the house or do chores for the neighbors,” Gosney and Popenoe argued. “Others with a little more ability may get limited work on farms or in an industrial occupation.”67 Paroled young women ended up disproportionately as domestic servants, where they could earn both room and board. More than half of the young women in Popenoe and Gosney’s study earned less than ten dollars a month in cash.68 Yet to Popnoe and Gosney, the threat remained everywhere they looked. It was even in Los Angeles’ public schools. They looked at the family histories of children in special classes within the city schools and concluded that “they represented an even lower level of family background than do the sterilized wards of the state.”69 As an organization, the Los Angeles Psychopathic Association (LAPA) does not appear to have gone on record one way or the other about eugenic sterilization. Nor do any of its members show up in later lists of members of eugenics organizations like the Human Betterment Foundation. However, the doctors among the LAPA members must have been aware of the connections between institutionalization and the possibility of forced sterilization. The one member whose surviving records show he did speak publicly in favor of eugenics, although not in his capacity as a member of LAPA, was Dr. Thomas Orbison, who argued that, “It is not a question of eugenics alone, but of self-preservation. Feeble-minded children are not fit to care for themselves.…Feeble-mindedness could be wiped out by sterilization.” However, he cautioned, “this step should be taken with every scientific precaution and with reason, however, and not rushed into.”70 Orbison aside, the LAPA as a whole may well have silently endorsed eugenic sterilization as a means to an end. It was certainly willing to make common cause with Progressive reformers who were also known eugenicists, such as John Randolph Haynes, when need be. Although not a member of the LAPA, Haynes was an active member of the California State Board of Charities and Corrections, which had oversight of institutions for the feeble-minded.71 In 1917, Haynes’ interest in eugenics had led him to advocate alongside the LAPA for the building of what would be the Pacific Colony.72 What role, if any, LAPA played in this controversy must remain unknown. Mrs. W. S. James died in 1930,

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and without her indominable energy, the Psychopathic Association seems to have quickly faded away, leaving no organizational records behind it.73 In California, race, gender, age, and class had long played a double role in institutionalization. First, they helped to determine who ended up institutionalized, and second, they helped to predict who would be victimized by eugenic sterilization. There exist some California state hospital records of individuals who had been sterilized and who spoke positively about the procedure. However, such accounts should likely be taken with a grain of salt because accepting sterilization was the fastest path to release. It seems unlikely individuals would have been honest with their doctors and thus endanger being released. In her analysis of data from Pacific, Alexandra Minna Stern found that women were at greater risk of being sterilized than men. Young people, particularly those under the age of eighteen, were a higher risk than those over eighteen, and individuals with Spanish surnames were 2.4 times more likely to be sterilized than those with non-Spanish surnames.74 These trends hold true throughout state institutions of this era. For example, in her study of California’s juvenile justice system, Miroslava Chávez-Garcia notes that, there, too, “the application of science and scientific research as well as the latest theories of delinquency, intelligence, heredity, and race intersected and shaped the experiences of children and youths of color who, for various reasons, ended up caught in the web of the juvenile justice system.”75 Although neither the Department of Institutions nor its successor, the Department of Mental Hygiene, ever engaged seriously with the question of racial inequities in admissions to state hospitals, some individuals working within the system seemed at least somewhat aware of the disparities and their probable causes. Dr. George Tarjan, who first joined the staff of Pacific in 1947, reflected in later life that, “if you look at the early days of Pacific, among the mildly retarded, the ethnic minorities are overrepresented.” He called this phenomenon “the Fourth of July mental retardation.” He used the example of a young person who sets off firecrackers on the Fourth of July in violation of city ordinances. A young white person, picked up by the police for this, was likely to be scolded and returned to their parents. A young nonwhite person was likely to be picked up by police and then taken to juvenile hall. If not immediately claimed by their parents, they might spend days in the system. By the time they were subjected to an IQ test, Tarjan argued, “that poor little kid was scared stiff. They could have given him any kind of test—He flunked it [a score below seventy, which supposedly indicated feeble-mindedness].

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And immediately he was in trouble with a second social system. Applications were filed to Pacific. They ended up on a waiting list and were urgent cases for admission and were picked for immediate admission.” Such young people were likely to come from “families that don’t know how to manipulate the social system, who couldn’t hire an attorney, who couldn’t talk their way out.” Even well-meaning parents often bowed to pressure from medical and political authorities. This phenomenon was, Tarjan said, a “social force” that had nothing to do with medicine but was singularly powerful nonetheless.76 Mexican and Mexican American individuals caught up in either California’s state hospital system or its juvenile justice system were often subject to sterilization, oftentimes out of proportion to their actual presence in institutional populations. In her extensive study of eugenic sterilization at Pacific, Natalia Lira found that “between 1928 and 1952, Pacific Colony processed 2,090 sterilization requests and 533 of those—approximately twenty-five percent—were for people with Spanish surnames. Over the years, the number of sterilization requests for Spanish-surnamed residents never dropped below 13.5% and peaked at 36% in 1939.” This was one of the “social forces” Tarjan later described: psychologists, educators, and social workers had by the 1930s “constructed Mexican-origin youth as inherently defective and prone to deviant behavior and economic dependence.”77 Sonoma, under the leadership of Dr. Fred O. Butler, wholeheartedly embraced the eugenic sterilization of the individuals in his care. California passed its sterilization law in 1909, and the first sterilization at Sonoma was carried out in 1911. It was not usual to have 200 to 300 individuals a year sterilized at Sonoma, many of the procedures being carried out by Butler himself. As a 1965 history of Sonoma put it, “Dr. Butler’s personal attitude towards sterilization was that it made the morally delinquent, feeble-minded patient less restless and more amenable to discipline.”78 In her insightful analysis of sterilization records from the Sonoma State Home, Wendy Kline concluded that women and girls were sterilized after being labeled as feeble-minded, morons, or promiscuous.79 Alexandra Minna Stern found something similar for men whose sexuality was regarded as transgressive by the standards of the day: vasectomies were often performed on men who had been accused of engaging in same-sex encounters.80 At Pacific, Tarjan was not the ardent advocate for sterilization Butler was. But he also does not seem to have particularly strong objections to it.

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He believed, although he admitted he could not prove it, that California’s sterilization laws in many cases drove the commitment process itself, with individuals being committed specifically so they would be sterilized.81 At Pacific, every individual who arrived was subject to a medical staff decision was to whether they should be sterilized. Rather than objecting to doing this outright, all Pacific’s doctors insisted, according to Tarjan was that the consideration of whether or not the individual could return to society be added to their calculations. If they could not, then there was no need to sterilize them. At Sonoma under Dr. Butler, both the moderately and the mildly developmentally disabled were sterilized. At Pacific, Tarjan reflected somewhat proudly, only the mildly disabled were.82 Betty Jean Mock’s birth mother likely fell victim to these attitudes. She had suffered a severe head trauma on the school playground at the age of six and had stopped developing mentally after that. Estimated to have a mental age of eight, she stayed in school until the age of seventeen and was able to manage routine tasks around the house. Following the death of her mother in 1925, her father said he could no longer both work and care for her at home. By the time Betty Jean’s birth mother passed into the hands of state authorities, she was six months pregnant, father unknown. After the child’s birth and subsequent adoption, the young woman was sent to Sonoma State Hospital where she was eugenically sterilized. She returned home briefly and then was committed to Pacific State Hospital. She was patient number thirteen there. Authorities at Pacific had regarded her as “high functioning,” and thus she “had been able, over the years, to be outside of the hospital most of the time on work release. She had been largely able to earn her own living all these years,” her daughter later wrote. “She was a good worker at simple tasks such as care of small animals or laundry.”83 Sterilizations were carried out throughout California’s state hospitals for the mentally and developmentally disabled, either on-site or in nearby hospitals. Silent film star Alma Rubens was committed to Patton State Hospital in the mid-1920s to treat her narcotics addiction after numerous stays in other state facilities had failed to cure her. Like many Americans of the era, Rubens had first become addicted after a doctor had given her prescription morphine; in her case, it was for unspecified gynecological pain. Doctors assured her at the time it was the appropriate treatment and kept her readily supplied. Unable to wean herself from the drugs and determined to hide her addiction from her mother and her new husband, actor Ricardo Cortez, she had then turned to heroin and cocaine, calling

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herself a “snowbird,” period slang for a female addict. She had always had, she wrote, “a vivid imagination and an almost uncontrollable desire to do the forbidden.”84 In her memoir, Rubens recalled being awakened in the middle of the night in Patton by a woman across the hall from her, who was “moaning and writhing in physical agony”: When the attendant came around—this one was a particularly brutal one— I asked her what was the matter with the girl across the way. “What ails her?” I demanded. “Nothing but what they all get,” she responded callously. “They sterilized her today. Guess it hurts her a little. But that’s just what they all get—and what you’ll get, too, if you get to making eyes at the men when you’re transferred to one of the cottages.” At that instant the poor creature across the way shrieked in a highpitched voice that fairly curdled my blood. I begged the attendant to let me go in with her and try to do something to ease her pain. Instead, she crossed over, unlocked the door and went in herself, cautioning me to get to bed and mind my own business. “Shut up!” She commanded the screaming unfortunate. And, to my horror—I had climbed back up to my vantage point [looking through the bars on her cell door]—she turned the poor, screaming, bandaged thing over onto its stomach and beat her unmercifully on the back with her huge ring of big brass keys.85

On another occasion, she later recorded, an unnamed doctor threatened her with sterilization after she turned down his sexual advances in return for a cigarette (smoking was forbidden in Patton, at least for women). “‘Don’t you try to fool me,’ he said. ‘You’re just like all the rest. I can make you or break you. I’ll say you’ve been annoying the men, and then, they’ll operate on you. Now what do you say?’” Rubens recalled him saying. “The picture of what had happened to that other poor unfortunate, whom I had seen beaten after her operation, when she was lying on her cot, undergoing the tortures of Hell,” Ruben wrote, “haunted me.” She well remembered her response to the doctor in question: “‘Go to hell!’ I hurled at him.”86 At Camarillo State Hospital in the 1930s, Wilma Wilson noted that the men there often had what was called “ground parole,” which allowed them to go anywhere within six miles of the hospital, including the nearby small town of Camarillo itself. Women were rarely granted such a privilege. She heard rumors that only women who had already been sterilized

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were allowed ground parole. “If this be true, the only conclusion I can draw is that the State is indifferent to its patients’ conduct if there be no consequences.”87 California’s state hospitals continued to track the individuals, whether they had been subject to eugenic sterilization or not, to make sure they had not returned to society only to disrupt it once again. In 1914, an after-care service had been established by the State Commission in Lunacy. It consisted of one doctor, Dr. Eva C. Reid, based in San Francisco. She was responsible for all paroled and discharged individuals from state hospitals who lived in the Bay Area. The advantage of having individuals on parole from the hospitals, instead of discharged, was that they could quickly be swept back into the system if authorities deemed it necessary.88 Social work service departments were also created at all the state hospitals for the mentally disordered in the 1920s. They served a similar function as Los Angeles County’s psychopathic parole officers.89 “In a sense,” Popenoe and Gosney explained in 1929, “the social workers were the ‘middle men’ between the commodity (vocationally-trained retarded patients) and the market (work placement situations outside the institution). However, it was Dr. Butler’s sterilization program which provided the leverage. While sterilization was not given as a necessary condition for parole or discharged, it is true that most of the released patients had been sterilized prior to their leaving the State Home.” By 1950, of the 60,000 sterilizations that had occurred in the United States in thirty-two states, one-third of them (20,000) had been in California.90 Any space in state institutions for the mentally disabled freed up by parole was quickly filled, frequently by a new focus of state concern: the substance abuser. As we have seen, California’s judges had been sending individuals to state hospitals for alcohol abuse since the 1850s, even though such a process was not, strictly speaking, within the confines of state commitment laws. They justified this by arguing that alcohol abuse was a symptom of insanity. That changed in 1911, when new laws allowed judges to commit both alcoholics and drug addicts to state hospitals as “inebriates” rather than as “insane.” Hospital superintendents, outraged, declared that the last thing individuals with mental and developmental disabilities within state hospitals needed was to be housed side by side with alcoholics whose morals, the doctors declared, must automatically be suspected.91 American doctors had long relied on asylums for the treatment of chronic alcoholism because, they believed, only within an asylum or

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similar institution would the sufferer find a long enough period of “enforced abstinence” to cure them of the disease. As the nation awoke to the issue of narcotic abuse at the end of the nineteenth century, most treatment plans for it followed the same approach as those for alcohol abuse. Some physicians, however, advocated instead for so-called “ambulatory treatment” in which an individual would either receive a gradually tapering dose or a maintenance dose from a doctor as a better path to a cure. Beginning in 1909, California’s Board of Pharmacy “required physicians to register ‘medical addicts’” who could be maintained by a doctor if they confirmed the individual would not survive without the narcotic. The City of Los Angeles even briefly maintained a morphine dispensary for seven months in 1920, but it was met with an outcry in the local papers and from federal authorities and quickly closed.92 In 1914, the United States passed the Harrison Narcotics Tax Act, which among other things allowed physicians and pharmacists to register as licensed handlers and dispensers of some narcotic drugs. Subsequent regulations allowed only “normal” doses to be handed out, thus making ambulatory treatment difficult. California law first officially allowed for the commitment of “inebriates and drug habitués” to state hospitals for the mentally disabled in 1911. Within the next year, 728 people were committed. However, it soon became clear that having individuals with addictions and those with mental disabilities in the same institution wasn’t conducive to either group’s recovery. The California State Legislature began to look at its options. Its initial idea was to create specialized units at Southern California State/Patton and Napa State Hospital, but it wasn’t until 1927 that new legislation was passed authorizing the creation of a state narcotic hospital.93 Research into addiction was still in its infancy, and California authorities were struggling to understand what it was, let alone how to treat it. “In practically every case the habit is secondary to some disease, usually a mental one,” Dr. Charles C. Pinkham, secretary of the State Board of Medical Examiners, explained in 1928. “Habit cures are made, but no attempt is made to investigate the sickness.”94 California had, in fact, in previous decades tried to treat addicts at state hospitals for the mentally disabled, but it had never had much success because so many of those individuals had simply walked away.95 In the summer of 1928, California opened the state’s first narcotic hospital, somewhat ironically at the site of the first, failed version of Pacific State

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Hospital in Spadra, California. It even reused some of the same buildings. Both public and private hospitals had been experimenting with this approach to treating addiction, but there was as yet no solid statistical data on whether such a drastic measure as commitment worked. “I believe that each case taken in at this new institution should be treated individually,” Pinkham added, “keeping in mind that each case will educate us to handle future ones and gradually stamp out the use of drugs in this State.” The state narcotic hospital thus really had two goals: treating addicts and collecting data to see if treating addicts worked. Counties were expected to pay $25 a month to maintain each individual they sent to Spadra.96 In addition to morphine, marijuana, opium, heroin, and cocaine addicts, Spadra also admitted a few alcoholics and habitual barbiturate users. An individual committed to the hospital faced a term of not less than eight months of custodial care to be followed by sixteen months of supervision by a parole officer. The medical superintendent of the hospital, Dr. Thomas F. Joyce, understood that such a sentence must seem grueling, but stressed that anything less than a six-month term would cause the individual to “fall short of achieving the results which we have in mind,” i.e., return them to the community too soon and thus trigger a relapse. While at the hospital, and again echoing other state instructions, addicts were, as part of their treatment, expected to help raise fruits and vegetables and perform manual labor of the site’s ten-acre truck garden and orchard. This was designed both to provide for “their physical upbuilding” and to ingrain in them “the habit of work.” Otherwise, “treatment” at Spadra consisted mainly of isolating the individual from their supplier.97 Federal convictions in California courts under the Harrison Narcotic Act had been trending steadily upward for some years, and by 1929, California was behind only New York and Illinois in its number of annual drug convictions. But not all drug users were considered equal in the state. California’s State Narcotic Committee spoke very clearly about who concerned them. “Legal medical addicts” were beyond their purview, they argued, because their addictions had resulted from “incurable disease, accident, or injury, or the infirmities of age” and because they had gotten their narcotics “legally furnished or prescribed in good faith by licensed physicians.”98 Federal changes in drug policy also had a very direct impact on California and how the state structured its response at the local, county, and state levels. In 1930, the federal narcotics division was reorganized

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under a new leader, H. J. Anslinger, recently assistant commissioner of the Bureau of Prohibition. Upon his promotion to federal narcotic commissioner, Anslinger decided to refocus the roughly 250 agents under his control on international smugglers and distributors. There was also a new appointed supervising narcotic agent for the entire United States west of the Rockies, one Harry D. Smith. This left local enforcement up to the states, which was, as far as California was concerned, “where it most properly belongs.”99 Morphine was the most popular narcotic used in California, making up 85% of arrests statewide. Only in Los Angeles was “marihuana” a major source of arrests, and there it was attributed to “Mexican addicts.” In Los Angeles in 1926, arrests for marijuana and morphine routinely flipped back and forth in the number one spot. Opium was third, and there were a small number of arrests for heroin and cocaine as well. In San Francisco and statewide, morphine consistently held first place.100 In the 1920s, authorities in California assumed that narcotics addiction happened predominately to men. The population at the Spadra institutions was entirely male until 1929, when silent-film actress Alma Rubens was sent there for court-ordered treatment. Before arriving at Spadra, Rubens had been in and out of private sanitariums for two years, most of which either offered her more narcotics or required her to go “cold turkey.” One of her regular drug suppliers was a “Dr. C,” who, according to her, had once worked at the state asylum at Patton. Frustrated with his wife’s addiction and not aware that he was one of her suppliers, Ricardo Cortez called upon “Dr. C” to help force his wife into treatment. Rubens, however, was determined to finish the picture she was working on. She ran from the doctor and his nurses and down the street. When “Dr. C” grabbed her, she pulled out “a dull but pointed paper knife” and “struck him in the tender portion underneath his back suspenders buttons.” The doctor survived the encounter, and Alma was taken to a private sanitarium in Glendale, where she “saw one of them carry a dead woman from the cell I was to occupy!” She spent three weeks there with “Dr. C” still supplying her with drugs, for a price. Soon she was deemed cured and released. She quickly spiraled deeper into her addiction. In her memoir, Rubens maintained she then personally applied for commitment to Spadra, claiming that a “very wealthy and influential man,” a friend of the family, had personally intervened with California Governor Young so Rubens could go to the new state narcotic hospital. Los Angeles Superior Court Judge McCohn committed her for a sentence of eight months to

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two years. The story quickly became a press sensation, with Superintendent T. P. Joyce insisting to newspaper reporters that he was under strict orders from the department of institutions not to speak about Rubens’ case.101 As the first and, at that point, only woman committed to the narcotics hospital, Rubens was given special quarters in the same part of the building where Joyce, his family, and the female employees lived. Rumors quickly circulated that she had attempted to escape, although Joyce insisted that wasn’t the case. Rubens confessed in her memoir that she hated it at Spadra, and she particularly hated the two nurses (one for day, one for night) assigned to her. “I grew tired of looking at them,” she explained. “Perhaps they felt the same way about me. I wouldn’t be surprised if they did.” One of the nurses proved willing to smuggle whiskey to Rubens but, when an empty bottle was discovered, Rubens was the one who landed in solitary confinement. “My thoughts turned to suicide; my plans for escape,” wrote Rubens. Ever resourceful, she faked a toothache so she could be taken to a dentist in town. While there, she slipped into the downstairs drugstore and “asked for a patent medicine wine tonic, one with a high alcoholic content, which one of the men patients at Spadra had recommended for use as an emergency substitute for whiskey.” She drank the whole bottle and let the dentist extract a perfectly good tooth to cover up her ruse, after which she threw a tantrum that got her returned to the hospital and sedated. She woke up in a private home in Pomona, near the hospital, where she received treatments from hospital staff. Rubens maintains in her autobiography that it was her mysterious benefactor who had gotten her moved; newspaper articles at the time attributed it to Joyce. When Rubens was once again able to get alcohol from a nurse, she was sent (in a straitjacket) to a private facility, said to be in Pasadena. “I was placed in a beautiful three-room suite, tastily and comfortably furnished. It ought to have been. Afterwards I learned that it cost a thousand dollars a month.” Rubens left there after ten days. By 1929, Rubens had relapsed into drug use again. This time, her husband and mother had her committed to Patton State Hospital, where she stayed for approximately five months.102 Not surprisingly, as the situation (or at least the number of arrests) worsened, California responded by demanding more institutionalization of addicts and for longer periods of time. A short-lived Industrial Farm for Women opened in Sonoma County in 1922. Nineteen of the twenty-three

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individuals sent there were alcohol or narcotic addicts. California soon realized it was far too expensive to operate a specialized institution for so small a number of individuals when they could be transferred to existing state hospitals. It also discovered the land on which the Industrial Farm had been built was unsuitable for farming. The Industrial Farm closed in 1923, and its buildings went to the Sonoma State Home.103 As with Californians who were mentally or developmentally disabled, conversations about Californians with addictions were often couched in economic terms. Because they were spending all their money on drugs, addicts were responsible for more than $50,000,000 of “economic waste” annually on the Pacific Coast, W. J. Herwig, general superintendent of the Narcotic Research Association, claimed at a 1929 meeting (he did not explain how he had arrived at that number). “The narcotic evil here,” he declared, “is almost as much of an industrial menace as it long had been a social one.” At the same meeting, law enforcement officer Captain Harry S. Seager spoke even more bluntly. “Once a hop-head,” he said, “always a hop-head. Dope and crime go always hand-in hand, and all hop-heads sooner or later, become criminals.”104 The state of California, however, continued to insist that not only should drug addiction be treated, but that it had to be treated to prevent further damage to the state and its communities. “It would be far cheaper for our state to segregate and care for these people, save those that are curable, and protect society from the spread of this contagion,” a California State Narcotic Committee report proclaimed. “Destroy the market for the peddler and put him out of business by isolating his customers, rather than permitting them to remain at liberty preying on society.” The State Narcotic Hospital had opened with fifty beds, which was quickly expanded to ninety-five, but there were an estimated 30,000 addicts in the state.105 Much of the blame for the failure of institutionalizing drug addicts was at the time laid at the feet of judges up and down the state. They were constantly changing, rotating in and out of courts. They were unfamiliar with drug addiction. Worst of all, they might “unwisely yield to entreaties, sending addicts to Spadra when they are facing a long jail or prison sentence, many cases impossible to cure, because of a low criminal type.” Such cases then crowded out “the young addict with no serious criminal records against him, who is honestly trying to get off the drug.” Given the rigors of life at the State Narcotic Hospital, escape was a regular part of life for the first few years. Although the site was isolated

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even by the standards of 1920s Southern California, there were no natural or man-made barriers around it. During the first year of its operation, 30% of the addicts escaped; during the second, 34%. A thirteen-foot-high fence around the hospital was added in 1929, but escapes continued. The state department of institutions blamed the escapes on long-time addicts (“the dregs of humanity,” one authority called them) being sent to Spadra who had no intention of reforming. By the 1930s, plans for the site thus included effective fencing, fingerprinting, more stringent regulations, and increasing the penalty for escape from eight months in the county jail to one year.106 However, the economic slump that marked the beginning of the Depression marked the beginning of the end for California’s only state narcotic hospital. The number of individuals sent there continued to drop, and the fewer were sent, the harder it became for Joyce to justify its continued operation. There was speculation (likely correct) that counties were no longer sending addicted individuals to Spadra because they did not want to part with the monthly maintenance and transportation costs. Worse still, as the first sets of data on the hospital’s cure rate were made publicly available, they proved a crushing disappointment for everyone involved. The percentage of individuals who remained drugfree two years after their release from Spadra was just under 18% for 1928–1931.107 As with the institutionalization of mentally and developmentally disabled individuals, the failure of institutionalization to have any lasting impact on the overall numbers of addicts in the state soon led to questions about the efficacy of California’s approach and its ongoing impact on the state budget. This debate came to a head during the Great Depression. In 1933, the California State Legislature called for the closure of the state narcotic hospital as a cost-cutting measure. The governor, however, vetoed the bill calling for its closure. Instead, its administrative functions were combined with those of Pacific, even though they were still two different facilities, both in location and function. Throughout the 1930s, however, the narcotic hospital was repeatedly threatened by the state legislature with closing, due both to costs and to the stillfalling numbers of addicts being committed. Each time it was threatened, defenders went to the press arguing its importance to the state. In 1939, when the legislature was discussing closing it and replacing it with clinic care, the executive committee of Southern California Women’s Christian Temperance Union (WCTU) passed a resolution opposing such a change. “The committee pointed out,” said one newspaper account, “that while,

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according to reputable physicians, narcotic addicts are curable, the clinic method has proved a failure in States in which it has been tried.” The chief state narcotics enforcement officer at the time, Paul E. Madden, argued that without the Spadra hospital, “it would be necessary to utilize his entire staff to police public institutions to prevent the spread of narcotic addiction” as “more than fifty percent of narcotic addiction results from association with other addicts.”108 To keep the hospital operating, in 1939, the Department of Institutions instead proposed establishing an “inebriate colony” within the narcotic hospital, with only one-sixth of the 180 beds reserved for narcotic addicts and the rest given over to alcoholics. “Insane alcoholics,” however, would still be sent to the state hospitals for the mentally disabled, as had been standard practice since the mid-nineteenth century. By September of that year, however, California’s Director of Institutions Earl E. Jensen entered an official protest to Governor C. C. Young, arguing that the state was using Spadra as a “dumping ground or clearing-house for the criminal addicts and felons” and for addicts with physical disabilities. Jensen was backed up in his protest by Dr. Walter M. Dickie, director of the department of health, who reportedly said that the hospital was an experiment in rehabilitating addicts and that the courts needed to give it a fair chance to succeed without burdening it with patients who, in Jensen’s and Dickie’s opinions, were unlikely or unwilling to be rehabilitated.109 While legislators and bureaucrats in Sacramento quarreled over the ultimate fate of the state narcotic hospital, in Los Angeles, the chief of police received authorization from the police commission in 1939 to transfer “chronic drunks and moral offenders” to the new Camarillo State Hospital located north of the city in Ventura County. This was done specifically to relieve overcrowding in city jails. It was this new policy that resulted in Wilma Wilson being sent to Camarillo when she violated her terms of her parole by drinking again.110 Throughout the United States, the use of state power against individuals deemed “mentally disordered” expanded as the country moved into the twentieth century. It is visible in the increased use of court-ordered commitments against alchoholics and drug addicts. It is also visible in the increasing use of eugenic sterilization, not just in California but nationwide. Prior to World War I, most of the eugenic sterilization laws passed in the United States (although not California’s) were repealed or struck down by the courts. Although the first wave of American interest in sterilization had originated in the medical community, it wasn’t until public

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figures like Theodore Roosevelt, the popular press, and professional social workers publicly supported eugenics that it really took hold. They gave it legitimacy, as Nancy L. Gallagher explains.111 By 1924, over thirty states had sterilization laws. But except for California, many were not widely used due to fears of the doctors or the states being sued; that sterilization violated equal protection; or that it was cruel and unusual punishment. The United States Supreme Court’s infamous decision in 1927’s Buck v. Bell case changed this because it effectively gave the court’s blessing to eugenic sterilization. Although there had been a handful of legal challenges to sterilization laws before 1927, none had come from California. The decision opened the floodgates on newer, much more farreaching, and much more dangerous eugenics laws across the country.112 By the 1960s, institutions in the United States had overseen the forced sterilization of more than 65,000 Americans.113 In California, the reality was that many of the surgical interventions used against mentally disordered individuals were done for social and institutional convenience. With the advent of antibiotics, which lowered the risk of infection, sterilizations, lobotomies, and even in some cases hysterectomies so women would no longer menstruate: all became part of mid-twentieth-century institutional “care.”114 Rubens survived her experience at Patton, the “California Crazy House,” as she called it. Like Sara Ramsey fifteen years earlier, she vividly remembered the terrible sense of despair there: “gray was the prevailing color at Patton. The walls were supposed to be white-washed, but they, too, were gray. Gray walls, gray furnishings, gray clothing, gray food, and drab-gray existence for the near five thousand souls incarcerated there. That’s Patton.” She wrote of the rattling keys worn by attendants and of the appalling food. “Never a day without beans,” she wrote, “white Mexican beans, swimming in grease.” She was assigned to the infamous floor polishing squad before being reassigned to administer baths to the other individuals there. “Poor, broken bodies housing poor broken minds,” she wrote. “How I pitied those poor victims of heredity and abuse, which I bathed. I felt so sorry for them that I even forgot to HATE the job [emphasis hers].” Her stay in Patton did, however, give her time to reflect on her own situation. “Search my mind as I would, I could find no reproach for myself. I didn’t become a drug addict because I wanted to. I did it because I couldn’t help myself. It was an illness, just like diphtheria, whooping cough, scarlet fever, any number of children’s diseases

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from which I had suffered early in my girlhood. The dope habit was the same thing. I’d caught it, and I must endure it until I was well.”115 A decade later, Wilson’s recollections of her confinement at Camarillo echo those of Rubens, and to some degree of Ramsey before her. There were only eight doctors at Camarillo to serve the 3,000 patients there in 1939. She didn’t find the doctors callous so much as perfunctory, but she speculated this was the best they could do given the impossible demands on their time. As a result, attendants had “such continuous and terrifying power over the lunatics and so seldom exercise this power intelligently.” She tried to get a jury trial, only to be horrified to learn that the state laws allowing the insane to request a jury trial did not extend to alcoholics or narcotic addicts. Having been placed there by judges for “their own good,” only a judge could release them early. Just as she had in jail, she found herself extremely uncomfortable around the mentally and developmentally disabled who made up the bulk of Camarillo’s population. Worse still, she noted: Mental patients are but people. There were pleasant ones and unpleasant, troublesome and lovable. However, insanity resembles drunkenness inasmuch as it frequently brings out in an individual all that is ugly. Of the hundreds of insane persons there, few were likable. With the sure instinct for self-preservation the sane patients determined which of the mental patients to avoid when possible.…There always emanated from [the] rooms a sour, revolting stench. This was not the fault of the institution. The buildings were clean and modern. The fault lies in the nature of the hospital’s mission. There is an indefinable odor to insanity, an identifying scent as unmistakable as the odor of death, and far more unpleasant. Once smelled, it’s always easily recognizable: it is not the odor of blood, or vomit, or urine, or excrement, or sweat, or pus, nor yet a combination of these, although all of these were present. It is something more, intangible but distinguishing.116

Although Wilson did not attempt to put a name to the odor, it may well have been the smell of despair. Unless an inspection was eminent, the food was terrible. The work demanded of the individuals inside the institution, including constant floor polishing, was mind-numbing as well as often physically exhausting. She was a keen enough observer to be aware that the labor of individuals committed to Camarillo was being used to make up for chronic shortfalls in staff. “Every doctor has an inmate secretary and an inmate housekeeper,” she noted. Wilson herself was assigned

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to sick bay, where she helped feed, bathe, and care for the sick, and then to the hydrotherapy rooms.117 After eight months in Patton, Rubens was told she was cured of her addiction. She began planning a comeback vaudeville tour and relocated to New York City. But she soon began using again. “‘Cured?’ did I say?” she later wrote in her memoir. “‘Cured?’ Bah! Only temporarily cured. I was just a ‘set-up,’ and ‘pushover’ for the first unscrupulous doctor that came along.” She also began to write her memoir. Although she had been asked before to speak publicly about her experiences—by local clubwomen, no less—she had not been able to bring herself to do so. Now, however, “I have been motivated by two things into setting forth my experiences, and revealing the deepest secrets of my soul, as I have. The first is, I hope that reading them may guide some—even one—poor unfortunate away from the dark cavern where King Dope has set his trap,” she declared. “The other reason is to earn money. I have hopes of selling this chronicle.”118 Wilson also confessed her motives for writing her memoir, many of which seem to have revolved around her friends. “You all agreed a book about the inside workings of a bughouse SHOULD be written [emphasis hers]. So here it is—our little saga. When you’ve finished this book, you will think I’ve been too moderate. Definitely. I’ve ‘pulled my punches,’” she wrote. “But I felt, in the interests of accuracy, I should write solely of such incidents where I had been on the scene and strictly ignore tales we heard of other wards.” She noted that “nowadays everyone is aware that insanity is no disgrace or proof of tainted heritage. Everybody realizes it can strike in any home. How comforting then,” she argued, “to know that science is rapidly conquering madness.” But, she lamented, doctors in the state hospital were still unable to do much to treat alcoholics, largely due to a shortage of doctors and no ability to provide followup care. “I had been gyped [sic] by this hospitalization,” she complained. The memoir was accompanied by her own humorous sketches, most not much more than stick figures, of her experiences before and during her commitment to Camarillo. “As much as I disliked Camarillo, and futile as I felt it to be for most alcoholics, still the place had taught me a great deal. No experience is ever fruitless,” she confessed. She noted that the state of California was “groaning under her burden of indigents and their concomitant expense.” Although she acknowledged that the state was unlikely to listen to her, she suggested several reforms, including making it clearer to alcoholics that no cure would be given in state hospitals

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“beyond detention and labor” and improving civil services requirements so better, more sympathetic attendants could be hired. Alcoholics and their families, she wrote, needed to know how hard it could be to get released from a state hospital once committed. “Basically, this is all the age-old problem—lack of brotherly love and education.”119 Alma Rubens and a female friend were arrested just after the New Year in January 1931 for cocaine possession and allegedly attempting to smuggle morphine from Mexico into the United States. Rubens was quickly released on bail, but she never stood trial. A cold she had contracted turned into pneumonia. The thirty-four-year old soon slipped into a coma and died on January 21, 1931. “Alma died fighting,” a motion picture magazine quoted Alma’s mother as saying. “I’m proud of her.”120 Wilma Wilson also did not get a chance to finally conquer whatever demons plagued her. She was murdered on June 5, 1943, in Hermosa Beach, California, by a soldier with whom she’d spent the day drinking. She was thirty-one years old.121

Notes 1. Anderberg and Wilson, They Call Them Camisoles—Revisited, 12, 61. 2. Pond and Brody estimate individuals on parole from Sonoma earned $15–$30 per month in addition to room and board. However, it is unclear how they arrived at those numbers. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 38. 3. Stern, Eugenic Nation, 83. 4. The National Committee on Mental Hygiene had been created out of a need to critique the existing systems and attitudes surrounding mental health in nineteenth-century United States. Clifford W. Beers, who himself had spent time in institutions, sought, in the words of Theresa Richardson, “to reform institutional practices in the custodial care of mentally ill adults” by “creating a voluntary organization which would oversee medical practice.” The term “mental hygiene” had been coined by psychiatrist Adolf Meyer, who took an early interest in Beers’ work but soon steered it away from reform and toward the furtherance of psychiatry as a research field. Richardson, The Century of the Child, 46–49; Michael Rembis, “Disability and the History of Eugenics,” in The Oxford Handbook of Disability History, 88, 91; Stern, Eugenic Nation, 83. 5. Fox, So Far Disordered in Mind, 84–86.

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6. Fox, So Far Disordered in Mind, 181–182. 7. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 443–444. 8. The more commonly agreed upon individual who fit that criteria seems to have been the indigent elderly, who, it was agreed, frequently needed custodial care but not mental health care. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 443–444. 9. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 445. 10. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 105–106, 445. 11. Fox, So Far Disordered in Mind, 78. 12. The following year, 1908, the farm itself was expanded again to 333 acres. Fliedner, Centennial, 63, 65, 69. 13. Fox, So Far Disordered in Mind, 62–63. 14. Yanni, The Architecture of Madness, 146. 15. Fox, So Far Disordered in Mind, 36, 39. 16. Fox, So Far Disordered in Mind, 64, 67, 71. 17. Fox, So Far Disordered in Mind, 76–77, 185. 18. Its official name was “The Psychiatric Department of the Superior Court.” Surviving records muddle the names changes over time, but it was also known over the decades as Department 54; “the Psychopathic Court,” the “Psychiatric Court,” and, by the late 1950s, Department 95. In 1947, the State of California, for perhaps understandable reasons, renamed the psychopathic probation officer a “counselor in mental health. However, the Los Angeles Superior Court continued to use the term “psychopathic probation officer” until 1954. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 435. 19. Lunacy Law in the State of California, 1913 (Sacramento: Superintendent of State Printing, 1913), 21–22; Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 193. 20. This would not be resolved until 1957, when Juvenile Hall was moved to the jurisdiction of the probation department. This in turn seems to have better facilitated the flow of information between referral and clinic. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 420, 433 n1 and n2. 21. In 1954, the Los Angeles County Board of Supervisors moved the position to a separate county department and made it a civil service job. By the 1950s, the duties of the parole officer included assisting with preparation of petitions making inquiry into the facts of petitions; submitting social reports to the court; supervising persons in the community under Sects. 700, 702, and 5076 of the Welfare and Institutions

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22.

23.

24.

25.

Code; supervising persons in the sanitaria under Sect. 5076; administering County funds for the cost of persons’ maintenance in sanitaria; moving such persons, when necessary, to suitable facilities, returning cases for rehearing by the court; assisting in sanitaria placements; and following up of cases for the Court committed under Sect. 5100. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 435; The Superior Court of the State of California in and for the County of Los Angeles, “Manual of Court Procedures. The Psychiatric Department, printed February 1959,” 1, 3, quoted in The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, n7. Photo, “Margaret Fillmore’s Sanity Questioned,” 1936, Los Angeles Herald Examiner Photo Collection, Los Angeles Public Library, Los Angeles, California. Mother and daughter continued to be at war with one another until Fillmore died in 1939. “Margaret Shelby,” https:// en.wikipedia.org/wiki/Margaret_Shelby. Five years to the day of their first commitment, Sara and James Ramsey were back in the psychopathic ward of the Los Angeles County Hospital. Now running the “Ark of God Church,” they were charged with trying to help several young men evade the draft for World War I. The ultimate outcome of that investigation is unknown. Ramsey, And What Is Hell?, loc. 369 of 2684, Kindle; “Charged with Insanity,” Los Angeles Evening Express, December 20, 1917; Anderberg and Wilson, They Call Them Camisoles—Revisited, 18–31; Alma Rubens, Alma Rubens, Silent Snowbird: Her Complete 1930 Memoir, with a New Biography and Filmography, eds. Gary D. Richardson and Alexander Webb (Jefferson, NC: McFarland and Co., Inc., Publishers, 2006), 124–125. Mrs. Oliver P. Clark is the only member of the Los Angeles Psychopathic Association that I was able to confirm was also a member of the Psychopathic Parole Society, but there may well have been others. “Society,” Los Angeles Times, May 22, 1912; Myra Nye, “Los Angeles Women Will Play an Important Part,” Los Angeles Times, May 22, 1912; Barbara Sicherman, “The Paradox of Prudence: Mental Health in the Gilded Age,” Journal of American History 62 (March 1976): 898; Regina Markell Morantz, “The Perils of Feminist History,” Journal of Interdisciplinary History 4 (Spring 1974): 652 n7, both quoted in Fox, So Far Disordered in Mind, 125. In his study of commitment records from late nineteenth-century San Francisco, Richard W. Fox concluded there were likely two factors at work in explaining this phenomenon. First, elderly individuals who were showing symptoms of dementia or other cognitive decline associated with age may well have been interpreted by onlookers as “insane” and thus in need of commitment. Second, Californians had a gendered view of

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26. 27.

28.

29. 30.

31. 32. 33. 34. 35.

36. 37. 38. 39.

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which impoverished elderly person was most in need of a permanent “home.” While Californians might willingly tolerate an elderly man living on the streets, they were far less likely to tolerate an elderly woman doing so, even if that was her choice. California’s handful of almshouses increasingly focused on a male clientele, so state hospitals became the first choice for placing impoverished elderly women. He notes that this was a national trend as well. In the years prior to the New Deal, almshouses nationwide were becoming increasingly restricted to the male aged. Fox, So Far Disordered in Mind, 131–132 and n29. Fox, So Far Disordered in Mind, n28. As with the other handful of sanitariums that survived into the midtwentieth century, Resthaven adapted to the changing landscape of care and became a specialized facility, in this case, Resthaven Psychiatric Hospital. See, for example, letter from Dr. J. Allen Marshall, Resthaven Psychiatric Hospital, to Frank Lanterman, December 7, 1967, Frank D. Lanterman Papers, California State Archives, Sacramento, California, 1– 2. On funding streams prior to 1949, see “And Greatest of These Is Love,” Venice Daily Vanguard (Venice, California), January 26, 1915. Elisa Jordan, Rockhaven Sanitorium: The Legacy of Agnes Richards (Cheltenham, UK: The History Press, 2018), 19–23, 29, 40–42, 54, 56; Joseph O. Stanton, Fifty Guests of Resthaven, December 1949, available in the New York Academic of Medicine Library, New York Academy of Medicine, New York, New York; Sydney Yord, “Women’s Work, Women’s Clubs,” Los Angeles Times, March 23, 1912. Anderberg and Wilson, They Call Them Camisoles—Revisited, 194. Sir Frances Galton coined the term “eugenics” in 1883. Shorter, The Kennedy Family and the Story of Mental Retardation, 14; Rembis, “Disability and the History of Eugenics,” 87. Elizabeth Catte, Pure America: Eugenics and the Making of Modern Virginia (Cleveland, OH: Belt Publishing, 2021), 23. Shorter, The Kennedy Family and the Story of Mental Retardation, 17. Richardson, The Century of the Child, 12. Gallagher, Breeding Better Vermonters, 52–53. Association of Medical Officers of American Institutions for Idiotic and Feeble-minded Persons, Proceedings of the Association of Medical Officers of American Institutions for Idiotic and Feeble-minded Persons, 517–518. Noll, “Institutions for People with Disabilities in North America,” 312, 315. Shorter, The Kennedy Family and the Story of Mental Retardation, 18. Rembis, “Disability and the History of Eugenics,” 92. Stern, Eugenic Nation, 85–86. See also Molina, Fit to Be Citizens?, 146– 147.

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40. Robert T. Osgood, The History of Special Education: A Struggle for Equality in American Public Schools (Westport, CT: Praeger, 2008), 34–35; Brockley, “Martyred Mothers and Merciful Fathers,” 300; Lira, Laboratory of Deficiency, 99. 41. Joel T. Braslow, Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century (Berkeley, CA: University of California Press, 1997), 56–57. 42. Popnoe and Gosney, Twenty-eight Years, 8, 159–160. 43. Popnoe and Gosney, Twenty-eight Years, 8, 159–160. 44. Popnoe and Gosney, Twenty-eight Years, 8; E. S. Gosney and Paul Popenoe, Sterilization for Human Betterment, rpt. ed. (New York: Arno Press, 1980), 159–160. 45. Popnoe and Gosney, Twenty-eight Years, 8; Gosney and Popenoe, Sterilization for Human Betterment, 159–160. 46. Popnoe and Gosney, Twenty-eight Years, 8; Gosney and Popenoe, Sterilization for Human Betterment, 159–160. 47. Nancy Ordover, American Eugenics: Race, Queer Anatomy, and the Science of Nationalism (Minneapolis: University of Minnesota Press, 2003), 79; Victoria F. Nourse, In Reckless Hands: Skinner v. Oklahoma and the Near Triumph of American Eugenics (New York: W.W. Norton and Company, 2008), 61, 123. For more on the panic over “sexual deviancy” and the “sexual psychopath” in this era, see Estelle B. Freedman, “‘Uncontrolled Desires’: The Response to the Sexual Psychopath, 1920–1960,” The Journal of American History 74, no. 1 (June 1987): 83–106. 48. Nourse, In Reckless Hands, 123. 49. Chávez-Garcia, State of Delinquency, 5. 50. Nourse, In Reckless Hands, 21–22; Chávez-Garcia, State of Delinquency 5; Lira, Laboratory of Deficiency, 114–116. 51. Committee on Provision for the Feeble-minded, Report of the First Year’s Work, 2, 16. 52. Committee on Provision for the Feeble-minded, Report of the First Year’s Work, 2, 16. 53. California State Joint Committee on Defectives, 19, 54–55. 54. California State Joint Committee on Defectives, 19, 54–55. 55. Popnoe and Gosney, Twenty-eight Years, 39–41. 56. The organization closed following Gosney’s death in 1942. Jill Briggs, “Human Betterment Foundation,” The Embryo Project Encyclopedia, https://embryo.asu.edu/pages/human-betterment-foundation-19281942. 57. Popnoe noted in the same speech that “last year,” the United States Supreme Court had declared sterilization perfectly legal. Paul Popnoe,

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58. 59. 60. 61.

62. 63. 64. 65. 66. 67. 68. 69. 70.

71. 72. 73. 74.

75. 76.

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“Sterilization and Criminality,” n.d., New York Academy of Medicine Library, New York, New York. Popenoe and Gosney, Twenty-eight Years, 17–20. Popenoe and Gosney, Twenty-eight Years, 17–20. Popenoe and Gosney, Twenty-eight Years, 17–20. This was actually the second statistical study carried out by this organization: the first had been in 1925. “Effect of Eugenic Sterilization as Practiced in California” insert, in Popenoe and Gosney, Twenty-eight Years, 1. Popnoe and Gosney, Twenty-eight Years, 5–6, 16; Lira, Laboratory of Deficiency, 128. Popenoe and Gosney, Twenty-eight Years, 1. Popenoe and Gosney, Twenty-eight Years, 17–20. Popnoe and Gosney, Twenty-eight Years, 17–20. Popnoe and Gosney, Twenty-eight Years, 17–20. Popnoe and Gosney, Twenty-eight Years, 29–31. Popnoe and Gosney, Twenty-eight Years, 29–31. Popnoe and Gosney, Twenty-eight Years, 25–27. At that time, the state’s argument rested largely on the need to stop individuals from reoffending. That bill was repealed and replaced in 1913. It was updated again in 1917 to emphasize the need for sterilization in state institutions on eugenic grounds. Stern, Eugenic Nation, 98; “Social Experts Approve Plan for Curbing Defectives,” Los Angeles Herald, September 3, 1915. Stern, Eugenic Nation, 98. Stern, Eugenic Nation, 103. “Social Worker Succumbs,” Los Angeles Times, August 21, 1930. Joel T. Braslow, Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century (Berkeley, CA: University of California Press, 1997), 64. Chávez-Garcia, State of Delinquency, 4; Stern, Eugenic Nation, 121. Tarjan and all state hospital superintendents were legally required to hold such individuals in the hospital for two weeks before re-examining them. By then, many young people had “calmed down,” and they often reassured each other that as long as they passed the upcoming tests, they would be let to go. They often did. Tarjan thus had to invent the term “mental retardation recovered” for official records to explain the young people he met who, while they had scored low on an IQ test weeks before, were clearly not developmentally disabled now. “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, Vol. I,” interview by Michael S. Balter, 1990, Oral History Program, UCLA Special Collections Department, University of California, Los Angeles, CA, 205–207; Lira, Laboratory of Deficiency, 167.

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77. As Natalia Lira notes, many Anglo authorities didn’t bother distinguishing between Mexican-origin individuals who were US-born and those who were immigrants. Thus, she prefers the term “Mexican origin” to describe this population. Lira, Laboratory of Deficiency, xiii, 5; Hernandez, “Hobos in Heaven,” 435–436. 78. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 35–37, 43. 79. Wendy Kline, Building a Better Race: Gender, Sexuality, and Eugenics from the Turn of the Century to the Baby Boom (Berkeley, CA: University of California, Press, 2001), 86–94. 80. Alexandra Minna Stern, “Gender and Sexuality: A Global Tour and Compass,” in The Oxford Handbook of the History of Eugenics, eds. Alison Bashford and Philippa Levine (New York: Oxford University Press, 2010), 184. 81. In her research into sterilization requests from Pacific, Natalie Lira did find several for young Mexican-origin women committed “for sterilization only.” Lira, Laboratory of Deficiency, 91; “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, vol. 1,” 210–211. 82. Even Tarjan’s interviewer in 1990 questioned how Tarjan could be so certain that a pregnancy could not occur for an individual inside Pacific. Tarjan insisted that since all the wards were closed, males and females lived in separate parts of the hospital, and, on the rare occasions they were allowed to mix socially or at work, they were carefully supervised, it was not. Whether Tarjan was correct in his assessment is not known. “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, vol. 1,” 210–211. 83. In researching the life of her birth mother, Betty Jean Mock was surprised to discover that she herself had been tracked by authorities of the California courts for at least two years following her adoption in case she, too, showed signs of being developmentally disabled. Naturally, since the cause of her birth mother’s disability was likely her childhood head injury, Mock never had any issues. But ideas about disability being heredity ran deep. By the time Mock and her birth mother were finally able to meet, her birth mother was eighty years old and living in a statefunded California facility. Betty Jean Mock, Persimmon Days (Maitland, FL: Xulon Press, 2008), 205–207, 213–219. 84. As a young theater actress, she also survived at least two sexual assault attempts that left her traumatized. Even now, she wrote about the second incident, “I quiver with fright when I try to recall the incident.” Rubens, Alma Rubens, Silent Snowbird, 42, 49, 63, 86, 92–93. 85. Rubens, Alma Rubens, Silent Snowbird, 135. 86. Rubens, Alma Rubens, Silent Snowbird, 140–141. 87. Anderberg and Wilson, They Call Them Camisoles—Revisited, 202.

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88. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 37. 89. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 37. 90. E. S. Gosney and Paul Popnoe, Sterilization for Human Betterment (New York: MacMillan Co., 1929), xiii, quoted in Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 38; Stern, Eugenic Nation, 115. 91. Fox, So Far Disordered in Mind, 151. 92. However, Jim Baumohl found that as late as 1931, the Narcotic Committee of the Los Angeles County Medical Association (LACMA) maintained a handful of sick and elderly addicts within the psychopathic ward at Los Angeles County General Hospital. This eventually led to a series of arrests and an ugly court fight. Jim Baumohl, “Maintaining Orthodoxy: The Depression-era Struggle over Morphine Maintenance in California,” in Altering American Consciousness: The History of Alcohol and Drug Use in the United States, 1800–2000, eds. Sarah W. Tracy and Caroline Jean Acker (Amherst: University of Massachusetts Press, 2004), 226–227, 230, 2234–239. 93. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 162. 94. “Pomona to Get Drug Asylum,” Los Angeles Times, March 27, 1928. 95. The California State Narcotic Committee freely admitted that an estimated 40% of addicts who had been sent to other state hospitals had simply walked off because there were no mechanisms in place to stop them. California State Narcotic Committee, The Trend of Drug Addiction in California (Sacramento: California State Printing Office, 1931), 31. 96. “Pomona to Get Drug Asylum,” Los Angeles Times, March 27, 1928; California State Narcotic Committee, The Trend of Drug Addiction in California, 19–20, 27, 29–30; Baumohl, “Maintaining Orthodoxy,” 243. 97. Barbiturate users at the time were called “veronal users” because Veronal was the first commercially available barbiturate. California State Narcotic Committee, The Trend of Drug Addiction in California, 19–20, 27, 29– 30; “Barbital,” wikipedia.org https://en.wikipedia.org/wiki/Barbital; “Addict Hospital to Be Enlarged,” Los Angeles Times, December 14, 1928. 98. California State Narcotic Committee, The Trend of Drug Addiction in California, 9, 12. 99. California State Narcotic Committee, The Trend of Drug Addiction in California, 11.

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100. California State Narcotic Committee, The Trend of Drug Addiction in California, 13. 101. “Actress in Institution for Addicts,” Los Angeles Times, March 4, 1929; Rubens, Alma Rubens, Silent Snowbird, 106–113. 102. “Alma Rubens Placed in Private Sanitarium,” Los Angeles Times, April 17, 1929; Alma Rubens, Alma Rubens, Silent Snowbird, 38, 112–117. 103. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 167. 104. “Narcotic Peril Stressed,” Los Angeles Times, May 29, 1929. 105. In 1930, the state legislature also amended the state’s Medical Practice Act to prohibit ambulatory treatment of addicts, that is, a doctor trusting an addict with his own supply and treating them without admission to a hospital on the grounds that such treatment was too easy for doctors who were themselves addicts to abuse and that it allowed too many drugs to get into the hands of “peddlers” and thus to be resold. California State Narcotic Committee, The Trend of Drug Addiction in California, 16–17, 29. 106. California State Narcotic Committee, The Trend of Drug Addiction in California, 31; “Dope Addicts to be Guarded,” Los Angeles Times, November 3, 1929. 107. California Special Crime Study Commission, Final Report of the Special Crime Study Commission on Adult Correction and Release Procedures (Sacramento: 1949), 9. 108. “Cuts in School Aid Passed,” Los Angeles Times, March 15, 1933; “State Economy Veto Foreseen,” Los Angeles Times, March 23, 1933; “Spadra Hospital Appeal Made,” Los Angeles Times, January 14, 1939; “Spadra Hospital Closing Fought,” Los Angeles Times, April 6, 1939. 109. “Inebriates Colony Planned as Adjunct to Spadra Hospital,” Los Angeles Times, August 12, 1939; “Narcotic Hospital Protests,” Los Angeles Times, September 30, 1939. 110. Such transfers were allowable under the revised state welfare and institutions codes of the time. Oddly, the parole (in this case, the time an individual had to abstain from alcohol or be committed/recommitted) varied by county. In Los Angeles County, it was twenty months; in Santa Barbara, it was five months; in Ventura County, it was two months. According to Wilma Wilson, an oft-heard lament at Camarillo was “Wisht [sic] I’d got drunk in Ventura!” “Chief Plans Jail Population Cut,” Los Angeles Times, August 2, 1939, quoted in Anderberg and Wilson, They Call Them Camisoles—Revisited, 32, 239. 111. Gallagher, Breeding Better Vermonters, 53. 112. Nourse, In Reckless Hands, 25–31; Noll, “Institutions for People with Disabilities in North America,” 318. 113. Nielsen, A Disability History of the United States, 100.

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114. Shorter, The Kennedy Family and the Story of Mental Retardation, 22. 115. It’s interesting to note that Rubens also attributes some of the disability she sees to heredity, but given how common such beliefs were at the time, it’s not particularly surprising. Rubens, Alma Rubens, Silent Snowbird, 139–145. 116. Anderberg and Wilson, They Call Them Camisoles—Revisited, 59, 61, 64–65, 114–115. 117. In her memoir, Wilson also noted that, back in Los Angeles, one doctor had provided only the rosiest picture of life at Camarillo, including declaring that the “girls” committed there were allowed to decorate their own rooms. “I think [he] had us confused with the Campfire Girls at Vassar,” she quipped. Anderberg and Wilson, They Call Them Camisoles—Revisited, 70, 75, 82, 101, 103, 113, 188, 202. 118. Rubens, Alma Rubens, Silent Snowbird, 197–198. 119. Anderberg and Wilson, They Call Them Camisoles—Revisited, 14, 166– 167, 240. 120. Dorothy Calhoun, “She Fought the Good Fight,” Motion Picture, May 1931, 30, quoted in Rubens, Alma Rubens, Silent Snowbird, 33–36, 122–156. 121. Anderberg and Wilson, They Call Them Camisoles—Revisited, 242–243.

CHAPTER 6

“Their Responsibility”: From the Great Depression to the Birth of the Community Clinic

Luther Osborne thought he had everything. In 1931, he was sixty-one years old, owned his own home in Oakland, California, and had a loving wife and several grown sons. He had worked for thirty-six years at the U.S. Customs House in San Francisco, eventually rising to cashier of customs for the district and port of San Francisco. He owned a restaurant and several rental properties. Life was good. Then, in October of 1931, he found himself abruptly arrested at his place of work on a charge of insanity. He steadfastly maintained that he was “in full possession of all my faculties and perfectly sane.” Nonetheless, when the judge at the commitment hearing informed him tests had shown he had a blood infection, Osborne agreed to the commitment. Accompanied by a deputy sheriff, he was transported to Napa State Hospital. There he was quickly placed on a round of malaria treatment. After two months, he was put to work in the institution’s dairy, typing and keeping the records. “Occupational therapy?” he scoffed in a letter to a friend There are about three thousand five hundred patients here and about two thousand of them are working every day—maybe more. Calling some of the work here ‘occupational therapy’ is more or less of a joke. Most of the real work is done by the patients, and it is just plain, hard work….What you could call the small army of workers here are patients who get nothing but their bed and board and cheap clothes, and some of them pay for these; and some of them are kept here for periods of a few years to twenty years © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 E. V. Wallis, California and the Politics of Disability, 1850–1970, https://doi.org/10.1007/978-3-031-21714-2_6

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and more. It has been called slavery by many and it had been charged that many are kept here for their labor value regardless of their condition.1

Osborne’s observation was not far off: individuals’ labor was indeed routinely used in asylums throughout North American, often to make up for budget shortages that prevented superintendents from hiring the outside workers they needed. With their labor very much in need, this may have affected decisions asylum doctors made about who got released, and when, and why.2 What illness or disability affected Osborne? In his memoir and his letters, he never provides any more details than that he had a “blood infection,” albeit one that could evidently be treated by a private physician just as efficaciously as a state hospital. In California’s hospitals and asylums, malaria treatment became available beginning in the late 1920s. Malaria treatment was in fact one of the only new “therapies” introduced in this era. It was used alongside older “treatments” like hydrotherapy, sedatives, restraints, and sterilization.3 It was widely used in 1930s and 1940s as a general treatment for paresis, or general paralysis of the insane, a tertiary form of syphilis that manifested ten to twenty years after the initial infection. As Joel Braslow explains, “physicians believed that paresis often led from a subtle ‘perversion’ of the patient’s disposition to a maniac like insanity marked by extravagant ‘delusion.’ The final psychological manifestation was dementia with ‘rapid and complete mental decay’ accompanied by bodily symptoms including seizures, paralysis, and incontinence.4 ” In the decades before the introduction of penicillin, the inevitable outcome was death. In the early twentieth century, researchers in America and Europe had begun experimenting with deliberately infecting patients with malaria to induce high fevers to treat a range of psychiatric illnesses, including paresis.5 Many individuals admitted to California’s state hospitals were not even exhibiting any symptoms of paresis. Some had only tested positive for the antibodies for syphilis, and some were only suspected of carrying the disease.6 Stigma characterized the treatment of paresis. Both individuals and families often refused to discuss it openly, instead using a host of euphemisms. Doctors themselves often spoke disparagingly of these individuals.7 If Osborne was indeed suffering from syphilis, this would easily explain why he never named his illness. As a respectable, middle-aged, white, married man, a husband and a father, it was hardly the kind of thing he was likely to want to publicly discuss. A diagnosis of paresis also might help the readers

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understand the hostile relationship he quickly formed with the physicians at Napa. For physicians, “a diagnosis of paresis often structured and determined what they saw when they examined a patient. For example, if they believed a patient suffered from paresis, they found signs and symptoms that confirmed this diagnosis, and this was especially true of subtler neurological signs.…What doctors saw cannot be separated from what they believed.”8 To friends and family, Osborne spoke disparagingly of the medical care at Napa, arguing that it focused more on “rigid control” than on cure. After a few months, Osborne applied to the superintendent, Dr. Charlesworth, to return home and continue any treatment needed with his personal physician. His leave was initially approved but then rescinded when one of his sons refused to sign the paperwork. He ultimately was held at Napa, against his will, for six years.9 Osborne blamed a former business partner and his oldest son for conspiring to commit and then keep him in the state hospital for their own financial gain, as his sons thus had gained control of his businesses. Osborne wrote letters to everyone he could think of: his family; his doctors; lawyers; politicians, including Governor Frank Merriam; newspapers; even old business acquaintances and family friends who might be able to intervene and secure his release. He continued to insist he was mentally and physically fit and so too, he suspected, were many of his fellows inside Napa. But life in the asylum quickly ground everyone down. “The state hospitals are in a class by themselves when you consider the vast activities of the state government. Practically, most everything else is a matter of business, while in the state hospitals the element of human misery is present in most of the cases, and with some it is a matter of life or death, or the absolute wrecking of a human life,” he recorded in one letter. “It is probably an under-estimate to say that fifteen to twenty-five per cent of the patients here are perfectly sane. And the management of the unfortunates who belong in an institution of this kind is no credit to the state.” “I know the history of some of the sane patients here,” he wrote in another. “Some are ambitious and making every effort they can to get away from the place; others are deserted, dejected, forlorn, and forgotten men and women who are pitiful in their resignation, hopelessness, and helplessness, and still are heroic when you consider the awful thing that has been done to them.”10 Osborne’s family relationships quickly began to suffer as well. He blamed his oldest son, now his legal guardian, for helping to get him committed and now refusing to sign for his release. “I have never been a

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mental case; I have never been insane for one moment in my life, and I have never shown as visible signs of foolishness as you have, even when drinking,” he wrote bitterly to his oldest in 1934 I have been kept here for two years and three months; I have been living in paper boxes and one old steamer trunk, with all the other inconveniences, and on a bed with a one-inch mattress with thirty others in a dormitory. It is an uncomfortable, irritating, unjust, undeserved, depressing existence, productive of no good result and altogether unnecessary. The routine is monotonous, long walks and reading the only diversion, and the doctors tell you that the best results will be obtained under these conditions. The statements you and others report as from the doctors, would not be believed by an intelligent man, and I give you credit for knowing better. That they “do not think it advisable for me to go home at the present time” would be a joke if it were not so expensive and serious in other ways.11

But Osborne reserves his greatest vitriol for the doctors, most of whom, he maintains, he rarely saw. In his account, sometimes they told him his malaria treatment would take two years; at others, three. They told him he could go home, then told him he could not. What the incompetent doctors who are handling these cases announce as their conclusions, is appalling on many cases. With a series of tests, examinations and tabulations, they assume to be master of the great untracked mysteries of the human mind, and ponderously decide that one patient had not fully recovered, that another needs constant supervision day and night, and so on to the absurd limit. In many cases, there are no tests or examinations of any kind for years, and the victims are kept in the various wards, more as numbers than as humans, doing their share of “occupational therapy”(?) [punctuation his] In some cases this treatment results in death for the patient, and while it may not be premeditated, it is on the border line of criminal indifference and unpremeditated murder.12 Dissatisfaction and criticism, of the management particularly and of conditions here in general, is widespread by both employee and patient. It is not so outspoken, as they are afraid of losing their jobs or privileges. The acute overcrowded conditions here at times is caused by the doctors holding so many patients here for months and years after they should have been sent home.13

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By the 1930s, the state of California had a mature system of state hospitals for the mentally and developmentally disabled. It featured an intensely hierarchical bureaucracy with its leadership based in Sacramento. Virtually all funding was done through annual appropriations from the California State Legislature, an arrangement that sharply constrained how the hospitals operated and what services they could offer. As a system, the state hospitals still seemed as incapable of responding or adapting to social, political, and economic change as the asylums had decades before. On the rare occasions an individual or the family members of an individual challenged it, the mental health bureaucracy responded defensively, if it responded at all. California’s bureaucracy of disability had become selfsustaining. Later generations of administrators and politicians continued to build on the structures created during the Progressive era, finding them to be “innovations [that] satisfied them in countless ways, from helping them to clear crowded court calendars, to maximizing their control over inmates and patients, to buttressing the legitimacy of their institutions.”14 This rigidity, combined with the upheavals of the Great Depression and World War II, pushed the system to its breaking point and made individuals in the system ever more vulnerable to potential abuses. The crises of the 1930s and 1940s were threefold: first in finances, then in staffing, then in an aging infrastructure. They did, however, also lead some professional and medical personnel to begin to envision a system of care beyond that vested in the state hospitals. Many reformers and physicians increasingly “understood that many of the intellectual presuppositions undergirding institutionalization rested on fallacious assumptions.”15 Shaped by the growth and expansion of child guidance and community mental health clinics across the state and the growing involvement of parents and other activist groups, these two decades also laid the groundwork for the statewide transformations that were to come. By the end of the 1920s, change was in the air. The growing popularity of Freud and changing views about disorders of the nerves (neurasthenia) were slowly allowing laypeople and doctors alike to increasingly separate individuals who might suffer from a minor or temporary mental illness but could (and, many argued, should) remain in their own communities and those who were “insane” and individuals suffering from acute mental disabilities who, it was still believed, needed institutionalization.16 The Los Angeles County Poor Farm, which in 1923 had received an infusion of $500,000 from a county bond measure to improve its physical plant, was shifting away from accepting “indigent, able-bodied men

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and women” in favor of accepting “patients who were often helpless, who often had fatal diseases and rarely recovered.” The care provided for them at the time was custodial; rehabilitation services would not be available until after World War II. Although there were more than 250 mentally disabled individuals at the farm, it was only in 1928 that the County of Los Angeles hired the farm’s first ever resident physician with expertise in psychiatry, Dr. Douglas W. Ritchie. The first full-time social worker followed in 1930 or 1931. The only “treatments” available for the mentally disabled at the farm were restraint, sedation, and hydrotherapy. The violent were still quickly sent to the state hospitals. In 1932, the county farm was officially renamed “Rancho Los Amigos,” Ranch of the Friends. It also began to phase out its farm operations as their earnings could no longer keep pace with the costs of providing care, although the process would not be complete until the 1950s.17 California had also begun tightening the residency requirements for assistance. The Indigent or Pauper Act had stipulated three months as the time needed to establish residency in a California county. As fears in the 1920s grew that indigents from outside the state might try to take advantage of this policy, it was amended to require proof of living in the state continuously for at least one year. In 1931, just as the Depression was beginning to bite, it was amended again to demand three years of continuous residence in the state. California’s county residence requirement became one year of continuous residence.18 Even at the federal level, some progress was being made, although most of the results ultimately were drowned out by the Depression and World War II. In 1930, the White House Conference on Children had brought together some of the foremost researchers and activists to discuss issues affecting disabled children. Early in its existence, the Children’s Bureau had conducted studies on the same issues in the District of Columbia and Delaware. The U.S. Office of Education tracked educational efforts for disabled children on a state-by-state basis, and the Bureau of the Census had collected data on mental disability since 1840 and conducted annual enumerations of state institutions for those with developmental and intellectual disabilities since 1926.19 But the onset of economic crisis in 1929 changed the mental health landscape. As James W. Trent puts it, “in social and economic good times, the contours of control could afford to appear progressive and enlightened. During the 1920s, when employment opportunities were, for a time, plentiful, superintendents who only a few years earlier had

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warned of the menacing moron for nearly a decade were ready to send sterilized morons back into the community. The Great Depression and subsequent world war put an end to the progress. In bad times, the meaning of mental retardation entailed incarceration.”20 As we have seen, the idea of institutions for the mental disordered as place of treatment had begun to stall in the 1920s and then worsen during the economic upheavals of the 1930s. These were decades of institutional custodialism, when isolating “undesirables” from the rest of society took precedent over curing them or even, in many cases, caring for them at all.21 With the introduction of intelligence testing, physicians worked to divide individuals with developmental disabilities (the “feeble-minded”) into what they regarded as more precise subcategories. A “moron,” they now declared, was a mildly disabled individual with an IQ of fifty-five to seventy; an “imbecile” had an IQ of twenty-five to fifty-five and had disabilities ranging from moderate to severe. At the very bottom of the scale were “idiots,” individuals believed to have profound disabilities and IQs of less than twenty-five. In the never-ending search for precision of language, “feeble-minded” itself also gave way to “mentally defective” or “mentally deficient.” In 1934, for example, the American Association for the Study of Feeble-Mindedness became the American Association on Mental Deficiency.22 The cottage plan hospitals, so celebrated during the Progressive era as wide-open spaces of rest and recovery, also proved to have a distinct advantage as far as the state of California was concerned. The segregated institutional designs of Kirkbride had inherently limited the number of individuals who could fit under one or at most two roofs. This put hard architectural and practical constraints on how many Californians would be able to live in each asylum. In the nineteenth century, as we have seen, the state, albeit reluctantly, thus opened new asylums when capacity had been reached at existing ones. Although certainly not ideal, this helped to ameliorate overcrowding. But the cottage plan allowed for seemingly endless growth at the same site: more Californians would be admitted; new buildings would be constructed whenever needed; and more staff would be added.23 In reality, however, usually only the first part of that happened. By 1931, the state hospitals in Southern California, as well as the county farm, were once again overcrowded. The Los Angeles Times reported that Norwalk State Hospital was 800 individuals over its rated capacity; Patton State Hospital, 900 over; and the Los Angeles County Poor Farm, 600 over capacity. All of it was “causing great distress,” the

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paper declared. Adding to the overcrowding were issues confronting the oldest state hospitals such as Stockton, Napa, and Patton. Many of the buildings there were now more than fifty years old and increasingly no longer safe. Stockton State Hospital, in particular, was now hemmed in geographically by the urban growth of the city of Stockton around it.24 Shortly after his election to the governorship in 1934, Governor Frank Merriam appointed Harry Lutgens as the new director of institutions. Lutgens was neither a doctor nor a politician: most of his professional experience was in the ownership and management of newspapers, although he had served as secretary for Governor Friend W. Richardson in the 1920s. Lutgens freely admitted later that he hadn’t been particularly interested in the job, but, as he saw it, “the job was administration mainly, and I had administrative experience. I knew the medical men in each place would help me get information needed to make decisions about medical policy and it was my job to see that all policies were carried out.” His only demand was that he be allowed to run the institutions without political interference, a demand to which Merriam, for the most part, acquiesced. To get up to speed on the challenges confronting the system, Lutgens conducted a tour of all the state hospitals and spoke to all the institutional superintendents. He quickly identified three key issues: overcrowding, staffing, and the need for so-called “receiving” hospitals that would admit new mentally and developmentally disabled individuals as patients for diagnosis and preliminary treatment before they were sent on to state hospitals.25 During his visits, he saw individuals in the hospitals sleeping in hallways, in basements, and in recreation rooms that had been turned into dormitories. He also noted a shortage of staff, particularly of attendants, to supervise. However, as discussed, California’s state hospitals for the mentally and developmentally disabled were funded almost entirely by the state’s General fund. Lutgens had photographs taken of the overcrowded facilities that, in 1935, he took with him to the California State Legislature to show as he demanded an increase in state funding. “I thought it was my responsibility to bring it to their attention,” he later recalled, “and I thought it was their responsibility to appropriate money for a construction program we had planned and which we presented at the same time.…I also emphasized that I was going to be the lobbyist for the mental patients of California, because no one ever spoke for them. People weren’t interested in mental hospitals unless they had a relative in

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one, and then they didn’t want to talk about it.” As a former newspaperman himself, Lutgens was also a believer in the power of publicity. He hedged his bets by having the Department of Institutions release stories and photographs on the overcrowding to the press at the same time he was appearing before the state legislature. “We didn’t want to hide anything. We wanted everything right out in the open,” he recalled. It worked. Despite the Depression, the department received a $6-million appropriation for the coming year, more than it had received in years.26 Only one completely new institution opened during the Great Depression, Camarillo State Hospital, forty-five miles north of Los Angeles. The 1,648-acre site was chosen deliberately as one of “peace and quiet,” and in 1935, only 100 Californians lived there, all of them on industrial leave from other institutions. It was built in the cottage plan, with buildings in a mixture of Mission Revival, Spanish Colonial, and Moorish architectural styles. “An omelette [sic] predominately Spanish,” was how Wilma Wilson described the eclectic-looking facility. “Oh, well. Maybe the architect was a patient working out his board,” she mused. The population remained small there through the 1930s and then ramped upward quickly to meet demands. Within two decades, Camarillo was the largest hospital for mental disabilities in the state.27 California was not alone in this: overcrowding remained a major issue in institutions for the mentally and developmentally disabled throughout the United States. By the mid-1930s, there were 477 mental hospitals in the United States containing close to half a million people.28 The Great Depression added fuel to the urgency to do something, anything, to address the issues, up to and including eugenic sterilization: “eugenics had always thrived on a sense of doom, that the germ plasm (an early term for the gene) was degenerating, that the number of insane of impoverished people were increasing exponentially. By the 1930s, this seemed less theoretical, less a question of future population than of everyday life.”29 The so-called “boarding out” programs, designed to get individuals in state institutions released into and working in the community, began to fail during the Depression. State legislatures in general proved unwilling to fund such programs separately. They thus created tremendous burdens on already overworked staff now struggling to find placements and provide supervision; doing more would have required diverting money from the institutions themselves, which nobody was willing to do.30

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With a building program now underway at most of the state hospitals, Lutgens and his department turned their attention to the question of how individuals came into the system. As he later explained it to an interviewer: In the smaller counties where there were no psychiatric facilities, a mental patient was brought to the county jail which usually had what was called a padded cell. The patient was then brought before a judge and judged sane or insane based on the testimony of a local doctor. Then the judge, without any specific knowledge about the institution except what he, by chance, might hear, would send the patient to a certain institution. By law, the institution was required to accept the patient. Very often some institutions were terrifically overcrowded while others had room. The result was immense transfers of patients. This was costly and disturbing to patients.31

Although California’s judges held the awesome responsibility of deciding whether an individual would be committed, in Lutgens’ opinion, most knew little about the state hospital system, such as the fact that some had more experience with certain types of mental and developmental disabilities than did others. Lutgens was also distressed by the fact that county sheriffs were still being used to deliver Californians who had been committed to hospitals, but he was unable to get this policy changed through the state legislature.32 After considerable consultation with the superintendents about how to fix the state’s commitment system, the department hit on the idea of creating “a central receiving hospital, one north and one south. Observation, diagnosis, and preliminary treatment could be carried out there, and assignment for long term treatment made to the appropriate state hospital.” The ultimate outcome of this was the creation of the Langley Porter Clinic in San Francisco.33 Staffing was the next challenge. Doctors and nurses were in short supply. “The only nurses in a mental hospital were those on duty in the medical unit where psychiatric patients had medical treatment,” Lutgens later explained. Psychiatric attendants made up the bulk of hospital staff, and they were “people we picked up—many of them were drifters from one state to another. They may have been kicked out of one state for rough handling the patients and then would come to another. We’d have to hire them not knowing their history.” The department of institutions already had staff training programs in state hospitals, and attendants had to take a civil service exam, but “the demand for attendants was so great

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that new people would be put right on duty” and “we were not in a position to raise requirements.” When Lutgens took office, that ratio of individuals in the hospital to attendants was fourteen to one. Lutgens set a goal of a ten-to-one ratio but had only achieved a twelve-to-one ratio by the time he left.34 Under Lutgens’ leadership, California also worked to secure federal funds made available by the New Deal. “Mind you, we were a Republican state at that time and we were afraid that we wouldn’t get to much cooperation from Mr. [Harold] Ickes on the PWA [Public Works Authority],” Lutgens recalled. His fears proved unfounded, however, as PWA funds were secured and matched, as was required, by funds from the state. These funds were ultimately used at Mendocino, Napa, Stockton, and the Pacific Colony, with the bulk going to expanding Pacific. The successor agency to the PWA, the Works Progress Administration (WPA) also provided some funds to California’s state hospitals. Sonoma, for example, sometimes found itself unable to meet its payroll during the Depression. It issued chits or warrants instead of cash, and some employees worked for just room and board. It did, however, receive $4 million in Works Progress Administration funds to expand and remodel the on-site acute hospital. The WPA also assisted Rancho Los Amigos after it was damaged in the 1933 Long Beach Earthquake, assembling a “Tent City” for residents and helping repair buildings.35 As the Depression deepened, California’s politicians looked for ways to save money by either consolidating state functions and facilities or eliminating them outright. Repeatedly, the state narcotic hospital was a target. It had survived any major cuts in 1933, the first time the California State Legislature proposed its closure, instead being combined administratively, but not physically, with Pacific. The state narcotic hospital at Spadra was damaged by a fire in the summer of 1939, but it received WPA funds to rebuild. California’s plan was still to use it as a hospital for both narcotic addicts and alcoholics. To this end, it was once again administratively separated from Pacific in March 1939, with Dr. Robert Chandler of the State Home for Adult Blind in Oakland hired to administer the state narcotic hospital and Dr. Thomas F. Joyce, who had administered both hospitals since 1933, staying on to manage the newly expanded Pacific Colony. A state appropriation to activate the new “State Home for Inebriates,” however, was not forthcoming.36 The final nail in the coffin was the appointment of a new director of institutions in 1939. Dr. Aaron Rosanoff saw no value in continuing the state narcotic hospital. It officially closed

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in June 1941, and the small population that was still there was sent to other state hospitals.37 But the idea still cropped up from time to time. In 1949, for example, a Special Crime Study Commission looking into the number of alcoholics caught up in the state’s penal system called for the creation of two new “inebriate” hospitals for them, one in Northern California and one in Southern California.38 California repealed its 1901 Pauper Act in 1933, replacing it with a new law that nonetheless reaffirmed that counties had primary responsibility for the care of indigents.39 Five years later, in 1937, California created and adopted a new Welfare and Institutions Code. It brought together all the existing legislation related to individuals dependent on the state. It also changed the provisions around responsible relatives. It made individuals who had relatives who should be caring for them, but were not, eligible for aid. Before 1937, the state sometimes turned away individuals in those situations, an act no longer feasible or justifiable due to the lingering Depression. As Floyd Bond, Ray E. Baber, John A. Vieg, Louis B. Perry, Alvin H. Scaff, and Luther J. Lee, Jr. put it, “this amendment indicated that the legislature recognized the legal and moral obligation of adult children to support their aged parents whenever this was possible without causing undue financial hardship.”40 For its part, Southern California spent much of the 1930s preoccupied with preventing as many people from getting aid as possible. The region had long been somewhat fixated on vagrancy and particularly on “hobos.” These trends had been visible early on in other Progressive era institutions, such as prisons. Between 1880 and 1910, the American West had more individuals in jail and prisons per capita than anywhere else in the country, much of it driven by a “tramp panic.” Even before the Great Depression, the city of Los Angeles incarcerated more people than any other American city of its size. After all, since the boom of the 1880s, it had been a city obsessed with the maintenance of order. Much of that had been driven by the Midwestern Protestant origins of many of its new residents and, in turn, embedded in city ordinances. “Public drunkenness, sleeping in public, the use of whistles and trumpets on the streets,” and to “sing, shout, or make any loud noise” without a permit were all prohibited in the city.41 It also had “curfews for youth, established sensible dress codes for women on the beach, closed saloons on Sundays, and prohibited gambling, saloons, and manufacturing from expanding into the suburbs.”42 As Kelly Lytle Hernandez explains, Los Angeles area authorities deliberately tried to limit the time nonwhite itinerants spent

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in the county, using “social controls ranging from immigration restrictions to local patterns of racial segregation.”43 This now fell hardest on the city’s and county’s Mexican and Mexican American populations, who were victims of a mass deportation movement. Los Angeles County’s Department of Charities aided and abetted this by redefining the use of county medical services as seeking “charity.” It then created a “Deportation Section” (also called a “Transportation Section”) within the county hospital itself. Between 1931 and 1933, over 13,000 individuals were “deemed guilty of receiving county medical or financial aid.”44 “Despite the New Deal, bond issues, and the adoption in 1935 of a controversial state personal income tax and a revised scheme of corporate taxation, California’s governments remained cash starved. With seven hundred thousand Californians unemployed by mid-1932, its cities made themselves as unattractive as possible to the impecunious.”45 Los Angeles did, however, open a Workshop for the Blind in 1930, designed on the same model as the state’s industrial home.46 The Los Angeles County Health Department also helped to pick up some of the slack in services: by 1939, some forty independent communities across Southern California had contracted with it to provide services to their residents as well.47 Even before the Depression deepened, California had been moving toward increasing aid for elderly Californians in need, resulting in the Old Age Security Law of 1929. Scheduled to go into effect on January 1, 1930, the new act provided for “aid in old age” for every Californian if they met all the criteria established by the legislation. These included, for example, being seventy years of age; having been a resident of the county for at least one full year before applying but not having been a resident of an institution; and not having property, alone or with a spouse, exceeding $3,000 in market value. Until the passage of the Social Security Act in 1935, the state and the counties shared the cost of this aid. At Rancho Los Amigos, county employees scrambled to figure out who was now eligible to receive aid. Happily, many of the elderly residents of the institution found they now qualified for funds that allowed them to return to their homes. Some 300, however, turned down the state’s aid specifically so they could remain at Rancho Los Amigos. On April 1, 1936, the cost became shared between the federal government, the state of California, and the counties, and the California program was altered to meet the new federal guidelines.48 Funding changes wrought by the New Deal also began to change how Americans accessed health care: “America’s Great Depression helped

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undermine the beliefs about the dependent and defective classes, and fostered home-based relief and care policy.”49 Over the next three decades, New Deal legislation, and particularly the passage and then expansion of the Social Security Act of 1935, helped to lay the groundwork for the eventual deinstitutionalization of Americans with disabilities around the country. For the first twenty-five years after its passage, all the provisions of the Social Security Act were, as one historian explains, “explicitly anti-institutional.”50 The Social Security Act of 1935, for example, provided Old Age Assistance (OAA) only for individuals living in their own homes; elderly Americans in institutions were specifically prohibited by law from claiming it.51 In January 1939, Dr. Aaron J. Rosanoff became director of the Department of Institutions. Culbert C. Olsen’s recent election as governor had led Lutgens to depart the Department of Institutions. Although Rosanoff’s tenure was short, he played a pivotal role in shaping the vision of what California’s hospital system might become in decades to come. Rosanoff was a veteran of New York’s public hospitals and thus seemed well-suited for the task. In California, he quickly moved to address overcrowding through an ambitious plan of building new institutions and expanding existing ones, paired with increasing the number of individuals on parole from those institutions. He continued to support the creation of the Langley Porter Clinic in San Francisco and to lobby for one in Los Angeles. He also launched a major hiring effort for more social workers to supervise parolees. The expanded parole plan was, he said, to be called “convalescent leave.” Rosanoff therefore created a Bureau of Social Work within the department so there would be social workers in every community to supervise individuals on convalescent leave and set up a licensing office for private psychiatric beds, which outnumbered public beds in the state. “The ideas implicit in the plan involved a strategic approach to mental health policy development, the communication of these ideas to future leaders of the Department of Mental Hygiene, and the creation of an organized mechanism, centrally administered and controlled, to facilitate the release of patients,” Paul Lerman explains. “Strategically, Rosanoff appeared to view the problem as one that involved the state and other units of government, as well as the private sector. In today’s parlance, this would be viewed as ‘involving the community.’”52 That same year, 1939, California codified all its health and safety laws instead of leaving them scattered through the state statutes. The hope was that this would help organize and clarify where California stood on public

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health.53 Rosanoff also helped to recruit Dr. Portia Bell Hume to the Department of Institutions in 1941 specifically to address the problem of the “many people in the state hospitals who could be out of the hospitals if there were any service for them,” Hume remembered. She had spent the first eight years of her life in Napa, California, where she’d regularly encountered individuals from Napa State Hospital in the community. Only three years out of medical school when she met Rosanoff, and a resident in neurology and psychiatry, Hume became “the first person to hold, under state civil service, a position which required a trained psychiatrist.” She remained part of the system for more than twenty years.54 Rosanoff left the position in 1942 due to illness and died soon after. Subsequent directors did not pursue such aggressive targets, but as soon as World War II ended, they utilized the policies and structures he had put in place.55 California ended the war years with yet another bureaucratic reorganization. This time, it dismantled the bureau of institutions, shedding and shuttling elsewhere several institutions along the way. By the end of 1945, California’s state hospitals for the disabled belonged to its newly formed Department of Mental Hygiene.56 Despite budget shortfalls, staff numbers in California’s state hospitals steadily increased during the 1930s to keep pace with the enormous numbers of patients in them. With America’s entry into World War II in 1941, however, staffing plummeted as staff members left for the armed forced and for jobs in industry.57 California soon had an acute shortage of doctors willing to work in the state hospitals as well. In 1940, California had one physician per 301 individuals in state hospitals, compared to one per 245 in Illinois, one per 183 in Massachusetts, and one per 160 in New Jersey.58 With few able-bodied men available to work as attendants, new hires sometimes had questionable attitudes about the mentally and developmentally disabled. Attendants didn’t always see a difference between control and therapy.59 Conscientious objectors provided one of the few remaining pools of labor, and many worked in hospitals during the war.60 Sonoma in particular continued to struggle, with more “requests for admission….than at any previous time in the history of the institution, including the depression.” At the same time, its doctors and nurses were leaving to join the war effort, and no funds or supplies to add new buildings were available. The overcrowding there became horrendous: “double-deck bunks were used in many of the patients’ sleeping quarters while in the infants’ wards, children often slept two to a crib.”61

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The war also created a shortage of laborers to help maintain the farm facilities at state hospitals. In the past, laborers with hands-on experience in farming and animal husbandry had often been hired to oversee the work done by individuals living in the state hospitals, but they, too, had left. By 1943, advertisements were being run in college and university newspapers for “farm hands” to work at Camarillo, Mendocino, Napa, Patton, Norwalk, Stockton, and Pacific.62 Yet even as the available pool of labor was shrinking, California purchased two new surplus military hospitals, Modesto and DeWitt. The plan was to get them open as quickly as possible to relieve overcrowding in the system. In Los Angeles County, soldiers were quartered on the grounds of Rancho Los Amigos, which also set up their own war industry, WARCO, which won a contract with a local rubber company. A few of the state hospitals were also able to participate in the war effort: at Napa, for example, some of the individuals committed there wove camouflage netting for the armed forces. The Navy also was permitted to take over one of the newer buildings at Napa and transform it into the Mare Island Naval Hospital annex. Navy corpsmen stationed there played pool with the hospital attendants, but they described the original asylum buildings still in use around them as “spooky as hell.” Napa ultimately had to evacuate patients from its original 1875 building, nicknamed “The Castle,” in 1943 because there was no longer enough staff to run it and because “the only means of egress in and out of the Castle were steep, unlighted spiral stone stairways in each of the seven towers.”63 The war created a few new policies on disabilities that were to have lasting impact. In 1943, Congress passed Public Law 113 (also known as the Barden-La Folette Act), which funded medical and reconstructive services. It also made mentally disabled individuals eligible for vocational rehabilitation. Limited vocational rehabilitation services had been available in California since 1921. But now Harry I. Friedman, assistant director of the Los Angeles District of the Vocational Rehabilitation Bureau, greeted the expansion with joy. California was now “thinking of rehabilitation in terms of total rehabilitation [emphasis his.] We are attempting, through the numerous services rendered by the Bureau, to remove, as far as possible, all handicaps, physical, emotional, educational, social, and economic, that keep the individual from functioning to his fullest capacity.” He added, “In California, as part of a total rehabilitation program, there is a crying need for special schools and special classes for the mentally retarded.”64 Unlike funding for the

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state hospital, funding for vocational rehabilitation remained consistently popular with the American public because its recipients seemed to be truly “deserving.”65 Meanwhile, staffing and supply shortages changed the types of treatments available within the state hospital system. The state hospitals had, after all, justified their existence with the promise that they could treat people and quickly release them back to their communities to resume being economically productive citizens. War or no war, that had to continue. The state hospitals stopped using insulin shock therapy in 1942, largely due to the war demanding all available supplies of insulin. In 1941, Southern California’s California Institute of Technology helped doctors at Patton State Hospital experiment with a newly constructed electroconvulsive machine. Electroshock therapy was subsequently introduced at Stockton State Hospital in 1943, but it was not in widespread use until later in the decade. In his analysis of patient records for individuals in state hospitals at this time, Joel T. Braslow found that an individual’s actual diagnosis mattered little in the decision to use electroshock therapy (ECT). In fact, the most common reason for its use was disruptiveness to staff and other patients on the ward. Doctors saw behavior as disease and thus viewed treatment for those behaviors as warranted. They “saw little distinction between those interventions that benefitted the individual patient and those directed toward maintaining an ordered ward. Collective health and individual health were inseparably linked by a rationale that deemed certain behaviors diseased and their elimination cure.”66 “Indeed,” he explains, “the history of twentieth century somatic therapies is a series of increasingly invasive attempts to control the psychiatric patient through his or her body.”67 The first psychosurgery (lobotomy) performed in a California state institution was on a woman at Stockton State Hospital on March 8, 1947. The procedure soon spread to other facilities. The infamous Dr. Walter Freeman even visited Napa State Hospital to demonstrate his “simplified” transorbital or “icepick” lobotomy technique. By 1952, all California’s state hospitals performed lobotomies, but by the mid-1960s, the practice had for the most part disappeared.68 Braslow, using the records of Stockton State Hospital, assembled the most complete picture we have of the use of lobotomies in California for this era. In all, 245 occurred between March 1947 and June 1954. Of these individuals, 86 percent were identified as white; 7 percent Hispanic; 6 percent Black; and 1 percent Asian. The average age was forty-one.

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At least one of those lobotomies, but possibly more, were performed by the notorious Walter Freeman. Stockton State Hospital had a “lobotomy board” or “lobotomy clinic” where doctors made the collective decision. Individuals in the hospital considered candidates for the procedure were interviewed, but their desires do not seem to have necessarily affected the outcome. Because California state law required the written consent of the closest family member for such procedures, it was often their family’s consent or refusal to give consent that ultimately determined whether an individual was lobotomized. However, “physicians [at Stockton] were not above outright deception in convincing a hesitant loved one to sign the consent form.”69 Of course, with consenting to surgery often being what stood between an individual and their release, the entire idea of consent becomes questionable. In 1951, an individual confined to Stockton State Hospital explained it to his doctor this way. “The authorities placed me in the hospital. They thought I was sick. I believe it is immaterial; that the important thing is effect a cure to get me out of here.”70 Braslow’s analysis of lobotomy records from Stockton State Hospital also indicates a profound gender difference in who was subjected to the procedure. Eighty-five women were lobotomized, even though men outnumbered women in the hospital’s population at the time. This was likely due to the attitudes of physicians at the time and the idea that women needed to be returned to their duties as wives and mothers as quickly as possible, regardless of their actual psychological health or the impact the lobotomy might have on them long term.71 California ended its war years by once again reshuffling its bureaucracy of disability. As noted, the lunacy commission had been absorbed into the new department of institutions in the 1920s. In 1945, the department on institutions itself split into the department of corrections (responsible for the state’s prisons) and the department of mental hygiene (responsible for the state’s hospitals for the mentally and developmentally disabled). The reshuffling and renaming was justified because “the trend throughout the country definitely indicates a broadening of the scope of activities of departments such as ours beyond a mere business administration of institutions to include large scale extramural activities along the lines of preventative work, treatment of incipient cases, and after care of paroled and discharged patients. The present title of the department would not adequately describe these functions”.72 Both New York State and Massachusetts were already using the term “mental hygiene”

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in the titles for their similar departments, the new director of institutions, Dora Shaw Heffner, wrote in a memo to Earl Warren’s secretary Helen MacGregor. The reorganization also allowed the new department of mental hygiene to add the position of medical deputy director who had to be a psychiatrist. This was the first position in the department reserved specifically for an individual with that training. “Perhaps any weakness in the existing structure of the Department of Institutions lies in the fact that standards of treatment receive less attention than standards of business administration,” Heffner mused.73 Everyone, however, recognized that change was not happening fast enough. Just one year after the reorganization and renaming, a San Francisco journalist, Al Ostrow, published a series of articles in the San Francisco News exposing the dreadful conditions in the state hospitals, thus earning the department yet more negative publicity.74 Outside of the rigid constraints of the struggling state hospital system, however, doctors, researchers, social workers, and parents were rethinking how mental health care in the state worked. Much of this work had begun in the 1920s, but it was in the years immediately after World War II that it truly flourished. This rethinking had two distinct but related forms: how California could best provide for the psychological health (the “mental hygiene”) of both its disabled and able-bodied children, and what mental health care provided at the community level instead of the state level might look like. It is to these two stories we now turn. The concept of mental hygiene had reappeared in the 1920s, although in a slightly different form than in the Gilded Age. It still focused on physical health and disease prevention as the path to mental health. But this time, its proponents focused on children who were “simultaneously the most vulnerable and the most promising.”75 Much of the mental hygiene work done in the United States was driven by private philanthropy and focused on child guidance clinics that, at least initially, operated completely outside of state hospital systems. In fact, for a time, this new focus on mental hygiene initially shifted attention away from the institutionalized mentally and developmentally disabled. Eventually, however, the state system reasserted itself, and the two learned to coexist and even to cooperate.76 The metal hygiene of America’s children was a national as well as a state concern. The White House Conference on Children’s Health and Protection of 1930 had, for example, encouraged greater cooperation between federal, state, and county resources.77 As early as 1916, California had

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created a Bureau of Child Hygiene that held well-child conferences and licensed and inspected maternity hospitals and homes.78 But it was the intersection of the mental hygiene movement with the newly developing field of child psychology that had the biggest influence. The initial goal was to prevent juvenile delinquency, believed at the time to be a mental rather than a behavioral problem. Out of this, the child guidance clinic was born.79 Although for much of the twentieth century most of California’s child guidance clinics operated separately from the bureau of mental hygiene, they remain worthy of close examination as early examples of, and partial inspiration for, what came to be known as community-based care. In 1922, the National Committee for Mental Hygiene worked with the philanthropic organization the Commonwealth Fund to fund “demonstration clinics” around the country. By 1942, sixty of them were scattered across the United States.80 “The mental hygiene movement began with concern for the insane in state hospitals and now is concerned with the mental health and welfare of the general population. The child guidance clinic….was employed first for cases in the juvenile court,” a 1938 brochure explained. “Later it broadened in its scope to include children with problems other than delinquency. Gradually its philosophy and techniques are affecting the lives of all children, even though complete clinical study may be employed for only a minority of them.”81 The state of California put together a Commission for the Study of Problem Children in the late 1920s. Much of the work focused on coordinating resources already existing in a community through a coordinating council. The Berkeley Coordinating Council, formed in 1919, became the model for other councils springing up across California. Local citizens sponsored the work being done at these clinics, creating a system that complemented the state’s efforts without drawing on state financial resources.82 The language around the issues was slowly evolving as well. Charged with investigating “the prevention of juvenile delinquent, psychopathic, and maladjusted children,” the commission suggested the problem was better called one of “emotionally unstable children.” “Defective delinquents,” it argued, could be cared for or treated through the two existing state institutions for the developmentally disabled, while community organizations and clinics addressed all other cases.83 In Los Angeles, the pivot point for this work was Kenyon J. Scudder, who had been the secretary of the California Commission for the Study of Problem Children and who in 1931 was appointed chief probation

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officer for Los Angeles County. He pushed hard for the creation of more coordinating councils in the area, and by 1936, there were sixty-four of them.84 The child guidance clinics were primarily educational, designed to reach a broad community audience and convince them of the value of clinical services. Clinics went into a community “only upon the invitation of and assurance of support by the local agencies interested in welfare. When the cooperation of the Juvenile Court, the County Medical Association, school and health departments, as well as service clinics and public officials has been secured, the visit of the clinic becomes in large measure a local enterprise made possible by the State Department of Institutions and not merely another ‘paternalistic offering.’”85 Police departments that wanted training in child guidance could request a visit from staff at either the University of California, Berkeley or the University of Southern California (USC).86 The mental hygiene movement of the 1920s also pushed for the creation of juvenile courts that addressed both petty and serious crimes as well as non-age-appropriate behavior, such as drinking. The courts operated without a jury or lawyers. Instead, a judge provided guidance and a probation officer monitored the child’s future behavior. There were distinct class differences, however, in who was sent before such courts. Working-class children made up the bulk of those sent to juvenile courts. Middle-class children who came from families with some resources were instead far more likely to end up at a child guidance clinic, where they might be classified as “pre-delinquent,” i.e., demonstrating emotional and behavioral issues (truancy, tantrums, etc.) that hadn’t yet gotten them labeled “delinquent.” Not surprisingly, the prognosis for children sent to child guidance clinics was usually assumed to be better than for those who ended up before juvenile courts.87 Child guidance clinics did not attempt to provide services for mentally disabled children. Instead, those individuals and their families were quickly referred elsewhere. In California, this usually meant being directed back to the state hospital system. Thus, state institutions (the state hospitals and reform schools) increasingly received only the most “difficult” cases, further straining their limited staff and financial resources.88 Los Angeles County parents had additional options to turn to for help and guidance. In 1924, the first two geographically fixed child guidance clinics in the state were created in Los Angeles and Pasadena. They were funded through the county’s Commonwealth Fund initially

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and then through the Pasadena and Los Angeles Community Chests under the management of the Southern California Society for Mental Hygiene. These were the only places in the city that provided guidance and resources for the emotionally unstable child and their parents. Services ranged from diagnosis to psychiatric interventions for the child to casework with the entire family. Los Angeles’ clinic evolved into the Parent-Teacher-School Guidance Center. Although there is some confusion in the surviving historical record, it appears to have been originally founded in 1930s as the Child Guidance Clinic. The Tenth District of California Congress of Parents and Teachers soon expanded it to cover most of the city; the 31st District then duplicated the program to serve the sprawling San Fernando Valley. Funding came from the ParentTeacher Association and the city’s Community Chest, and ultimately five clinics were opened, each operating full-time during the school year. One director described it as “a hybrid organization, with roots both in voluntary philanthropy and in the field of public social services.” As with most similar agencies, the center always had more families requesting assistance than it could serve and thus put sharp limitations on who it served based on type of case and financial need.89 There was also the Exceptional Children’s Foundation, funded entirely by private donations. It asked for only $25 a month for care. Its reach, however, was limited.90 Families in the Bay Area could go to the Mills College Child-Guidance Clinic. Mills College had operated a psychological clinic since at least 1907, but due to funding constraints, it was only part-time. New Deal funding in the 1930s—first the Civil Works Administration and then the State Emergency Relief Administration—enabled it to become a full-time clinic. It ultimately became part of the Oakland Coordinating Council, offering services to children from the Oakland and East Oakland schools and the Alameda County Hospital. In 1947, a Berkeley State Mental Hygiene Clinic opened on the campus of the University of California, Berkeley. It both served the community and provided training for medical residents, social workers, and clinical psychologists.91 By 1960, several hundred organizations in Los Angeles County dealt with some aspect of children or families, some private, some public, some within institutions, some outside of them.92 The Department of Public Health had a Bureau of Mental Retardation. There were also a few shortlived traveling mental hygiene clinics, such as the one operated by the California Bureau of Juvenile Research that periodically sent psychiatrists and social workers to Whittier State School for Boys from 1929 to 1931.

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Although somewhat outside the scope of this book, it’s worth noting that the state of California also gave its blessing to the creation of a department of research (later the California Bureau of Juvenile Research) at Whitter State School that worked closely with the Eugenics Research Office (ERO).93 Perhaps the most influential new players on the scene by World War II were parents themselves. Since the 1920s, psychologists and social workers alike had stressed that family members of the developmentally disabled—and mothers, in particular—were in danger of overindulging and infantilizing them and thus prolonging the cycle of dependence longer than was necessary. A mother’s focus should be on her husband and family, they argued, and keeping a developmentally disabled child at home would distract her from that job. The reality, however, was that “public institutions could not begin to take all the people who were intellectually disabled in the United States.…Limited funding and the realities of institutional life made those facilities grim place to live, especially for the more disabled residents,” Janice A. Brockley explains. “Blaming mothers for their ‘excessive devotion’ obscured the real social problems that made the devotion necessary.… ‘excessive devotion’ translated into an unwillingness to accept the neglect and abuse of a public institution, the only help offered by the community.”94 Parents often felt intense shame, leading some even to conceal their disabled children. This was often exacerbated by psychiatry’s own turn toward psychoanalysis after World War II. Psychoanalysts often erroneously blamed parents, and particularly mothers, for their offspring’s physical and psychological problems.95 The institution,” as Edward Shorter explains, thus “towered over the…scene in the first half of the twentieth century—a physician’s first recourse, a last possibility for desperate parents.” He suggests that much of this was driven not only by the presumed “best practices” of the time, but also by physicians’ own sense of helplessness when it came to assisting these individuals. Parents who kept their children at home would present the doctor with a continual reminder of his own medical impotence. Although physicians did not say this aloud, it is clear that at a deeper psychological level, some of them wanted the child out of sight because retardation was not within the compass of what they considered themselves to do well: diagnose and treat acute illness.96

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By the 1950s and 1960s, however, a new era of questioning existing systems of care had opened. This occurred in postwar exposés of the terrible conditions plaguing America’s overcrowded institutions and also from parents of institutionalized children who were clearly seeing that “postwar prosperity had not come to the public institutions.”97 “How are they to get the specialized training?” the Los Angeles Times asked in an article on the education of developmentally disabled children in 1952. “That is the heartbreaking question many parents are asking themselves, knowing that the handicapped child should be removed from the home, both for his own training and for the welfare and normal development of other children.” However, the paper added, “private institutions are few, filled, and too expensive for the average family to consider for the long period for which such treatment must be given. Public institutions, especially in the southern part of the state, are very few and so overcrowded that they have lost some of the value.”98 In public lectures, Dr. George Tarjan, superintendent of Pacific State Hospital, stressed that parents need feel no shame about having a mentally disordered child. No one believed any more that bad blood or disease caused this, he said, and “often this type of child is born to parents who possess high intellectuality and no known hereditary traits.”99 Postwar parents quickly discovered “the quantitative and qualitative inadequacy of facilities and services which had been allowed to retrogress during the stresses of depression and war.”100 But they also found healthcare and educational professionals increasingly encouraging parents to take an active role in understanding their child’s needs and the many forms disability could take. One 1953 book for parents abandoned the term “feeble-minded” in favor of “the brain-injured child” and argued that such children should be seen as distinct from other developmentally disabled individuals. Such a child might or might not also have some form of physical disability, the authors explained, depending on what part of the brain had been injured. They were probably the offspring of “normal, intelligent parents” and had likely initially had the same intellectual potential as any other child until something had gone wrong. That something “might have been an external happening—a fall or a blow or a birth injury. Or it may have occurred internally as a result of an infection. We are not concerned here with how and when the accident happened but with what has happened and with what the parents can do about it.” The same authors, however, also equated the brain-injured child with a building damaged in a fire: just as an insurance adjuster would be needed

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to tell the building owner what, if anything, could be repaired, so too did the parents of a brain-injured child need the services of experts “before they can decide what can be done.”101 Even within the state institutions that housed children, there was a recognition that more activities and stimulation were needed. Some state hospitals had held occasional recreational activities, such as dances and baseball games, since in 1870s, but that was a far cry from offering organized recreational therapy. Occupational, speech, and music therapy had become available at Rancho Los Amigos in the 1940s, but not until 1950 were the first state-funded California state hospitals able to hire qualified recreation therapists. At Sonoma, for example, a “supervisor of rehabilitation therapies” was hired. Activities such as music, art, and handicrafts that had once been taught as part of the school program were moved into this new department. Before, only the so-called “higher functioning” children had attended school at the site and thus had received those services. Over time, programs at state hospitals expanded further to include outdoor sports, summer camping, and vocational and occupational therapy.102 As the populations of individuals in the two institutions for the developmentally disabled became younger and more seriously disabled, however, there was also a shift away from preparing them for eventual return to their communities to “moving the hospital population along a continuum from total dependence to relative independence within the institutional setting.”103 For its part, the Department of Mental Hygiene expressed joy at seeing parents involved in activism on behalf of their developmentally disabled children. In the past, it had been common for parents to maintain little or no contact with their children after institutionalization. At Pacific, Tarjan estimated that in the early 1950s, roughly 50 percent of individuals there had no real family contacts. Only 25 percent, in his estimate, had regular contact with family members, including parents who came to visiting days and occasionally took the individual home to see other family members and even to stay overnight before the individual returned to the institution. It was these parents who “were successful in stimulating or setting up a dozen new classes, day nurseries, sheltered workshops, summer camps, or parents education groups,” their biennial report noted. Such parent groups also provided “mutual understanding and guidance,” and “every aid and assistance possible was given by the department and the hospitals in the development of these groups.” By mid-century, “fortunately or unfortunately,” Tarjan noted, “families who had a mentally

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retarded person in the family knew at least as much, if not more, about mental retardation than the rank-and-file psychiatrists, including some very famous psychiatrists.”104 All these changes were slow in coming and, as Corbett Joan O’Toole notes, were not the result of changes in medical care at all. As she notes in a discussion of individuals with Down syndrome, “changes did not occur because suddenly medical science figured out a better way to minimize the impairments of Down Syndrome. These changes occurred because people with Down Syndrome and their families pushed against the stereotypes and asked not, ‘What is wrong with me?’ but instead ‘What is right with me?’ They developed new educational approaches and support systems that allowed many people with Down Syndrome to live outside institutions.”105 Alongside parents’ groups and child guidance clinics, California’s public schools also provided an “unprecedented opportunity for large scale intervention into child life, first in moral training, then in physical health, and finally in mental health.”106 Here, there were often more direct links between institutions and schools. In fact, reaching into the public schools and outpatient clinics was typical of institutional superintendents in this era. As James Trent notes, these men had expertise based on their years of experience and saw involvement with other endeavors as a way both to assert that expertise and to maintain public interest in their own institutions. Superintendents recognized that without special education programs in the public schools, too many young people (particularly young people from minority communities) were instead being institutionalized. Dr. George Tarjan vividly remembered an “impassioned plea” he made before an unnamed Southern California school board in 1949 to at least admit children with mild to moderate developmental disabilities, including Down syndrome. “I was convinced that if you can guarantee a family…that you will have some relief in the public schools because there will be classes by the time the youngster is six or eight years old, then there will be no reason for institutionalization for the next twelve. Now that, to me,” he recalled, “is maybe humanitarian on one end, but it is also very practical from somebody’s point of view who tried to serve a large population with limited beds if everybody comes in.”107 California had a division of special education within the state department of education beginning in the 1920s. For the first two decades after its creation, the division’s focus was on children with physical disabilities. In 1927, California created a special Bureau of Education of Crippled

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Children within the division specifically to address those students. It first surveyed the issue, finding 1,848 children with orthopedic disabilities in the state, of whom the majority (871) were enrolled in special education classes already. The state legislature that year appropriated more than $200,000 in additional funding it distributed to school districts offering special education classes. In 1928, the first two schools dedicated exclusively to the education of children with physical disabilities (“crippled children” was the term used at the time) in San Francisco and Los Angeles. For the first time, classes were held for children in tuberculosis sanitariums and children’s hospitals. The largest cities—Los Angeles, San Francisco, Sacramento, and Oakland among them—also began funding transportation to get these children to school or to bring a teacher to their homes for instruction. For children with more severe physical disabilities from families that could afford private care, by 1920, four private institutions in the entire state were devoted specifically to the care of physically disabled children in Marin, Sonoma, Los Angeles, and Santa Clara. These four facilities also accepted children who were anemic and those who were “predisposed to tuberculosis.” A handful of private facilities known as preventoria in California also focused on the care of malnourished children and those who were “pre-tubercular” in that decade. Children with more severe physical disabilities who did not come from wealthy families, or who had no families at all, however, often ended up in the same institutions as did children with developmental disabilities. Community groups, most notably the Shriners and the Rotary Club, fundraised for children with disabilities (a Shriner’s hospital opened in San Francisco in 1923) but also lobbied hard for more state intervention. In this, they were joined by an array of women’s groups and the California Society for Crippled Children. In 1927, they helped to get the Crippled Child Act through the state legislature and signed into law. This law allowed for “needy, physically defective or handicapped persons under 18 years of age and residents in California” to obtain a certificate from the court that could then be presented to the State Department of Public Health, entitling them to “obtain the necessary medical assistance, treatment, and/or hospital care.” The state of California was not, however, responsible for the cost: responsibility fell to the county in which the child lived. Unfortunately for the children of the state, California law at the time defined a “crippled child” very narrowly as someone “whose future capacity for self-support is threatened by disease of defects of the bones, joints, or

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muscles.” Thus, many children with physical disabilities did not qualify for aid under the new law.108 Although both the California School for the Blind and the California School for the Deaf continued to thrive, new educational options were opening for those students as well. In the 1930s, the school for the visually disabled developed a cooperative relationship to allow some of its students to enroll in public high schools in the city of Oakland. By 1933, the state had ten public day schools available for hearing disabled students (Eureka, Fresno, Long Beach, Los Angeles, Oakland, Pasadena, Pomona, Sacramento, San Diego, and San Francisco) and seven school districts that offered special classes in local public schools for them (Berkeley, Long Beach, Los Angeles, Oakland, Pasadena, Sacramento, and San Francisco).109 The first classes in public schools for the mentally disordered in California were ungraded classrooms that appeared in Oakland in 1898 and Los Angeles in 1900. Some school districts just made special provisions for them, while others provided separate classes. In 1921, the California School Law was amended specifically to allow individual school districts to create separate classes in elementary schools if needed. Just as in 1927, when California had created a special Bureau of Education of Crippled Children within the division specifically to address those students, it also created a Division of Special Education and, within that, a bureau of mental hygiene charged with figuring out how to educate mentally disordered children within the state’s public schools.110 California’s State Department of Education did not begin making strides in education for mentally disordered children until after World War II. In 1945, the state senate put together a committee to study the issue, which concluded there were approximately 32,000 “mentally retarded” students in the state’s public schools, or roughly 2 percent of the total population of any given state school district. In response, in 1947 and 1949, the state legislature passed and then amended and added to new legislation mandating greater funding for and access to special training schools and classes. Unlike the state institutions, these opportunities were required to be in the child’s community of residence. The state provided additional funding to make this possible.111 Francis W. Doyle, chief of the Bureau of Special Education within the department, stressed that a more careful, nuanced understanding of these students and their needs was needed. He particularly warned against the injudicious use of the term “feeble-minded” because it suggested no

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education at all was possible. In his experience, this was simply wrong in many cases. He suggested instead a distinction between those he called the educable mentally retarded and the feeble-minded and between those he called mentally retarded pupils and those who were in his estimation just educationally retarded (that is, educationally behind due to faculty instruction, illness, environmental conditions, etc.) The revised state education codes now made clear that either governing boards of school districts or county superintendents (who had the responsibility depending on the number of pupils affected) were required to “establish and maintain special training schools or classes for mentally retarded pupils” and provide transportation for the students attending them.112 These could be special boarding schools, special day schools, or special day classes within regular schools. Doyle felt strongly that “the needs of the majority of exceptional pupils will be best met in special classes in a regular school situation where these classes are offered as a special service and considered a part of and not apart from the regular school program.” This approach had two advantages, he explained. It “affords an opportunity to exceptional pupils to enter into general school activities with other pupils of their own age, and makes it possible for them to receive the same general services given to pupils in regular classes.”113 State codes now required that parents and guardians be notified before their child was placed in a special program within a public school. Doyle, recognizing that parents could potentially be both a help and a hindrance, suggested schools think carefully about which staff members had responsibility for interfacing with them. “Parental objection is often cited as a deterrent to the development of a program for mentally retarded pupils,” he wrote. “However, experience has shown that parents will demand rather than reject special classes if the school sincerely desires to provide situations in which every child has an opportunity for continuous growth and secures the best in teaching personnel, equipment, and supplied for such growth.”114 This also marked the beginning of a slow turn away from IQ tests as the lone determinant of ability in state public schools. As the Division of Research and Guidance, Office of the County Superintendent of Schools, Los Angeles put it, “the diagnosis of mental defectiveness is not a simple matter that can be entrusted to amateurs who merely know how to administer the Binet test of a battery of group intelligence or achievement tests. Rather it is a problem for experts (clinical psychologists or psychiatrists) who possess an extensive background and skill in clinical

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examination procedures. No child should be classified as feebleminded or mentally defective except as a result of a careful individual study from the standpoint of intelligence, educability, physical status, environmental background, and personal and family history.”115 To this end, the new state educational codes placed the major responsibility for diagnosis on the school psychologist. This, of course, only applied to those mentally disordered minors not (or not yet) caught up in the machinery of state institutions and/or the state juvenile delinquency systems. At Pacific and Sonoma, the two hospitals focused on caring for children with developmental disabilities, educational opportunities inside the institutions were expanded. At Pacific, 289 students attended the onsite school where they received instruction in academic subjects as well as music, art, homemaking, physical education, and vocational training, although not all attended daily (Fig. 6.1). Sonoma had 332 students attending school there in 1950–1952 and was able to successfully graduate forty-five in June 1952, the largest class ever. Modesto and DeWitt hospitals, which had also admitted some developmentally disabled individuals, had only limited educational opportunities at the time (Fig. 6.1).116 As discussed, some individuals with disabilities had had access to higher education in California for decades. Because of their geographic proximity to what was then just the University of California (later UC Berkeley), students from both the School for the Deaf and the School for the Blind attended classes there, with school staff providing whatever accommodations were needed. This was not a new idea: Corbett Joan O’Toole’s research suggests the first disabled person to graduate from UC Berkeley was Newell Perry in 1869.117 One must of course be careful not to overstate the impact of such new parental approaches. In their study of Pennsylvania Training School in the late nineteenth century, Brent Ruswick and Elliott W. Simon concluded, “parents struggled to make sense of their child’s disability and prospect for improvement at a historical moment where asylum superintendents, physicians, and social reformers were keen to claim professional expertise based on esoteric knowledge that parents lacked.”118 As late as the 1960s, Los Angeles County’s Welfare Planning Council report noted that developmentally disabled Californians and Californians with epilepsy were still most often committed by a parent or guardian.119 For the most part, parents were neither heroes nor villains.120 Most parental activism was still

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Fig. 6.1 “Pacific colony mental hospital classroom,” February 5, 1950. Courtesy Los Angeles Times photographic archive, library special collections, Charles E. Young Research Library, UCLA

the realm of middle-class white parents with disabled children in institutions. The year 1950 saw the formation of the National Association for Retarded Children (NARC).121 Spurred on by the mental hygiene movement, by the early 1950s, residential treatment centers (RTCs) began to appear, offering parents an alternative to state institutions for emotionally and mildly disabled children. Like the clinics themselves, most were funded by private philanthropy, but later, many RTCs also received government reimbursement for stays.122 The National Society for Autistic Children, founded in 1965, pushed for an understanding of autism as a neurological rather than a psychological condition and demanded their children be “among those requiring special education services for their disabilities.” In previous generations, these same children would likely have been labeled “mentally retarded” and institutionalized.123

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The work of the Department of Institutions under Lutgens and Rosanoff was one part of a larger reassessment of mental health care for adults. The California Conference of Social Work in 1927 initiated a mental hygiene survey of California conducted by Dr. Frederick Allen of the Child Guidance Clinic of Philadelphia and paid for by the state. One of the most significant recommendations was that California rewrite its commitment laws. The old one made mental illness a crime. The new one needed to “emphasize the medical treatment of the patient” instead. The assembly and senate passed a bill to do this in 1933, but the governor vetoed it.124 As discussed, outpatient care for mental illness and developmental disabilities in California had progressed in fits and starts, largely dependent on funding availability and interest, but it accelerated in the 1930s under Harry Lutgens’ tenure at the department of institutions. Shortly after World War I, Sonoma established the state’s first community clinic. Led by Dr. George Ordahl, Sonoma’s chief psychologist and director of education, the service consisted of a traveling unit, which eventually evolved into a separate traveling clinic, and a “home unit.” The first traveling clinic was held in Santa Rosa. These kinds of services played a vital role in providing psychiatric and pre-admission services in rural counties that otherwise would not have access to them. They also publicized the work of the state hospitals and, administrators hoped, would convince other communities to open their own outpatient clinics. The “home unit” in the Sonoma facility was a “forerunner of the diagnostic and pre-admissions” clinics of the 1950s. Because these types of treatments did not require commitment before care, it was hoped they would be better able to intervene in a moment of crisis, to treat patients quicker and more effectively, and perhaps to even stave off any need to institutionalize at all. Aftercare programs designed to ease the transition from institution to community also appeared in the 1950s.125 The idea was not entirely new. The early twentieth century had seen the development of the “psychopathic hospital” or “psychopathic clinic” in California. They were envisioned (and, to a certain extent, idealized) to provide outpatient and short-term inpatient treatment without the stigma of commitment. As part of the symbiotic relationship between the two, they could refer severely ill and disabled Californians on to the state hospitals if needed. Doctors had hoped that they would double as training, teaching, and research centers. David J. Rothman, however, suggests that there was never equality between the two; that clinics quickly became

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subservient to the state hospitals; and that this was most likely to occurany where acute overcrowding led clinics to focus more on simply containing individuals than on providing care for them.126 California opened its first state-funded, state-run community-based mental health clinic in 1943, the Langley Porter Clinic. It was, Harry Lutgens later declared, “a revolution in handling mental patients.” Lutgens negotiated with Dr. Langley Porter of the University of California School of Medicine; University of California, Berkeley President Robert G. Sproul; and the University of California Board of Regents to make a Northern California clinic a reality. To Lutgens’ disappointment, political opposition from Governor Merriam scuttled plans for a Southern California clinic for many years. Lutgens did, however, find allies to support the creation of the San Francisco clinic not just in the University of California, but also in the state’s Mental Health Association; the Bay Area’s Mental Hygiene Association; the California Federation of Women’s Clubs; and a reform-minded organization called the Southern California Committee of One Thousand. Perhaps understandably, World War II considerably slowed the development of the clinic. Although it did open as planned in 1943, it limped through the last two years of the war struggling to get the staff it needed and only became fully operational in 1945. The Langley Porter Clinic had both a small mental hospital and an outpatient clinic, but it was really focused on research and training. Although considered part of the California State Hospital System, it operated jointly with the University of California Medical School. The land on which it sat had been provided by the regents of the University of California. There was considerable overlap in staff and instructors between the clinic and the medical school. The state of California mediated the relationship between the two “with the intent that the clinic be a hospital for the treatment of early and acute cases of mental and nervous diseases. The facilities of the university are to be made available to the Langley Porter Clinic, and vice versa.” From the beginning, demand for treatment at Langley Porter outstripped the availability of staff. The Department of Social Welfare’s biennial report documented 8,602 requests for psychiatric treatment at Langley Porter in 1951–1952, of which the clinic was only able to accommodate 1,109.127 Training designed to help meet staff shortages at state hospitals was also available. “It was very difficult for us to get psychiatrists,” Harry Lutgens remembered. “The MDs who had smattering of psychiatry had never had an opportunity to expand that knowledge even if they were

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interested.” Now, though, Langley Porter offered a three-year residency training in psychiatry that consisted of one year of supervised work with inpatient cases and training in electric shock and insulin therapy; one year of rotating between different state institutions (typically a rotation between San Francisco City and County Hospital, Napa, Sonoma, and San Quentin) with ninety days spent at each; and one year in which six months were spent in the clinic’s outpatient ward and six months were spent at the child psychiatry and psychiatry units of the University of California Hospital. A resident wanting advanced training could apply for one of Langley’s two senior residency positions or one of four fellowships it offered under the National Mental Health Act. Doctors already working in state hospitals could take a twelve-week refresher course in psychiatry at the clinic. Psychologists, nurses, and psychiatric social workers training at the University of California Medical School and occupational therapy students from the University of California, San Jose State College, and Mills College also often spent time at Langley Porter.128 Beyond Langley Porter, California’s other institutions were not always so thrilled to be part of all this training. During the ninety-day training at Sonoma, for example, each resident was placed in charge of a ward. The existing Sonoma staff tolerated the young doctors politely but grudgingly, calling them “ninety-day wonders” behind their backs. There was sometimes a profound disconnect between what the doctors wanted to accomplish and what the staff knew to be realistically possible. One resident allegedly suggested Persian rugs be placed on the floors to keep them clean and give the residents a “sense of tidiness.” In any case, ninety days was rarely enough time to implement any of the doctor’s changes. A similar program was again attempted in 1959, this time with more success and considerably more time spent at each institution. Now the first and third years were to be spent in residence at Napa and the second year at Sonoma.129 California then turned to creating more outpatient clinics. As with Langley Porter, the goal was to have community-based mental health clinics where people could get assistance before a situation developed that might land them in a state hospital. These were state-funded, at an estimated base cost to California of $8 per patient-hour of care provided. The department of mental hygiene detailed seven functions of a mental hygiene clinic: (1) diagnosis and outpatient treatment; (2) advising referral agencies and individuals; (3) providing referrals; (4) answering requests for information; (5) educating professional and lay groups about

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mental hygiene; (6) consulting with lay agencies, including schools, that needed psychiatric services; and (7) participating in community mental hygiene organizations. Care was to be provided regardless of “race, color, creed, or diagnosis.” Fees were charged on a sliding scale, and anyone without the ability to afford private psychiatric care was referred there.130 The mental hygiene clinics were frank about the limits of outpatient treatment in a clinic setting. Clinic psychiatrists were only able to do neuropsychiatric evaluations, so patients were expected to provide full physical evaluations from their own doctors. They also turned away all requests for psychological testing from outside agencies to focus on their own caseloads. Each clinic had some leeway about which patients to serve and how to prioritize them. The Los Angeles clinic, for example, chose to prioritize admitting children over adults. In general, the clinics usually refused to treat psychotic individuals, focusing instead on anxiety, “hysteria,” and more common psychological issues in adults and on behavioral issues (such bed-wetting or stealing) in children. If the client was a child, the parents had to be willing to be seen by clinic therapists as well. Clinics offered individual and group psychotherapy, as well as play therapy for younger clients. Los Angeles saw more patients than any other clinic.131 Clinics in the most urbanized parts of the states developed relationships with educational institutions around them. The Berkeley clinic (opened in 1948) was on the campus of the University of California and affiliated with three different departments there: psychiatry, psychology, and social welfare. Psychiatrists in resident training at the University of California routinely rotated through the Berkeley clinic. Opened in 1946, the Los Angeles clinic had a similar relationship with the University of Southern California and the University of California, Los Angeles (UCLA), as did the San Diego clinic (opened in 1948) with San Diego College.132 Clinics in Fresno and Sacramento also opened in 1948, followed by Riverside in 1950 and Chico in 1952. Although these were intended as community service providers, use of the mental hygiene clinics was profoundly racialized. The best statistics, available, again, for 1951–1952, show that clinics in California had admitted 3,680 individuals for outpatient treatment. Of those, 3,468 were identified as white; 102 as “Negro”; seventy-six as “Mexican-Indian”; two as “U.S. Indian”; fifteen as Chinese; eleven as Japanese; and six were “unspecified.”133 State hospitals up and down California quickly became overcrowded as the 1930s gave way to the 1940s. State funds for more buildings and staff lagged far behind. In many ways, the state of California had become

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trapped within its own system. “The dilemma for reformers who wanted to solve crime, disease, poverty, delinquency, and war by way of mental hygiene was that they did not want to change any of the structures that had caused the problems,” Theresa Richardson explains. “The effort was to make social institutions ‘work better’ without altering their basic character.”134 Some politicians, doctors, and reformers had begun to realize California wasn’t going to build its way out of the situation. Instead, new approaches, such as child guidance and outpatient clinics, were needed. What emerged were two parallel but linked systems: clinics, some statefunded, some not; and state-funded hospitals. However, even with these approaches, the populations in state hospitals for the mentally and developmentally disabled continued to spiral upward.135 Rapid population growth in California during World War II put enormous pressure on the existing institutional infrastructure, triggering a new building boom that peaked in the 1950s under Governor Earl Warren. Simultaneously, however, members of the California State Legislature itself proposed new possible solutions to the state’s mental health dilemma, one built largely on the foundations of the new approaches of the postwar era. As for Luther Osborne, he continued his crusade to be released from Napa State Hospital. At last, in 1937, he was granted a new hearing and sent home to Oakland, where he surveyed the financial and psychological damage wrought by his long absence. “I have lost many thousands— $2400 a year in salary alone,” he had written to a friend shortly before his release, “as much or more a year from business investments and activities and the loss of a restaurant appraised at $12,000, with every possibility of a greater value during these lost years.” He also promptly poured his thoughts and copies of the letters he’d written over his years in the asylum into a self-published book he titled The Insanity Racket: A Story of One of the Worst Hell Holes in the Country. “Do you care what happens to you, or to a member of your family, or to your friends?” he asked. “Of course you do. Everybody does. The ‘insanity racket’ is a menace to every family and a destroyer of human rights.…The insanity racket ‘works’ because of the ignorance and indifference of the average citizen whose general attitude is that ‘it cannot be possible,’ if they give it any thought at all. Statistics of the number of persons committed to these hospitals in California, and the numbers there, compared with other states, are startling.” Even after his own harrowing experience, he did not call for the shuttering of the state asylums, but instead for it to be placed in the hands of

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“competent men and women.” “The welfare, interests, and general wellbeing of the average patient is considered less than the livestock on the place, and until that sentiment is changed by intelligent management, no particular improvement can be accomplished. Laws cannot change human nature,” he admitted, “but they can help. And with the right kind of human nature in charge at these hospitals, the laws would work equitably…with competent officials in charge, the state would be safer for everybody.”136 He dedicated the book to the wife he’d lost while confined. Despite his pleas, he had not been permitted to leave Napa to be with her during her final illness. “To Harriet Estella Osborne,” the dedication reads. “One of the finest wives and mothers that ever lived.”

Notes 1. Luther Osborne, The Insanity Racket: A Story of One of the Worst Hell Holes in This Country (Oakland, CA: 1939), 5–8, 21. 2. Noll, “Institutions for People with Disabilities in North America,” 313. 3. Braslow, Mental Ills and Bodily Cures, 79–81. 4. Braslow, Mental Ills and Bodily Cures, 71–79, 93. 5. No randomized clinical trials of malarial fever therapy were even conducted, so if it actually worked remains an open question. Doctors at the time certainly believed it did, but admitted they were unsure of the mechanisms at work: Some believed the heat destroyed the spirochetes that cause syphilis; Others believed it stimulated an increased immune system response in the individual that then benefitted their entire system; and so on. Not understanding the mechanism at work was not considered a hindrance in using the treatment. Braslow, Mental Ills and Bodily Cures, 71–79, 93. 6. Syphilis was detected in this era through a test of the spinal fluid, known as a Wasserman complement-fixation test. Braslow, Mental Ills and Bodily Cures, 73. 7. Braslow, Mental Ills and Bodily Cures, 82. 8. Malaria treatment fell out of use with introduction of antibiotics and with other forms of psychiatric treatment. Braslow, Mental Ills and Bodily Cures, 90. 9. Osborne, The Insanity Racket, 5–10, 24. 10. Osborne, The Insanity Racket, 8, 10–11, 15. See also discussion of how doctors interpreted patient resistance to institutionalization in Lira, Laboratory of Deficiency, 152–153, 11. Osborne, The Insanity Racket, 88–89, 136.

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12. 13. 14. 15. 16. 17. 18. 19.

20. 21. 22. 23. 24.

25. 26.

27.

28. 29. 30. 31.

Osborne, The Insanity Racket, 16. Osborne, The Insanity Racket, 157, 177. Rothman, Conscience and Convenience, 7. Noll, Feeble-minded in Our Midst, 158. Fox, So Far Disordered in Mind, 170–171. Fliedner, Centennial, 105, 108, 128, 134–135, 176, 189, 293. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 146. However, until funds were provided by the Social Security Act of 1935, which provided federal grants in aid to state for maternal and child health and welfare, as well as services to “crippled” children, the Children’s Bureau was limited in how much assistance it could really provide to states. The New and More Open Outlook for the Mentally Retarded; The Proceedings of the Workshop on Mental Retardation Conducted under the Auspices of the Workshop Office of the Catholic University of America, ed. Elizabeth M. Kelly (Washington: Catholic University of America Press, 1966), 4. Trent, Inventing the Feeble Mind, 275. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 12. Noll, Feeble-Minded in Our Midst, 2–3. Yanni, The Architecture of Madness, 104. Between 1935 and 1937, the state of California spent more than a million dollars at Stockton alone. They created the Stockton Farm Annex six miles outside of town where more individuals could be housed and, at the original site, the hospital’s first medical treatment center was added. “Hastening Work on New Mental Hospital Urged,” Los Angeles Times, November 14, 1931; “Harry Lutgens: Publishing and Politics in California,” interview conducted by Edna Tartaul Daniel in 1961, Regional Cultural History Project, The Bancroft Library, University of California, Berkeley, Berkeley, California, 101–102. “Harry Lutgens,” 90. “Harry Lutgens,” 90–93; Eugene Bardach, The Skill Factor in Politics: Repealing the Mental Commitment Laws in California (Berkeley, CA: University of California Press, 1972), 19. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 84; Anderberg and Wilson, They Call Them Camisoles— Revisited, 46–51. Noll, “Institutions for People with Disabilities in North America,” 319. Nourse, In Reckless Hands, 22. Rothman, Conscience and Convenience, 363. “Harry Lutgens,” 93.

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32. Harry Lutgens attributed this to lobbying from the Sherriff’s Association, which did not want to lose the income this policy provided. He also blamed future California Governor Earl Warren, who was in the legislature at the time. Lutgens believed Warren opposed the policy change because it “limited the committing power of the judge.” “Harry Lutgens,” 94–95. 33. In his oral history interview, Lutgens uses the (hopefully theoretical) example of a judge in San Rafael, which had no state hospital of its own, deciding where to send an individual they had committed. The two closest state hospitals to San Rafael were Napa State Hospital and Mendocino State Hospital in Ukiah. But said judge might not have known that Napa had a general population while Mendocino had a large population of Californians judged to be criminally insane. “Harry Lutgens,” 94. 34. “Harry Lutgens,” 95–96. 35. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 44–45; “Harry Lutgens,” 100–101; Fliedner, Centennial, 194. 36. “State to Rebuild Damaged Spadra Narcotic Hospital,” Los Angeles Times, December 30, 1939; “New Spadra Hospital Head Named,” Los Angeles Times, March 4, 1940; “Institution for Drunks Appropriation Sought,” Los Angeles Times, February 18, 1944. 37. Baumohl, “Maintaining Orthodoxy,” 243–245. 38. The Narcotic Hospital closed in 1941, at which time the site became a United States hospital for rheumatic fever cases. California Special Crime Study Commission, Final Report of the Special Crime Study Commission on Adult Correction and Release Procedures (Sacramento: 1949), 9. 39. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 182. 40. A district attorney could go after relatives in civil court to recover what they should have paid toward their family member’s maintenance. Bond, Baber, Vieg, Perry, Scaff, and Lee, Our Needy Aged, 65. 41. Hernandez, “Hobos in Heaven,” 410–413. 42. Hernandez, “Hobos in Heaven,” 410–413. 43. Hernandez, “Hobos in Heaven,” 410–413, 415, 426. 44. Molina, Fit to Be Citizens?, 136; Hernandez, “Hobos in Heaven,” 410– 413, 415, 426. 45. Baumohl, “Maintaining Orthodoxy,” 255. 46. However, because the workshop was unable to provide accommodations for vision-impaired individuals who had nowhere to live, it appears to have been of limited use. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 156.

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47. United States Public Health Service, Report of a Survey of the City Health Department of Los Angeles, California, April–August 1939, 412. 48. Bond, Baber, Vieg, Perry, Scaff, and Lee, Our Needy Aged, 56–66; Fliedner, Centennial, 177–178. 49. Lerman, Deinstitutionalization and the Welfare State, xiv, 211. 50. Lerman, Deinstitutionalization and the Welfare State, xiv, 211. 51. Lerman, Deinstitutionalization and the Welfare State, 213. 52. As Paul Lerman notes, this was a marked change from Rosanoff’s earlier stance as reflected in his writings, which had argued for more commitment to state institutions for eugenic reasons. Lerman, Deinstitutionalization and the Welfare State, 83–85; “Portia Belle Hume,” 55. 53. State of California Department of Public Health, California’s Health, 1870–1970: Centennial Issue (Berkeley, CA: State Department of Public Health, 1970), 38. 54. “Portia Belle Hume,” “Earl Warren and the State Department of Mental Hygiene: Frank F. Tallman, M.D., Dynamics of Change in State Mental Institutions”; “Portia Belle Hume, M.D., Mother of Community Mental Health Services,” 4–5. 55. Lerman, Deinstitutionalization and the Welfare State, 85. 56. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 13. 57. Something similar had happened during World War I. Braslow, Mental Ills and Bodily Cures, 26–27; Fliedner, Centennial, 92–93. 58. Braslow, Mental Ills and Bodily Cures, 80. 59. Braslow, Mental Ills and Bodily Cures, 27. 60. Conscientious objectors were among the first Americans to speak out about the terrible conditions they had seen in the nation’s overcrowded state hospitals for the disabled. Lindsey Patterson, “The Disability Rights Movement in the United States,” in The Oxford Handbook of Disability History, 440–443. 61. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 45. 62. Because the institutions in question were part of the state system, civil service exams were required of any potential hire. See, for example, “Farm Hands Needed,” Stanford Daily, October 29, 1943. 63. Modesto and DeWitt were distinct from Sonoma and Pacific because they did not directly admit individuals with developmental disabilities. They only accepted overflow populations from other state hospitals. State of California Department of Mental Hygiene, Biennial Report for 1950– 1952, 70, 87; letters from Jack Reynolds to the Napa County Historical Society, September and October, 1998, quoted in Prestinary, Napa State Hospital, 81, 83; Fliedner, Centennial, 209, 215.

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64. Harry I. Friedman, “Vocational Rehabilitation Services for the Mentally Retarded,” in Exceptional Children’s Foundation, The ECF Bulletin 2, no. 3 (October 1952). 65. Although largely beyond the scope of this study, this was of course particularly true for Americas veterans. Friedman, “Vocational Rehabilitation Services for the Mentally Retarded”; Richard K. Scotch, “American Disability Policy in the Twentieth Century,” in The New Disability History, eds. Paul K. Longmore and Lauri Umansky (New York: New York University Press, 2001), 382. 66. Braslow, Mental Ills and Bodily Cures, 109. 67. Braslow, Mental Ills and Bodily Cures, 80, 100–101, 108, 172; Noll, “Institutions for People with Disabilities in North America,” 319. 68. Braslow, Mental Ills and Bodily Cures, 128; Prestinary, Napa State Hospital, 72. 69. Braslow, Mental Ills and Bodily Cures, 128–133. 70. Stockton State Hospital case 60726 2 January 1951, Clinical Case Conference, 1, quoted in Braslow, Mental Ills and Bodily Cures, 9. 71. Braslow also notes that, at Stockton at least, women were under constant medical surveillance, including having their menses tracked in their official patient records. Additional statistical research is needed into the use of lobotomy at other California state hospitals to determine if Stockton was an aberration. Braslow, Mental Ills and Bodily Cures, 155–157, 161–162. 72. Dora Shaw Heffner to Helen MacGregor, February 26, 1945, in “Helen R. MacGregor: A Career in Public Service with Earl Warren, with an Introduction by Earl Warren,” interviews conducted by Amelia Fry, June Hogan, and Gabrielle Morris in 1973, Earl Warren Oral History Program, Regional Oral History Office, The Bancroft Library, University of California, Berkeley, Berkeley, California, Appendix B, 208–210. 73. Dora Shaw Heffner to Helen MacGregor, February 26, 1945, in “Helen R. MacGregor: A Career in Public Service with Earl Warren, with an Introduction by Earl Warren,” interviews conducted by Amelia Fry, June Hogan, and Gabrielle Morris in 1973, Earl Warren Oral History Program, Regional Oral History Office, The Bancroft Library, University of California, Berkeley, Berkeley, California, Appendix B, 208–210. 74. Heffner to MacGregor, February 26, 1945; Bardach, 79; Al Ostrow, “People in the Dark: A Series of Ten Articles on California’s Hospital System,” San Francisco News, 1946, quoted in Lira, Laboratory of Deficiency, 56. 75. Richardson, The Century of the Child, 1, 5. 76. Noll, “Institutions for People with Disabilities in North America,” 312, 317; Deborah Blythe Doroshow, Emotionally Disturbed: A History of

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77. 78. 79.

80. 81.

82.

83. 84. 85. 86. 87. 88. 89.

90. 91.

92. 93. 94. 95.

Caring for America’s Troubled Children (Chicago: University of Chicago Press, 2019), 3. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 113, 126. State of California Department of Public Health, California’s Health, 1870–1970, 31. Theresa Richardson notes that the first English language text in child psychiatry, by Leo Kanner, wasn’t published until 1935. Richardson, The Century of the Child, 15. Doroshow, Emotionally Disturbed, 15. Norman Fenton, State Child Guidance Service in California Communities (Sacramento: California Bureau of Juvenile Research, 1938), 100–101. Fenton, State Child Guidance Service in California Communities, 13; Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 91. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 89–90. Fenton, State Child Guidance Service in California Communities, 14. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 91. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 91. Doroshow, Emotionally Disturbed, 15. Doroshow, Emotionally Disturbed, 15. The Mental Health Survey of Los Angeles County, 1957–1959, 341– 342; Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 92–93. “Before We Adjourn,” Los Angeles Times, January 20, 1952. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 93; “Portia Belle Hume,” “Earl Warren and the State Department of Mental Hygiene: Frank F. Tallman, M.D., Dynamics of Change in State Mental Institutions; and Portia Belle Hume, M.D., Mother of Community Mental Health Services,” 17–18. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 350. Richardson, The Century of the Child, 105; “Portia Belle Hume,” 56; Chávez-Garcia, State of Delinquency, 6. Brockley, “Martyred Mothers and Merciful Fathers,” 294. Psychoanalysis itself, however, was rarely used within California’s institutions, in part due to staffing limitations and in part because doctors believed mentally disordered individuals were not capable of participating in it. Shorter, The Kennedy Family and the Story of Mental Retardation, 2–3, 8.

6

96. 97. 98. 99.

100. 101.

102.

103. 104.

105. 106.

107.

108. 109. 110. 111.

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Shorter, The Kennedy Family and the Story of Mental Retardation, 5–7. Trent, Inventing the Feeble Mind, 252–253. “Before We Adjourn,” Los Angeles Times, January 20, 1952. In 1954, the National Association for Retarded Children held its annual meeting in Los Angeles. It was only the third annual conference the organization had held. “Before We Adjourn,” Los Angeles Times, January 20, 1952; “Greetings from Foundation President,” Exceptional Children’s Foundation, The ECF Bulletin 2, no. 3 (October 1952). The New and More Open Outlook for the Mentally Retarded, 6. Richard S. Lewis, Alfred A. Strauss, and Laura E. Lehtinen, The Other Child: The Brain-injured Child, A Book for Parents and Laymen, 2nd ed. (New York: Grune & Stratton, 1960), 2–3. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 23–24; Fliedner, Centennial, 213. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 25. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 68; “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, vol. 1,” 306–310, 315. OToole, Fading Scars, 18. Similar efforts in Europe and Great Britain actually predate American work in this field. Canada also followed suit. Richardson, The Century of the Child, 14. In this particular case, Tarjan felt not only had his pleas been in vain, but also that the school board in question probably was left questioning America’s immigration laws and that he was “either crazy or a troublemaker.” Trent, Inventing the Feeble Mind, 154–155; “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, vol. 1,” 205– 206, 211. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 108–111. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 118, 124. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 132. Above and beyond the regular funds provided for public schools, a school was to be reimbursed “75% of the excess cost of educating mentally retarded minors up to a maximum of $100 per unit of average daily attendance.” It was up to the superintendent of public instruction to figure out the math for their district. Francis M. Doyle, Questions on the Education of Mentally Retarded Minors in California (Sacramento: California State Department of Education, 1950), 26.

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112. As originally written, these laws applied to students between eight and eighteen. Francis M. Doyle, Questions on the Education of Mentally Retarded Minors in California (Sacramento: California State Department of Education, 1950), iii, 1–3. 113. Doyle, Questions on the Education of Mentally Retarded Minors in California, 5. 114. Doyle, Questions on the Education of Mentally Retarded Minors in California, 14. 115. Thomas W. Smith, “A Study of Problems Connected with the Selection of Children for Special Training Classes,” Unpublished manuscript prepared for the Division of Research and Special Guidance, Office of the County Superintendent of Schools, Los Angeles, 11–18, quoted in Doyle, Questions on the Education of Mentally Retarded Minors in California, 6. 116. Modesto and DeWitt were distinct from Sonoma and Pacific because they did not directly admit individuals with developmental disabilities. They only accepted overflow populations from other state hospitals. California Department of Mental Hygiene, Biennial Report for 1950–1952, 70, 87. 117. OToole, Fading Scars, 76–77. 118. Ruswick and Simon, “Industry, Improvement, and Intellectual Disability,” 150. 119. A “mentally abnormal sex offender” was defined at the time as someone who was “neither mentally ill nor mentally deficient as defined by law but who, because of lack of power to control their sexual impulses, are likely to attack or injure the objects of their uncontrolled desires.” The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 109, 433. 120. Ruswick and Simon, “Industry, Improvement, and Intellectual Disability,” 150. 121. Now it is known as the Arc of the United States or just the Arc. Lindsey Patterson, “The Disability Rights Movement in the United States,” in The Oxford Handbook of Disability History, 312, 445; “About Us: Our History,” The Arc (https://thearc.org/about-us/history/). 122. Doroshow, Emotionally Disturbed, 30, 190–191. 123. Doroshow, Emotionally Disturbed, 204. 124. Cahn and Bary, Welfare Activities of the Federal, State, and Local Governments in California, 169. 125. This was not an entirely new idea: In the 1880s, Pennsylvania had begun treating patients in a dispensary attached to the Pennsylvania Hospital, and Boston tried something similar in the 1890s. Pond and Brody demonstrate that the Sonoma clinics died out during the Great Depression, resumed after World War II, and then operated sporadically

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126. 127.

128. 129.

130. 131. 132. 133. 134. 135. 136.

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through the 1950s. Yanni, The Architecture of Madness, 146; Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 29–31. Rothman, Conscience and Convenience, 309–313. Lutgens recalled that the University of Southern California expressed interest in becoming the home of a Southern California receiving clinic to benefit their own medical school. However, Governor Merriam insisted that the only place to put a Southern California facility was at Norwalk/Metropolitan State Hospital. Lutgens never quite figured out why Merriam drew that line in the sand, but he decided not to try to defy him and to focus instead on moving the Northern California clinic forward. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 74–75, 94; “Harry Lutgens,” 94–99. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 74; “Harry Lutgens,” 95–98. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 52; State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 74–75. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 75. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 75–76, 95. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 76. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 76. Richardson, The Century of the Child, 190. Noll, “Institutions for People with Disabilities in North America,” 312, 317, 321. Osborne, The Insanity Racket, 1–4, 9.

CHAPTER 7

“To Promote Mental Health”: The Bureaucracy of Disability at Midcentury

In 1962, a major Hollywood film was shot at the Pacific State Hospital. Starring Burt Lancaster and Judy Garland, A Child Is Waiting was the tale of a developmentally disabled boy and the institutional workers determined to help him. The film had a “glittering” preview screening in Washington, DC, as “part of the First International Awards dinner for ‘outstanding achievement in research, service, and leadership in mental retardation,’ sponsored by the Joseph P. Kennedy, Jr., Foundation.” Lancaster was in attendance, along with President John F. Kennedy, his sister Eunice Kennedy Shriver, and her husband, Sargent Shriver. It wasn’t the first motion picture filmed in a California state hospital for the mentally or developmentally disabled (that was the 1948 film The Snake Pit, starring Olivia de Havilland, which filmed exterior shots at Camarillo State Hospital), but it was the first to make such extensive use of buildings and grounds and the first to cast actual individuals living there as background actors.1 Reviews of the film were mixed. “It is neither documentary nor staged drama—or rather, it attempts to be both,” one of the Los Angeles Times ’ film critics opined. “It is just depressing, and its entertainment qualities are nil. Its message, for those who will sit through it, may have a certain sociological value, for it does say that handicapped youngsters like those depicted have a better, if limited, opportunity of gaining some sort of

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euphoric ‘happiness’ if they are placed in the proper institution instead of being left with well-meaning but clueless parents.”2 Although the lead child role was filled by a child actor, Dr. George Tarjan, administrator of Pacific at the time, allowed fourteen children at the institution, aged nine to twelve, to appear in A Child is Waiting as background actors. Producer Stanley Kramer later said that their involvement “was exciting. They surprised us every day in reaction and what they did.” In an interview at the time, Lancaster reported, “we have to ad-lib around the periphery of a scene and I have to attune and adjust myself to the unexpected things they do. But they are much better than child actors for the parts. They have certain gestures that are characteristic, very difficult for even an experienced actor.” The New York Times heralded the children “who appear uninhibitedly in this film. To them and to John Cassavetes, who directs them with notable control—and perhaps to these children’s teachers who must have helped him from close by behind the scenes—we must be thankful that what might have been harrowing and even distasteful beyond words to behold comes out as a forthright, moving documentation of most unfortunate but hopeful youngsters in a school.” The children who participated are billed, not by their individual names, but simply as “the children of the Pacific State Hospital in Pomona.”3 For mental health facilities at both the state and the county levels, the 1950s was a decade of assessment and recalibration. The many changes wrought during the 1930s and 1940s had produced a tremendous amount of disruption and disarray for doctors, staff, and, above all, the individuals caught in the system. Future author Edward Bunker, who spent his childhood in Los Angeles bouncing between foster homes and state institutions, recalled being sent to state hospitals twice for observation while still in his early teens. His grimmest recollections were of a ninety-day stay at Pacific Colony (which sometimes took observation cases from the youth authorities) in the late 1940s. He recalled, Its one locked ward was the most brutal place I’ve ever been. Even that far back, if the savage realities of the place had been exposed, it would have been a scandal. Most of my time was spent in the dayroom sitting on the benches that lined three sides. Each bench had four names written on tape. We sat in silence with our arms folded. Any whispering and an attendant walking on crepe soles behind the benches might knock you on to the floor. The fourth side of the dayroom had cushioned wicker chairs.

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Four of them were on a raised dais where the attendants sat. Their goons used the chairs at floor level.

Bunker recalled attendants staging fights between the individuals in the institution for their own amusement. He saw other boys forced to polish the floor with “the block,” a slab of concrete wrapped in blankets and coated with paraffin wax, as a punishment. Polishing floors with “the block” is a recurring theme in almost all firsthand accounts of California’s state hospitals for the mentally and developmentally disabled. On a practical level, it was a way to keep floors clean in a high-traffic environment, but it was also used simply to keep people occupied and, as Bunker indicates, a form of punishment. One of Dudley Raymond Wilder’s sketches, likely done in Patton in the mid-1950s, shows a man with his head in a literal fog holding a handle connected to an enormous fabric-wrapped block on the floor. The caption reads, simply, “therapy” (Fig. 7.1).4 Brutal and, according to Bunker, unprovoked beatings by attendants marked his stay at Pacific. “They could get away with anything,” he wrote in his autobiography. “I’d seen brutalities that would never happen in reform school, or even a prison for that matter, where there are procedures for hearings. This was a hospital [emphasis his]. We were patients being cared for.” After one particularly bad beating, he recalled the ward doctor, “a little man with an accent,” visiting his room. “He clucked like a chicken as he poked at my swollen and disfigured face. It was in terrible shape. My closed eye stuck out like an egg. ‘I don’t think you’ll strike another attendant, will you?’ he asked. I shook my head and thought, Not unless I could kill him [emphasis his].”5 The state of California embarked on a massive physical expansion of its state hospitals for the disabled while at the same time continuing to expand services at the local level. Two different reports for the era, the State of California Department of Mental Hygiene Biennial Report for 1950–1952 and one from Los Angeles County, provide snapshots of these two systems that, while still having significant overlap, were growing farther and farther apart. In the state hospitals, “the patient is out of the community’s sight and it is unhappily true that too often the patient is out of the community’s mind.”6 For the California Department of Mental Hygiene, the 1950s opened as a decade full of promise. The state had grand plans to reinvest in infrastructure after the lean years of the Depression and World War II. New scientific developments and new approaches in the field of psychiatry were

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Fig. 7.1 Patton State Hospital, San Bernardino, California: a psychiatric patient mopping the floor as therapy (Drawing by D. R. Wilder, ca. 1954. Courtesy of the Wellcome Collection)

reinvigorating the profession and attracting a new generation of doctors and reformers to state institutions. The department foresaw a future that would move beyond the idea of institutions and asylums as simply places of custodial care. Instead, reinvigorated with more money and new ideas, they would be transformed into hospitals in more than name alone. They

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would be sites of research, education, and rehabilitation that would be the envy of the world. One photographic image repeats itself over and over again in department publications from the early 1950s. It shows the old brick tower at Napa State Hospital, originally built in 1875, tumbling to the group to make way for new buildings at the site. Evidently, the department liked the symbolism.7 The department can perhaps be excused some of its optimism because the most important figure in the state was on their side: Governor Earl Warren. “He was always interested in people’s problems,” someone who worked with him later reflected. “He’s a very warm-hearted person. All you had, with Earl, to do is be sick and he’d want to help you. That’s Earl.”8 Almost as soon as he’d entered the office in 1943, Warren had been taken on a special tour of state hospitals so he could see firsthand how dilapidated and dangerous many of the nineteenth-century buildings had become and how profound the overcrowding was. Warren, to his credit, returned to Sacramento determined to act. He never forgot what he had seen. “It has been our continuing endeavor to take our state out of the asylum age and establish it in the hospital age, where a high quality of medical care working toward rapid and complete cure is substituted for mere custodial care,” he vowed in 1952. In 1949, he assembled a twoday Conference on Mental Health that brought together 900 interested parties from all over the state. The conference produced a short-lived Governor’s Continuing Committee on Mental Health. In January 1952, it was replaced with a California Advisory Committee on Mental Health. The eighteen-member committee of “active” and “interested” Californians was to advise both the governor and the director of the department on all matters relating to mental disorders. Although open to all Californians, at least on paper, the committee was usually dominated by doctors, medical school personnel, and prominent individuals active in mental health charities. Several judges from Los Angeles, including one who had served on the psychopathic court, were part of the committee’s first incarnation. In the meantime, forty-three of the most unsafe buildings used to house more than 5,000 patients in the system were condemned and closed. This, of course, temporarily made the overcrowding situation even worse. California had purchased two surplus US Army hospitals during the war (Dewitt in Placer County and Modesto in Stanislaus County, the

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latter of which was originally supposed to be temporary), but they were not yet open.9 Following Dr. Aron Rosanoff’s sudden resignation due to ill health in 1943, Governor Warren appointed Dora Shaw Heffner to head the department of institutions. Heffner was not a psychiatrist, but rather a juvenile court lawyer from Los Angeles who had been an activist on the issue of delinquent girls. Dr. Portia Belle Hume later reflected that Heffner was a good choice because she was “in some ways very much concerned with the kinds of problems of women and young people in this curious problem of the interaction between correctional needs and emotional needs. I thought she was an interesting appointee for Warren to make. Apparently, she was in support of changes in the department.” However, Heffner “got into lots of difficulty because of criticism regarding the way she operated the state hospitals. There was always some scandal coming to lights; she was a target.” Adding to the complexity, the department of institutions became the department of mental hygiene in 1946, and “the Youth Authority, and all the things [Heffner] was most conversant with” were placed under the management of another department.10 Heffner eventually also become ill and stepped down. Dr. Lawrence Kolb, formerly of the US Public Health Service, was temporarily in charge. Warren now saw an opportunity to place someone in the position who was a trained psychiatrist and had experience with similar institutions to California’s state hospitals. His choice, Dr. Frank Tallman, recognized the decaying infrastructure of the system, “the physical plant,” as he called it, as one of the first challenges. “At that time, California could afford things—which it doesn’t seem to be able to now,” he reflected years later. After touring the state hospitals, including their farms, Tallman “thought that the animals were better taken care of than the patients,” Hume recounted.11 Tallman saw that Warren was “prepared to use the power of his office to do those things for the mentally ill that he felt ought to be done. He did not take the position that he was a psychiatrist and he, therefore, knew what ought to be done [emphasis his]. So he asked for advice for many sources. He listened to it carefully,” Tallman recalled. “There were times when he had to be convinced. Be he was always willing to agree when he thought the information was sound….His involvement in worrying about the mentally ill, as kind of a problem that unfortunate people had, very rapidly broadened into knowledgeable concern.” In this work,

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Warren was aided by his confidential secretary, Helen MacGregor, who strongly believed in and supported the work of the department of mental hygiene and was always happy to make sure their concerns were shared with the governor. “She kind of elected Mental Health and Corrections as her babies—and we were very fortunate in terms of their mother, so to speak,” Tallman remembered.12 Verne Scroggins, Governor Earl Warren’s press secretary, described this work as “California’s transition from ‘the asylum age’ to the age of the modern psychiatric hospital.” There were to be three prongs to the new approach: construction; the “creation of a modern program of active diagnosis and medical treatment”; and new programs “to prevent mental illness and promote mental health.”13 Between 1943 and 1952, California’s legislature appropriated more than $126,000,000 specifically for institutional construction of everything from new buildings to upgraded sewer and heating systems. It also included the construction of two entirely new ones: Porterville, which opened in 1953, and Atascadero, which opened in 1954. Two more, one near San Fernando and one for the developmentally disabled near Costa Mesa, were in the planning stages. Some of this growth was driven by outside factors: for example, with community fears about “sexual psychopaths” and “sexual deviants” on the rise in postwar America, two wards had been created specifically for individuals identified as such, one at Mendocino and one at Norwalk. The department of mental hygiene predicted they would soon have a system capable of holding 36,800 mentally disabled Californians and another 12,700 developmentally disabled ones.14 New funds were also flowing in from the federal government. With the passage of the National Mental Health Act in 1946, the department of mental hygiene had been made the state authority for handling those funds in California, and a National Institute of Mental Health had been established. One of the jobs of the California Advisory Committee on Mental Health was suggesting how to spend those federal funds. The department was also responsible for assisting with the distribution of federal grant-in-aid funds to community agencies or for creating new services. This seed money went to, for example, a child guidance clinic in Bakersfield; the creation of thirteen family service associations in rural parts of California; and the state’s first halfway house. Located in Los Angeles, it was for men with chronic schizophrenia who had been released from state hospitals or the VA. When possible, the committee tried to

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meet at the state hospitals themselves so its members could observe firsthand the challenges confronting the department.15 Dr. Frank Tallman remembered that not all the hospital superintendents were immediately on board with California’s grand plans for expansion and improvements. “I would say that the reception was circumspect but polite,” he recalled. Warren encouraged Tallman to push the superintendents toward “a less parochial and isolated attitude and role and to be helped to be active in community mental health affairs.” To help manage the state hospital system, Warren and Tallman authorized the creation of a deputy director for the department. Dr. Portia Belle Hume was the first person to hold the new position.16 At Pacific State, twelve new wards and a school complex were added in the 1950s as the population ballooned to 2,800 individuals and 1,355 staff, most of them residents of Pomona and the surrounding communities.17 In 1950, California had purchased part of the adjacent Diamond Bar Ranch so Pacific could once again expand. Between 1950 and 1953, the institutional hospital facilities there doubled in size; the school facilities tripled; and the number of admissions “increased drastically” (Fig. 7.2).18 This was also an era of growing professionalization for the doctors, nurses, and social workers within the department, in large part to solve ongoing shortages of staff systemwide. World War II provided a boost in the number of psychiatrists in postwar California. Many of them had been trained by the US military and were either stationed in California and/or had settled there after the war ended. Dr. George Tarjan himself is a good example of this. Tarjan had been born in 1912 into a Jewish family in Hungary. He had been nudged into medicine by his father, who anticipated future political unrest in Europe and felt that medicine was both a highly portable profession and, should his son ever be drafted, the Army position least likely to get him killed. Tarjan routinely faced antisemitism in college and in medical school in Hungary and left for the United States in 1939. He was able to get an internship at a predominately Jewish hospital in Kansas and then a residency at a hospital in Wisconsin. It was there he met and married an American nursing student named Helen. In 1941, the couple were settled in Utah where Tarjan was a psychiatric resident at Utah State Hospital.19 Like a lot of young psychiatrists, he found that the work wasn’t quite what he expected. “You’ve got to understand the 1941 state hospital in Utah, or for that matter anywhere in the United States. Just to give you some examples of what I mean, the hospital had

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Fig. 7.2 “Pacific Colony nursery cribs jammed together due to overcrowding,” February 5, 1950 (Courtesy Los Angeles Times Photographic Archive, Library Special Collections, Charles E. Young Research Library, UCLA)

two sides to it, which was customary in those days. A male side and a female side,” he recalled. “On each side there were roughly five hundred patients. When I arrived in Utah the good superintendent said, “you’ve got the female side.” You can judge from the number of patients and the amount of just ordinary medical care that one had to deliver that this more fancy psychological medicine I was thinking about could not be practiced.” He became a US citizen in 1943 and then served in the US Army during World War II, assigned first to Letterman General Hospital in San Francisco. “The army didn’t have too many psychiatrists. There was a great shortage of psychiatrists during that part of the Second World War, because there were very few civilian psychiatrists. Most of the civilian psychiatric practice was restricted to state hospital practices like the one I came from. And unexpectedly the psychiatric casualty rate skyrocketed

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in the US Army.” So, he later recalled, “everyone who was in a specialty for which the army had less need, particularly those who were in obstetrics, for example, or gynecology, or those who were in pediatrics, were sent to a school of psychiatry. The army immediately made me a psychiatrist at Letterman.” He was then sent to serve in the South Pacific as part of the 105th General Hospital. After leaving the Army in 1946, he became part of the Group for the Advancement of Psychiatry (GAP), an organization of psychiatrists, many of them returning from the military, who wanted to reinvigorate American psychiatry, which they felt was still dominated by “the pre-Second World War psychiatric establishment, most of whom were essentially employed psychiatrists, federally employed or state-employed in the state hospital system.” Increasingly interested in what was by then being called “mental retardation,” but recognizing that his own training had taught him nothing about it, Tarjan became interested in focusing his career in that direction. “I thought mental retardation must be something like the congenital dislocation of the mind,” he reflected years later. He took the job as clinical director at the Pacific State Hospital in 1947.20 This was a brand-new position in the system, designed, Tarjan thought, “for a miracle man who would modernize an institution for the mentally retarded.” Although Pacific’s original charter had called for research to be conducted there, that had never happened. The ambitious Tarjan knew an opportunity when he saw one. I could create a program the way I wanted to create it, from the ground up. Very challenging to me that I could create a program out of ignorance. And I mean that very sincerely: out of ignorance. My experience in the two state hospitals prior to that time was that the institutions operated on what I often referred to as institutional superstitions, and these superstitions just perpetuated themselves. That I could try to find out what are facts and what are transgenerational, employee, transgenerational, fantasies was just enormously challenging. I thought that in this process I could correct what I thought was a big deficit in my image of a psychiatrist, namely somebody who ought to know about all conditions of the human brain, including its congenital dislocation, namely retardation.

In 1949, when Pacific’s superintendent left, Tallman “bullied” (Tarjan’s words) Tarjan into becoming superintendent of Pacific.21 With improved physical facilities came approval and recognition from the larger American medical community. The hospitals in Napa and

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Sonoma in Northern California, and Patton in Southern California, for example, earned the approval of the American Medical Association for the training of resident psychiatrists.22 In-service training for nurses was available at Pacific starting in the 1950s. Pacific was also experimenting with using what it called “socio-psychological” teams in which parents, a social worker, and a psychologist worked together on behalf of the individual.23 “The people who worked in the old state hospitals, which were fundamentally asylums before the war, were essentially well-meaning, honest, diligent people. Otherwise, they didn’t stay,” Tarjan argued. “The occupation didn’t pay high enough to retain anybody for its money value. Yes, there were some people who had characterological defects and that’s why they stayed in the employment of state hospitals. But even in the old days, they were, sooner or later, weeded out. The young and the energetic left. There was an enormous turnover.” To address this, the state of California created a new civil service classification, the psychiatric technician. Additional training was required for an attendant to move into that classification. However, doing so was accompanied by an increase in salary. Shift hours were adjusted, and overtime pay improved. At Camarillo State Hospital, which had opened in 1934, some units shifted from being locked to open wards; a children’s unit was added; and geriatric individuals were assigned to hospital personnel with an interest in health care for the aged. Camarillo, Metropolitan, and Patton subsequently became sites for a three-year residency training program in psychiatry, overseen by the Council on Medical Education and Hospitals of the American Medical Association. Residents received stipends and participated in a regular weekly schedule of seminars and trainings. They spent six months of the residency affiliated with the psychiatric department and Mt. Sinai Hospital and could also choose to spend time affiliated with Atascadero to study forensic/legal medicine or at Pacific to study “the care of the mentally deficient.” After a resident had successfully completed the program and an additional two years of practice, they could take examinations for certification as qualified psychiatrists by the American Board of Psychiatry and Neurology.24 Hospitals pursued research grants, such as a $180,000 grant Camarillo received from the National Institute of Public Health to carry out a three-year study comparing different treatment methods of schizophrenics in Camarillo’s care.25 State institutions of higher learning also began to expand their medical education programs to include mental health care. The University of California, Los Angeles, in 1955 opened a general hospital that included

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an eight-bed locked psychiatric unit. Admission to the small unit was, however, tailored to meet the needs of UCLA’s teaching and research programs rather than the needs of the community. The university was also in the midst of construction on a new, 188-bed neuropsychiatric institute to be operated by the California State Department of Mental Hygiene and opening in 1961. It was intended to serve for Los Angeles many of the same functions the Langley Porter Neuropsychiatric Institute did for San Francisco, with medical staff holding joint appointments in the UCLA Medical School and the department of mental hygiene.26 To help further make up for persistent staffing shortages, the state of California in the 1950s also ran extensive volunteer programs at all its state hospitals. The county farm in Los Angeles County did the same. At state hospitals, volunteers served as assistants during special events and escorts on field trips or provided specialized instruction, such as dance lessons, as part of therapy programs. Sonoma’s volunteers were almost all parents of children in the institution. Norwalk’s volunteer program was the largest, with 881 volunteers providing over 8,360 hours of service over the two years detailed in the report.27 As part of their new modern, medicine-based approach, the department of mental hygiene worked hard to downplay any stigma attached to their institutions. “We will not talk about the ‘average’ mentally ill patient because there is none,” the biennial report for 1950–1952 argued. “There are just people who get sick.…Sometimes when people get sick, the glands beneath their jaws swell and we say they have mumps. Sometimes when people get sick they accuse their neighbors of tuning in on them with radar and we say they have paranoia—it’s as simple as that. (Until it comes to treating them!)” California’s state hospitals for the mentally and developmentally disabled were now actively encouraging individuals to admit themselves voluntarily if they felt they needed care. That provision had been in the state’s welfare code since 1911, but in Tallman’s opinion, it hadn’t been used often because the public and local mental health officials had not been educated on how to use it. However, when voluntary admissions to state hospitals went up and there was no corresponding drop in involuntary court commitments, Tallman recalled: That was something that made the politicians very unhappy and shows what a dangerous position an unwise person can get into. When services begin to improve, whether it’s in case-finding or in treatment, instead of your admission rate going down, it goes up. This is because you find more

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patients—let’s say the medical group in a community decide that your hospital is a good one and learn better how to diagnose who should be in a hospital, your rates go up instead of down…more people are found and are also willing to be sent to a mental hospital. More families are willing to commit patients to a mental hospital. More people are willing to go on their own on a volunteer basis, and more doctors, for example, are willing to advise mental hospital treatment. So I would advise anybody who wants to improve services to never claim that improving the services is going to reduce the rate of admissions; it never does. It works exactly the opposite. It’s an easy trap to get into.28

The department also expressed awareness of the criticism that was increasingly directed at institutions for the disabled both inside and outside of California. “We are coming closer to the day we can truthfully say that California’s share of the ‘shame of the states’ has vanished, to the day when we are doing everything for the victim of mental ills that science can do.” For example, although one out of seven individuals in the state hospitals had a court-appointed guardian, department staff noted that in California compared to other states, “a discharge as recovered from a state hospital is equivalent to a court order of restoration of capacity in a guardianship” without any actual court order needed. The department also fought to convince the public that the vast majority of the mentally disordered were not dangerous. “The vast majority…are withdrawn, fearful, out of contact with reality, and harmless. (This is less chance of physical violence being done to you on ninety percent of the wards in a mental hospital than there is on the streets of a city.)” To downplay the stigma attached to mental disability, in 1947, Section 5040 of the state’s Welfare and Institutions Code was amended to eliminate the use of the word “insane” in any civil commitment hearing. Public outreach and education became a substantial part of the department’s job. Clinic workers in the 1950s spent an estimated 17.5% of their time on community activities not directly related to patient caseload, the department reported, and the staff of the state hospitals spent an estimated 6,100 hours every year speaking to community groups, giving public lectures, etc.29 Perhaps most importantly, Californians once again seemed to care about the mental health of their fellow residents. There were at least thirty mental hygiene societies in the state; organizations ranging from the PTA to the Federation of Women’s Clubs had mental hygiene committees and study groups; and some county and city governments were even offering their own services.30

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A major reorganization of the department’s bureaucracy also occurred between 1950 and 1952. To make communication easier and to clarify and define responsibilities, the department of mental hygiene now had four main components under the superintendent and medical director at every institution under its control. The director of clinical services handled both inpatient and outpatient treatment, oversaw any research being conducted, and supervised any training programs for nurses or psychiatric technicians held at the site. Next, an assistant superintendent (medical) oversaw all forms of therapies and became acting superintendent in the superintendent’s absence. A business manager oversaw the finances of the institution, including farm and livestock operations for hospitals that still had them. Last, an administrative secretary oversaw personnel and payroll and handled all the clerical duties.31 Recognizing that some overlap in function between the many state agencies now existed, California also created in 1951 a State Mental Health Coordinating Committee to encourage and support collaboration between the departments of mental hygiene, education, public health, social welfare, youth authority, recreation, and corrections on matters relating to mental health. As departments were not used to working collaboratively on a single issue, the creation of this committee was evidently something of a feat in and of itself. One of the coordinating committee’s first acts was to assemble a pamphlet wherein each department could explain to the others what they did and how they might contribute to overall mental health in the state.32 Although the next decade did indeed see a boom in hospital construction, expanding the state’s networks of outpatient clinics emerged as a second focus of energy and attention, continuing the two-pronged approach that had tentatively begun in the 1930s and 1940s. The two issues were in fact linked to some degree: as waiting lists for admission to a state hospital kept getting longer and longer (more than 30,000 individuals were waiting for admission to either Pacific or Sonoma in 1950–1952), other kinds of interventions were needed. The California State Legislature added Atascadero State Hospital to the state hospital system in 1954. It was specifically for men identified as mentally disabled who had been sentenced to a psychiatric facility by the California courts. Porterville State Hospital and Fairview State Hospital, both for the developmentally disabled, opened in Porterville in 1953 and Costa Mesa in 1954, respectively. Two information centers that also provided diagnostic and preadmission services for those two institutions were established in

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San Francisco and Los Angeles. California also added to its network of outpatient clinics providing psychiatric and preventative services. By the end of 1952, there were seven: the Berkeley Mental Hygiene Clinic in Berkeley; the Los Angeles Mental Hygiene Clinic in Los Angeles; the San Diego Mental Hygiene Clinic in San Diego; the Sacramento Mental Hygiene Clinic in Sacramento; the Fresno Mental Hygiene Clinic in Fresno; the Riverside Mental Hygiene Clinic in Riverside; and the State Mental Hygiene Clinic that traveled between Chico, Marysville, and Redding before fixing on Chico as its permanent home. For Eureka, where staff could not be found to open a clinic, a traveling clinic was put together at Sonoma that regularly serviced the area. Camarillo performed a similar function for the city of Oxnard, as did Pacific for the Pomona Valley. A second neuropsychiatric institute was also added to the system in 1961, located at UCLA and thus serving Southern California as Langley Porter did Northern California.33 California was not alone in seeing a possible path forward in outpatient treatment: similar discussions were taking place all over the United States in the postwar era. After all, since the founding of the first outpatient clinics in the 1940s, the unwritten assumption underpinning them had been that facilities would simultaneously be able to keep individuals from ending up in state hospital systems and keep them in their communities. In 1957, researchers from the California’s department of mental hygiene decided to explore that idea. They quickly discovered that there was no way to study a hypothetical (i.e., would someone have been admitted to a clinic instead of a hospital?). Instead, they decided to test “whether clinics can provide a more effective and more economic treatment disposition for certain hospital admissions.” They assembled a relatively small pilot study of admissions to three California state mental hospitals and two state community clinics, all in the Bay Area. Their preliminary conclusion was no. According to their findings, mental health hospitals and outpatient psychiatric clinics in the state “have distinctive and, at least, occasionally, supplementary rather than identical and competing functions in the care of the mentally ill.” Indeed, they concluded, the issue was not that one should supplant the other, but that communications between the two needed to be streamlined into “integrated treatment when transferring from inpatient to outpatient status, and vice versa.” The greatest value of outpatient treatment was that clinics were needed to treat psychiatric illness in its early stages, before it had progressed far enough that hospitalization might be required. By the time an individual had reached

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a hospital, “outpatient psychotherapy by itself is not ordinarily enough, since the problem has become one of rehabilitation rather than simply of treatment.” The researchers also suggested further development of intermediate steps between the clinic and the hospital, such as the day hospital, night hospital, and halfway house. Available intermediate steps, they hoped, would fill that gap in psychiatric services without expecting someone already in crisis to figure out how to do that on their own. Although the two systems were increasingly parallel, they both needed the energy, attention, and funding from the state legislature to continue. As Dr. Tallman himself had put it in an address in 1949, “it is a fallacy to believe that a state is on the right road because it runs a few good mental hygiene clinics, if at the same time it operates a few bad mental health hospitals. Remember, it is in the mental hospital that the most seriously ill are sent for treatment and if it is inadequate the State finds itself in the embarrassing and disgraceful position of preaching one thing and being forced to practice another.”34 For its part, Rancho Los Amigos in 1949 still housed more than 500 individuals in what had been renamed its “Mental Hygiene Wards.” Patients were placed there by the mental health department of the superior court and assigned their own parole officer. Rancho Los Amigos was, however, quickly transitioning to a specialized facility for individuals recovering from polio and those with long-term chronic illnesses. In 1955, the Los Angeles Board of Supervisors approved renaming it Rancho Los Amigos Hospital. As Colleen Fliedner explains, “beginning in 1957, informal court proceedings were held in the mental health buildings to determine the mental competency of each patient. Some of the patients were found to be mentally stable and were transferred to private convalescent homes, county-funded board and care homes, or into the long-term care wards at Rancho.” “For many of those remaining after the wards were unlocked, it was a strange experience,” she notes. “They had been in the closed ward for such a long time that they had difficulty grasping the concept of being able to leave the building. Many sat in their chairs, looking dolefully out the open doors and windows, afraid to step outside.” Individuals who had been adjudged insane were sent to state hospitals for the mentally ill. By the end of the 1950s, Los Angeles County was thus out of the business of providing long-term care for mentally disabled individuals, instead shifting that responsibility back to the state of California.35

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One legacy of California’s nineteenth-century asylums that continued well into the middle of the twentieth century was agricultural production. Four thousand acres of land were being cultivated across the system. Nine hospitals grew some or all the fruits and vegetables they needed, and six had canneries that together produced roughly 500,000 gallons of canned produce a year. Milk, pork, eggs, and poultry raised on-site fed many of the hospitals. Surplus was sent to other institutions or, if shipping wasn’t possible, sold. In fact, agricultural production was one of the only parts of the state hospitals on which California earned rather than lost money, and this was despite having to hire paid employees in addition to the individuals in the hospitals doing the work. As with farm labor, individuals in the hospitals also formed a large part of the labor force doing laundry. In both cases, this was classified as “industrial therapy.”36 The State of California Department of Mental Hygiene Biennial Report for 1950–1952 was created primarily as a public relations document. But it is worth looking at in some detail to understand how bureaucracy explained and justified what it did and why to itself, to legislators, and to voters. One of the most notable shifts in the state hospital system as it moved into the 1950s that’s reflected in this report is its renewed interest in research. Nationally, there had been some research done in asylums when superintendents were able to secure the research funding and equipment.37 Medical research had never been a major part of California’s state hospitals, largely because their focus was mainly custodial. Superintendents were often focused on more prosaic issues, such as overcrowding and whether the annual state appropriation would be sufficient to cover the institution’s bills. In the post-World War II world, however, allowing hospitals to carry out robust research agendas became a way to claim legitimacy in a changing medical world and to attract young, ambitious medical personnel. California’s state hospitals for the mentally and developmentally disabled used research to distance themselves from their dark pasts. They were no longer asylums like in the bad old days, their statistical reports seem to declare. They were modern research hospitals. This also explains why, in 1953, the word “home” was at last dropped from the names of the two state institutions for the developmentally disabled. The Sonoma State Home became Sonoma State Hospital, and Pacific became Pacific State Hospital.38 In this endeavor, doctors were assisted by the department of mental hygiene’s new research division, also known as its statistical research

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bureau. In fact, the postwar department was seemingly obsessed with collecting and reporting statistics. Statistical data tells us nothing, of course, about the humanity behind the numbers, about the lived experiences of the individuals within the system. But they did provide the department with a way to highlight, compare, and contrast its work with other similar institutions elsewhere and to justify its continued existence to an increasingly budget-conscious state legislature. Before delving into what the midcentury research agenda in California state hospitals looked like, we must pause here again and consider the issue of consent. Throughout America in the nineteenth and twentieth centuries, institutions—asylums, hospitals, prisons, orphanages— were popular sources for research subjects. Undoubtably, many such experiments were done without the individual’s knowledge. Others may have assumed it was part of some larger treatment objective. Others still may have feared that refusing a procedure would get them labeled “noncompliant,” which inevitably made life inside an institution far more difficult. Physicians openly acknowledged the need for such large, easily accessible groups of individuals to study. They worried more about the difficulties inherent in using them than with the ethics of their actions. Children and individuals with mental disabilities, they lamented, could not always be relied upon to complacently provide samples of blood, saliva, or tissue. Small children and infants in institutions, on the other hand, only needed to be restrained for however long a given procedure might take. Permission from the institutional director or chief medical officer was all that was needed, and it was not unusual for published studies to thank such individuals by name for providing access. Until the early twentieth century, it was rare for physicians to bother getting the permission of parents and guardians.39 There were in fact limits to what doctors could get away with, even before World War II. “At no time were American investigators free to do whatever they pleased with their human subjects,” Susan E. Lederer explains. “Neither their peers nor the public would have stood for reckless experimentation that endangered human lives. Thus, many researchers expressed their apprehension about risking patient welfare in tests of new drugs and procedures, mindful of the difficulties—professional and legal—that could arise if a patient were seriously injured.”40 Fearing a loss of public support, by the 1920s and 1930s, many researchers “insisted that consent (or parental permission) and avoidance of risk were essential conditions of ethical human

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experimentation. The failure of some investigators to meet these conditions created problems, but defenders of medical research maintained that abuse was rare.”41 As Eileen Welsome argues, the idea that human subject researchers in the mid-twentieth century could act with impunity because there was nothing preventing them from doing so is wrongheaded, to say the least: there were still the Hippocratic Oath, the American Medical Association’s 1946 guidelines, and the 1947 Nuremberg Code. Some researchers still proceeded with experiments without informing individuals of the risks and benefits and, sometimes, without informing them they were part of an experiment at all. Welsome attributes this to the outsized respect most Americans had for the medical profession in this era. “The 1940s, 1950s, and 1960s were decades when doctors were treated liked gods,” she writes, “and patients like children.”42 California’s new “research” orientation came largely at the expense of the Californians living in institutions. The medical and social interventions the department of mental hygiene offered became ever more intrusive, both to an individual’s body and to their personhood and autonomy. Individual voices from disabled Californians in this era often became even harder to hear because they were now buried under reams of statistical data. Behind the veneer of science, institutionalization still served the function of maintaining social order. As Edward Shorter puts it, “the apparently scientific language of the clinic and the laboratory became a screen behind which undesirables could be whisked away.”43 Nonetheless, with a clear goal of reinventing themselves as rehabilitative rather than custodial institutions, the department of mental hygiene turned to research. Tarjan argued that most American psychiatrists of this era were either analysts; “hardcore biological psychiatrists, who were primarily committed to somatic treatments…electric shock and insulin”; or “eclectic psychiatrists, who said we embrace the good from both sides and omit the bad from either side.” Tarjan himself identified as eclectic, and judging from the Biennial Report, most of the other doctors in California’s state hospital system were either eclectic or biological psychiatrists.44 At Stockton, the oldest of all the asylums, they launched the Stockton Pilot Study, which ran between 1950 and 1951. The study was Dr. Frank Tallman’s brainchild. He wanted, he later said, “to establish the principle that the legislature should provide money for research for the Department of Mental Hygiene, and at the same time I wanted a research project that would demonstrate that increased staff would produce an accelerated

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discharge rate.” He was determined to prove to the legislature that “it was cheaper to have a well-staffed institution and get your patients treated and get them back into the community, than it is to keep building buildings and warehousing patients—even through a relatively well-staffed warehouse.” The focus was thus on what the department called “back ward patients,” individuals who had failed so far to respond to treatment and who seemed doomed to haunt the more isolated parts of the institution. Staffing increased dramatically to provide around-the-clock care for them. It was a “total push”: “every kind of therapy known to be efficient in the treatment of mental diseases” was on the table for the 200 men carefully selected to participate based on diagnosis, prognosis, and other variables. What consent, if any, these men gave to their participation is not known. Most had been diagnosed as schizophrenic, and half of them had already been in the institution for more than ten years. At the end of the study, the director reported a marked improvement in all the men in the study, some of whom were, for the first time, able to regularly leave Stockton for days out and visits with family. The study had, however, added an additional $1,048 per person per year to the care of these individuals, for a total of $1,966 per person per year instead of the usual $918. The department immediately recognized that getting an appropriation that would cover that kind of cost for every individual in its institutions was unlikely, to put it mildly. It nonetheless hoped to build on what it saw as the nonmonetary takeaways from the study: the value of teamwork and “correct attitude in nurses; the importance of groups therapies; and the critical role forging and developing social connections played even for individuals who had been institutionalized for a long time. ‘There are no ‘hopeless’ mental patients where no organic damage exists,’” their annual report cheered. A similar study was conducted the following year at Pacific on developmentally disabled children, who also improved when more staff was hired to provide more care, more attention, and more individualized therapies. Dr. George Tarjan recognized that most psychiatric residents had received no real education in what was now being called “mental retardation.” He used the training programs he was creating at Pacific to emphasize the commonalities between psychiatry for mental retardation and child psychiatry because, in his words, “they were equally, essentially, very dependent people.”45 For the men, women, and children in these institutions, things were changing, but not quickly enough. In the early 1950s, the department of mental hygiene at least did away with the terms “escaped” and “escapee”

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in recognition that one couldn’t rightly “escape” from a hospital (unless, of course, it was from a locked ward). The department was, they admitted, deliberately trying to create distance between the ideas of “patient” and “prisoner.” “Unauthorized absence” was chosen as the new term.46 Ending, or at least minimizing, the use of restraints was also a work in progress. The department had advanced far enough by the mid-1950s to recognize that the use of physical restraints correlated with poor staff training and an overall lack of personnel, and those in turn helped create exactly the sort of abuse Edward Bunker later recounted in his memoir. The department of mental hygiene attacked the problem from two angles. The first was through policy. In August 1950, a policy letter was sent from the department to all the institutions. It read, “It is the policy of this department to reduce the amount of restraint and seclusion to an absolute minimum. It is our belief that restraint other than to prevent helpless patients from falling out of bed and chairs can be with rare exceptions eliminated.” The other was through creating paper trails. Every state hospital now had to report the total number of individuals held in restraint each month and the total number of hours per individual. Any use of physical restraint required a signed order from the physician. Whether these paper trails had any significant impact is not known.47 Due to persistent budget and staff shortages, treatment options remained limited at institutions for the mentally and developmentally disabled in California. On the less invasive side, individual psychotherapy was the treatment of first choice, but also the one most often limited due to staff shortages. Instead, many hospitals were using group therapy, which not only allowed them to treat more patients at a time but could also be led by a trained individual who wasn’t a psychiatrist or psychologist. At Langley Porter, relatives also often participated in their own therapy groups, such as one for the parents of adolescents being treated at the clinic. Psychodrama, which allowed individuals to act out assigned roles, was also used. For developmentally disabled Californians, Pacific offered interview-type psychotherapy, play therapy, speech therapy, and group therapy. Sonoma in the early 1950s was only able to provide psychotherapy to “mildly retarded patients” but hoped to expand their program in the future. Physiotherapy, which had been used since the nineteenth century, continued. Hydrotherapy (packs, special baths, electric light cabinet); mechanotherapy (massage; passive and active exercises; gait training); and light therapy (ultraviolent and infrared) were also available.

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Routine medical and dental services were also provided, as were occupational, music, and recreational therapies. Most of the institutions now had circulating libraries and televisions in the common rooms. Patton, Sonoma, and Pacific all also had beauty parlors. Professional beauticians from the surrounding communities staffed them, but individuals who had shown interest in such work served as assistants. For the department of mental hygiene, the beauty parlors served double duty as both recreational therapy and vocational therapy.48 At the same time, advances in surgical techniques and technology made aggressive, invasive procedures to “treat” mental disabilities possible for the first time. Staffing and budget shortages may also have driven this shift, as psychosurgery presented doctors with an additional way to get patients treated and released relatively quickly. In the early 1950s, the most commonly used such treatment in California state hospitals after psychotherapy was electroshock (now more correctly called ECT). Chillingly, the department admitted that while it did not understand the “exact mechanism” by which ECT worked, “the effectiveness of electroshock treatment is undisputed.” In their annual report for 1950– 1952, they reported that 136,624 treatments had been used on 9,302 patients in that two-year period. Among the hospitals for the mentally disabled, the most frequent use was at Agnews, while the least use was at Mendocino, a difference that the department attributed to different populations and diagnosis rather than policy differences. “Napa has found,” the same report said, “that the use of occasional electroshock treatment in disturbed, chronically ill patients has been a satisfactory means of improving behavior on large wards.” Pacific and Sonoma also used electroshock in 1951–1952, Pacific on sixteen people and Sonoma on eighteen, with most individuals being treated multiple times. Sonoma also conducted a study as to whether electroshock was effective in “carefully selected cases” of developmental disability. In the institutions for the mentally disabled, electronarcosis and insulin shock therapy were also used, although much less frequently. Insulin therapy had been introduced in California state hospitals in part by Dr. Jacob P. Frostig, who had pioneered its use to treat mental disabilities in pre-World War II Poland. He helped set up the first two insulin therapy units in the state during the 1930s, at Camarillo and at Stockton. A full course of treatment using insulin could last up to two years. “Insulin therapy is, in many ways, the most desirable form of shock therapy,” said the 1951–1952 report, “but the drug is expensive and the techniques involve the use of more

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personnel than does electroshock.” Insulin shock therapy was therefore reserved for “the more disturbed patients.”49 Lobotomies (surgical, procaine injection, and/or saline injection) were used at the hospitals for the mentally ill. Two hundred and fifty-seven Californians were lobotomized by the state in fiscal years 1951–1952 alone. However, the department of mental hygiene had qualms about its use. For one thing, its efficacy was extremely difficult to judge or to quantify—and this new and improved department was all about quantification. It was generally used only when all other treatments had failed. At Agnews, for example, the average individual subjected to a lobotomy had already been in the institution for nine years. Thus, “it is virtually impossible to evaluate the success of this surgical technique because ‘success’ must be considered in comparison with what were in almost every case complete treatment failures of long standing before the operations,” they explained. According to the 1950–1952 biennial report, the Langley Porter Clinic was carrying out active studies of the procedure.50 Release took on renewed emphasis in the years after World War II as well. Outright discharge remained rare, and the department of mental hygiene wanted to carefully track and provide aftercare for all individuals who departed from its institutions. Careful tracking was of course an integral part of preventing social disorder. Discharges also made it extremely difficult to return someone to an institution. Instead, most Californians who left institutions did so on leave and thus with a great deal of planning and preparation going into each individual case. By 1950, there were three options for leave from a state institution. An individual who returned to their family or who left to live independently was on “home leave.” In a “work placement,” a department social worker would locate a “carefully approved” place of employment that provided the individual with wages, maintenance, and “24-hour supervision.” The newest option of the three, “family care,” allowed for “carefully selected and supervised homes” to “provide a family atmosphere for one to six patients.”51 By the 1950s, attitudes about individuals with epilepsy had also changed dramatically. Historically, Californians with epilepsy had been treated like the mentally and developmentally disabled and placed in the same institutions. As discussed, they were not always welcome there and were often kept segregated from others, particularly at the Sonoma State Home. The opening of Porterville State Hospital in 1954 solved this for the most part, as most of the individuals with epilepsy at Sonoma were now transferred to Porterville. State laws around care for individuals

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with epilepsy changed in 1951. Those in need of hospital care were now directed exclusively to the state hospitals for the mentally ill rather than hospitals for the developmentally disabled. The state legislature’s logic was that the hospitals for the mentally ill were more likely to have the treatment equipment needed. Even then, stays were expected to be brief in all but the most extreme cases. Most importantly of all, the department of mental hygiene now questioned whether these Californians needed institutionalization at all. They admitted that uncontrolled epilepsy could sometimes cause “intellectual deterioration” and that it was sometimes associated with other developmental disabilities, if it wasn’t, then in their view there was no reason to even consider commitment to an institution. “The epileptic patient should be cared for in the community,” the department said firmly, “and treated by his family physician.”52 At the two hospitals for the developmentally disabled, and at Sonoma in particular, the department of mental hygiene was increasingly focused on medicine and surgery rather than on custodial care. Over the course of the 1950s, as those individuals who could be shifted to communitybased outpatient care were paroled or released, the two state hospitals admitted individuals who were younger, more seriously disabled, and more likely to require long-term care. This population change led to a corresponding shift in how these institutions operated. More doctors and nurses were needed, and the “goals” of rehabilitation were often lowered. When Sonoma had first been created in the 1880s, the vision was for “academic education, industrial training, and social rehabilitation.” Now, for some severely disabled individuals, it was just “basic self-care.”53 Pacific State Hospital received government funds to develop a new research center at the site. In 1962, John Kennedy assembled the President’s Panel on Mental Retardation and later appointed George Tarjan Vice Chair of the first National Panel on Retardation. Tarjan had been working for years to convince the Joseph P. Kennedy, Jr., Foundation to focus on mental retardation. The Kennedy administration also saw the passage of the Mental Retardation Facilities and Community Mental Health Care Construction Act of 1963. In 1964, the George Tarjan Research Center for Mental Retardation opened at Pacific, the first research building in the nation on the grounds of a hospital for the intellectually and developmentally disabled. It collaborated with UCLA, the University of California, Riverside, and the University of California, Irvine, on research projects and won over $13 million in research

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grants in its first year alone. The center was later folded into UCLA’s neuropsychiatric institute.54 In August 1965, Tarjan left Pacific to take a job as the director of the new mental retardation unit at UCLA.55 Pacific State Hospital’s population had peaked in 1962 with 3,058 individuals living in the institution. It also had 1,450 employees and about 2,000 volunteers.56 But Tarjan remained optimistic. “We can make hospitals for the retarded obsolete in the next two decades,” Tarjan vowed.”57 There appears to have been some openness in the California State Legislature to at least consider reform. In 1959, for example, a proposed California constitutional amendment came before the state legislature called the “Mental Health Bill of Rights.” It proposed to make commitment possible only through a jury trial. The main objections to the proposed amendment were threefold: (1) costs (it was estimated it would cost an addition $600,000 per year in Los Angeles County alone); (2) necessity, as the number of commitments in the state was already trending downward in many counties; and (3) historical, as it would dismantle the decades of work California’s doctors and jurists had put into making commitment largely a medical, not a legal, procedure. It ultimately went nowhere.58 California continued to express anxiety about substance abuse in the state and particularly about alcohol abuse. “California has been called the most alcoholized [sic] state in the nation and San Francisco and Los Angeles have the greatest number of arrests per capita from intoxication of any large cities (except Seattle),” the department noted. Their nowdecades’ worth of collected statistical data on alcohol abuse had revealed one key feature, though: that the vast majority of arrests for drug abuse were repeat arrests of the same individuals, not of new addicts. California thus no longer sought to treat narcotic and alcohol addiction in separate hospitals, arguing instead that severe cases could be handled in state mental hospitals provided the existing space limitations could be overcome. Instead of the months-long stays of the 1920s, physicians now advised short stays with proper treatment for addictions. “Proper treatment” in the early 1950s consisted primarily of vitamin therapy and food to build back an individual’s strength as well as group psychotherapy and occupational and industrial therapy. All the state hospitals save Modesto (which did not admit individuals with addictions) worked with and hosted regular meetings of Alcoholics Anonymous. If the individual requested it, Antabuse could also be used as a treatment aid. But the department

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of mental hygiene was fatalistic about this group of Californians. Most didn’t really belong in state hospitals, they argued, but most couldn’t afford private hospitals, and most county hospitals wouldn’t take them. “The scattered few local facilities specifically for alcoholics are woefully inadequate to the problem, and overnight jail or emergency treatment does absolutely no good. The ‘iron cure,’ the ‘swinging door system of constant arrest and re-arrest seem to be still the only answer offered to most alcoholics in California, and the tremendous financial cost continue to mount.”59 Elderly Californians who had nowhere else to go, and particularly those who were showing signs of dementia or other age-related declines in health, had for decades also been shuffled into state hospitals and asylums. In 1940, individuals sixty-five years old or older made up 18% of the state hospital population. By 1959, they made up 31%, even though only 8% of California’s overall population was sixty-five or older. Everyone understood that what elderly Californians needed was “good food, adequate supervision, and freedom from anxiety,” not psychiatric care. But there were very few other places they could go. In 1951, the Governor’s Conference on Care and Treatment of Senile Patients met in Sacramento to discuss the issue. Not only did the elderly with dementia end up separated from their communities, the conference discussed, but they, too, were putting pressure on the straining state hospital system. The counties seemed a better solution for delivering care to these needy Californians, it concluded. A bill appropriating $1 million to provide matching grants to counties that set up appropriate facilities for the care of the “nonpsychotic senile” was introduced in the state legislature later that year, but it also went nowhere. The aging population already inside state hospitals was a related concern. A joint project of the National Institute of Mental Health and Department of Mental Hygiene launched in 1962 at DeWitt State Hospital. Although the study was small, it was able to conclude that it would be both impossible and a “disservice” to the elderly at DeWitt to simply return them to the community. Half of them would perhaps do well in a nonpsychiatric custodial care facility, particularly a familytype setting that would help these individuals reengage with the world around them. The study leaders, however, expressed skepticism that most California counties had facilities up to the financial and staffing challenge that would pose. On top of that was the stigma that came with having been institutionalized. Many of the DeWitt individuals had been diagnosed with chronic brain and psychotic disorders. Community centers

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often refused to accept individuals with those diagnoses. “A problem facing society is to devise a way of rendering structure services to elderly patients in a manner which will meet their needs,” the report concluded, “and minimize their dependency and loss of personal identity.”60 Indeed, the state of California was increasingly looking to the counties to carry their share of the load, metaphorically speaking. “Too many of the counties of California rely too much on the State and fail to provide the proper clinics and county psychiatric wards for the early recognition and treatment that would do so much to cut the terrible told of the mental illnesses,” the department of mental hygiene complained. After all, “what hospital can truly be called a ‘general’ hospital that fails to provide a ward for treatment of the illnesses that fill half the hospital beds in the United States? We believe it an important part of our job to stimulate the development of such community mental health resources as much as is possible.”61 Concerns over rising costs and how the state was going to fulfill the seemingly endless demand for more hospital beds also plagued the state’s elected politicians. Between 1955 and 1957, the California State Senate adopted a series of resolutions (No. 148 [1955]; No. 20 [1956]; and No. 160 [1957]) calling for ongoing investigations of the operation of state facilities that treated the mentally disordered. A Senate Interim Committee on the Treatment of Mental Illness assembled, charged with collecting as much information as possible and then reporting back to the state legislature. Senator Alan Short (DSan Francisco) became chairman, with Nathan F. Coombs (R-Napa) as his vice-chair. Other senators rotated on and off the interim committee as needed.62 For Californians leaving state institutions, access to ongoing rehabilitation treatment was problematic at best. Within the state hospitals, dedicated rehabilitation departments provided occupational, recreational, music, and industrial or work therapy. Social service departments were also created to ease the transition back home. However, only an individual on indefinite leave was entitled to continued rehabilitative therapy outside the hospital, and “the evidence strongly suggests an ever greater reservoir of other patients directly discharged by these same hospitals and by many other types of psychiatric institutions, who are abroad in the county and whose rehabilitation is nobody’s special responsibility.”63 By the mid-1950s, a medical revolution was underway thanks to new drugs. Valium had been discovered during World War II and had proved useful in treating individuals with post-traumatic stress disorder (PTSD).

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The antibiotic streptomycin became available in 1946 and proved the best tool available thus far to treat and even cure tuberculosis. Drug treatments were available for epilepsy and syphilis. Psychotropic drugs were also coming onto the market, and the California State Senate was being barraged by questions about whether the new psychiatric drugs chlorpromazine and reserpine could be used to treat this or that patient or condition. Others asked if such drugs were already being used in state hospitals, and, if so, why and how. Unable to satisfactorily answer that question, the senate concluded that it was time for a new statewide survey on mental illness. The three-man committee selected consisted of Assemblyman Alan Short (D-San Francisco) as chairman, Nathan F. Coombs (R-Napa) as vice-chair, and George Miller Jr. (D-Contra Costa).64 Up until that point, the use of pharmaceutical interventions in state institutions had been limited largely to the administration of insulin to schizophrenics (a practice already rarely used due to the risk to the patient) and of Metrazol, which was used as a chemical substitute for electroconvulsive therapy (or electroshock therapy, as it was called at the time). California’s state hospitals had started using electroconvulsive therapy in roughly 1940. During the committee hearings, Dr. Walter Rappaport, then-head of the department of mental hygiene, testified that none of the state hospitals used insulin shock anymore, but that the Langley Porter Institute still might, for research purposes only. Surgical interventions had also been used. In his testimony before the committee, Dr. Olliver of the Napa State Hospital said that Napa had first performed a lobotomy there in 1951. He calculated that they had performed roughly 300 of the procedures at Napa alone, either by bringing in a consultant neurosurgeon or by sending the patient to the Langley Porter Clinic. “We reserved this operation as a last resort when everything else had been tried and failed,” he explained. “The operation does produce certain damage to the personality and psychiatrists in general are pretty uncomfortable about this…lobotomy, I am sure I am safe in saying has passed its peak of usefulness….We have done almost none at Napa in the last two years.”65 The Veteran’s Administration was already studying the efficacy of chlorpromazine (best known by one of its trade names, Thorazine) and reserpine (Serpasil). Doctors at Modesto and DeWitt state hospitals and at the Langley Porter Clinic were already using these drugs and publishing their research findings, and a small additional appropriation had already been made in the state budget for the purchase of the new drugs. However, one of the committee’s first suggestions was that the department of mental

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hygiene conduct a larger, comprehensive study more along the lines of what the VA was doing.66 In fiscal year July 1, 1956, to June 30, 1957, California’s thirteen state hospitals housed 48,188 individuals, a number that did not include individuals currently on leave. The state’s seven outpatient clinics were treating an additional two to three thousand. Costs were high: the committee found California was second only to Michigan in expenditures per patient per year ($1176). Cost, the committee admitted, was in some ways at the heart of the discussion. “We feel that the public and the legislature can expect that each person charged with the responsibility of expending public funds will carry on a continuing and intensive analysis to determine whether or not the particular program concerned is producing the best possible result,” they explained. “In a program of such great cost and importance to the health and welfare of the State as is that of the Department of Mental Hygiene this obligation is exceptionally great.”67 Dr. Rapaport had already appointed his own “Committee on Tranquilizing Drug Report” in October 1955 that had called for a much larger appropriation for larger amounts of drugs and research personnel. “It is our opinion that the failure of the Department of Mental Hygiene to adequately prepare for and carry out research on the so-called tranquilizing drugs is a good example of the need for competent research direction in the department.” When he appeared before the committee, Rapaport was grilled as to why California was not using the new drugs as extensively as other states were. “I take the full responsibility for it,” he admitted, “because it is my opinion, right or wrong, that we are not yet in the position where we can expend recklessly or extravagantly going for these new drugs….I am not going to criticize somebody else for what they do. I can only do what my conscience dictates I should do.” He openly expressed skepticism about some of the spectacular results other studies of the drugs seemed to be producing. “I am not prepared to say that it is causing 40-50-60-or 82 percent as I saw in one document—one journal—of remissions and cures, because it just doesn’t make sense—they wouldn’t have any hospitals in those states—wouldn’t have any need for them.” Once the drugs “prove up,” he explained, he would be more than open to a much more widespread use in California. Dr. Leo Hollister of the Veteran’s Administration hospital in Palo Alto also testified. He explicitly cautioned the committee not to expect any direct cost savings should California widely adopt the use of psychiatric drugs in its institutions. “We

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use our tub rooms less. We use electroconvulsive therapies less. We use lobotomy less,” he admitted. “Our social service department, however, is working harder trying to find places for people to go. We need more people to talk to the patents who are now able to communicate for the first time so that where you make a gain economically in one direction, you may lose it in the other simply because you are obliged to take more responsibilities for the patients and do more for them.”68 Dr. Olliver from Napa also warned the committee about the potential dangers of the drugs. These things are not without danger and particularly chlorpromazine. Now, we have had a couple of deaths here in the hospital. We have been a little suspicious that the patient actually died of pneumonia. The question of whether the lessening of muscular activity in general seemed to contribute to this, but you can’t prove it one way or the other, but we are suspicious about it. Now another thing, you have heard a lot about tranquilization, and everybody assumed apparently that this is a wonderful thing to tranquilize, everybody, now there are people who don’t need to be tranquilized. I’d like to give you a couple of examples. One of our doctors who is running a group therapy project and two or three patients in the group who were terribly overactive, who were disrupting the whole group. They were participating all right, but he puts them on reserpine and they became tranquil and they got a silly grin on their face and they sat around in the group and didn’t participate at all. Now, this isn’t getting them any place.

“Could it be an overdosage in that particular instance?” Senator Short asked. “No,” Dr, Olliver responded. “It was a relatively small dosage and so we are not certain, I mean, is it psychiatrically good to tranquilize everybody? I am not positive about this thing.”69 The committee also collected written reports from all thirteen state hospitals about whether their existing budgets for psychiatric drugs were enough and whether they had collected any feedback or complaints about their use from families or staff. The responses hold varying levels of detail depending on the institution. Most reported limited use of drugs and thus no immediate need for more funds, as well as a cautious willingness to continue and possibly even expand drug use if their efficacy were proven. Dr. F. H. Garrett, superintendent and medical director of Camarillo State Hospital, wrote that not only had he received no complaints “from relatives” about the use of drugs, he was in fact getting numerous requests

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from them that additional individuals in the facility be given a trial of the new drugs. “We have been successful in explaining to the relatives that the drugs are not indicated in every individual case,” he reported, “or else we managed to place the patients on treatment.” Some relatives had refused to accept the hospital’s advice and “insisted upon sending the drugs to the hospital at their own expense.” The only other complaints had come from staff members who found that individuals who had been treated with a course of the drugs and then taken off them “had begun to slip back and require more care and supervision.”70 Administrators at the three hospitals focused solely on the developmentally disabled (Pacific, Porterville, and Sonoma) expressed concern. Dr. James T. Shelton, head of Porterville State Hospital, wrote that “there is insufficient knowledge at this point of studies indicating what kinds of mentally retarded patients and what kinds of behavior problems are most affected by the tranquilizing drugs. We are accumulating some knowledge of this as we go along,” he admitted, “as well as other hospitals in the country are doing. We have found the tranquilizing drugs of very effective use at our hospital, and yet they are no panacea for all kinds of problems.”71 The introduction of drugs thus did not have any immediate impact on the number of Californians released from state institutions.72 As the 1950s gave way to the 1960s, it was becoming clear change was on the horizon for Los Angeles County. It decided to take stock of where things stood; where it saw room for improvement; and what longterm trends it might forecast. In a study by the Welfare Planning Council of the Los Angeles Region, every element of the county’s mental healthcare system was scrutinized. The subsequently published report is worth studying in detail because it is, in retrospect, a snapshot of a key moment of transition for health care for Californians with mental and developmental disabilities. In Los Angeles County, at least, and with hardly anyone taking notice, the shift away from state hospitals had already begun. Over the course of a single year, Los Angeles’ private and public psychiatric hospitals and custodial institutions admitted more than 25,000 individuals, with the largest number, 8,600, ending up at Los Angeles County’s Psychiatric Hospital. Of those 8,600, about 3,000 were ultimately released, and 5,500 were transferred to another institution, such as a state hospital or a private sanitarium.73 By the late 1950s, the county had three general hospitals: Los Angeles County General Hospital, Harbor General Hospital, and John Wesley County Hospital. It also had

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three special hospitals. Olive View Sanatorium was reserved for individuals with tuberculosis. Rancho Los Amigos housed individuals needing long-term care other than those with psychiatric illnesses or tuberculosis, while Long Beach General Hospital cared for individuals with tuberculosis and geriatric individuals. Los Angeles County General, already one of the largest hospitals in the country with 3,579 beds in 1959, also housed the Los Angeles County Psychiatric Hospital. Occupying its own building on the hospital grounds, the psychiatric hospital was nonetheless able to draw on the staff expertise and resources of the general hospital. The building also housed department 95 of the Los Angeles County Superior Court, which oversaw psychiatric hearings and noncriminal commitments. Unlike the unit at UCLA, the psychiatric hospital served any resident of Los Angeles County experiencing a psychiatric emergency. It also provided diagnostic and referral services. Only individuals who could prove they had been resident in Los Angeles County for at least one year, resident in California for at least three years, and had no resources to pay for private care could be treated there, and even then, only for ninety days. After that, if additional treatment was needed, the individual was shifted to a state hospital. Psychotic disorders, schizophrenia, chronic alcoholism (which was not treated on-site; cases were referred to a state hospital), and senility were the top causes of admission in 1957–1958. Six additional smaller hospitals in the region had psychiatric inpatient departments: Methodist Hospital of Southern California in Arcadia; Mount Sinai Hospital; Queen of Angels Hospital; St. Vincent’s Hospital; St. John’s Hospital in Santa Monica; and White Memorial.74 Public hospitals without inpatient psychiatric services reported still being pressed to provide psychiatric care to their communities. On questionnaires and in telephone interviews, staff at those hospitals discussed the situation candidly. An interviewee at Torrance Memorial Hospital explained that “the small community hospital is faced with a problem in attempting to care for psychiatric patients both from the standpoint of community prejudices and the adequate staffing by trained psychiatric workers.” Hospitals in the San Fernando Valley lamented the “complete lack of psychiatric facilities” there, while the Children’s Hospital pointed out the shortage of facilities for treating children with emotional disturbances.75 As of 1952, Los Angeles, Long Beach, Pasadena, Beverly Hills, and Vernon were the only cities in Los Angeles County that had their own public health workers. Everyone else, including residents in unincorporated areas, relied on the Los Angeles County Health Department.76

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An additional 128 licensed private hospitals and sanatoria also served Los Angeles County. Most of these were quite small, some with fewer than ten beds, and quality varied from bare bones to luxurious. Private care rates in these homes ranged from $13 to $36 a day, putting them out of reach for most poor and working-class Angelenos. Half served only specific types of individuals: alcoholics; the intellectually and developmentally disabled; or individuals with epilepsy or cerebral palsy. Forty-five were custodial in nature, focusing less on treatment and more on providing a safe environment and routine daily care. The division of private institutions within the department of mental hygiene handled the inspection and regulation of these facilities. To prevent disasters like the Hope Development Home fire, they had to be inspected and approved by the office of the state fire marshal. Los Angeles County also had its own inspection services for all institutions, including nursing homes and sanatoriums. In their 1960 report, the Welfare Planning Council of the Los Angeles Region concluded that, given the responsibilities of care such institutions had, this redundancy was not a bad thing. Although the welfare planning council captured only a snapshot of admissions data for these private facilities, for July or August 1958, and although all the facilities surveyed insisted they took patients without regard to race, they found that individuals admitted to them were overwhelmingly Caucasian (95%). Negros [sic] and Spanish-Americans [sic] each made up only 2% of admissions, and Orientals [sic] less than 1%.77 Although the report did not speculate as to why so few non-white Southern Californians were availing themselves of these private institutions, it was likely a combination of cost, location, cultural preferences for other forms of care, and/or individual facility admission policies that may have been engaging in de facto racial discrimination as a way to maintain a sense of exclusivity. In Los Angeles County, local demand for all mental health services save full-pay private hospital care for adults already exceeded supply, investigators concluded, and the shortage was likely to get worse due to a chronic shortage of mental health professionals at all levels. Outpatient services were in greatest demand, and the county estimated that even with the “concerted efforts of the community,” it would be at least five to ten years, if not longer, before that gap could be closed. Mental health care for children and teens was desperately needed: most psychiatrists and psychologists in private practice surveyed reported that they did not accept patients under the age of twelve.78 Los Angeles County sent most of its residents in need of in-patient care to Metropolitan State Hospital

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at Norwalk, Patton State Hospital near San Bernardino, or Camarillo State Hospital south of Ventura. Of those, Camarillo was both the newest (opened in 1934) and by far the largest (with more than 6,000 beds versus just over 2,000 at Metropolitan and just over 3,000 at Patton).79 Camarillo was the only one of the three that had a Children’s Ward (160 beds), leading to long waits for admission.80 Cost calculations also figure prominently in the survey. A patient in the care of a private Los Angeles County psychiatrist was, on average, in their care for one to two years at an estimated cost of $1,880. A patient in the care of a private Los Angeles County clinical psychologist was usually with them for less time (approximately one year) at a cost of $720.81 Geography was another hurdle. Los Angeles County was big, with what seemed at the time like an endlessly growing population, most of it in the county’s most urban areas. Yet the mental health hospital system they had inherited from the nineteenth century had emphasized distance from urban areas, not proximity. This not only made it difficult for the people in those institutions to stay connected to their friends, families, and communities, but it also strained employees by isolating them from professional colleagues and opportunities for additional training. The statistics on overall access to any kind of mental health services in the county were grim. In the thirty-five statistical areas within the county that investigators had created for their study, sixteen did not yet contain a community psychiatric clinic. Those same sixteen areas had a combined population of 1,897,211 people.82 More often than not, the police remained the first point of contact between an adult or child in distress and the county’s mental healthcare system. Just as the Psychopathic Association of Los Angeles had noted in the 1920s, the welfare planning council argued that law enforcement training to deal with mental health issues was inadequate. Recruits for the Los Angeles Police Department received three, one-hour training sessions on mental health and law enforcement; the Los Angeles County sheriff’s department, two one-hour sessions; and the Long Beach Police Department tried to cover it in one, one-hour-long session. Investigators expressed sympathy at the pressures police departments were under, both in time and in budget, when training recruits. “Obviously, and understandably,” they wrote, “major emphasis is placed on the procedures which an officer may legally employ in meeting situations with which he will be confronted. Citizens who ‘call the police’ expect action.” Nonetheless, they went on to argue, such “a sketchy introduction to a

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large and important problem…leaves the new officer with only his own judgement to supplement what he had been able to absorb in one hour.” Law enforcement personnel surveyed for the study reported wanting to help but often finding themselves hamstrung by the gulf between what the public wanted them to do and what it was legally possible to do. An individual who was arrested for committing an offense, or who had had a complaint filed against them alleging they’d committed an offense, would be arrested and, if suspected of being disturbed, examined by a physician. But many of the cases involved complaints regarding behavior, not allegations of criminal activity. One officer told the story of being called to a private sanitarium to remove an eighty-six-year-old man who had grown increasingly violent and belligerent. The unnamed doctor wanted the man arrested and thus removed from his facility. When the responding officers explained to the doctor the proper procedures to transfer the man to the Los Angeles County General Hospital Psychiatric Unit, the doctor protested that “the officers should handle it. He [the doctor] was very strong in his condemnation of the police and seemed to be of the opinion that they were derelict in duty for not removing this patient from his care.” The general public, doctors, social workers, nurses, and ministers needed an education as much or more than law enforcement did, the study authors concluded: they were the ones whose advice to families and individuals was “to often fall back upon the old blanket remedy, ‘call the police.’” The welfare planning council also expressed disgust that the old law about sheriffs having to accompany committed patients to a state hospital was still being used. The law was “generally considered an undesirable remnant of the earlier criminal procedures used in dealing with the insane.” The department of mental hygiene had expressed a similar distaste a few years earlier: “Speaking medically, the main fault with such procedure is the taint of criminality attached to court proceedings, the possibility that a sick person might be detained in a jail facility while awaiting hearing and the changes of mishandling through misunderstanding that might do much to make a sick person sicker.”83 Los Angeles County found a few things to be proud about in the overall report. It was one of the only counties in the state that had made meaningful reductions in the number of senile patients it sent to state mental hospitals (the guideline was no more than 10%), and its number of admissions overall had dropped between 1950 and 1958 while other county’s numbers (most notably San Francisco’s) had gone up.84 Los Angeles County had also recently began to offer halfway houses to help

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people transition from an institution to a more “home-like” environment, day hospitals, and night hospitals. The latter two options were intended to provide needed care for part of the day without separating the individuals from their homes and families and had the advantage of being cheaper than twenty-four-hour care. However, the three state mental hospitals where most Los Angeles County residents were sent were still overcrowded. Worse still, when determining overcrowding, the state of California was using a lower standard for itself than it used for the private and nonstate hospitals it inspected and licensed. The need for custodial care was another challenge identified. Custodial institutions, such as sanatoriums and rest homes, cared for an estimated 3,000 Angelenos. These individuals might otherwise have ended up in state institutions not so much due to any specific illness or disability but because they needed food and shelter and had no where else to get it. Some of these individuals were mentally disabled and/or senile, but many were not. Custodial institutions often lacked adequate funding and had few if any community resources upon which they could rely. This was an issue for elderly Californians dealing with age-related cognitive decline. Their families often did not want them at home and “wished to be relieved of their care,” but hospitals and sanatoriums often did not want to devote scarce financial and staffing resources to patients with “such unpromising prognoses.” Some elderly Californians still ended up committed to state hospitals even though such admissions had been explicitly condemned by the California State Department of Mental Hygiene. “The orderly organization of the community to deal with its various specific health and welfare problems is not accelerated,” the welfare planning council cautioned, “either by ignoring the distinctions between a psychiatric treatment and a need for humane shelter or by confusing the areas of responsibility of different levels of government.”85 Public opinion in the county about the care of individuals with disabilities remained sharply divided. On the one side were those who “feared the powers of the court and would like to see them curtailed”; on the other were those who advocated using commitment procedures more frequently if that was the only way to get people treatment. The latter group often pointed to the shortages in both inpatient and outpatient treatments and expressed fears that dangerously mentally disabled individuals were at large in their communities. One man who grew up in Pomona and worked at Pacific as an adult recalled that he and his childhood friends called Pacific State Hospital “the place where the weird people lived.”86

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For its part, the welfare planning council was willing to concede that many individuals were indeed urged to seek help and were given resources to do so who did not do it. At the county level, no office or agency was charged with tracking such individuals. The office of the counselor in mental health within the superior court could perhaps do so, but they were already overwhelmed with the cases they had.87 In the early 1960s, Robert Edgerton launched a study of 110 individuals who had once lived at Pacific State Hospital. Edgerton was particularly interested in examining the ways the stigma of the label of “feeble-minded” was affecting the lives of individuals even after they had left Pacific. As Edgerton wrote in his 1967 book, these men and women understood very well the lasting stigma having been institutionalized had attached to them: “unlike the psychotic, who at times may be considered (and, in fact, may be) competent to manage his practical affairs, the mental retardate is forever doomed to his condition [emphasis his]. As everyone ‘knows,’ including the ex-patients, mental retardation is irredeemable. There is no cure, no hope, no future. If you are once a mental retardate, you remain one always.”88 He found the individuals he interviewed anxious to put their time at Pacific behind them, with most insisting that they have been confined wrongly in the first place and denying that there was anything wrong with them, intellectually or otherwise. Not only did most show no evidence of being “socially deviant,” they were actually anxious to fit in. “Their every effort,” he explains, “is directed toward effecting a legitimate entry into the ‘outside’ world. To do so they will lie and cheat, but they practice their deceptions in order to claim a place in the ‘normal’ world, not to deviate from it. Their behavior, in fact, represents the very antithesis of social deviance.”89 Although Edgerton was appreciative of the help Pacific State Hospital had given him in identifying and contacting suitable subjects for his study, he ultimately concluded that Pacific had failed in preparing these individuals for life in the community “as fully as they, the ex-patients, or we, the judges, might have hoped.” He attributed this not to any issue with Pacific per se, but instead to the financial and staff limitations affecting any similar institution of its size.90 At the time they occurred, most of the changes detailed in this chapter were done to try to make the existing state hospital and clinic system work better. However, as Paul Lerman points out, one can see that, however inadvertent their creation, all the pieces were now also in place for deinstitutionalization in California:

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leaders in critical positions, at central administrative levels, committed to the nontraditional conceptions of mental illness, new state hospital functions, and a modern treatment paradigm; a patient-release organization legitimated by law, experienced in placement development and supervision skills, politically protected at a central level, and led by a person with extensive contacts in the legislature, the judiciary, and in local communities; a new medical technology that was relatively inexpensive and easily adaptable to any type of placement decision, and a state executive leadership and legislature sympathetic to, and supportive of, entrepreneurial approaches to public policy development. When the new federal funds were made available, the state could take advantage of the opportunities with alacrity and enthusiasm.91

What was still needed, however, was public pressure and a legislature willing to push back against bureaucratic inertia to alter the system. This coalition emerged in the 1960s, but it ultimately went way beyond altering it: it transformed it, unleashing a cascade of both intended and unintended consequences that continue to impact California.

Notes 1. Gary Fishgall, Against Type: The Biography of Burt Lancaster (New York: Scribner, 1995), 227; “The Snake Pit” (1948), imdb.com, https://www. imdb.com/title/tt0040806/?ref_=fn_al_tt_3. 2. The Shrivers knew Dr. George Tarjan; they had visited Pacific State Hospital in the late 1940s as they were exploring the possibility of creating a family foundation, and he worked with them on and off for the next several decades. “‘A Child Is Waiting’ Sociological Tract,” Los Angeles Times, January 24, 1963; “The Screen: ‘A Child Is Waiting,’” New York Times, February 14, 1963. Eunice Kennedy Shriver, interview by John Steward, May 7, 1968, John F. Kennedy Library Oral History Program, John F. Kennedy Presidential Library and Museum, Boston, MA, 1–2; “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, Vol. 2,” 320–335. 3. The production was troubled due to tensions between Kramer and director John Cassavetes. The later felt that Kramer wanted a more “sentimental” picture than Cassavetes wanted to make. Production was also affected by Garland’s ongoing substance abuse issues. Fishgall, Against Type, 215–216, 223–224; Raymond Carney, American Dreaming: The Films of John Cassavetes (Berkeley, CA: University of California Press, 1985), 77–78, 316. 4. Bunker, Education of a Felon, 20–23.

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5. Bunker also spent time under observation at Camarillo State Hospital and was placed in both the Whittier State School and the Preston School of Industry before, as an adult, ending up at San Quentin, Atascadero State Hospital, and Folsom State Prison. Based on the location, timing, and the physical description, it is likely Dr. George Tarjan was “the little man with an accent” he is describing here. Bunker, Education of a Felon, x, 20–23, 239, 247. 6. “Frank Tallman,” 81. 7. See, for example, State of California Department of Mental Hygiene, Biennial Report for 1950–1952 (Sacramento: California State Printing Office, 1952), 9. 8. “Frank Tallman,” “Earl Warren and the State Department of Mental Hygiene: Frank F. Tallman, M.D., Dynamics of Change in State Mental Institutions; and Portia Belle Hume, M.D., Mother of Community Mental Health Services,” 6. 9. The Advisory Committee on Mental Health existed through several more governors, but after Warren, at least according to Hume, it became little more than a “rubber stamp committee.” DeWitt State Hospital opened in 1950, and Modesto State Hospital opened in 1951. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 3, 9, 18–22, 36, 87; Bardach, The Skill Factor in Politics, 32; Kolb was also considered the father of the National Institute for Mental Health. “Portia Bell Hume,” 40, 42–32. 10. “Portia Belle Hume,” “Earl Warren and the State Department of Mental Hygiene: Frank F. Tallman, M.D., Dynamics of Change in State Mental Institutions; and Portia Belle Hume, M.D., Mother of Community Mental Health Services,” 20–21. 11. Kolb was also considered the father of the National Institute for Mental Health. “Frank Tallman,” 1, 5–6, 16, 18–19, 22–23, 27; “Portia Belle Hume,” “Earl Warren and the State Department of Mental Hygiene: Frank F. Tallman, M.D., Dynamics of Change in State Mental Institutions; and Portia Belle Hume, M.D., Mother of Community Mental Health Services,” 29. 12. “Frank Tallman,” 1, 5–6, 16, 18–19, 22–23, 27. 13. “Mental Health,” from Verne Scroggins, Press Secretary to Governor Warren, in Frank Tallman, “Earl Warren and the State Department of Mental Hygiene: Frank F. Tallman, M.D., Dynamics of Change in State Mental Institutions; and Portia Belle Hume, M.D., Mother of Community Mental Health Services,” 90. 14. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 22. 15. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 18, 62; “Portia Belle Hume,” “Earl Warren and the State

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16.

17. 18. 19.

20. 21. 22.

23. 24.

25.

26. 27. 28.

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Department of Mental Hygiene: Frank F. Tallman, M.D., Dynamics of Change in State Mental Institutions; and Portia Belle Hume, M.D., Mother of Community Mental Health Services,” 43–46. “Frank Tallman,” 15, 19–20; “Portia Belle Hume,” “Earl Warren and the State Department of Mental Hygiene: Frank F. Tallman, M.D., Dynamics of Change in State Mental Institutions; and Portia Belle Hume, M.D., Mother of Community Mental Health Services,” 24. William King, Pomona: The Citrus Empire (Carlsbad, CA: Heritage Media Corp., 2001), 79. “History of the Establishment and Growth of Lanterman Developmental Center.” Tarjan never saw his father, stepmother, or younger half-brother again. “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, Vol. 1,” 1, 29, 31–41, 55, 83–87, 93–95. “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, Vol. 1,” 97–98, 107–109, 121, 172–173, 188. “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, Vol. 1,” 178–179. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 91; “Portia Belle Hume,” “Earl Warren and the State Department of Mental Hygiene: Frank F. Tallman, M.D., Dynamics of Change in State Mental Institutions; and Portia Belle Hume, M.D., Mother of Community Mental Health Services,” 8–9. “History of the Establishment and Growth of Lanterman Developmental Center.” The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 103–104; “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, Vol. 1,” 163. The study divided schizophrenic individuals “with good prognoses” into four groups. One group received just “good routine hospital care”; one received care plus tranquilizing drugs; one group received good care but electroshock therapy; and the last group received good care plus intensive psychotherapy. The outcome of this study is unknown. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 104. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 129, 131; “Frank Tallman,” 38, 42. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 59, 70. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 7; “Frank Tallman,” 50–51; Frank F. Tallman, M.D. and A. Edward Nichols, “Legal Rights of the Mentally Ill,” The Journal of the

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29. 30.

31.

32. 33.

34.

35. 36.

37.

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Alumni Association School of Medicine College of Medical Evangelists 22, no. 3 (March 1951): 7. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 5, 20, 52. After 1947, “insanity” was a term used only in criminal proceedings. State of California Department of Mental Hygiene, Biennial Report for 1950– 1952, 52; Tallman and Nichols, “Legal Rights of the Mentally Ill,” n1. In 1952, the Department of Mental Hygiene also abandoned the outdated names of “attendant” and “matron” for staff, replacing them with “technician” and “nurse,” respectively. Standardized training was expected, and psychiatric technicians after one year on the job as a trainee could take a civil service exam and move up a level. Further promotion was possible as experience was earned. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 56–57; State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 10–14. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 18. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 4, 18–19, 84, 90, “Atascadero State Hospital,” Wikipedia.org, https://en.wikipedia.org/wiki/Atascadero_State_Hospital; “Porterville Developmental Center,” https://www.dds.ca.gov/services/state-facili ties/porterville-dc/; “Fairview Developmental Center,” https://www. dds.ca.gov/services/state-facilities/fairview-dc/; “Semel Institute for Neuroscience and Human Behavior,” https://www.semel.ucla.edu/ semel/jane-and-terry-semel-institute-neuroscience-and-human-behaviorucla. The study’s authors called for a controlled longitudinal study to investigate all these issues further. This does not appear to have happened. Harold Sampson, David Ross, Bernice Engle, and Florine Livson, Research Report No. 1: A Study of Suitability for Outpatient Clinic Treatment of State Mental Hospital Admissions (Sacramento: State of California Department of Mental Hygiene, 1957), 1, 37–39; “Frank Tallman,” 74. Fliedner, Centennial, 234–239, 262, 282, 295. For example, in 1950, agricultural production for the whole system cost California $2,814,920, but earned the state $3,296,998. State of California Department of Mental Hygiene, Biennial Report for 1950–1952 (Sacramento: California State Printing Office, 1952), 80. At the Eastern Pennsylvania Institution for the Feeble-Minded in the 1890s, for example, doctors conducted pathological research and research into cerebral meningitis, as well as experiments with craniectomy and craniotomy. Trent, Inventing the Feeble Mind, 154–155.

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38. In 1953, the year its name was officially changed to the Pacific State Hospital, it had a population of 2,000, a staff of 615, and a waiting list of 1,000. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 14; “History of the Establishment and Growth of Lanterman Developmental Center.” 39. Susan E. Lederer, Subjected to Science: Human Experimentation in America Before the Second World War (Baltimore: Johns Hopkins University Press, 1995), 15–17. 40. Lederer, Subjected to Science, xv–xvi. 41. Lederer, Subjected to Science, 124–125. 42. The 1946 AMA guidelines set three criteria for an ethical experiment on a human subject: consent; prior animal experimentation; and appropriate medical supervision. The Nuremberg Code stressed that any participation in any kind of experiment needed to be voluntary. If it wasn’t, that the experiment should not proceed. Eileen Welsome, The Plutonium Files: America’s Secret Medical Experiments in the Cold War (New York: The Dial Press, 1999), 190, 213–214, 482. 43. Shorter, The Kennedy Family and the Story of Mental Retardation, 25. 44. “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, Vol. 1,” 133–134. 45. “Frank Tallman,” 44–45; State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 25–28; “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, Vol. 1,” 168. 46. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 37. 47. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 38. 48. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 35, 54–59, 68–69. 49. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 55, 70; “Insulin Rocks the Foundations of Reason and Yet Seems to Restore Sanity in Many Cases,” Los Angeles Times, March 24, 1940, 16, quoted in Anderberg and Wilson, They Call Them Camisoles— Revisited, 248–249. 50. More than half of the lobotomies inflicted on Californians that year were surgical. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 56. 51. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 77. 52. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 9; State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 39, 63.

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53. Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 13; State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 74. 54. “History of the Establishment and Growth of Lanterman Developmental Center History”; Valerie J. Bradley, Deinstitutionalization of Developmentally Disabled Persons (Baltimore: University Park Press, 1978), 5; Trent, 246–247. 55. “History of the Establishment and Growth of Lanterman Developmental Center.” 56. “History of the Establishment and Growth of Lanterman Developmental Center History.” 57. Tarjan was quite deliberate in connecting not just surrounding universities that had medical schools to Pacific, but also Pacific to regional universities in general. USC’s department of social work, for example, regularly sent students to train and even write their master’s theses on Pacific, its programs, and the individuals who lived there. “History of the Establishment and Growth of Lanterman Developmental Center”; “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, Vol. 2,” 439, 457. 58. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 446. For more on the contents of the proposed amendment, see “Senators Hear Views on Mental Health Laws,” Los Angeles Times, December 10, 1959. 59. In comparison, the department was far less worried about individuals addicted to narcotics because so far there were fewer of them showing up in state hospitals. When they did, however, treatment mimicked what was done for alcoholics. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 31, 61–62, 66. 60. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 32; Theodore Scott, Charles Deveraux, and Elizabeth Janes. California Mental Health Research Monographs, No. 2: Potential Social Rehabilitation of Elderly Patients (Sacramento: State of California Department of Mental Hygiene, 1962), 1, 20, 31. 61. State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 40. 62. California Legislature, Senate Interim Committee of the Treatment of Mental Illness, State-Operated Clinics and the Short-Doyle Act (Sacramento: Senate of the State of California, 1958), n.p. 63. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 256–257, 304. 64. Senate Resolution No. 148, June 8, 1955, and Senate Resolution No. 20, April 3, 1956, had initiated the process. Senate Interim Committee on the Treatment of Mental Illness, California State Senate, First Partial

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65.

66.

67. 68. 69. 70.

71.

72.

73.

74. 75. 76.

77.

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Report: Senate Interim Committee on the Treatment of Mental Illness (Sacramento: Senate of the State of California, 1956), 1; Prestinary, Napa State Hospital, 114. California State Senate, First Partial Report, 68; “Alan Short,” Wikipedia.org, https://en.wikipedia.org/wiki/Alan_Short; “Nathan F. Coombs,” joincalifornia.com, http://www.joincalifornia.com/candidate/ 5585; “George Miller, Jr.,” Wikipedia.org, https://en.wikipedia.org/ wiki/George_Miller_Jr.. In the 1950s, chlorpromazine was also sold under the trade names Largactil, Megaphen, or RP. Reserpine was also sold as Rauwolfia Serpentine. California State Senate, First Partial Report, 7, 11–13, 21, 49, 64, 67. California State Senate, First Partial Report, 9, 11. Director’s Committee on Drugs, quoted in California State Senate, First Partial Report, 13, 49–50, 55–56. California State Senate, First Partial Report, 776. Agnews, Camarillo, DeWitt, and Modesto housed both the mentally and the developmentally disabled; Atascadero, Mendocino, Metropolitan, Napa, Patton, and Stockton housed only the mentally disabled; and Pacific, Porterville, and Sonoma housed only the developmentally disabled. California State Senate, First Partial Report, 87–103. The committee also requested similar data from hospitals in other states, but not all responded. Those that did are included in the published committee report. California State Senate, First Partial Report, 104–203. Clearly, the hope underpinning this was that drugs could replace electroshock with the added benefit of being able to be used in an outpatient setting. Lerman, Deinstitutionalization and the Welfare State, 88, 98. In addition to the twenty-seven-member appointed commission, professionals and volunteers from all over the county and state were also enlisted in the effort to design and carry out the study. State Department of Mental Hygiene Deputy Director Dr. Portia Bell Hume and Director of Research and Statistics Richard D. Morgan provided expertise, as did Dr. Frank Tallman. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, vi, 1–2, 17, 175. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 131, 134, 138. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 149–150. Winston W. Crouch, Wendell Maccoby, Margaret G. Morden, and Richard Bigger, Metropolitan Los Angeles, A Study in Integration: V. Sanitation and Health (Los Angeles: The Haynes Foundation, 1952), iii–iv. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 151–153.

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78. Napa State Hospital also had a children’s ward, but Napa was of course too far from Los Angeles to be of use in this situation. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957– 1959, vi, 1–2, 17; State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 88. 79. This of course does not mean conditions at Camarillo were by any means comfortable. Beds there were said to be jammed so closely together that there was barely room for a chair or small table to hold personal possessions between them. Both Patton and Metropolitan were targeted under the building boom in state institutions during the 1950s. Patton was soon expanded to just under 5,000 beds, and Metropolitan to just under 4,000. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 102–104. 80. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 102–104. 81. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 2. 82. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 17. 83. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 3, 12, 403–412; State of California Department of Mental Hygiene, Biennial Report for 1950–1952, 53. 84. For a discussion of the possible causes of this difference, see the Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957– 1959, 120. 85. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 2–4, 12, 49, 180, 447. 86. “State Facility Closing Draws Curtain on a California Career,” The State Worker, December 10, 2014. 87. The report noted that the number of staff in that department had in 1959 dropped from nineteen to twelve and that in 1958–1959, each employee had a caseload of 38.2 cases per month. The idea that the office as it existed at the time would be able to take on the additional work of following up on individuals who had refused treatment was, the report concluded, “questionable.” The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 448. 88. Robert B. Edgerton, The Cloak of Competence: Stigma in the Lives of the Mentally Retarded (Berkeley, CA: University of California Press, 1967), 207. 89. Edgerton, The Cloak of Competence, 207. 90. Edgerton, The Cloak of Competence, 211–212. 91. Lerman, Deinstitutionalization and the Welfare State, 99.

CHAPTER 8

“Whistling in the Dark”: California’s Politics of Disability Transformed

By the end of the 1950s, the California Department of Mental Hygiene, rapidly approaching a hundred years old, was one of the largest departments in state government, with a whopping annual budget of $105,535,319 in fiscal year 1958–1959 alone. There were nine hospitals for the mentally disabled: Stockton; Napa; Agnews; Patton; Mendocino; Norwalk/Metropolitan; Camarillo; Dewitt; and Modesto. There was also Atascadero; four facilities for the developmentally disabled (Sonoma, Pacific, Fairview, and Porterville); the two neuropsychiatric research institutes (Langley Porter and the Neuropsychiatric Institute in Los Angeles); and numerous clinics scattered around the state. The director of mental hygiene was appointed by the governor and oversaw a staff that included deputy directors (one each for medical services, community services, and business services). By 1966, the department had an estimated 22,000 employees, about one-fifth of all state employees. There was also a Governor’s Advisory Council on Mental Health made up of twentyfour “civic leaders, psychiatrists, medical educators, judges, and other people selected on a statewide basis who bring to bear on the State’s mental health problems both broad community points of view and also specialized experience.” The department “also inspected and licensed 314 non-governmental hospitals, sanatoriums, and similar facilities,” half of which were in Los Angeles County. The division of responsibility for care remained essentially what they had been since the nineteenth century: © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 E. V. Wallis, California and the Politics of Disability, 1850–1970, https://doi.org/10.1007/978-3-031-21714-2_8

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California’s counties were responsible for the poor and the sick, and the state of California was responsible for the mentally disabled. Each institution operated with some degree of autonomy and largely independently of one another.1 But there were many other fingers in the bureaucratic pie. The State Department of Public Health played a role because it administered 1946’s federal Hill-Burton program, which provided federal and state funds for the construction of voluntary and governmental hospitals, public health centers, rehabilitation centers, and other facilities. It also handled planned and estimating future need. Meanwhile, the County of Los Angeles and its board of supervisors oversaw emergency hospital care and the provision of health care of indigent county residents. Other players included the Hospital Council of Southern California, which tracked general hospital need in the area, and the Sanitarium Association of California, the bulk of whose members were in Los Angeles and performed a similar duty for those institutions. Professional organizations like the Southern California Psychiatric Association and the Los Angeles County Medical Association and organizations with a mixture of professionals and concerned citizens, including the Mental Health Association of Los Angeles and the welfare planning council, also all demanded seats at the table. It was a messy system. “There is no one group that attempts to co-ordinate and harmonize all interests to achieve the best overall service,” the Welfare Planning Council of the Los Angeles Region lamented. With so much change already underway, “it is now difficult to say whether [the result] will be a hodgepodge of unrelated, competing institutions with overlapping in some services and gaps in others, or a reasonably well coordinated program meeting all of the community’s needs.”2 But in the meantime, a larger social transformation had begun. One component was the emergence of the Disability Rights Movement in the 1960s. Lip service had been paid to the rights of disabled Californians before, of course. “Patients in mental hospitals are individuals just as we are,” Dr. Frank Tallman had argued in 1949. “They are entitled to the same inalienable rights which above all include dignity of person and the right to be human. In fact, they have a right to be ill and society does not yet fully grant them that.”3 That may have indeed been what Tallman believed, but it was certainly not reflected in the operation or policies of the department of mental hygiene under his administration.4 As discussed, the individuals committed to state hospitals seldom felt as if their “dignity of person and the right to be human” were being

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respected. Although some of D. R. Wilder’s sketches from Patton are affectionate or semi-affectionate portraits of the individuals around him, in others, he is clearly expressing frustration with the authorities and power structure. No doubt most of the people lampooned would have been instantly recognizable to someone who knew Patton’s staff. One attendant is shown as kind (handing an individual a cigarette and “never forget[ing] the golden rule”), but another is shown with keys and a whip in his hands, handcuffs attached to his belt, and a badge that reads “cop.” “Why is it,” Wilder asks in the caption, “that some technicians (ha) are so impressed by their own foolish importance as ‘jailers’ that they forget this is supposed to be a hospital?” Another is caricatured as a giant pig. “The Superior Type: you know who,” the caption reads. The doctors fare little better. In one of Wilder’s most striking images, an individual is bound and gagged in a chair while he listens helplessly to two doctors discuss amputating his head to treat a headache. “And besides,” one doctor says to another, “it would provide experience for we interns” (Fig. 8.1).5 By the 1960s, however, inspired by the Civil Rights Movement, individuals who identified as disabled focused on using collective action and protest to prod slow-moving government entities to protect the medical, social, political, and economic rights of individuals who identified as disabled. They also pushed for recognition of a fundamental right to receive those services individuals with disabilities needed to maintain their economic and social independence. Although much of the Disability Rights Movement’s leadership consisted of individuals with physical disabilities, a few organizations focused on the needs of the mentally or developmentally disabled. People First of California, for example, became the nation’s first advocacy and peer-to-peer support group founded by developmentally disabled individuals.6 Depending on the issue, these new organizations sometimes worked together with, and sometimes in opposition to, existing parents’ organizations. Although much of this early activism was centered in and around the Bay Area, what is most striking in the context of mental health reform is that members of the California State Legislature, even those directly involved in legislative reform around commitment as well as mental and developmental disabilities, apparently had virtually no contact with disability rights activists on these issues. This may perhaps be explained by two issues. First, as discussed, in a purely bureaucratic sense, physical disability fell under the purview of California’s counties, not the department of mental hygiene.

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Fig. 8.1 Patton State Hospital, San Bernardino, California: a clinical consultation among doctors at which the patient is not allowed to say anything. Drawing by D. R. Wilder, ca. 1954. Courtesy of the Wellcome Collection

This of course is not to say that there were not individuals with physical disabilities in the state hospitals system: there were. But it may not have occurred to either state legislators or department leadership to reach out to disability rights organizations on this issue because at the time, the legislature may have associated it strictly with physical disabilities, if they were aware of the movement at all. Second, neither the department nor any of its previous incarnations had ever asked for or even shown any interest in collecting feedback from those Californians who spent time in its systems. Save the handful of individuals who went public, either in the newspapers or in memoirs, stigma and a lack of social and political power likely kept many individuals with mental or developmental disabilities, and, often, their families, silent about their experiences and reluctant to weigh in on the subject. In the California of the 1960s, much of the political if not the social conversation around community-based care and

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deinstitutionalization from state hospitals took place separately from the emerging Disability Rights Movement.7 The 1960s were marked by a renewed interest at the federal level in issues related to disability. In anticipation of his election, in 1960, then-candidate John F. Kennedy assembled a Task Force on Health and Welfare. This was followed after his election with an ad hoc study group to learn more about the causes, prevention, and management of developmental and intellectual disabilities. Kennedy’s sister, Eunice Shriver, took the lead on much of this work on behalf of the president. Housed within the Department of Health, Education, and Welfare, the committee ultimately delivered to President Kennedy a final report containing ninety-seven recommendations. Out of these recommendations came two new pieces of congressional legislation: a community mental health center construction bill and a 1963 act that provided funding for states to begin their own comprehensive planning around the issue of mental retardation prevention and care. To all this, the 1965 Medicare bill provided funds for prenatal care and child health care that, it was hoped, might prevent or at least ameliorate the worst outcomes for high-risk mothers and their offspring.8 Through the 1960s and 1970s, the National Association for Retarded Children (which in 1973 became the National Association for Retarded Citizens) and the Council for Exceptional Children (CEC) worked with the Kennedy and Johnson administrations “to provide expertise, counsel, and funding” for Americans with developmental disabilities.9 The rise of healthcare insurance in the United States was also changing the dynamics for Americans with disabilities and their families. Congress’ 1960 passage of Medical Assistance to the Aged (MAA) that provided nursing-home services and home healthcare services for income-qualified seniors allowed many to be released from state institutions or to remain in their own homes. That was followed in 1962 by new regulations that allowed individuals to claim Aid to Permanently and Totally Disabled (APTD) while living at home, in a family-care setting, or in a board and care facility and the 1963 passage of the federal Community Mental Retardation and Community Mental Health Centers Construction Act that funded the creation of more community-based service centers.10 The 1966 federal Fair Labor Standards Act now prohibited unpaid labor in state hospitals.11 As Deborah Blythe Doroshow notes, the new, third-party insurers being founded generally preferred short-term psychiatric care delivered

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in general hospitals to longer stays in psychiatric hospitals or residential treatment centers. This made it increasingly difficult for many private institutions like the sanitariums to stay afloat financially.12 The creation of Medicare and Medicaid changed things, too, allowing many individuals to remain in their home communities and receive services there. Federal Medicare payments now supplemented California General Fund monies.13 Social Security Disability Insurance had been expanding since its creation in 1956. Eventually, it was accompanied by automatic Medicare coverage, a combination that helps explain increasing participation in the program through the late 1970s before it leveled off. For Dr. George Tarjan, who by the 1960s had left Pacific for a career at UCLA’s neuropsychiatric institute and as a federal-level advisor on issues related to mental retardation, this was not altogether a good thing. “It was a very simple argument that you don’t have to provide for mental health care the same way as for general health care because there is an independent, separate system which takes care of the mentally ill both while they are in the hospital and while they are in the community. Now, I consider that, in the long term, a terrible outcome because even today [in 1990] the difference between the quantity of general health care and mental health care is substantial. In comparison to physical health care through programs like Medicare and Medicaid, no such systems were provided in mental health.”14 Crisis intervention treatment had also been introduced. According to a 1967 Wall Street Journal article, roughly half of the 1,300 general hospitals in the county that had psychiatric units now offered some sort of crisis intervention that was “brief and designed to zero in on a specific incident that caused the crisis.…The aim is to get the person functioning and back into society as soon as possible.” Dr. Edward Stainbrook, chairman of the psychiatry department at USC, was quoted in the article as saying, “The geneticist figures you’re done for when you’re born; the psychoanalyst figures you’re done for when you’re six; but the crisis intervenor says you’re not done for until you’re dead.”15 The American public in general was also waking up to the terrible conditions in America’s hospitals for the mentally and physically disabled. In 1962, Ken Kesey published his novel One Flew Over the Cuckoo’s Nest, which was followed by a feature film version in 1975. In 1966, Burton Blatt published his “Christmas in Purgatory” photo exposé of the horrible conditions on wards for the developmentally disabled. It was later reprinted in Look magazine.16 This was followed in 1972 by Geraldo Rivera’s infamous exposé of the conditions at Willowbrook State School

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in New York. In the latter case, the public and political outrage was so intense it helped lead to the facility closing in 1987.17 Some of these changes were reflected in the department of mental hygiene itself. Although sterilizations still occurred, they were becoming less frequent. There was no grand pronouncement from the department, nor does there seem to have been any large public or even private discussion about ending the practice, even though there had been a partially successful court challenge to the practice, Garcia v. State Department of Institutions , in 1939.18 Tarjan attributes his own changing attitudes to former Department Director Frank Tallman. Tarjan claimed that Tallman had felt that, logically, eugenic sterilization simply made no practical sense. Tarjan came to agree with this assessment: This was essentially an involuntary sterilization. The staff decided; the patient was operated on. And it was one of the essential tickets to get out. One of the essential tickets or you couldn’t get out. It just made no sense to me….I do know that one of the first notions that struck me was that for every patient that got into Pacific there were at least nine patients on the outside who were alike to the patient who was on the inside. But only the patient who got into Pacific, because of his problem with two social systems, got sterilized. And that we were not even making a discernable scratch, let alone a dent, on what the eugenic movement originally conceptualized. We were whistling in the dark.19

Tarjan confessed later to being “enormously disturbed” by some patient’s reactions to being told they were to be sterilized, including young women who screamed the whole way into surgery. He was also inspired by Pacific’s hiring in the early 1950s of a young pediatrician, Dr. Mario Valenti, who, due to his Roman Catholic faith, refused to vote on or even participate in staff decisions about patient sterilizations. Many of the young patients at Pacific who had been sterilized were Mexican American, and thus likely Catholic, but the hospital had sterilized them nonetheless. That knowledge now pricked Tarjan’s conscience.20 Together, Tarjan and Tallman had gone to Sacramento to try and get California’s state legislators to change the laws. Although they spent considerable time sipping “scotch and soda” with politicians, they failed. They did, however, manage to get the laws amended to require informed consent of the parents or guardian and the patient and to provide “for an appeals process from medical staff to the superintendent to the director of mental hygiene, and potentially to the courts. Well, that essentially

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put sterilization out of business in California.” Tarjan’s memory here is a bit too rosy. Sterilizations continued, but there were fewer of them. By 1962, only three sterilizations were conducted at Sonoma, all of women or girls.21 This was, of course, still three too many, but it was a dramatic change from just two decades before. Other changes to the system, these more pragmatic, were also afoot. By the end of the 1950s, most of the farm operations were closed or being closed: there were fewer able-bodied individuals in these institutions to tend them for little or no pay, and the new generation of superintendents did not consider running farms a suitable use of their skills. Use of Pacific’s farmlands, for example, went to the nearby California State Polytechnic University at Pomona. Other in-house enterprises, such as gardening crews and industrial laundries, soon followed. No longer able to pawn much of the day-to-day labor that kept a hospital operating off on the individuals living there, operational costs quickly went up. There was also a shift in the language used by the state of California. It moved from “feeble-minded” and “idiot,” at least in official state publications and discussions, to “mental deficiency” and “mentally retarded.” This category was then further divided into mild, moderate, severe, and profound, with developmental goals keyed to each. The department of mental hygiene added to their convalescent leave program a program of small “board and care” or “family-care” homes, where up to six developmentally disabled individuals lived with a local family instead of in a state hospital. The department’s bureau of social work was charged with making sure that individuals placed in such homes were neither economically nor physically exploited. Only the profoundly developmentally disabled were now expected to need long-term hospital care, and the superintendents and state hospitals pushed to have available beds go to them instead to whoever was next on the waiting list. However, whereas the rapid expansion of state hospitals in the 1950s simply to provide more beds had not been accompanied by shifts in staffing and treatment, it perpetuated some of the same problems as before, including the deaths of vulnerable individuals in the state’s care. In Pacific’s case, Dr. Tarjan argued that the death rates there were increasing in the late 1950s specifically because the sicker the individual admitted, the greater the likelihood they might die there, through no fault of the doctors, nurses, or attendants. Rising death rates anywhere in the state hospital system, however, for any reason, understandably drew negative publicity and the unwanted attention of state legislators. This was not always the case, however: there

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were genuinely suspicious deaths during Tarjan’s tenure at Pacific. These included, in just one year, the death by strangulation of a ten-year-old, severely developmentally disabled girl in her bed with a pair of shoelaces and the death of a three-and-a-half-year-old girl just three weeks after she entered Pacific. The California State Assembly’s Interim Committee on Social Welfare in December 1955 spent just one day examining charges of mistreatment at Pacific before clearing the institution of any wrongdoing. If the hospital was guilty of anything, the committee concluded, it was failing to notify parents in a timely manner of impending deaths. Four parents of individuals at Pacific even appeared at the hearing to testify in support of the hospital. The Interim Committee published a more comprehensive report in 1957 that included not only a discussion of the deaths at Pacific, but also suspicious deaths at Mendocino and Agnews it had investigated. The 1957 report also provides details about the many pending cases of hospital staff accused of abuse and/or neglect before the state’s board of personnel. As in previous reports, however, the committee ultimately concluded there were no major issues with the state hospitals.22 Tarjan remained a staunch defender of institutionalization, nonetheless. In the old days, he argued, developmentally disabled individuals who could afford it had been cared for by private nurses or in private sanatoria. For families with no other option than sending a loved one to a state hospital, they had to wait both until the individual was old enough to admit and a bed was available. The result, he claimed, had often been the same. “They were equally out of sight, and many died. They just died.”23 Many individuals in the department of mental hygiene or who were familiar with its work had long predicted a future in which most mentally and developmentally disabled would receive community-based care, with only the most severe cases being hospitalized. This would in turn necessitate a shift in the focus for state hospitals to medical treatment for those requiring long-term care; physician training; and research. For its part, the California State Legislature still paid relatively little attention to the state hospital system. After the Senate Interim Committee on the Treatment of Mental Illness completed its work in the early 1960s, only the Senate Finance Committee and the Assembly Ways and Means Committee had subcommittees that did any work on mental health policy, and even there it was considered just one part of the larger context of “all matters of health, education, and welfare.” Eugene Bardach, who in the late 1960s was a doctoral student at the University of California, Berkeley, studying

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California’s mental health programs, explains the general indifference thusly: Although from the inside the activities of state hospital administrators seem to raise highly political issues, from the outside—that is, from the perspective of the general public and the legislature—the operation of a state hospital is largely an administrative, and perhaps a somewhat technical, matter in which it would be unprofitable and inappropriate to intervene. Even when issues are raised concerning the very existence and function of state hospitals, as has been happening for well over a decade, legislators still define them narrowly: Will a community-based system save the state money? Do the doctors and other experts think it is a better way to help people?24

Or, as Dr. George Tarjan put it more succinctly, “institutions were out of sight, out of mind.” The only time most legislators bestirred themselves on the issue was when anyone proposed closing a hospital: in that situation, the legislator who represented that district would quickly mount a vocal defense of keeping it open and preserving those jobs. In this, they were always backed up by the powerful state employees’ union. This was particularly true in rural parts of California where a state hospital was often the largest regional employer.25 As we have seen, in the 1950s, some doctors and activists in California had begun to turn against the idea of state asylums and institutions for Californians with mental and developmental disabilities. As medical science advanced, these kinds of institutions seemed increasingly like relics of the past. Dr. George Tarjan, for example, had tried to keep Pacific State Hospital relevant both as an institution and as a site for research. But for the most part, the future seemed to promise a shedding of state hospitals in favor of entirely new approaches. “The future of psychiatry would be to conduct research on diseases, rather than to manage institutions,” Carla Yanni explains. “The institutions themselves began to be neglected by both the doctors and the state because they carried negative associations. They were filled with incurable people who reminded both doctors and the public of past failures.”26 In 1959, Dr. Daniel Blain was appointed the new head of the department of mental hygiene. He pushed hard to parole as many individuals as possible from state hospitals, although likely more as a cost-cutting measure than due to any belief that they were cured. As Eugene Bardach explains, individuals were usually placed “on leave” from state hospitals rather than released outright, because being

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“on leave” gave the department’s estimated 400 social workers the ability to monitor their progress and provide assistance with housing, work, and, sometimes, welfare assistance. In 1966, this department was renamed from the department of social welfare to the division of adult protective social services, although most people still called it by its previous name.27 California was not alone in this shift to moving individuals out of state hospitals. Speaking of both the United States and the United Kingdom in the 1960s and 1970s, Roddy Slorach explains, “economic expansion, technological and scientific advances, and the foundation of welfare states allowed more disabled people to live longer and carry out activities of which they had until then been considered incapable.…These changes did not, however, immediately transform the lives of disabled people. Although services…were now in theory allocated according to need, disabled people were in practice rarely consulted,” he notes. “Instead, they remained passive recipients of services prescribed or imposed by medical or other professionals. The number of patients in mental asylums in the UK and the U.S. continued to rise and many physically disabled people remained institutionalized until the 1970s or even later.”28 The introduction of psychiatric drugs further complicates the story, although it is important to know that deinstitutionalization in California began before the widespread use of pharmaceuticals in institutional and outpatient settings. It is likely politicians overstated the benefits of the first generation of antipsychotic, antidepressant, and sedative drugs more as a cost-cutting measure than as a real alternative to institutionalization.29 The state of California had long been looking for ways to encourage counties to take on more of the expense for individuals with mental and developmental disabilities. It had also been experimenting with offering state-funded outpatient clinics since the 1920s, although those had never received the time, energy, or, most importantly, budget appropriations the state hospitals had. Los Angeles County, in which annual expenditures on the care of mentally and developmentally disabled in state hospitals remained more than double that of the next nearest county, San Francisco, continued to search for what it hoped would be a more equitable way to handle mental health care spending statewide. In fiscal year 1959– 1960, Los Angeles County spent $26,613,216 on county residents in state hospitals for the mentally and developmentally disabled. San Francisco County, the next largest spender, spent $10,639,699. Santa Clara County was in a distant third place, spending $3,094,560. These trends held true all through the 1960s.30

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No other individual in California state legislative history is as closely associated with midcentury reform in the care of the mentally and developmentally disabled than State Assemblyman Frank Lanterman (D-Los Angeles). On paper, however, he must have been the unlikeliest ally imaginable. By his own admission, Frank Lanterman never had any great political ambitions. He had been born in 1901, the son of a doctor and heir to a large property in the La Cañada-Flintridge area northeast of Los Angeles. His grandfather had been a “coughing pilgrim” who came west from Michigan to recover from his bronchitis. Lanterman’s only real passion as a young man was music, organ playing in particular.31 His career began in 1938 as a member of the Los Angeles County Republican Central Committee, which soon tapped him to run for the state assembly. His only political issue when he entered politics was water rights, and that was only because it directly affected his family’s lands and the community of La Cañada. “I came here [Sacramento] at full maturity, at age fifty. I was not a young ambitious [man]; I was a mature middle-aged person and I came for the purpose of non-political reasons.” He ended up serving for twenty-eight years and became “the dean of the Assembly Republicans.” His long service earned him the trust of fellow legislators from both political parties, even though he considered himself “a conservative curmudgeon” by temperament. He quickly become one of only a handful of state legislators interested in changing policies around mental health and disability. On these issues in particular, Lanterman successfully leveraged his reputation as not just as a staunch Republican, but as a “bedrock fiscal conservative.” “His support for certain social programs has carried more weight with his colleagues than it might have had it come from a loose spending source,” the Cal-Tax News, the bimonthly newsletter of the conservative California Taxpayer’s Association, admitted. Lanterman’s experience as a legislator, his knowledge of issues surrounding the state’s mental health system, and the trust other legislators had in his wisdom and judgment all played major roles in the transformation of California’s mental health laws.32 Lanterman’s first exposure to the department of mental hygiene and the state hospitals was in 1953, when he became acting chairman of the assembly’s Social Welfare Committee. He then joined a bipartisan legislative team of six in investigating accusations of brutality and abuse at Modesto State Hospital. Lanterman felt that the investigation was politically motivated by the state senate and then-Attorney General Edmund

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G. “Pat” Brown and aimed at Dr. Walter Rappaport, the director of the department of mental hygiene. In Lanterman’s view, Rappaport was being targeted for refusing to extensively utilize tranquilizers in state institutions under his control. Dr. Rappaport was a highly qualified and recognized expert in the field of forensic psychiatry. And he’s a good personal friend. And I went down to put out that fire as a tribute to a man whom I thought was highly qualified to be the director of the Department of Mental Hygiene, and who had the interests of his patients at heart. The reason he refused to take a big order from one of the big pharmaceutical firms that was trying to peddle it, was because he said, “I will not order all those psychotropic drugs, that volume, until we have tried it in controlled cases to see what the side effects are on the various qualities of patients.” This is a medical problem. We told them to leave the hospital alone.

For Lanterman, a staunch Republican but a pragmatic one, what had happened at Modesto was the product of state neglect and understaffing at the hospitals. Lanterman was still a part of the Assembly’s Social Welfare Committee in 1957 when it issued its wide-ranging fact-finding report on the state of California’s asylums. During testimony, he had asked questions of various witnesses, particularly around how services in the state were funded, but ultimately he did not dispute the overall conclusions of the committee.33 Lanterman soon returned to the issue of mental health reform not through his work on the Social Welfare Committee, but through his key role in a fight over the fate of the outpatient clinics. This was part of a larger fight between Sacramento and the department of mental hygiene on the one side and the counties on the other. By the early 1950s, Los Angeles had three outpatient clinics operated by the department of mental hygiene that served individuals released from psychiatric hospitals. Frank Lanterman considered them “service stations,” making up for the enormous distances between Norwalk, Patton, and Metropolitan State Hospitals in the region. California’s State Legislative Analyst Alan Post argued that Los Angeles County was getting a benefit no other county had, and that it should thus bear 50 percent of clinics’ operating costs. Lanterman, who represented the region, was not having that. “You understand, purely economic,” Lanterman later explained. “It was a necessary adjunct to the hospitals because they were so far away you had to have an outpatient clinic for patients who needed to come and get reoriented

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temporarily, even for day care, where they could be taken care of.” For her part, Dr. Portia Bell Hume argued that the way forward was to not just keep the Los Angeles clinics, but to contract with counties to set up outpatient clinics throughout the state with a cost share of 75% on the state side and 25% on the county. During his last year in the position of director of the department of mental hygiene, Dr. Frank Tallman proposed something similar to the California State Legislature, a bill patterned after the New York legislation that was similar in broad outline to the program that ultimately became law in California….I got this bill introduced for educational purposes because I knew perfectly well that the legislature was not knowledgeable enough to pass it. It didn’t pass [emphasis his] and quite honestly I didn’t expect it to pass. I have always felt that you have to prepare both the public and the legislature for forward-moving steps and that the way you prepare them is to present the problem and present a solution purely as an educational device. More times than not you fail the first time. So I proposed things to the public and the legislature somewhat like I’d give a lesson to a class, so to speak, knowing perfectly well that I was planting a seed that wouldn’t sprout right away.34

Hume echoed Tallman’s memories of how difficult it was for these new ideas to gain any traction. She recalled that the proposal had originally gotten a frosty reception from hospital superintendents as well. “I think the only reason why, in retrospect, they took it as well as they did and went along with it is that they thought it would never succeed. You know, it was a dream that this wild woman had dreamt up.” They were, she concluded, only looking out for their own interests and “to go along with me was almost like, you know, cutting your own throats, but they did go along.”35 Within the state legislature, Frank Lanterman, at least, embraced this idea with open arms. It was perfectly obvious to me…that what they needed more than anything was inpatient clinics at the local level, so that they did not have to go to the state hospitals to be rescued, to be send back to outpatient clinics. Now, anybody who knew anything at all about the European system, those that don’t have big mental hospitals, they have small community facilities, you cannot return people to reality unless they’re at home. They need a home base to have reference to. And so, with the experience we had in Los

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Angeles County with the psychiatric wards at the hospital….we found that they needed more screening when they came than afterwards. What you need is diagnostic evaluation of a patient and his needs to begin with. Isn’t that what every doctor does? Isn’t that what everyone should do where there’s a health problem involved? What is the nature and the extent of the disability?

He also asserted that this kind of screening also kept many individuals from being sent on to the state hospitals in the first place. Los Angeles County worked to divert elderly Californians with mental disorders (Lanterman called them “seniles”) from commitment to state hospitals because they were not actually psychotic, but they needed sanitarium, not mental hospital, care.36 Lanterman and, by now, several other members of the California State Legislature decided that Hume was right about the clinics. Perhaps a cost sharing agreement between the state and the counties would induce the counties to offer more care at that level. For its part, the Senate Interim Committee on the Treatment of Mental Illness had reached a similar conclusion. Legislators, citizens and citizen associations, and the medical and psychiatric professions, in consultation with the California Medical Association and the County Supervisors Association, were charged with figuring out a workable formula. They proposed a 50/50 split, with counties and the state of California sharing costs equally. The final version of the proposal was known as the California Community Mental Health Services Act, but it quickly got nicknamed the Short-Doyle Act after two of its co-authors, Alan Short (D-San Francisco) and Donald D. Doyle (RMarin).37 Although given present-day political alignments, it may seem odd that two of the biggest advocates for this potentially massive spending program were Republicans (Doyle and Lanterman), it is worth remembering longtime California journalist Lou Cannon’s assessment that, at this time, “the leading GOP legislators in the Assembly were moderates or liberals in the Earl Warren mold who believed that government had social responsibilities.”38 The Mental Health Committee of the California Medical Association (CMA), the more conservative members of which were uncomfortable with the proposed changes to the system, managed to stall the passage Short-Doyle for several years. In the meantime, the only outright opposition to the plan came from the far right of the political spectrum: from Libertarian Californians, members of the John Birch Society, and similar

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organizations. Their objections were, however, confined mainly to editorials in rightward-leaning newspapers and to the occasional angry screed sent to Frank Lanterman’s legislative office. It does not appear anyone involved in drafting the legislation took such objections particularly seriously.39 Passed by the legislature in 1958, the act encouraged communities to find local level solutions to their residents’ mental health challenges. Short-Doyle identified five types of services a county or local government agency could offer: if it was able to provide two or more, it could seek reimbursement from the state for up to one-half of the costs of running those programs. The options were (1) outpatient services; (2) inpatient hospital care under certain restrictions; (3) rehabilitation services; (4) public education on mental illnesses; and (5) consultation and counseling services. Options 1, 2, and 3 were to be available only to those residents who could not afford private care. The counties largely had administrative responsibilities for the program, while the California State Department of Mental Hygiene was to ensure quality and assist with allocating state monies. If the staff of a Short-Doyle program could not or did not feel it was appropriate to accept an individual for treatment, they could refer that individual to a private doctor or clinic where treatment would be covered under Medi-Cal.40 The Los Angeles County Board of Supervisors decided to participate in Short-Doyle by a vote of three to two. In 1959–1960, the first year of the program, Los Angeles County counted on Short-Doyle funds to offset its more than $1 million in program spending. This included two new inpatient programs at Los Angeles County General Hospital and Harbor General Hospital; two new outpatient programs, also at Los Angeles County General Hospital and Harbor General Hospital; three new psychiatric consultation services, two at Los Angeles County General Hospital and one at the county schools department; three new rehabilitation programs at Rancho Los Amigos, Olive View Sanatorium, and the county parks department; and two programs in mental health education, one in the county schools and the other in the county health department. The proposed investment in rehabilitation at Rancho Los Amigos generated particular excitement. Rancho Los Amigos housed many individuals who had degenerative nervous system diseases or had been affected by poliomyelitis and paraplegia. The County of Los Angeles hoped that expanding rehabilitation services for those individuals might allow some to regain enough mobility to eventually return home. By 1960, Santa

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Monica, Long Beach, Pasadena, and the city of Los Angeles were all also moving forward with plans to create reimbursable programs providing mental health care at the municipal level.41 Thus, the new system being created through Short-Doyle broke care up between multiple smaller facilities, each with considerable local autonomy, but with the state of California providing oversight. Most counties offering Short-Doyle programs used their county hospital’s psychiatric ward and reserved a number of beds there for county use. Although that part wasn’t entirely new, the level of independence counties now had to create and run programs was in many ways the antithesis of the state hospital system. Many professionals could already see the writing on the wall. “The State should reconsider the policy of establishing more and ever larger state mental hospitals,” the welfare planning council of the Los Angeles region advised in 1960. They continued: because of its relatively large number of private psychiatric institutions and its nucleus of psychiatric departments in general hospitals, Los Angeles County is in a good position to begin to implement the Short-Doyle Act without having to wait for the creation of new agencies and the building of new physical facilities. A small start can be made relatively quickly and then, if experience should indicate a need, additional facilities can be built later. The implications for the state hospitals of such possible developments as these should be carefully considered.42

In other words, Los Angeles was already looking beyond the state hospitals. If other counties were to follow suit, what would happen next? The California Department of Mental Hygiene, however, plowed ahead, calling for a permanent shift away from state hospitals in favor of community-based care. Between 1967 and 1968, state appropriations for California state hospitals for the mentally and developmentally disabled dropped from $122 million to $112 million, but appropriations for ShortDoyle program rose from $18 million to $23.9 million. By the end of fiscal year 1966, Short-Doyle programs had treated over 115,000 people “and closed the year with a caseload of nearly 33,000, all but ten percent of them in outpatient status.” In the same period, state hospitals for the mentally and developmentally disabled admitted 26,800 individuals, 60% of whom were first admissions. Three-quarters of admissions to the state hospitals were involuntary. The overall population in state hospitals that year dropped from 30,193 people to 26,567. At least on paper, the new

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system seemed to be working. Short-Doyle also was one of the models for the National Mental Health Act of 1963, which provided federal funds for community mental health centers as long as they had a local match. In his study at the time of these shifts, however, Eugene Bardach noted a few troubling trends in the limited data available that, in retrospect, should perhaps have gotten more attention. First, he found that both voluntary and involuntary admissions to state hospitals were “drawn disproportionately from the less affluent and less powerful strata of society.” Many were also welfare recipients, lower income, or unemployed. Although the population in California’s state hospitals for the mentally and developmentally disabled was largely white, their numbers in proportion to their share of the state’s population, Black Californians were overrepresented in state hospitals by 33%. Bardach also accuses most Short-Doyle facilities of concentrating on “easy” cases and sending the “hard” ones to the state hospitals, although he does not substantiate that claim. In the first few years of the program, Short-Doyle did not seem to be benefitting all Californians equally.43 In 1962, California assembled a task force of doctors, nurses, social workers, reformers, and anyone else interested in the issue of mental health to create a “Long Range Plan for Mental Health Services in California.” In its final recommendations, the task force reemphasized that mental health care needed to take place in local communities. State hospitals were a relic; the future was in community mental health. A recurrent analogy in the rhetoric supporting this aim was “the battlefield,” Eugene Bardach notes. “Mental illness was the enemy. An army of dedicated if none too numerous mental health workers would oppose it. The community mental health programs would act as a ‘main line of defense’ against mental illness, while the state hospitals would be the ‘back-up resources.’”44 Short-Doyle also did not fix the issues of unequal spending on mental health in California’s counties. The California State Legislature remained aware of that problem. “Under the present system, some counties do not contribute their fair share of the costs of mental health services for residents of their counties,” the assembly’s Ways and Means Committee wrote in 1967. “These counties rely almost exclusively upon state-financed institutions, thereby placing excessive demands on taxpayers of other counties who may also be contributing extensively to support expensive local programs in their own counties. This is obviously

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inequitable.” However, it concluded, “under the present system” there was no way to fix this.45 Or was there? The California State Assembly Subcommittee on Mental Health Services, part of the Assembly Ways and Means Committee, dug into the structural issues facing individuals with mental and developmental disabilities again in 1963, when it adjusted the cost sharing formula for Short-Doyle to 75/25 and held a discussion on the need for more community services for children with developmental disabilities. It was a three-person committee, consisting of chair Assemblyman Jerome Waldie (D-Antioch), Nicholas Petris (D-Oakland), and Lanterman. The subcommittee did so again in 1965. Led largely by subcommittee member and now Assembly Majority Leader Jerome Waldie, the subcommittee’s focus was a reexamination of the state’s involuntary commitment laws.46 The subcommittee’s logic for so doing was explained a few years later as this: The key obstacle to creating a truly responsive mental health system lay in the commitment process. It was their belief that the commitment process itself perpetuated the public’s erroneous equation of mental illness with dangerousness. This public attitude, they felt, provided much of the justification for the institutional treatment system, complete with locked wards and dehumanizing procedures, and the curtailment of patient’s civil rights.…If the commitment system were abolished, the legislators reasoned, a chain reaction would start, resulting in fewer involuntary placements, shorter periods of hospitalization, diversion of patients and dollars to a variety of community services, development of new attitudes and procedures among treatment personnel, and, most important a change in public attitudes towards mental disorders and how to deal with them.47

The subcommittee’s brief was clear. To rebuild the mental healthcare system in California, they were first going to have to break it. Frank Lanterman later recalled that it took eight months of work with psychologists, psychiatrists, medical staff, nursing staff, technical advisors, and social workers for the committee and its staff to collect as much data as possible before it formulated a plan. The research began with the committee sending more than 1500 questionnaires to “professionals, lawyers, judges, and concerned citizens.” Committee staff then conducted in-person inspections of all California’s hospitals for the mentally and developmentally disabled, including Dewitt and Sonoma; researched “the professional literature”; and reviewed “mental health systems in other countries.” After that, a second round of questionnaires was sent to

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320 private and public hospitals caring for the “mentally disordered” in the state as well as to the commitment courts in the forty counties with the largest populations. Social Psychiatry Research Data, a private research firm, processed and analyzed all the data collected, which were then assembled into a report that sharply criticized the existing judicial commitment procedures. “The basic dilemma [was the practical incompatibility of] ‘the two basic objectives of California’s mental health system—individual health and public safety,’ which forced those responsible for administering its policies ‘to choose between the medical objectives of treating sick people without legal delays and the equally valid legal aim of insuring that persons are not deprived of their liberties without due process of law.’” The existing state of mental health care in California—with its blend of state hospitals, Short-Doyle clinics, state mental health hygiene clinics, community mental health centers, and other agencies—the very system that had seemed so revolutionary twenty or even ten years earlier was now, Lanterman, Petris, and Short declared, too fragmented and, worse, “legally inadequate.”48 In their statewide survey of California commitment court proceedings, the subcommittee found that the average courtroom hearing only took 4.7 minutes, and that one-third of them lasted less than two minutes. The committee then held a series of public hearings in December 1965, January 1966, and again in December 1966. These hearings gave “psychiatrists, judges, public defenders, social workers, and hospitals administrators” a chance to share their experiences with and air any grievances they had with either the committee’s work or with the commitment procedure itself. No individuals with actual lived experience with commitment to a state hospital (i.e., mentally or developmentally disabled) appear to have testified during these hearings, and there is no indication they were asked to do so. It is quite possible it simply did not occur to the committee members to seek out those voices. However, this seems particularly odd in retrospect since one of the topics under discussion at these hearings was the social stigma resulting from and long-term negative impact for individuals that resulted from a commitment. Major organizations that weighed in on the issue over the next few months included the California Association for Mental Health (CAMH, a reform-minded civilian organization); the California Medical Association (CMA); the American Civil Liberties Union (ACLU); and the department of mental hygiene itself. Responses to the idea of reform ranged from enthusiasm to guarded ambivalence. One of the most vocal sources

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of opposition to the plan came from superior court judges around the state. These were the same individuals who had been overseeing the commitment process for years. Judge Bill Dozier of San Joaquin County, for example, appeared before one of that county’s board of supervisors meetings regarding the proposed changes to angrily declare, “The people are not being railroaded into the state hospitals [emphasis in original]…. Right now these men on the panel and the judge, at least this year when I handled it, we don’t want anybody to go to the state hospitals who doesn’t obviously have to be there.” He also ominously warned the board of supervisors that should it pass, the new bill was going to be a shift of “nearly all the people in the state hospitals on the county.” Not all of California’s judges were against the reforms, however. Arthur H. Karesh, a retired judge from San Francisco who for many years had presided over a commitment court there, testified that now, when he thought back to the individuals he had committed, all he could see was his own eccentric, elderly father. “There but for the grace of God goes my father,” Karesh told them. “And I vowed never to do it again.” According to Petris, Karesh was the one who dubbed the bill the subcommittee was working on the “Bill of Rights for the Mentally Ill.”49 Out of these hearings and conversations came a committee recommendation that a community-based system of emergency service units replace the commitment of individuals to state hospitals through commitment courts. In May 1966, Waldie moved on to the United States Congress following a special election, so Petris and Lanterman took over leadership on the issue. A proposal to reform California’s commitment laws was soon drafted, Assembly Bill 1220.50 Unfortunately for Lanterman and his allies, a new player was on the scene, a political neophyte with no experience in mental health policy or indeed in legislation. His name was Ronald Reagan, and in 1966, he became the governor of California. Reagan had been swept into office in part due to simmering political anger over what many Californians viewed as the “wrong” direction state politics was moving in the mid1960s. This was exacerbated by a state budget crisis that began toward the end of Edmund G. “Pat” Brown’s term as governor and lasted well into Reagan’s.51 The mid-1960s through the early 1970s was an era of panic about spiraling healthcare costs and inflation at both the national and state levels. On the campaign trail, Reagan had promised deep cuts to unnecessary programs and that his administration would weed out the deserving from the undeserving.52 As he came into office

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in 1966, “Reagan had only a Republican minority in the state assembly. Worse still, Assemblyman Frank Lanterman was one of the only state legislators with a favorable view of the governor.”53 Reagan never really cultivated a working relationship with California’s proudly bipartisan state legislators.54 The inexperienced Reagan entered the governor’s office to find a state facing an estimated $250 million budget deficit. He responded by pushing a 10% across-the-board slash to appropriations, starting with laying off 3700 employees in the state mental health system (later reduced to 2600) and closing two of the smallest state hospitals. Reagan maintained that individuals in state hospitals could easily be returned to and cared for in their home communities and that those who remained would face a reduction in quality of care. On the campaign trail, he had referred to the state hospitals as “in a sense, hotel operations.” It quickly became apparent that local and county systems would not be able to handle such a massive shift as Reagan proposed. Worse still, there were no guarantees individuals would be welcomed back by their families once they were released from the hospital. In retrospect, it appears Reagan and his staff fundamentally misunderstood the situation: they read the decline in population in these hospitals as a sign they were ripe for cuts instead of understanding that while psychiatric drugs had allowed many to be released, those who remained were actually more likely than ever to need high levels of care. In this misapprehension, Reagan was aided by the latest director of the State Department of Mental Hygiene. Dr. James Lowry had come into the office in 1964 from the United States Public Health Service. Finding the department’s bureau of social work an “ossified, twenty-five-year-old dynasty,” he immediately had set about trying to bring it under his direct control. Ultimately, the bureau was completely removed from the department of mental hygiene and shifted to the state’s department of social welfare. He also sought to break the hospitals into regional service areas, an approach known as the Mendocino Plan. Although he himself had recently been pushing for increased staffing at state mental hospitals, Lowry did not or could not defy the new governor’s will even though a 10 percent across the board cut meant a $19.3 million blow to the department’s annual budget.55 Eugene Bardach eloquently described what happened next: The governor had certainly not anticipated the stormy reaction to his announced staff cuts. Although his popularity with the voters remained

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high, those with whom he was out of favor mentioned as their primary objection to him his cuts in the mental hospitals more often than any other reason. His own party in the legislature was infuriated that neither he nor his aides had consulted with them or even bothered to inform them of what was coming. Lanterman, too, was angry; for he, Frank Lanterman, long-time friend of the mentally ill, beloved of the CAMH [California Association of Mental Health] and the CCRC [California Council for Retarded Children], would have to defend the cuts in public. Not only were they indecent in his view; they were also unrealistic. Though an ardent and genuine admirer of the governor, Lanterman was not necessarily so devoted to his assistants. By haranguing the governor’s deputies, the word got back to the governor that Lanterman expected the administration (including the DMH [Department of Mental Hygiene] of course!) to support AB 1220. Lanterman’s sense for drama, and his natural fluency at thumping and blustering, brought results. In the end, the governor declared his support for the bill “in principle.” It was not a strong endorsement, but it was better than nothing.56

Letters from concerned citizens and groups scolding the governor and his administration for the proposed cuts and pleading with Reagan’s fellow Republican Lanterman to intervene soon began to arrive in Sacramento.57 For his part, former governor Pat Brown was so angry at what Reagan was doing that he wrote an entire book about it. To Brown, Reagan’s approach to mental healthcare funding was “noisy, confusing, vacillating, amateurish, and based on the most falsely narrow economic viewpoint.”58 The proposed layoffs understandably also created conflict between the state legislature and the California State Employees’ Association, particularly after the closing of Modesto and DeWitt State Hospitals. The State Department of Mental Hygiene tried to run interference by suggesting the creation of satellite hospitals that would rehire some of those who had lost their jobs. Lanterman, at his most curmudgeonly, quickly swatted that proposal down. “I said, ‘look, you can’t run your other hospitals, not worth a dime. They’re underfunded, understaffed, and you have acquiesced to it. In fact, insisted upon it. And that is around your neck, not the legislature’s.”59 “The whole system game unglued and it blew up in our faces right away,” Ken Hall, one of Reagan’s cabinet members, remembered. Reagan and his administration also failed to notify the state legislators with state hospitals in their districts before announcing the plan, leaving them

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to face blowback from angry constituents. “The roof fell in on the whole thing,” Reagan later admitted. The statewide cuts to the hospitals continued, although hospitals for the developmentally disabled “received a slight increase in funds, as did the two prestigious neuropsychiatric institutes.” The total state budget actually increased over the previous years.60 Meanwhile, the proposed AB 1220 continued to wind its way through the California State Legislature. Support from mental health organizations was growing: the California State Psychological Association (CSPA) called it “the Magna Carta of the mentally ill.” A virtual who’s who of California organizations expressed support for the bill: the California and Stanford Law Reviews, the California Congress of Parents and Teachers, and the California Nurses Association joined the ACLU, the State Department of Mental Hygiene, and the California Association for Mental Health in backing the proposed changes. Petris felt that having members from both parties was key to drumming up so much support, both inside and outside of the state legislature. “When they look at Petris at one end and Lanterman on the other, Petris being one of the most liberal members of the Senate and had been in the Assembly, Lanterman the most conservative assemblymen, they figured it can’t be all bad if these two guys are both for it,” he recalled.61 The California State Assembly voted seventy-seven to one (with two abstentions) to move the bill on to the senate. There, however, progress quickly stalled. To keep AB 1220 alive, and with the blessing of Speaker of the Assembly Jesse Unruh (D-Orange County), AB 1220 was joined with Senate Bill 677, which revised the Short-Doyle Act (particularly its reimbursement formulas) so the two were now folded together. Collectively, they were known as the Lanterman-Petris-Short bill or the Community Mental Health Services Act. It was signed into law by Governor Reagan in 1968 to take effect July 1, 1969. The final product, Lanterman, Petris, and Short wrote, “does not solve all the problems nor does it completely conform to the wished of any one professional group. The Act is based on factual studies and the fullest participation of hundreds of people with different views. The final product,” they vowed, “represents a consensus and is generally regarded by all who have participated in its formation as a major necessary step forward.”62 The Lanterman-Petris-Short bill now made the establishment of a community mental health service mandatory for any county with a population of 100,000 or more. Every county was required to prepare an

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annual report for the department of mental hygiene that formed the basis for how the now 90%/10% reimbursement would be calculated. In it, each county had to detail all the services provided, whether by county facilities, in state hospitals, or in private facilities under contract with the county. The local community mental health director was now the main person in charge. Reimbursable categories now included ten possibilities: inpatient services, outpatient services, partial hospitalization, emergency services, diagnostic services, rehabilitation services, pre-care and aftercare services, training, research, and evaluation. A fifteen-member citizens advisory board was created to advise the director of mental hygiene. Thirteen-member local health advisory boards, consisting of doctors, social workers, and mental health professionals, were also created.63 Appropriations for state hospital services for the mentally retarded were still separate but could also be provided at the county level and were reimbursed using Short-Doyle’s new 90%/10% reimbursement formula. All available county-level public and private facilities had to be utilized before an individual could be sent to a state hospital.64 On treatment and commitment, Lanterman-Petris-Short emphasized voluntary treatment, “moving away from indefinite confinement, and adopting behavioral criteria rather than ‘need for treatment’ justifications for confinement.”65 It did away with judicial commitment for Californians with epilepsy, the “mentally disordered” and anyone “impaired by chronic alcoholism,” but also added that it did not change any existing commitment laws for “mentally disordered sex offenders, narcotic drug addicts, habit-forming drug addicts, mentally abnormal sex offenders, mentally retarded persons, juvenile court wards, and mentally disordered criminal offenders.”66 Judicial commitment of anyone deemed disabled or disorderly had, of course, been the backbone of the state system since 1850. Now, individuals “conspicuously in need of care and treatment but unwilling or unable to accept public or private services” could still be brought to a designated county facility approved by the department of mental hygiene “by a peace officer, member of the attending staff of an evaluation facility, or other person designated by the county” and involuntarily held, but only for seventy-two hours, excluding Saturdays, Sundays, and holidays. A court order could also produce an involuntary hold, but only with the required prepetition screening and a court-ordered evaluation.67 The goal was to get the individual the help they needed within those seventy-two hours, whether that was going home, a referral to another facility for care on a voluntary basis, or recommendation

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for conservatorship.68 If the hold had not produced the desired results, however, and if the individual was still refusing treatment, involuntary treatment could be extended, but not for more than fourteen days and not without notifying the superior court involved in the original detention. “Every person detained by certification for intensive treatment had a right to judicial review of his case, and must be granted a hearing by writ of habeas corpus in Superior Court within two judicial days after a petition is filed,” the department of mental hygiene explained after the bill had passed. “The hearing is meant to ensure that the patient’s civil and legal rights are not violated and that he is not held against his will without good cause.”69 The Lanterman-Petris-Short Act also clearly spelled out, for the first time in the state’s history, the rights of the individual being treated, even if they were on an involuntary hold. These included the right to have visitors every day; the right to refuse shock treatment; the right to refuse lobotomy; and the right to have access to telephones. The act required these rights to be clearly posted in both English and Spanish in each facility. A professional in charge of a facility could deny these rights for “good cause,” but such refusal had to be recorded in the individual’s records and made available upon request to the individual, their attorney, or their conservator as well as the county board of supervisors and the state legislature.70 As large and unwieldy as the state mental healthcare system had been, it paled in comparison with the complexities now confronting the counties. The county of Los Angeles and its board of supervisors still oversaw emergency hospital care and the provision of health care of indigent county residents. The county had also assembled an advisory committee on the Short-Doyle Act to help ensure it remained in compliance with the new law.71 For Los Angeles County, the new legislation posed a formidable challenge. The county department of health in 1968–1969 had a budget of $16 million but anticipated it would need triple that amount to meet the demands of the new California Mental Health Act. The subsequent California Mental Retardation Act of 1969 (discussed below) further expanded services to county residents with developmental disabilities. It coordinated those services with the state department of mental hygiene under the 90/10 formula devised under the Short-Doyle Act revisions.72 By the end of the 1960s, Los Angeles County had one of the largest and most complex healthcare delivery systems in the country. “What in many other communities is a small pamphlet telling people

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where to find help,” one author lamented, “is in Los Angeles a 217page book.…Superimposed on this maze of fragmented resources are various coordinating agencies and mechanisms designed to provide liaison of health professionals and a continuum of care for patients.”73 A handful of Californians continued to criticize what had just been done. Superior Court Judge Richard F. Harris of San Luis Obispo County sent a letter to his state assemblyman William M. Ketchum in 1970. “Let me say, that San Luis Obispo, as well as every other county in the State, will someday have a killing result because someone who won’t qualify for detention under ‘LP’ [Lanterman-Petris] is allowed to roam at will through our streets. When that comes, I hope the legislators and the various members of their staff who ‘foisted’ this legislation are around to explain how such a situation was allowed to exist.”74 For reformers, however, there was one final piece to the legislative puzzle. Two years after initial meetings in the subcommittee on mental health services about the need for more community resources for children with developmental disabilities, in 1965, the state began experimenting with regional centers to provide services to them. The idea was to create locations within communities where families could go for assistance as soon as they felt it was needed, rather than waiting until a crisis precipitated contact with state and local agencies. Once again, California’s counties were chosen as the appropriate level to house the experimental regional centers. This was followed in 1968 with a formal study by the legislature of all facilities and programs for the developmentally disabled (“mentally retarded persons” in the language of time) in the state. A 1967 study, conducted by the Assembly Interim Committee on Ways and Means’ Subcommittee on Health, Education, and Welfare Services (and chaired by Nicholas Petris), identified two key issues (“gaps and deficiencies in existing services for handicapped children” and “poor coordination of these services”) while the formal 1968 study identified seven issues, ranging from a shortage of funds overall to a lack of services in some parts of the state to an excessive reliance on the state hospital system. Services were fragmented in some places, duplicated in others, and often simply unavailable. This state of affairs made it even more difficult for individuals to get the early interventions experts deemed critical for future success. Dr. George Tarjan, in particular, argued that the state needed to not replicate what he viewed as some of the mistakes of deinstitutionalization in mental health. “The community must be readied for the acceptance of the mentally

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retarded before institutions can be depleted of their populations,” he argued. “Which was essentially, in the mental health deinstitutionalization program, approached the other way around—let’s empty the institutions before we worry about what is going to happen to them in the community.” As the subcommittee report put it, “it is most important that those interested in services for the retarded avoid the mistake of placing this issue in ‘either/or’ terms. The state hospitals have, and will continue to have, a significant job to do. But they are not the only way in which the state should honor its obligation to this group of children” (emphasis theirs). As a side note, the committee report also pointed out that if individuals with developmental disabilities lived in the community instead of in hospitals, they would be “eligible for child welfare, medical, surgical, recreational and educational services provided by local public and private agencies” as well as benefitting from “being assimilated into the mainstream of community life.”75 In response to concerns like this, Lanterman, Petris, and Waldie drafted new legislation. Waldie was “the real stemwinder,” as Lanterman recalled; together, they were “the three musketeers” of the ways and means committee. A “triumvirate,” Dr. Frank Tallman called them. Their ultimate goal was, he said, “to provide an alternative to hospital commitment for life.”76 Their bill was named the California Mental Retardation Act of 1969 (also known as the Lanterman Mental Retardation Services Act) and passed through the California State Legislature in 1969, taking effect July 1, 1971. It expanded the regional center model across the state. There were already nine before the act took effect. Most were actually former outpatient clinics that had already existed and were now simply changed in function (and sometimes in name): Golden Gate Regional Center in San Francisco; Children’s Hospital of Los Angeles Regional Center in Los Angeles; Children’s Hospital of Orange County Regional Center in Orange; Children’s Hospital and Health Center, San Diego Regional Center in San Diego; Loma Prieta Regional Center in San Jose; Alta California Regional Center in Sacramento; Central Valley Regional Center at Fresno in Fresno; Far Northern Regional Center in Redding; and Tri-Counties Regional Center in Santa Barbara. Joint planning took place between the state’s human relations agency, health planning council, and the departments of mental hygiene, public health, finance, youth authority, rehabilitation, human resources development, healthcare services, social welfare, and the California Association for the Retarded. Thirteen mental retardation planning boards were also created across the

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state with an eye to creating future regional centers.77 Each regional center was staffed with doctors, nurses, educators, and social workers administered by a board of directors that was based in the community, but funding still came from the state (in this case, the state department of public health). “Limited federal and community funds, both governmental and voluntary,” were also used to support the centers.78 The act did not completely eliminate the possibility a developmentally disabled individual might be committed to a state hospital. Hospital services could be provided under the new legislation if the care team at a regional center deemed it necessary and if the individual did not pose a danger to themselves or others. The expectation, however, was that unless severely disabled, an individual would live at home or in a group facility, not in a state hospital.79 Numerous state government pamphlets and brochures were quickly published and circulated, most aimed at understandably anxious parents and all promising a seamless transition to the new system. Most also included a reprint of a letter from Governor Ronald Reagan on official letterhead lauding the changes. The act, he wrote in one of them, “provides us with a dynamic framework on which we shall build a comprehensive system to assure that the mentally retarded develop to the fullest extent of which they are capable.”80 Parents, however, expressed fears about future stability for their developmentally disabled children, particularly if they were now to be shifted from a state institution to some sort of a private care facility. “Private agencies make no long-term commitment to their children and…such agencies can and do go out of business,” one observer noted. “Understandably, these parents want some assurance of the state’s continuing care for their children.”81 For its part, the department of mental hygiene took all the changes on board and recalibrated its approach to mental health. “Standards of care in state hospitals for the mentally ill are progressive and enlightened, but the large mental hospital no longer provides the only solution to the treatment of mental illness. When a patient enters a state hospital he usually leaves his home and community behind, even though only temporarily,” it explained in a 1969 brochure. “It is agreed that many mentally disordered patients do not need to be hospitalized…. they can receive satisfactory treatment within their own communities on either an inpatient or outpatient basis, sometimes remaining self-supportive or practically self-supportive and living with their families or near them.”82

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For Reagan, who signed both the Community Mental Health Services Act/Lanterman-Petris-Short and the Lanterman Mental Retardation Services Act without protest, the new legislation quickly became a point of pride. In 1969, Reagan reversed his previous budgetary course and increased the department’s budget to a record $28 million, but he also went ahead with the plan to close Modesto State Hospital. In 1970, when the American Psychiatric Association held its annual meeting in San Francisco and invited Frank Lanterman to be a guest speaker, Reagan sent a letter to the organization’s then-president Dr. Raymond Waggoner. Lanterman, Regan wrote, “is the ‘father’ of recent legislation benefitting both the mentally ill and the mentally retarded in California and great credit is due him.” The governor explained that “basically, his legislation advances the intent of California Government to return services to local communities wherever possible—together with the resources to operate them. Now 52 of our 58 counties have mental health programs. These counties, with a population of more than 19.5 million, served 148,000 patients last year.” Even in a year of tight budgets, “when I have tried to eliminate every unnecessary expense,” Reagan had asked the state legislature for $75 million in appropriations to pay for 90% of the cost of these local services in the next fiscal year. “I view our substantial increase in total mental health expenditures, in part, as a profitable investment,” he explained. “Not only does improved mental health service provide our citizens with prompt, effective treatment, but it also contributes to the reduction of the number of patients in our hospitals for the mentally ill.”83 Reagan celebrated that the number of individuals in state hospitals for the mentally disordered had dropped from 30,000 to 13,000 over five years, even while the state’s population was growing.84 Correspondence between the two men remained relatively warm, with Reagan always addressing Lanterman as “Frank.” “I know just how trying the [1969 legislative] Session was both physically and mentally for you, and how hard you struggled to protect us upstairs,” Reagan wrote in one letter. He applauded Lanterman’s work on the state’s ways and means committee as key to “maintaining fiscal discipline” in the state. “You have,” Reagan admitted, “volunteered for what is most of the time a thankless job.”85 In 1970, Reagan appointed Lanterman to the Governor’s Ad Hoc Commission on Health Insurance. Lanterman also advised Reagan directly on appointment to the Citizens Advisory Board of the Department of Mental Hygiene.86 Reagan described Lanterman as “one of my closest and most valuable friends in the State Legislature.”87

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Reflecting on his early career at Pacific in the 1950s, Dr. George Tarjan later said, “You know, in those days we happened to be so very proud of the institutionalization in the mental health field, and it took us another decade—two decades actually—to begin to realize that we kind of overlooked thinking about what will happen in the community.”88 In those two subsequent decades, California’s state legislature had completely rewritten the state’s major laws about commitment, care, and the institutionalization of the mentally and developmentally disabled. From a state with a Sacramento-based, intensely hierarchical system of state hospitals, California had transformed itself into a state with hundreds of small to mid-sized community-based clinics trying to provide care on a regional level. The legislators who created this new system were certain it would be more successful than the one it replaced. Indeed, it was heralded at the time as a breakthrough: a humane, individual-based approach to mental health care that promised to produce the results the state hospitals never had. Although the state hospitals themselves continued to exist, the decline in population that had begun in the 1950s turned into a plunge. With ever-shrinking populations, it became more and more difficult for the state to justify the state hospitals’ continued operation. At the same time, however, the promise of a new system of state-funded, community-based care solving, once and for all, California’s mental health issues proved bitterly illusory.

Notes 1. The council could offer advice to the director as well as the governor, but they was under no obligation to take it. The Welfare Planning Council of the Los Angeles Region, The Mental Health Survey of Los Angeles County, 1957–1959, 101–102; Bardach, The Skill Factor in Politics, 20, 30, 87. 2. The Welfare Planning Council of the Los Angeles Region, The Mental Health Survey of Los Angeles County, 1957–1959, 181–182. 3. “Frank Tallman,” 76. 4. “Frank Tallman,” 76. 5. Patton State Hospital: patients and staff, drawings by D. R. Wilder. 6. Longmore and Umansky, “Introduction: Disability History: From the Margins to the Mainstream,” 11; “History of People First California,” https://www.peoplefirstca.org/history; Osgood, The History of Special Education, 102–103; “Frank Tallman,” 76; Glenn, Forced to Care, 193. 7. From the 1970s on, however, the two are of course as inextricably linked in California as elsewhere.

292 8. 9. 10. 11. 12. 13. 14.

15.

16. 17.

18.

19. 20.

21.

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The New and More Open Outlook for the Mentally Retarded, 11–13. Osgood, The History of Special Education, 102–103. Lerman, Deinstitutionalization and the Welfare State, 89–90. Prestinary, Napa State Hospital, 9. Doroshow, Emotionally Disturbed, 191. Bradley, Deinstitutionalization of Developmentally Disabled Persons, 5; Bardach, The Skill Factor in Politics, 19. Medicare and Medi-Cal also transformed care at Rancho Los Amigos. Scotch, “American Disability Policy in the Twentieth Century,” 380; “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, vol. 1,” 192; Fliedner, Centennial, 312. W. Stewart Pinkerton, Jr., the author of the article, spent time at the Benjamin Rush Clinic for Problems of Living in Los Angeles to write the article, so these services were available in at least some places in California by 1967. W. Stewart Pinkerton, Jr., “Mental First Aid: Psychiatric Teams Use a Fast New Technique with the Mentally Ill,” Wall Street Journal, November 27, 1967. Noll, “Institutions for People with Disabilities in North America,” 321. One Flew Over the Cuckoo’s Nest, 1975, imdb.com, https://www.imdb. com/title/tt0073486/?ref_=nv_sr_srsg_0; Noll, “Institutions for People with Disabilities in North America,” 321. I call this case partially successful because although the mother in question, Sara Rosas Garcia, was not able to keep her daughter Andrea out of Pacific State Hospital after she’d been picked up by juvenile authorities, one of the dissenting judges in the case argued that the department of institutions had far too much power over the bodies of individuals in its charge, up to and including sterilizing them without their consent. This was the first time an individual in a position of power in the state came out against the practice of eugenic sterilization. Although Andrea did end up at Pacific, she successfully evaded sterilization by escaping. When Pacific staff was unable to recover her, she was declared officially discharged without ever having been returned to the institution. Lira, Laboratory of Deficiency, 177–179. “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, vol. 1,” 210–212. In his oral history interview, Tarjan was also asked how his own identity as a European-born Jew shaped his opinions about eugenics in the wake of the horrors of Nazism and World War II. He suggested the two were definitely related in his thinking but did not provide many details. “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, vol. 1,” 231–234. Tarjan’s memory on this is not exact (perhaps because of the Scotch and soda), but he suggests that State Representative Frank Lanterman, soon to be so pivotal to a whole host of new legislation in the state, was

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22. 23.

24.

25. 26. 27.

28. 29.

30.

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likely involved in this effort. The revisions, which also included removing syphilis and “sex perversion” as grounds for sterilization, were passed by the state senate in 1951 and the state assembly in 1953. “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, vol. 1,” 217–219, 228, 232–234; Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 12; Stern, Eugenic Nation, 135. Bardach, The Skill Factor in Politics, 26–27; “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, vol. 1,” 235–236. Initially, the minimum age of admission at Pacific was five years. One of the newest hospitals for the developmentally disabled, Fairview, had particularly high mortality, so much so that for a time, Tarjan was assigned there as well as to Pacific to try and decipher the cause. He discovered it was due to endemic diseases common to communal living facilities (shigellosis, amebiasis, hepatitis) that the less experienced staff at Fairview had not recognized. State of California Human Relations Agency, Lanterman Mental Retardation Service Act, 13; “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, vol. 1,” 194–195, 199–202, 220, 270, 285. Bardach, The Skill Factor in Politics , 29; on state legislative committees, see, for example, the 1965 interview with Dr. Donald M. Bramwell, superintendent and medical director of Sonoma State Hospital, in Pond and Brody, Research Monograph No. 3: Evolution of Treatment Methods at a Hospital for the Mentally Retarded, 61. Bardach, The Skill Factor in Politics, 26–27; “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, vol. 1,” 235–236. Yanni, The Architecture of Madness, 146. Blaine was a celebrated figure in American psychiatry and helped push for more “progressive therapeutic ideologies” in the state hospitals. However, because he refused to uproot his family from Philadelphia, he commuted back and forth from there to California, and much of the day-to-day operation of the department was left to underlings. Lerman, Deinstitutionalization and the Welfare State, 89–90; Bardach, The Skill Factor in Politics, 21, 93. Roddy Slorach, A Very Capitalist Condition: A History and Politics of Disability (London: Bookmarks Publication, 2016), 128–129. Interestingly, the growing popularity of Freudian psychoanalysis played virtually no role in deinstitutionalization because it was designed to treat relatively mild neuroses, not the major psychiatric illnesses one was likely to encounter in an institution. As discussed, it was seldom used in California’s state hospitals. Yanni, The Architecture of Madness, 145–148. In fiscal years 1967–1968, Los Angeles County remained in first place, spending $32,410,664. San Francisco County spent 12,836,016, and Santa Clara County, $4,682,216. Although the data is for “care of the

294

31.

32.

33.

34.

35.

36. 37.

38. 39.

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mentally ill,” it is likely that it includes spending for the developmentally disabled as the two types of hospitals had always been regarded as parts of the same whole by the state of California, at least for budgeting purposes. California Bureau of Budget Planning, “Estimated Expenditures by County for the Care of the Mentally Ill in State Hospitals for the Mentally Ill, 1960–1968,” February 26, 1968, Frank D. Lanterman Papers, California State Archives, Sacramento, California. “Frank D. Lanterman: Crusades of a Republican Legislative Leader, 1951– 1978: Water, Mental Health, Education, Ways and Means,” interview conducted by Gabrielle Morris in 1977, 1978, Governmental History Documentation Project, Regional Oral History Office, The Bancroft Library, University of California, Berkeley. Berkeley, California, iii, 1, 28–29. “Frank D. Lanterman: Crusades of a Republican Legislative Leader,” 3a, 44–45, 47; Bardach, The Skill Factor in Politics, 26, 119; Ralph Juvinall, “Frank Lanterman: Grand Old Man,” Cal-Tax News, June 1978, quoted in “Tiger and the Pussycat: The Lanterman Legend,” in The La Cañada Valley Sun, July 6, 1978. Lanterman believed that Rappaport was ultimately forced out of his position due to this fight, but that cannot be confirmed. “Frank D. Lanterman: Crusades of a Republican Legislative Leader,” 10–11, 61. On Lanterman’s role in the California Legislature Assembly Interim Committee on Social Welfare’s 1957 investigation, see Problems of State Mental Hospitals 19, no. 5 (1957): 10, 12–13, 21–24, 46, 69. In 1963, Short-Doyle was amended to raise state reimbursement to 75% for any services started by cities and counties before October 1965. “Frank D. Lanterman: Crusades of a Republican Legislative Leader,” 11– 13; “Frank Tallman,” “Earl Warren and the State Department of Mental Hygiene: Frank F. Tallman, M.D., Dynamics of Change in State Mental Institutions; and Portia Belle Hume, M.D., Mother of Community Mental Health Services,” 28. “Portia Belle Hume,” “Earl Warren and the State Department of Mental Hygiene: Frank F. Tallman, M.D., Dynamics of Change in State Mental Institutions; and Portia Belle Hume, M.D., Mother of Community Mental Health Services,” 28. “Frank D. Lanterman: Crusades of a Republican Legislative Leader,” 13. California Department of Mental Hygiene, The New California Mental Health Act (Sacramento, 1969), 3, 5; “Donald D. Doyle,” Wikipedia.org, https://en.wikipedia.org/wiki/Donald_D._Doyle. Lou Cannon, Governor Reagan: His Rise to Power (New York: Public Affairs, 2003), 170. See, for example, “Are You Mentally Ill?” The Ledger, March 31, 1955.

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40. Medi-Cal was “the state’s conduit for federal funds appropriated under Title XIX of the 1965 Medicare amendments (concerning the medically indigent as opposed to the aged, who were covered in Title XVIII).” The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 102, 482–485; Bardach, The Skill Factor in Politics, 20, 23, 35. 41. According to the Welfare Planning Council Report, in this first year, the county of Los Angeles was indeed reimbursed by the state of California for $529,887. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 102, 482–485. 42. California Department of Mental Hygiene, “A Long Range Plan for Mental Health Services in California” (Sacramento: Department of Mental Hygiene, March 12, 1962), n.p., and California Department of Mental Hygiene, “A Long Range Plan: Mental Health in California: Community Centered Services, Meeting Statewide Needs” (Sacramento: Department of Mental Hygiene, 1964), n.p. 43. According to Eugene Bardach, “those individuals who were not first-time admissions were either readmissions or court-ordered observation cases.” Bardach, The Skill Factor in Politics, 19, 23–24, 83; Anitra C. Hurley, “Portia Bell Hume, MD: Architect of California’s Community Mental Health Program,” in “Portia Belle Hume,” 118. 44. Bardach, The Skill Factor in Politics, 39. 45. Assembly Ways and Means Committee, “The Future Organization of Mental Health Services in California: A Preliminary Statement,” November 29, 1967, Frank D. Lanterman Papers, California State Archives, Sacramento, California, 2. 46. Nicholas C. Petris recalled in a subsequent oral history interview that the ways and means committee had originally approached the issue from a standpoint of whether California was getting its money’s worth from its mental health spending, but it quickly broadened far beyond that question. California (State) Legislature Assembly Interim Committee on Ways and Means, Subcommittee on Mental Health Services, “The Dilemma of Mental Commitments in California,” November 1966, 6–7, quoted in Bardach, The Skill Factor in Politics, 100; “Interview with Nicholas C. Petris,” 107. 47. Department of Mental Hygiene, Division of Local Programs, “California Mental Health Services, Short-Doyle Act and Lanterman-Petris-Short Act,” February 16, 1973, Frank D. Lanterman Papers, California State Archives, Sacramento, California, 2. 48. California (State) Legislature Assembly Interim Committee on Ways and Means, Subcommittee on Mental Health Services, “The Dilemma of Mental Commitments in California,” November 1966, 6–7, quoted in Bardach, The Skill Factor in Politics, 100; Department of Mental Hygiene,

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49.

50. 51. 52. 53.

54.

55.

56. 57.

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Division of Local Programs, “California Mental Health Services, ShortDoyle Act and Lanterman-Petris-Short Act,” February 16, 1973, Frank D. Lanterman Papers, California State Archives, Sacramento, California, 2; Assemblyman Frank Lanterman, Senator Nicholas C. Petris, and Senator Alan Short, “The Mental Health Act of 1967, S.B. 677, Summary of an Act of Solve the Dilemma of Mental Commitments in California,” Frank D. Lanterman Papers, California State Archives, Sacramento, California, 1–3; California Legislature Assembly Committee on Ways and Means, Special Committee on Mental Health Services, “Confidential Staff Report Visit to Dewitt State Hospital, July 23, 1964,” 1–3. “San Joaquin County, Transcript of Board of Supervisors Meeting Held on December 7, 1967, 1:30 p.m. re: Lanterman-Petris-Short Bill on Mental Health—Appearance of Judge Bill Dozier,” Frank D. Lanterman Papers, California State Archives, Sacramento, California, 1; Interview with Nicholas C. Petris,” 119. “Frank D. Lanterman: Crusades of a Republican Legislative Leader,” 13– 14; Bardach, The Skill Factor in Politics, 19, 101, 102–105, 111. “Frank D. Lanterman: Crusades of a Republican Legislative Leader,” 17. Doroshow, Emotionally Disturbed, 193. Lanterman was, above all, a loyal Republican, and Reagan knew that. “Together, we reestablished a viable party in 1966,” Reagan once wrote to Lanterman. “Together, we will achieve a legislative majority in 1968.” Letter from Governor Ronald Reagan to the Honorable Frank Lanterman, June 11, 1968, Reagan, Ronald Gubernatorial Papers, 1966–1975, Correspondence Unit: X-Files, Box. 442, Ronald Reagan Presidential Library, Simi Valley, California; Cannon, Governor Reagan: His Rise to Power (New York: Public Affairs, 2003), 170. Bob Spitz attributes this phenomenon to the legislature being part-time until 1967. Thus, legislators living in Sacramento, likely without their families, had both the time and the need to interact socially across party lines. These personal friendships often carried over into legislating. Bob Spitz, Reagan: An American Journey (New York: Penguin Press, 2018), 347. Lowry’s proposal to shift the hospitals to regional service areas took effect on July 1, 1965. The shift of the Bureau of Social Work occurred on July 1, 1965. San Francisco Chronicle, June 1, 1966, quoted in Bardach, The Skill Factor in Politics, 31; “Frank D. Lanterman: Crusades of a Republican Legislative Leader,” 15; Bardach, The Skill Factor in Politics, 94, 142, 163, 169–170. Bardach, The Skill Factor in Politics, 125. See, for example, “Mrs. Carl Rosenfeld, Chairman of the Alameda County Council of the League of Women Voters, to the Honorable Ronal Reagan,” December 31, 1967, and “Superior Court Judge William B.

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58. 59. 60.

61.

62.

63. 64.

65.

66.

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Neeley to the Honorable Frank Lanterman,” April 6, 1967, Frank D. Lanterman Papers, California State Archives, Sacramento, California. Edmund G. “Pat” Brown, Reagan and Reality: The Two Californias (New York: Praeger Publications, 1970), 81. “Frank D. Lanterman: Crusades of a Republican Legislative Leader,” 15. Why Reagan and his administration continued to pursue the cuts to the state hospitals remains a bit of a historical mystery. Eugene Bardach speculates that it was because adult Californians with metal disabilities had no real political or social power and thus were easy targets. Ken Hall, interview with Bob Spitz, July 17, 2014, and Ronald Reagan, interview, October 26, 1968, 3, Lou Cannon Archives, Davidson Library, University of California Santa Barbara Special Collections, both quoted in Spitz, Reagan: An American Journey, 342–343; Cannon, Governor Reagan, 189–193; Bardach, The Skill Factor in Politics, 142, 145–146. Memo from Joe A. Gonsalves, Assembly Office of Research to the Honorable Frank Lanterman, February 23, 1968, Frank D. Lanterman Papers, California State Archives, Sacramento, California, 3; California Department of Mental Hygiene, The New California Mental Health Act (Sacramento, 1969), 3; Bardach, The Skill Factor in Politics, 126, 133; Bardach, 133–139; “Interview with Nicholas C. Petris,” 121. California Department of Mental Hygiene, The New California Mental Health Act (Sacramento, 1969), 3; Bardach, The Skill Factor in Politics, 126, 133–139; Assemblyman Frank Lanterman, Senator Nicholas C. Petris, and Senator Alan Short, “The Mental Health Act of 1967, S.B. 677, Summary of an Act of Solve the Dilemma of Mental Commitments in California,” Frank D. Lanterman Papers, California State Archives, Sacramento, California, 1. California Department of Mental Hygiene, The New California Mental Health Act (Sacramento, 1969), 3, 5–8. California Department of Mental Hygiene, The New California Mental Health Act (Sacramento, 1969), 3, 5, 11; Department of Mental Hygiene, Division of Local Programs, “California Mental Health Services, ShortDoyle Act and Lanterman-Petris-Short Act,” February 16, 1973, Frank D. Lanterman Papers, California State Archives, Sacramento, California, 4. M. Susan Ridgely, Randy Borum, and John Petrila, The Effectiveness of Involuntary Outpatient Treatment: Empirical Evidence and the Experience of Eight States, by M. Susan Ridgely, Randy Borum, John Petrila; prepared for the California Senate Committee on Rules (Santa Monica, CA: RAND Health; RAND Institute for Civil Justice, 2001), xviii; Bardach, The Skill Factor in Politics, 107. California Department of Mental Hygiene, The New California Mental Health Act (Sacramento, 1969), 16–17.

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67. California Department of Mental Hygiene, The New California Mental Health Act, 16–17. 68. A conservator was someone allowed to act in the individual’s stead if they were deemed too disabled or impaired to conduct their own affairs. Every conservatee had the right to a jury trial to determine whether they were “gravely disabled.” A conservatorship only lasted one year, but it could then be renewed. California Department of Mental Hygiene, The New California Mental Health Act (Sacramento, 1969), 19–20. 69. There were a few situations in which involuntary detention could be extended further, including if an individual was deemed suicidal or a physical danger to the community. California Department of Mental Hygiene, The New California Mental Health Act (Sacramento, 1969), 18; “Welfare and Institutions Code, Division 5, Community Mental Health Services, Part 1. The Lanterman-Petris-Short Act,” Frank D. Lanterman Papers, California State Archives, Sacramento, California, 3. 70. California Department of Mental Hygiene, The New California Mental Health Act (Sacramento, 1969), 19. 71. The Welfare Planning Council, The Mental Health Survey of Los Angeles County, 1957–1959, 181–182. 72. Malcolm Hendricks Merrill, Future Directions for Health Services, County of Los Angeles, 1970 (New York: American Public Health Association, Community Health Action Planning Services, 1970), 23, 31, 125. 73. Merrill, Future Directions for Health Services, 23. 74. “Letter from Judge Richard F. Harris to the Honorable William M. Ketchum, April 17, 1970,” Frank D. Lanterman Papers, California State Archives, Sacramento, California, 3. 75. The relationship between the 1967 and the 1968 reports is unclear: they have simply been an extension of one another. State of California Human Relations Agency, Lanterman Mental Retardation Service Act (Sacramento: Human Relations Agency, 1971), 5; “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, vol. 2,” 349; Department of Mental Hygiene, Division of Local Programs, “California Mental Health Services, Short-Doyle Act and Lanterman-Petris-Short Act,” February 16, 1973, Frank D. Lanterman Papers, California State Archives, Sacramento, CA, 2; California Legislature Assembly Interim Committee on Ways and Means, Report of the Committee on Health, Education, and Welfare Services on Services for Handicapped Children 21, no. 19 (1967): 9; California Legislature Assembly Interim Committee on Ways and Means, Subcommittee on Mental Health Services, A Redefinition of State Responsibility for California’s Mentally Retarded 21, no. 10 (1965): n.p. 76. “Frank D. Lanterman: Crusades of a Republican Legislative Leader,” 17; Bardach, The Skill Factor in Politics, 101; “Frank Tallman,” 55. 77. Lanterman Mental Retardation Service Act, 5.

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84.

85.

86.

87.

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Lanterman Mental Retardation Service Act, 7. Lanterman Mental Retardation Service Act, 5. Lanterman Mental Retardation Service Act, 1. Bradley, Deinstitutionalization of Developmentally Disabled Persons, 9. California Department of Mental Hygiene, The New California Mental Health Act, 3, 5. Letter from Governor Ronald Reagan to Raymond Waggoner, M.D.,” n.d., reprinted in 1–10: California’s One System, Ten Services: A Journal of Treatment and Care of the Mentally Disordered 1, no. 1 (May 18, 1970): n.p. (New York Academy of Medicine Library, New York, NY). “Letter from Governor Ronald Reagan to Raymond Waggoner, M.D.,” n.d., reprinted in 1–10: California’s One System, Ten Services: A Journal of Treatment and Care of the Mentally Disordered 1, no. 1 (May 18, 1970): n.p. (New York Academy of Medicine Library, New York, NY); Canon, 194. Letter from Governor Ronald Reagan to the Honorable Frank Lanterman, October 10, 1970, Ronald Reagan Gubernatorial Papers, 1966–1975, Correspondence Unit: X-Files, Box 442, Ronald Reagan Presidential Library, Simi Valley, California. Letter from Governor Ronald Reagan to the Honorable Frank Lanterman, August 25, 1970, and Letter from Governor Ronald Reagan to the Honorable Frank Lanterman, February 16, 1970, Ronald Reagan Gubernatorial Papers, 1966–1975, Correspondence Unit: X-Files, Box 442, Ronald Reagan Presidential Library, Simi Valley, California. Letter from Governor Ronald Reagan to the Honorable Jack Williams, January 10, 1969, Ronald Reagan Gubernatorial Papers, 1966–1975, Correspondence Unit: X-Files, Box 442, Ronald Reagan Presidential Library, Simi Valley, California. UCLA Neuropsychiatric Institute and Hospital: George Tarjan, vol. 1,” 289.

CHAPTER 9

California After the Lanterman -Petris-Short Act

By 1970, both the Los Angeles County Sherriff’s Department and the Los Angeles Police Department were complaining to the Los Angeles Times that the state’s new laws around commitment had produced “sick people in jail right now who should be in mental hospitals but can’t get there.”1 The hospital unit attached to the county jail could provide medication but no other forms of treatment. “There was an unknown number of mentally ill prisoners among the more than three thousand in the main jail who are getting nothing more, perhaps, than a pill now and then,” the subsequent Los Angeles Times article reported. “I am against treating the prisoners here because I would then be stuck permanently with this place being a mental hospital. A jail should not be a mental hospital,” declared Dr. Marcus Crahan, medical director of the Sheriff’s Department, to the Times ’ reporter. For his part, Frank Lanterman wrote off such complaints as unwarranted grumbling from professionals who didn’t want to adapt to the new way of doing things. In the bad old days, Lanterman declared, the judiciary “consistently committed people just to get rid of them.” Granted, the courts could no longer do that, but, he said, “the difficulties we are having are minor and can be dealt with. You can’t expect to revise a century-long accumulation of legal crud without making a lot of people upset because their toes have been trod on.”2

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That same year, the California State Legislature ordered a study of the state hospital system. Arthur Bolton Associates, a public policy research firm, carried it out. Issued in January 1970, the report declared that “the state’s mental hospitals were so poor they could no longer be considered ‘appropriate places’ for the treatment and care of mentally disordered children,” Pat Brown recalled. “It declared that treatment was inadequate, crowding in the wards was acute, and living conditions for the children were starkly depressing.”3 Nonetheless, in the spring of 1970, the California Department of Mental Hygiene sent out the first issue of its new publication 1–10 to state hospital employees, members of mental health advisory boards, private hospitals, and college and university libraries. Subtitled California’s One System, Ten Services: A Journal on Treatment and Care of the Mentally Ill, the newspaper captures a snapshot of a system in transition.4 One article celebrated the recent closure of Modesto State Hospital. Modesto was one of the newest hospitals in the system, having opened only in 1947 after having been an Army hospital during World War II. The state claimed that the hospital was simply no longer needed, with the last two individuals held there having been transferred to Patton State Hospital and a private hospital in Los Angeles, respectively. An estimated 70% of its employees moved to other jobs within the system, with others choosing to resign or retire rather than be moved. California proudly proclaimed this to be the first time such a successful closure of a state hospital had happened in the United States, a belief echoed in a letter from Governor Ronald Reagan reprinted in the same issue. Although the authors of the article are not listed, whoever wrote it could not resist a dig at New York State, which a hundred years before had been a model for California. “The closing attests to the capability of California’s progressive mental health program and the single system of community action for the mentally disordered. By contrast, New York is currently committing to $500 million to new state hospital construction.” Another article detailed the plan to shift administrative responsibility for DeWitt State Hospital from the department of mental hygiene to Placer County by the end of 1971, at which point any programs there for the mentally deficient would become eligible to receive funds through Short-Doyle.5 Throughout the 1970s, proposals for how to further reform the various state hospital systems across the United States took many forms, from abolishing all forms of civil commitment to embedding the commitment process entirely within hospitals instead of courts. Many reformers

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and activists pointed to what California had done as the new model.6 Not until 1972–1974, for example, would the rest of the United States catch up to California’s deinstitutionalization rate.7 Other articles in 1– 10, however, did not paint such a rosy picture. One noted that patients in hospitals for the developmentally disabled (Pacific, Porterville, Sonoma, and Fairview) were now younger and more severely disabled than ever before. The population was also statistically more male than before. Older, ambulatory patients from these facilities and those thought likely to respond best to rehabilitation services had been transferred to Agnews, Camarillo, and Napa, placed on leave, or discharged, leaving a more disabled population behind. The newspaper fretted about the impact this was going to have on hospital staffing demands, but reported that so far, hospital training programs designed to help individuals manage their own basic care needs seemed to be working. More ominously, another small article detailed the new policy for using chemical mace on individuals in the state hospitals: “only in extreme circumstances where life is threatened and other measures are inappropriate.”8 Frank Lanterman’s name was by now synonymous with mental health care in California. “His unwavering defense of the community-based mental health system won him the highest honor a partisan Democrat can bestow upon a card-carrying Republican,” the Cal-Tax News chuckled. “He was accused of being a Democrat.” As Assemblyman Jack Fenton (D-Los Angeles) put it, “Mr.Lanterman, we’ve all known it for a long time: you’ve got an ‘R’ after your name and a ‘D’ in your heart.”9 Yet Lanterman knew, better than anyone, that his victories were not without a dark side. As he approached the end of his political career, he acknowledged that in the course of their work on mental health, he and his cohort had upset many Californians. “Almost any change seems threatening to some and frightening to others. The fear of change, although it is often more imagined than real, results in resistance and antagonism,” he explained in a speech. “I have been called everything from a bleeding-heart liberal to a crusty conservative curmudgeon reactionary— and these are my friends! Others such as certain employees’ organizations have described me in X-rated terms.” However, he continued, “despite the expected castigations that seem to haunt those who seek change, there is an inner satisfaction that one gains from trying bold new approaches to tired old problems. I think it’s accurate to say that I have been a boat rocker and wavemaker, particularly with respect to finding new

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ways to provide services to the mentally retarded and developmentally disabled.”10 While still in office, Governor Reagan continued to frame the issue of disability largely as one of the deserving versus the undeserving. In a letter to Patrick G. LaPointe of Shasta County’s board of supervisors, for example, Reagan assured anxious county officials his plans would not be to their detriment, even though he had just vetoed budget items related to welfare and Medi-Cal. “My sole objective in taking that action,” Reagan wrote, “is simple and straight-forward: to insure that California’s already-overburdened local property taxpayers are not required to pay for any more welfare….As you know, I have repeatedly assured you that our welfare reform program will not shift costs to the counties.…I am sure we all share the same goal of making government more efficient while simultaneously taking care of those who truly need public assistance.”11 “We are, of course, deeply concerned with providing for our fellow citizens who are unable—due to age, disability, or other reasons— to support themselves,” the governor wrote to a constituent in Modesto. “These truly needy, however, are in a tragic number of instances being denied sufficient care while more ‘voluntary unemployed’ are swarming onto the welfare and health care rolls daily.” He acknowledged, however, that what he could do as governor was limited and that real change was going to have to come from the state legislature.12 By 1970–1971, budget analysts were still predicting a budget deficit for the state. They projected that welfare spending would increase by $40 million and MediCal by $30 million. This was paired with an anticipated annual drop in state revenues of $71 million. Director of Finance Verne Orr suggested a wide range of cuts to try and close the gap, much of it directed at higher education in the state and at the department of social welfare, including its homemaker-attendant care program “in those cases where relatives now provide the care without charge.”13 In 1973, Reagan moved to transfer California’s visually disabled, aged, and disabled programs to the federal government, which had lower payment and reimbursement rates than California did. This immediately launched a partisan fight in the state legislature, with Democrats attempting to restore state assistance and Republicans, at Reagan’s urging, to block it. Welfare groups quickly sued the state and won an appeal.14 Back in Sacramento, Governor Reagan doubled down. In January 1973, he announced a plan to close all state hospitals for the mentally disabled by 1977 and all state hospitals for the developmentally disabled

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by 1981. This provoked an immediate backlash from the powerful California State Employees Association (CSEA), which represented some 16,000 employees within the state hospital system. After intense lobbying, the legislature bowed to the pressure and passed a bill proclaiming that no hospital could be closed without its approval. When Reagan vetoed it, they overrode his veto.15 News of Reagan’s plan also sent mental health organizations and parents’ groups up and down the state into a panic. Things got so bad that the new head of the department of mental hygiene, Dr. William Mayer, had to send out both a public press release and a letter to the California State Legislature vowing that no definitive plans had been made and that any changes would slowly play out over a number of years. “During the past month considerable speculation, misunderstanding, and misinformation have been circulated regarding the closing of state hospitals,” he told the legislators. “I have regretted this very much as it had raised undue concerns in the minds of parents, friends, and relatives of our patients.” Reagan’s political opponents nonetheless quickly made hay out of his words, with the Democratic Attorney General Edmund G. “Jerry” Brown, Jr., who had an eye on the governorship for himself, quickly declaring to the press that “budget cutting must not be done at the expense of the mentally ill.”16 In 1973, the California State Senate approved Senate Resolution 20, a Senate Select Committee on Proposed Phaseout of State Hospital Services. The committee’s final report argued that its work was justified considering the changes wrought by both Short-Doyle and LPS as well as by “official reports of future closings of state-operated mental health facilities.” This investigation was likely a preemptive strike against Reagan, as it allowed the committee to hold eleven hearings up and down the state and to tour numerous state hospitals, thus keeping the issue before the public and the press. Although the final report did call for some minor adjustments to LPS based on its findings, it insisted there was no “legislative intent” to close the hospitals and that over the course of the hearings the Department of Health had indicated it has already abandoned all plans to do so.17 CSEA continued to fight tooth and nail to prevent any further reductions in state hospital staffing. It directed most of its ire at Reagan and Lanterman who, in its view, had been the chief architect of the changes now underway in the system. To help their cause, the CSEA routinely argued in its publications and to the press that closing state hospitals would result in placing the mentally disabled in

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their communities and that such individuals might be both dangerous and disruptive. Craig Turner of the Los Angeles Times characterized what was happening as “the revolving door syndrome,” in which “chronic patients bounce in and out of hospitals, living from crisis to crisis.” Although the overall numbers of individuals admitted to state hospitals was dropping as planned, Turner noted in a 1974 article, their readmission rate to those same hospitals was 52.5%.18 To further complicate matters, the 1970s were an inflationary period in the United States. This resulted in cutbacks to Medi-Cal and Medicaid, two programs that had underpinned much of the state’s health care spending in the late 1960s. Even had Reagan not been a twoterm governor, budgeting for mental health care in California would still have been a fight over ever-scarcer resources. Certainly, Reagan’s indifference and occasional outright hostility to mental health spending didn’t help. Dr. Werner Mendel, a professor of psychiatry at the University of Southern California, for example, had initially been supportive of Lanterman-Petris-Short (LPS) but quickly turned critic. “Governor Reagan has made a lot of the right decisions for the wrong reasons,” he told the Los Angeles Times. “The money he saved the state hospital system he did not use for alternatives. If you’re going to change from one system to another, you’re going to have to develop the alternative. It was never developed the way it was originally thought of,” Mendel lamented.19 Ever the party loyalist, for the remainder of his time in the state legislature, Frank Lanterman placed what pressure he could on Governor Reagan to keep funds flowing to both the state hospitals and the Short-Doyle program. Lanterman sent letters to Reagan declaring his willingness to mediate between Reagan and the state legislature over budget battles. If that didn’t work, Lanterman had no qualms about buttering up the governor. In the midst of a bruising legislative fight over proposed mental health spending cuts in the summer of 1974, for example, Lanterman wrote first to the governor declaring that “California’s mental health program is viewed nationally as the most advanced in the country and despite partisan claims to the contrary, your Administration has been greatly responsible for its success.”20 When that letter produced no results, Lanterman followed up with a letter declaring that he was “deeply concerned and personally anguished” by Reagan’s actions.21 The Cal-Tax News recounted a slightly different version of the story: “‘You’re not going to get away with this, ‘ Lanterman recalls telling Reagan. ‘I don’t give a damn what you do, you’re not going to get away

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Fig. 9.1 “California State Mental Health Funds Get $18 Million Boost under Bipartisan Agreement with Governor Ronald Reagan, August 1974.” From left, State Assemblyman Frank D. Lanterman, State Senator Anthony Beilenson, Governor Ronald Reagan, State Senator Alfred Alquist, and Assembly Speaker Leo McCarthy. Courtesy of the Frank D. Lanterman Political Papers, Lanterman House Archives

with it.’ When State Senator Alfred Alquist and Assembly Speaker Leo McCarthy, both Democrats, successfully negotiated a deal to restore the funding, Lanterman made certain to have a celebratory photo taken with the governor as Reagan signed off on the deal (Fig. 9.1).22 Lanterman also continued to provide cover to his fellow Republicans and his governor. “It is quite possible,” he declared in a press conference after the 1974 budget battle had ended, “that in the turmoil of the closing days of the budget session we did not deliver the budget in time to the Governor to adequately review the needs of some of the programs which he had now had brought to him in specific recommendations;

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and I am sure his response had been, as I knew it would be, positive and constructive and agreeable.”23 The passage of 1978’s Proposition 13, which put strict limits on the ability to raise property taxes in the state, further reduced funding available to spend on state mental health hospitals and community health programs.24 In the face of growing criticism about the Short-Doyle bill and, particularly, the Lanterman-Petris-Short (LPS) bill, the state of California stood firm, continuing to argue that a great historical wrong had at last been righted. In a “frequently asked questions”-style memo from 1973, it insisted that passing LPS had been the right thing to do. “Railroading” is a strong word, but if railroading means taking a way [sic] a person’s liberty for an indefinite period after a cursory examination on a crowded observation ward and a perfunctory commitment hearing less than five minutes, then we have been guilty of “railroading” in the commitment court. Uninformed community attitudes toward eccentric, unwanted, and burdensome citizens; and the lack of available local mental health services were the main reasons which perpetuated this tragic handling of more than one thousand citizens every month—year after year.25

The hospitals themselves continued to change to reflect new realities. In 1972, a “Foster Grandparent Program” was created. Started at Pacific in 1969, the program offered a small stipend to eligible seniors if they would spend time with residents of facilities for the developmentally disabled. The program was a favorite of then Governor Reagan’s wife Nancy, who did much to publicize it.26 In 1973, the department of mental hygiene was merged into an “umbrella” state health agency, the department of health. Functions that had been deliberately pulled apart and placed in separate agencies in the early twentieth century were now folded back together on the grounds that a single system would be more financially and administratively efficient. A few of the old guard questioned the wisdom of this decision. “It’s going to have everything in the world in it: rehabilitation, public health, mental health, and bits and pieces of other programs that are now in other state departments,” Dr. Portia Bell Hume, who had long since retired, explained. “I feel this is a real step backward….it becomes a kind of monopoly, you know, a state monopoly on health.” Hume was correct, at least about this: in 1978, the department of health was pulled apart again, with many of the functions

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of the old mental hygiene department placed under either the department of mental health or the department of developmental services.27 For the men and women who had been directly involved in building or running California’s state hospital systems, its legacies were many and complex. Ever the political realist (“Conflict, argument, debate, and compromise are the anvils of good legislation,” he once argued), Lanterman held fast to his belief that California had done the right thing with Short-Doyle and Lanterman-Petris-Short. In an oral history conducted near the end of his legislative career, he did admit that no one back in 1968 had anticipated how quickly money would hamstring California’s grand plans for a better, more nimble, and more humane system of care. The mental health thing locally became so under-financed, Mr. Petris [Nicholas C. Petris] says he wished he had never voted for it [LantermanPetris-Short], the fact that we couldn’t get funding, he got the idea that the act was faulty. The act was not faulty. The act was essentially a sound concept. You return the patient to his home environment as quickly as possible, and you keep an investigation for all those in the hospital, and give them a yearly review so the nobody can just stay there as they used to in the old days.28

Lanterman’s old ally Petris was indeed perturbed by how his legislation seemed to be unraveling over time. Reflecting on the early 1970s, Petris later argued that the changes he had helped design started to fall apart rather quickly due to state finances. When we started keeping people out of the state hospital, it was under the intention that the state dollar for mental health was going to follow the patient. So if you had a person mentally ill that was not sent to the state hospital, there’d be money [locally] for that person that ordinarily, otherwise, would have gone to the state hospital. That never happened because, although Reagan signed the bill, much to his credit, he really emasculated it. He cut something like twenty or thirty million dollars out of it the first year. He put that back in the General Fund. That took the guts right out of this state money for local treatment. It emptied out the hospitals but there was no follow-up treatment. That’s what contributed to the current homeless problem as a matter of fact….not only here; it’s happening all over the country. But it was aggravated here by Reagan’s

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refusal to put the money back….We managed to get part of the money back…we have never caught up.29

Petris was also far more reflective than Lanterman about potential flaws in the laws in the system he had helped create. In this overemphasis to get away from this tyrannical and oppressive system [in the state hospitals], of incarcerating people so easily, we went overboard the other way. [Procedures for follow up appointments at the city or county level] never got off the ground. And then it was very difficult for people who tried, because they had no handle on people. There was no way to compel them to do anything. They couldn’t threaten to run them in again, because of the harsh definition we adopted and said that you don’t incarcerate someone against his will unless he’s a danger to himself or others, or he’s so gravely disabled that he just can’t take care of his normal functions. Well, that’s very severe.…And then later we had the problem of doctors fearing lawsuits, being afraid to certify that somebody should be incarcerated, because they might get sued.30

When he tried to have honest discussions about these issues, “I ran into tunnel vision,” Petris recalled. “Everybody just looking at his own narrow approach, and doesn’t have any wide view at all.”31 Meanwhile, Lanterman worried aloud that Californians had somehow gotten the idea into their heads that this new system would be cheaper to operate than state institutions. Worse still, Lanterman was beginning to see that misplaced belief trickle into policy decisions. Everywhere he looked, getting adequate funding to communities so they could provide care was becoming an issue. “We’ve never been able to get the fact through to anybody that non-hospital board and care in the community costs, instead of one-third the cost of hospital care in the community, nearly the full amount minus a small amount for overhead of the hospital. That should have all followed the patients into adequate community care program and cure. And that had not been developed. I have had to fight like a banshee to try and do it, and this is my last year and a half to try and bring it to a head,” Lanterman later recalled in an interview.32 He grew increasingly frustrated about the shortage of funds for community mental health care as he got closer to his planned retirement from the legislature. He was willing to work with Reagan, but he was often openly hostile to the Democratic governor who followed Reagan, Jerry Brown, the son of his old rival, former governor Edmund G. “Pat” Brown, the very same

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state attorney general Lanterman had quarreled with over the fate of Dr. Walter Rappaport of the department of mental hygiene back in 1953. Brown was elected to his first term in 1974. Lanterman now saw his role as making sure Governor Jerry Brown “realized his responsibilities as it related to the mental hospitals, and the handicapped children. And that he refused to do as long as he had a convention to go scalawagging back to, and have extra-territorial political ambitions.…he’s now parading all over the place, having pictures taken,” Lanterman said bitterly.33 “I have devoted my life to taking care of the mentally ill, the handicapped, the developmentally disabled, and apparently, it is coming to a rather sad and confused conclusion,” the Desert Sun newspaper quoted Lanterman in an interview. “Thousands of mentally ill patients were released from mental hospitals to fend for themselves because the few community mental health programs there were to help homebound patients were grossly inadequate. And that was supposed to be one of the major things in the act. If you don’t fund local care to the extent of the need and for the population requirements, you have virtually canceled the effectiveness of the act.” Brown’s ongoing failure to adequately fund mental health services in the state, Lanterman claimed, verged on criminal neglect.34 In public, Governor Jerry Brown was somewhat more gracious to Lanterman than Lanterman was to him. In his 1978 state-of-the-state address, Brown said, “Frank Lanterman, this is your last year in the legislature, and may it be the year of mental health.”35 However, Brown vetoed Lanterman’s last piece of legislation, a bill that would have given free health care to women at high risk of giving birth to a child with a developmental or physical disability.36 Lanterman retired in 1978. That year in his honor, the California State Legislature officially renamed Pacific State Hospital the Frank D. Lanterman Hospital and Developmental Center in recognition of his work on the state’s mental health system.37 In the 1980s, California dropped the term “state hospital” from all state institutions “in order to more accurately reflect the movement away from viewing our clients as ‘patients’ rather than as individuals with special needs and abilities, and to recognize the emphasis on progressive habilitative training being provided to its residents.” The former Pacific Colony thus became the Lanterman Developmental Center.38 Although the population of Californians inside state institutions was shrinking, the state hospitals continued to be plagued by scandals. In 1976, multiple investigations were again made into suspicious deaths at Pacific, Napa, Sonoma, Metropolitan, Porterville, Patton, Fairview,

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Agnews, and Atascadero, although they resulted in no major criminal indictments. One state authority estimated that there had been a major scandal at state hospitals for the mentally and developmentally disabled every fourteen or fifteen years since their founding in 1850.39 By the end of the 1970s, California’s state hospitals had once again been largely forgotten. Their population had shrunk from 37,000 to 6,000. Only the sickest, most violent, and most severely disabled were sent there. The morale of state employees working there had plummeted along with the populations they served. State Legislator Nicholas C. Petris later remembered nurses driving garbage trucks at Sonoma in the 1970s because there was no money to hire anyone else to do it. The best and the brightest doctors, nurses, and administrators from the old department of mental hygiene, he noted, left California for work in hospital systems in other states where funding streams were more stable. The reforms that had been so celebrated in the 1950s and 1960s as heralding a new solution to mental and developmental disabilities had not produced the hoped-for results. “We believed, and I was one of them, that we really could close down the state hospitals,” one doctor told a newspaper in 1977. “That money did not buy what we thought it was going to buy.”40 Although many Californians remained ambivalent about how the changes to the state’s mental healthcare system were playing out, other enormously positive changes were underway. Much of these changes from the 1970s on was driven by developments outside of the California state hospital system and, in some cases, those outside of the state entirely.

Notes 1. Harry Nelson, “Mental Health Act: Burden on Public, Police: New State Legislation Stirs Up Complaints but Also Gains Supports,” Los Angeles Times, April 11, 1970. 2. Harry Nelson, “Mental Health Act: Burden on Public, Police: New State Legislation Stirs Up Complaints but Also Gains Supports,” Los Angeles Times, April 11, 1970. 3. Edmund G. “Pat” Brown, Reagan and Realities, 92. 4. 1-10: California’s One System, Ten Services: A Journal of Treatment and Care of the Mentally Disordered 1, no. 1 (May 18, 1970): n.p. New York Academy of Medicine Library, New York, NY. 5. 1–10: California’s One System, Ten Services: A Journal of Treatment and Care of the Mentally Disordered 1, no. 1 (May 18, 1970): n.p. New York Academy of Medicine Library, New York, NY.

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6. For examples, see Kent S. Miller, Managing Madness: The Case Against Civil Commitment (New York: The Free Press, 1976), Chapter 7. 7. Lerman, Deinstitutionalization and the Welfare State, 94. 8. 1–10: California’s One System, Ten Services: A Journal of Treatment and Care of the Mentally Disordered 1, no. 1, n.p. New York Academy of Medicine Library, New York, NY. 9. Ralph Juvinall, “Frank Lanterman: Grand Old Man,” Cal-Tax News, June 1978, quoted in “Tiger and the Pussycat: The Lanterman Legend,” in The La Cañada Valley Sun, July 6, 1978. 10. Frank Lanterman, Draft Speech, April 24, 1974, Folder 10, Box 1 Developmental Disability Printed Materials, Frank D. Lanterman Political Papers, Lanterman House Archives, La Cañada, California. 11. Letter from Governor Ronald Reagan to the Honorable Patrick G. LaPointe, July 9, 1971, Ronald Reagan Gubernatorial Papers, 1966–1975, Correspondence Unit: X-Files, Box 442, Ronald Reagan Presidential Library, Simi Valley, California. 12. Letter from Governor Ronald Reagan to James Lankford, January 12, 1971, Ronald Reagan Gubernatorial Papers, 1966–1975, Correspondence Unit: X-Files, Box 442, Ronald Reagan Presidential Library, Simi Valley, California. 13. Letter from Verne Orr, Director of Finance, to the Honorable Frank Lanterman and the Honorable Donald L. Grunsky, June 12, 1970, Ronald Reagan Gubernatorial Papers, 1966–1975, Department of Finance Director’s Correspondence, Box F33, Ronald Reagan Presidential Library, Simi Valley, California. 14. Spitz, Reagan: An American Journey, 376–377. 15. Scull, Decarceration, 73; Miller, Managing Madness, 14. See also Peter Sedgwick, Psycho Politics (London: Pluto Press, 1982), 211. In his footnotes, Sedgewick notes that at least one prominent California Republican, S. I. Hayakawa, supported Thomas Szasz’s organization, the American Association for the Abolition of Involuntary Mental Hospitalization. Hayakawa, however, never served in the California State Legislature and was not elected to the United States Senate until 1977, long after deinstitutionalization was underway in California. Work remains to be done to explore what, if any, impact Hayakawa had on national mental health policy after 1977. Segewick, Psycho Politics, n49. 16. William Mayer, M.D., to Member of the California Legislature, February 16, 1973, Folder 14, Box 13, Frank Lanterman Papers, Regional History Collection, USC Special Collections, USC, Los Angeles, California; “Politics Has No Place in Mental Health Care,” The Sacramento Bee, January 23, 1973. 17. Whether the California Department of Health had ever seriously planned to close the state hospitals “by 1982,” as was the rumor, is unclear;

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22.

23.

24.

25.

26. 27.

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what is clear, however, is how much such reports alarmed both the public and the state legislature. Bob Spitz, Reagan: An American Journey (New York: Penguin Press, 2018), 376–377; California Legislature, Senate Select Committee on Proposed Phaseout of State Hospital Services, Final Report (Sacramento: Senate of the State of California, March 15, 1974), 6. See, for example, Memo from Frank Lanterman to all legislators re: CSEA Attack on L-P-S, March 1, 1972, Folder 9, Box 13, Frank Lanterman Papers, Regional History Collection, USC Special Collections, USC, Los Angeles, CA; Kent S. Miller, Managing Madness: The Case Against Civil Commitment (New York: The Free Press, 1976), xii. On “Revolving Door Syndrome,” a phase Turner claimed he had heard from mental health care workers themselves, see Craig Turner, “Local Area Aftercare for Mentally Ill Falters,” Los Angeles Times, May 5, 1974. Craig Turner, “Local Area Aftercare for Mentally Ill Falters,” Los Angeles Times, May 5, 1974; Fliedner, 322–323. Letter, Frank Lanterman to the Honorable Ronald Reagan, June 29, 1974, Folder 4, Box 15, Frank Lanterman Papers, Regional History Collection, USC Special Collections, USC, Los Angeles, CA. Letter, Frank Lanterman to the Honorable Ronald Reagan, July 10, 1974, both Folder 4, Box 15, Frank Lanterman Papers, Regional History Collection, USC Special Collections, USC, Los Angleles, CA. Letter, Frank Lanterman to the Honorable Ronald Reagan, June 29, 1974, Letter, Frank Lanterman to the Honorable Ronald Reagan, July 10, 1974, and Press Conference, August 6, 1974, all Folder 4, Box 15, Frank Lanterman Papers, Regional History Collection, USC Special Collections, USC, Los Angeles, CA; Fliedner, 322–323; Juvinall, “Frank Lanterman: Grand Old Man.”. Press Conference, August 6, 1974, all Folder 4, Box 15, Frank Lanterman Papers, Regional History Collection, USC Special Collections, USC, Los Angeles, CA. Letter, Frank Lanterman to the Honorable Ronald Reagan, June 29, 1974, Letter, Frank Lanterman to the Honorable Ronald Reagan, July 10, 1974, and Press Conference, August 6, 1974, all Folder 4, Box 15, Frank Lanterman Papers, Regional History Collection, USC Special Collections, USC, Los Angeles, California; Fliedner, Centennial, 322–323. “Question: What Is the Origin of the L-P-S Act and Why Was It Necessary?,” October 26, 1973, Frank D. Lanterman Papers, California State Archives, Sacramento, California, 3–4. “History of the Establishment and Growth of Lanterman Developmental Center.”. Hume also predicted that any costs savings in recombining the departments would ultimately prove illusory. “Portia Belle Hume,” 75–77; “Earl

9

28.

29.

30.

31.

32. 33. 34. 35. 36. 37. 38.

39.

40.

CALIFORNIA AFTER THE LANTERMAN-PETRIS-SHORT ACT

315

Warren and the State Department of Mental Hygiene: Frank F. Tallman, M.D., Dynamics of Change in State Mental Institutions; and Portia Belle Hume, M.D., Mother of Community Mental Health Services,” ii. For more on the current configuration of these department, see, for example, “Department of Developmental Services homepage, https://www.dds.ca. gov/. “Frank D. Lanterman: Crusades of a Republican Legislative Leader,” 20; California Department of Mental Hygiene, The New California Mental Health Act, 5. Interview with Nicholas C. Petris by Gabrielle Morris, December 20, 1988, February 14, February 26, April 6, October 12, and October 31, 1989, State Government Oral History Program, California State Archives, Sacramento, California, 110–111. Interview with Nicholas C. Petris by Gabrielle Morris, December 20, 1988, February 14, February 26, April 6, October 12, and October 31, 1989, State Government Oral History Program, California State Archives, Sacramento, California, 134–135. Interview with Nicholas C. Petris by Gabrielle Morris, December 20, 1988, February 14, February 26, April 6, October 12, and October 31, 1989, State Government Oral History Program, California State Archives, Sacramento, California, 137. “Frank D. Lanterman: Crusades of a Republican Legislative Leader,” 15. “Frank D. Lanterman: Crusades of a Republican Legislative Leader,” 10. “Mental Health Advocate: A Bitter End to His Career,” The Desert Sun, July 18, 1978. “Mental Health Advocate: A Bitter End to His Career.”. “Frank D. Lanterman: Crusades of a Republican Legislative Leader,” 10. “State Hospital Is Renamed for Lanterman,” Los Angeles Times, November 19, 1978. “Lanterman Developmental Center: Realizing Potentials, Providing Opportunities,” Lanterman Developmental Center Collection, Archives and Special Collections Department, California State Polytechnic University, Pomona, Pomona, California; “Lanterman Developmental Center History”; “Frank Lanterman Dies; Legislator for 14 Terms: Republican, 79, Was Father of California Mental Health Plan,” Los Angeles Times, April 28, 1981. “Metropolitan Hospital Typifies State’s Mental Health Problems,” Los Angeles Times, April 25, 1977, quoted in Anderberg and Wilson, They Call Them Camisoles—Revisited, 260. Interview with Nicholas C. Petris, 130–131; “Metropolitan Hospital Typifies State’s Mental Health Problems,” Los Angeles Times, April 25, 1977, quoted in Anderberg and Wilson, They Call Them Camisoles—Revisited, 260.

Conclusion

By the early 1970s, the federal government had shifted away from use of the term “mental retardation” in favor of the term “developmental disabilities.” It had also worked out a functional diagnosis of developmental disabilities, now defined as lasting effects due to physical or mental impairment resulting in functional impairment in three of seven life skills. Dr. George Tarjan, the man who had once admitted he himself couldn’t really define what “mental retardation” was, describes being “heartbroken, or at least mindbroken [sic],” that such a definition excluded some individuals from getting the assistance that they needed.1 After leaving Pacific for UCLA and the neuropsychiatric center, he continued his advocacy and policy work at the federal level. But he ran into many of the same issues Lanterman and Petris had noted. The need was still there, but increasingly what was missing was the political will to act. And even if the political will to act existed, in the 1970s, there just wasn’t the will to spend the money. “The concept of street people, of mentally ill street people, of chronic mental illness, of enormous segments of underserved or unserved populations in the mental health field, including minorities, including the impoverished, including children, adolescents, was well known during the Carter administration,” he explained in an oral history interview. “But to come up with suggestions that the government ought to spend a new billion, which could easily and justifiably be spent in the mental health field, was pie in the sky.”2 Tarjan also noted that the changes in laws around commitment had made it far more difficult to © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 E. V. Wallis, California and the Politics of Disability, 1850–1970, https://doi.org/10.1007/978-3-031-21714-2

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keep track of individuals in need of care in California. According to him, it took years to figure out how to track developmentally disabled young people using California’s regional centers. “I, at one time, you know, made the comment that it’s very nice to speak about our individual liberties, but when you are so dependent as a severely retarded youngster, maybe your independence isn’t worth as much as the fact that somebody will track and find out what the dickens is happening to you.”3 Advocacy in all realms of public health, and grassroots advocacy in particular, also characterized California in the 1970s and 1980s. While Sacramento squabbled, communities up and down the state decided their days of waiting for the state to voluntarily provide adequate and equitable mental and developmental health services were over. This was a radical departure from the top-down bureaucracy of the old department of mental health. Californians were also beginning to draw connections between health care and other systems of oppression. In an undated position paper from the National Council for Negro Women, Inland Empire Section, the council spelled out quite clearly the racial and class inequities they saw in California’s mental healthcare system. The larger bureaucracies of both mental and public health in the state in the early 1970s, they declared, had gotten things wrong: The notion had been that the poor, particularly minorities, make casual use of service due to lack of values. This is not so. Minorities have a very definite culture, traditions, and folkways. Folk medical advice may be sought from a respected member of the community, known as a curandera in the Mexican American culture, before going to a Clinic. It has been established through various demonstration programs, that services will be utilized, if provided within a conceptual framework with which the poor can identify.

The state of California may have changed the legislation around mental health, but that didn’t change the fact that minority families and the poor were still being left out of the system. The system itself, the council declared, remained fragmented and difficult to use: The facilities are generally located in an area both psychologically and geographically inaccessible. If there is an outreach effort, it is often severely limited, time-wise, both in hours and days of availability. It is available if a person or family can get to the office, on a specific day at a given hour—weeks later than the day the need became evident.

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The reality factors of emotional condition, transportation, and money are discounted….[Moreover,] there is a barrier in the increasing complexity in delivery of health services in connection and combination with the uncertainties about the cultural and social structures, commonly referred to as racism or class prejudice.…Racism had been a key factor in creating and maintaining explosive neighborhoods in the cities. Thus far attitudinal changes are primarily evident in administrative directives, which are minimally, if at all, implemented at the local level. Efforts of local citizens to participate in the decision-making process about services met with resistance from agencies. They must unite into an advocacy body before the system will consider alternations.4

As a success story, the council pointed to the Welfare Rights Organization, founded by women living in the Delmann Heights neighborhood of San Bernardino, a “disadvantaged” neighborhood. Having decided that “its problems can only be solved by systematized social action to enhance their sense of self-worth and dignity,” the group had already organized a tutoring program and now wanted family counseling and public health services provided in their community. Similar work was also taking place in other parts of the state. In 1978, both the advocacy group American Disabled for Attendant Programs Today (ADAPT) and the Sacramento-based Disability Rights California formed, the later emerging from Congress’ call that there be an organization in every state and territory dedicated to promoting the rights of individuals with developmental disabilities.5 For those with developmental disabilities, the very idea of voluntary admissions was increasingly called into question, since those individuals might be more easily coerced into agreeing to institutionalization. In the Supreme Court case Wyatt v. Stickney (1972), the courts found that the right to habilitation (that is, an exchange of liberty for care) had been violated by the terrible conditions in one Alabama institution for the developmentally disabled. Out of the court’s decision came the first established minimum standards of care for institutions housing the mentally and developmentally disabled.6 Other new legal protections for individuals with disabilities were also being put in place. In 1973, the U.S. Supreme Court ruled in Souder v. Brennan that any work an individual did while in a state hospital had to be covered under the Fair Labor Standards Act. Suddenly, the idea of work as “therapy” became irrelevant. Although the decision was later weakened, Elizabeth Catte notes that “without the ability to use patient

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labor, many institutions could no longer sustain the operation of their large facilities, and Souder marked a turning point in a larger national trend of deinstitutionalization.”7 As Alexandra Minna Stern notes, eugenic thought did not disappear from the United States after World War II: it was just “repackaged.” Forced sterilizations still occurred in California. In 1975, a group of “Mexican-origin women filed a class action suit asserting that their civil and constitutional rights to bear children were violated when they were forcibly sterilized by obstetricians at the USC Medical Center.” In 1979, led by Assemblyman Art Torres, chairman of the Assembly’s Health Committee, the California State Legislature unanimously at last removed all traces of the state’s sterilization law from its books. In 2003, then Governor Gray Davis issued a formal apology on behalf of the state of California to the estimated 60,000 men, women, and children who had been subjected to its eugenics sterilization policies since the early twentieth century.8 The growing national and international Disability Rights Movement helped usher forth a host of new ideas about the rights of individuals with disabilities. In 1971, the United Nations passed the Declaration on the Rights of the Mentally Retarded, and in 1975, Congress passed the Developmentally Disabled Assistance and Bill of Rights. The same year saw the passage of the Education for All Handicapped Children Act (expanded and renamed the Individuals with Disabilities Education Act [IDEA] in 1988). Disability rights activists in Berkeley, California, created the nation’s first Center for Independent Living (CIL) in 1972. Individuals who regarded themselves as survivors of psychiatric treatment, either inside or outside of an institution, were also organizing and advocating for change through organizations such as the San Francisco-based Network Against Psychiatric Assault. In 1975, the United States Supreme Court held in O’Conner v. Donaldson that a state cannot constitutionally confine an individual who is not a threat to themselves or others. 1990 saw the passage in Congress of the Americans with Disabilities Act, the culmination of years of work by activists and their allies. These legal developments undermined much of the remaining rationale for, and ability to, commit Americans to institutions for the mentally and developmentally disabled. They thus removed much of the threat that had been hanging over people’s heads for more than one hundred years. Speaking of the deinstitutionalization of the developmentally disabled in the late 1970s,

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Valerie Bradley of the Humane Services Research Bureau noted a collective “failure to understand the essentially ‘revolutionary,’ as opposed to ‘evolutionary,’ nature of the changes in care for developmentally disabled persons that deinstitutionalization has come to include over the past ten to fifteen years. Changes in attitude and approach have not come about in an incremental fashion but rather represent, in some instances, a 180-degree turn from the guiding principles of only two decades ago.”9 However, social change continued to lag far behind legal change. Presently, deinstitutionalization has become the norm, not just for individuals with mental or developmental disabilities, but also for the chronically ill and the frail elderly. Much of this is the culmination of decades of work by disability rights activists to create legal changes around institutionalization. The work continues: in 1995, for example, SelfAdvocates Becoming Empowered issued an official statement that “all institutions, both private and public should be closed. All people regardless of the severity of their disabilities should live in the community with the support they need.”10 Care remains as fraught and complex an issue as ever. Evelyn Nakano Glenn, for example, argues that contemporary deinstitutionalization is driven largely by “cost-containment structures imposed by health-care delivery and health-care financing systems.” But it also remains infused with the very old idea that “home” is simply better than any kind of institution. Under these rationales, she explains, hospitals and nursing homes became places for short-term stays only. However, this rests on “the assumption that all or most of the care will be provided for free by friends and family members.” Due to advances in medical technology, individuals are often sicker than in previous generations and may need care for longer periods of time. This creates serious issues both for individuals in need of reliable care and for their families and caregivers. In many ways, we are back where we were in the late nineteenth century, with those families and individuals who can afford private care (much of it now provided by immigrant and/or women of color) paying for it directly and family caregivers (mostly women) struggling to balance the demands of providing care with the economic need for them to also participate in the paid labor force.11 If nontraditional and short-term facilities are counted, there actually hadn’t been a reduction in the overall number of institutions in the United States by the end of the 1970s. Since then, however, institutional populations across the United States have dropped dramatically as

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more individuals who had been in them were moved into community care: 550,000 in 1955 to 71,000 in 1994 to less than 40,000 in 2014. However, researchers working on issues surrounding carceral justice note the rise in local, state, and federal prisons that now house large mentally disabled populations. Activists note the huge range in quality of care and living conditions in homes for the developmentally disabled. Voluntary living arrangements often still include what Paul Lerman calls “restrictive types of social control practices,” including curfews, supervision, and mandatory check-ins. There remains in both California and the United States large numbers of unhoused mentally and developmentally disabled individuals. The visibility of these individuals on California’s streets seems to have shifted the ways in which the general public (which, to be fair, generally knows little to nothing about the history of the issue) and the press think about disability and institutionalization. In his analysis of press coverage of mental health laws in California, Alex V. Barnard notes how quickly newspaper coverage of Lanterman-Petris-Short, in particular, shifted from the cautious optimism of the late 1960s to fears over “excessive” deinstitutionalization in the 1980s to calls for “hospitalization as an example of urgent compassion” in the 2010s and beyond. “Concerns have flipped from worries that people were being unnecessarily incarcerated,” he writes, “to fears that they are not being interned enough.”12 Another looming question in California is what to do with the former sites of state hospitals and similar institutions in the age of deinstitutionalization. The state of California continues to close facilities and consolidate functions. After its closure, the former Camarillo State Hospital, all its buildings and grounds, for example, became part of California State University, Channel Islands. In Los Angeles County, where shortages of open space and a lack of affordable housing are critical issues, the pressure to redevelop, readapt, and reuse sites of former state institutions as quickly as possible is enormous. The site of the former Lanterman Development Center is now part of the campus of California State Polytechnic University, Pomona. With more than 300 acres of land and another 185 acres operated by Cal Poly Pomona as Spadra Farm, both the campus and the city of Pomona have pinned much of their future hopes on the property. Ideas ranging from housing to a performing arts center to commercial space and even a future Metrolink station have all been floated.13 “Educational uses” for such sites, as Carla Yanni has noted, “are perhaps easier to accommodate than commercial ones in these buildings with difficult histories.”14

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The same pressures affect former county and private institutions. In 1968, Rancho Los Amigos was affiliated with the University of Southern California, and by 1970, its hospital was second in size only to Los Angeles County General Hospital, at that time the largest in the state of California. In 2003, with the county facing a $210 million shortfall, the Los Angeles County Board of Supervisors voted to close Rancho Los Amigos. It now sits empty, awaiting plans for its future use.15 Rockhaven Sanitarium sold in 2001 to another company that had intended to continue operating it as an elder-care facility, only to discover that the physical plant, much of it dating to the 1920s, no longer met safety and accessibility standards. It was closed again in 2006, put on the market, and threatened with development. The city of Glendale purchased the site in 2008 for $8.25 million. A community group, the Friends of Rockhaven, formed to help ensure the survival of the facility, including getting it on both the California and the National Registers of Historic Places in 2016. Currently, this site also continues to await restoration and reuse.16 As James W. Trent explains, California and other American states still have far to go when it comes to providing humane and equitable care for the mentally and developmentally disabled in our communities. “We have been more successful in correcting the horrors of state institutions than we have in developing humane alternatives in American cities and towns,” he notes. The horrors of mass institutionalization in the state hospital system are largely a thing of the past. That, however, is not the same as making space for Californians with disabilities in our communities or allowing them full participation in society. Stigma around disability and ableism remains as intense in California as anywhere else. The idea that controlling, containing, or removing the disordered, disabled, and deviant is still required to maintain social order runs deep. “The weight or normalization has remained on fine-tuning the deviant person to make her or him more ‘normal’ in his or her ‘normal’ immediate environment,” Trent writes, rather than adapting society to better accommodate difference.17 In the rise and ultimate fall of institutions for the mentally and developmentally disabled in California, we have seen how the state occupies a key transitional movement in disability history, at least when it comes to the rise of institutions in the United States. The Golden State was twenty to thirty years behind the creation of such facilities in the eastern United States, but twenty to thirty years ahead of their creation in the rest of the American West. By the time California’s very first state insane

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asylum (Stockton) opened in 1855, similar institutions in the East were already moving away from the idea that asylums could be places of healing and rehabilitation and toward the idea of the asylum as a largely custodial institution. By the mid-twentieth century, the situation was reversed, with California serving as the innovator in providing mental health care, up to and including its radical redesign of the system through ShortDoyle and Lanterman-Petris-Short. But institutions alone can never tell the full story. Although the voices of the individuals who maintained, and particularly of the individuals caught up within, California’s bureaucracy of disability can be difficult to recover from the available sources, they are invaluable for understanding the lived experiences of those affected by these systems of care and control. California also provides a valuable case study into how different levels of social, economic, and political power (local, county, state, and federal) intersected, and continue to intersect, to shape the lives of mentally and developmentally disabled Americans.

Notes 1. “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, Vol. 2,” 382. 2. “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, Vol. 2,” 394. 3. “UCLA Neuropsychiatric Institute and Hospital: George Tarjan, Vol. 1,” 291. 4. Although this report is not dated, most of its citations are from 1967 to 1969. Thus, I suggest it was likely written around 1970. “Position Paper submitted by the National Council of Negro Women, Inland Empire Section,” n.d., Folder 2, Box 17, Frank Lanterman Papers, Regional History Collection, USC Special Collections, USC, Los Angeles, CA. 5. “Position Paper submitted by the National Council of Negro Women, Inland Empire Section,” n.d., Folder 2, Box 17, Frank Lanterman Papers, Regional History Collection, USC Special Collections, USC, Los Angeles, CA; “Our History,” Disability Rights California, https://www.disabilityri ghtsca.org/about-us/our-history. 6. Bradley, Deinstitutionalization of Developmentally Disabled Persons, 23; Lindsey Patterson, “The Disability Rights Movement in the United States,” in The Oxford Handbook of Disability History, 312, 445. 7. Catte, Pure America, 175–176; Prestinary, Napa State Hospital, 9. 8. Lira, Laboratory of Deficiency, 190; Stern, Eugenic Nation, 3, 222–223; “State Issues Apology for Policy of Sterilization,” Los Angeles Times,

CONCLUSION

9.

10.

11. 12.

13.

14.

15. 16. 17.

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March 12, 2003; The Embryo Project Encyclopedia, https://embryo. asu.edu/pages/human-betterment-foundation-1928-1942. Bradley, Deinstitutionalization of Developmentally Disabled Persons, 8; Scotch, “American Disability Policy in the Twentieth Century,” 384; Lindsey Patterson, “The Disability Rights Movement in the United States,” 446–448. Self-Advocates Becoming Empowered, “Position Statement on Closing Institutions,” https://www.sabeusa.org/meet-sabe/policy-statements/ closing-institutions/. Glenn, Forced to Care, 4–5. 154–155. Lerman, Deinstitutionalization and the Welfare State, 9, 95, 217; Noll, “Institutions for People with Disabilities in North America,” 321; Lerman, Deinstitutionalization and the Welfare State, 95. By 2010, Lanterman had the smallest resident population of any similar facility in the state but also the highest costs. It was those costs that motivated the state of California to close the hospital permanently in 2014. Over its eighty-seven years, it had housed an estimated 14,000 individuals. On the site’s redevelopment, see, for example, City of Pomona General Plan Update, Corridors Specific Plan, Active Transportation Plan, and Green Plan, Vol. 1: Draft Environmental Impact Report, July 2013. Sometimes, however, the new uses of these sites are not, strictly speaking, educational. In New York State, for example, the former Buffalo State Asylum for the Insane has been repurposed into the Richardson Olmstead Campus, which includes a luxury hotel. Yanni, The Architecture of Madness, 151; Elizabeth Yuko, “From Historic Hospital to Hip Hotel, Buffalo’s Formerly-Abandoned Asylum Once Again Welcomes Overnight Visitors,” Roadtrippers.com, https://roadtrippers.com/magazine/richar dson-olmstead-campus-buffalo/, December 3, 2019. Fliedner, Centennial, 315, 319; “Board Votes to Close Rancho Los Amigos,” Los Angeles Times, January 29, 2003. Jordan, Rockhaven Sanitorium, 110–117. Trent, Inventing the Feeble Mind, 270, 275. 277.

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Index

A A Child is Waiting , 215, 216 Adams, Catherine, 41–44, 53 Addiction, 5, 51, 100, 104, 115, 123, 145, 148–150, 152, 154, 157, 239 Agnews, 66, 73, 236, 237, 258, 261, 269, 303, 311 Aid to Permanently and Totally Disabled (APTD), 265 Almshouses, 28, 29, 32, 44, 50, 59, 65, 66, 71, 77, 78, 88, 160 Alquist, Alfred, 307 American Association for the Study of Feeble-Mindedness, 175 American Association on Mental Deficiency, 175 American Civil Liberties Union, 280 American Disabled for Attendant Programs Today (ADAPT), 319 American Eugenics Society, 139 American Institute of Family Relations, 139

American Medical Association, 225, 233 American Medico-Psychological Association (American Psychiatric Association), 69 Americans with Disabilities Act, 182, 265, 320 Anslinger, H.J., 150 Asians or Asian Americans (also listed as Orientals), 185, 247 Assembly Bill 1220 (California Mental Health Bill of Rights), 281 Assembly Interim Committee on Ways and Means’ Subcommittee on Health, Education, and Welfare Services, 287, 295, 298 Association of Medical Officers of American Institutions for Idiots and Feeble-Minded Persons, 78 Association of Medical Superintendents of American Asylums for the Insane, 18 Asylum, deaths, 43 Asylum, keeper, 38

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 E. V. Wallis, California and the Politics of Disability, 1850–1970, https://doi.org/10.1007/978-3-031-21714-2

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INDEX

Atascadero State Hospital, 228, 253, 255 Aylett, W.D., 39

B Bardach, Eugene, 206, 269, 270, 278, 282, 295, 297 Bartholemy, Josephine, 110, 111, 120 Benevolent Associations, 45 Bentley, Edwin, 65 Bentley, Mrs. F.H., 78 Berkeley State Mental Hygiene Clinic, 190 Black, 185 Blind. See Disabled, visually Brainerd, Henry (H.G.), 102, 103 Brett, John, 39 Brett, Otis, 39, 40, 53 Brown, Edmund G. “Jerry” Jr., 305, 310, 311 Brown, Edmund G. “Pat”, 272, 273, 281, 283, 297, 302, 310, 312 Buck vs. Bell , 155 Bunker, Edward, 216, 217, 235, 253 Bureau of Education of Crippled Children, 195, 196 Bureau of Mental Retardation, 190 Bureau of Prohibition, 150 Butler, Fred O., 144, 145, 147

C California Association for Mental Health (CAMH), 280, 284 California Association for the Protection of Persons Charged with Insanity, 66 California Bureau of Juvenile Research, 115, 190, 191, 210 California Commission for the Study of Problem Children, 188

California Commission in Lunacy, 89, 90 California Community Mental Health Services Act, 275 California Conference of Social Work, 200 California Federation of Women’s Clubs, 131, 201 California Home at Eldridge. See Sonoma State Hospital California Home for the Care and Training of Feeble-minded Children. See Sonoma California Institution for the Instruction of the Deaf and Dumb, and the Blind, 83, 95 California Medical Association, 275 California Mental Health Act, 286 The California Mental Retardation Act, 286, 288 California School for Girls at Ventura, 112 California School for the Blind and the California School for the Deaf, 85 California Senate Finance Committee and the Assembly Ways and Means Committee, 269 California Senate Interim Committee on the Treatment of Mental Illness, 241, 257, 269, 275 California Society for Crippled Children, 195 California State Assembly’s Interim Committee on Social Welfare, 269, 279 California State Board of Charities and Corrections, 85, 96, 105, 113, 142 California State Board of Control, 105 California State Board of Education, 85

INDEX

California State Board of Health, 33 California State Employees Association (CSEA), 283, 305 California State Narcotic Committee, 149, 152, 165, 166 California State Polytechnic University at Pomona: Lanterman Development Center, 268 California State Psychological Association (CSPA), 284 California Supreme Court, 29, 86 California Taxpayer’s Association, 272 Californio. See Mexican American Camarillo State Hospital, 5, 131, 146, 154, 177, 215, 225, 244, 248, 253, 322 Caregivers, 14, 19, 76, 93, 321 Carr, Fanny Briggs, 67, 68 Catholic, 45, 70, 92, 267 Center for Independent Living (CIL), 320 Cerebral palsy, 247 Chandler, Robert, 179 Charity/charitable, 16, 17, 26, 62, 63, 70, 75, 77, 83–85, 88, 105, 132, 135, 139, 181 Children, infants, orphans, 63, 105, 232 Chinese, 29, 50, 136, 203 Christian, 16–17 Clark, Mrs. Oliver P., 43, 56, 104, 117, 160 Class, 13, 17, 55, 58, 76, 77, 81, 83, 86, 124, 131, 133, 139, 142, 143, 171, 182, 184, 189, 193–198, 247, 318, 320 Clubwomen, 131, 157 College plan, 184 Commission for the Study of Problem Children Commission in Lunacy, 86, 88, 96, 97, 105, 147

345

Commitment, Petitions for, 124, 125, 129 Committee on Provision for the Feeble-Minded, 101, 107, 116, 119, 138, 162 Community Mental Health Centers Construction Act, 265 Community Mental Health Services Act, 275, 284, 290 Coombs, Nathan F., 241, 242, 258 Costs: appropriations, contracts, bidding, rates, 30, 243 County Government Act of 1883, 63 Cretin. See Disabled, developmentally Crippled. See Disabled, physically Crippled Child Act, 195 Crippled children, 195 Custodian/custodial/custodialism, 2, 20, 101, 114, 136, 141, 149, 174, 175, 218, 219, 231, 233, 238, 240, 245, 247, 250, 324 D Death, 3, 36–38, 41–44, 52, 112, 134, 145, 156, 162, 170–172, 244, 268, 269, 311 Deinstitutionalization, 3, 182, 251, 265, 271, 287, 288, 293, 303, 313, 320–322 Delinquency, 82, 103, 143, 188, 198, 204 Dementia, 133, 160, 170, 240 Department of Institutions, 143, 151, 154, 177, 178, 182, 183, 186, 187, 200, 220, 292 Department of Mental Hygiene, 117, 143, 182, 183, 186, 187, 193, 202, 206, 208, 211–213, 217, 220, 221, 226, 228, 229, 231, 233–238, 240–243, 247, 249, 250, 253–259, 261–263, 267–270, 272–274, 276, 280,

346

INDEX

282–286, 289, 290, 295, 297, 298, 302, 305, 308, 311, 312, 315 Department of Public Health, 190 Department of Social Welfare, 88, 201, 271, 282, 304 Deputies, 128, 283 Developmentally Disabled Assistance and Bill of Rights, 320 Deviant, deviancy, 4, 16, 22, 45, 101, 124, 126, 144, 221, 251, 323 DeWitt State Hospital, 240, 242, 253, 283, 296, 302 Disability Rights California, 319, 324 Disability Rights Movement, 6, 212, 262, 263, 265, 320, 325 Disability rights, 263, 265, 320, 321 Disability, bureaucracy of, 3–5, 8–9, 56, 123, 135, 173, 186, 324 Disability, medical model, 3, 19 Disabled, developmentally, 4, 5, 7, 14, 17, 23, 56, 62, 64, 66, 69, 71, 75–79, 81, 86, 100, 101, 114, 124, 130, 134–136, 141, 145, 152, 153, 156, 163, 164, 173, 176, 177, 183, 186–188, 191–193, 198, 204, 215, 217, 221, 226, 228, 231, 234, 235, 237, 238, 245, 247, 258, 261, 263, 266, 268, 269, 271, 272, 277–280, 284, 287, 289, 291, 293, 294, 303, 304, 308, 311, 312, 318, 319–324 Disabled, hearing, 1, 6, 8, 29, 45, 56, 60, 83–86, 90, 95, 196, 198 Disabled, mentally, 4, 7, 8, 14, 15, 17, 21, 23, 25, 29, 30, 46, 56, 62, 64, 66, 69, 71, 75, 86, 101, 104, 126, 128, 130, 135, 141, 145, 147, 148, 152–154, 156, 173, 174, 176, 177, 183, 184, 186, 187, 189, 204, 215, 217,

221, 226, 228, 230, 231, 235–237, 250, 261–263, 266, 269, 271, 272, 277–280, 304, 305, 312, 319, 320, 322–324 Disabled, physically, 6, 15, 64, 75, 195, 266, 271 Disabled, visually, 6, 8, 17, 56, 75, 83, 84, 86, 196, 304 Discipline, 18–19, 68, 144, 290 Dix, Dorothea, 30, 49 Doctors, as the medial personage, physicians, 75 Down Syndrome, 194 Doyle, Donald D., 275, 294 Doyle, Francis W., 196, 197 Drugs and alcohol, abuse of. See Addiction

E Edgerton, Robert B., 251, 259 Education for All Handicapped Children Act, 320 Education, special programs, Pupils to inmates, 101 Elderly, 46, 62, 72, 131, 159–161, 165, 181, 182, 240, 241, 250, 275, 281, 321 Eldridge, Oliver, 110, 111 Epilepsy, 34, 58, 72, 79, 81, 90, 135, 198, 237, 238, 242, 247, 285 Escape, 3, 33, 73, 111, 151–153, 234, 235 Eugenics, 6, 8, 115, 124, 133–140, 142, 144, 147, 154, 155, 161, 177, 208, 267, 292, 320 Eugenics Research Office (ERO), 191 Euphemia, 24, 25 Exceptional Children’s Foundation, 190, 209, 211

INDEX

F Fair Labor Standards Act, 265, 319 Fairview State Hospital, 228 Families, 1, 4, 19, 28, 31, 39, 45, 56, 58, 59, 64, 74, 75, 89, 101, 106, 108, 132, 133, 139, 140, 144, 158, 170, 189, 190, 193–195, 227, 244, 248–250, 264, 265, 269, 282, 287, 289, 296, 318, 321 Farm, agriculture, 28–29 Federal government, 2, 16, 62, 63, 181, 221, 304, 317 Feebleminded, brain-injured child, 16 Female Asylum, 62 Fillmore, Margaret, 130, 160 Flint, Mrs. J. Powers, 107 Food, 7, 35, 70, 71, 74, 100, 155, 156, 239, 240, 250 Foster Grandparent Program, 308 Foucault, Michel, 6, 11, 16, 18, 47, 52–54 Freeman, Walter, 185, 186 Freud, Sigmund, 173, 293 G Garcia v. State Department of Institutions , 267 Gender, 29, 100, 124, 131, 143, 160, 186 Gosney, Ezra Seymour, 139–142, 147, 162, 163, 165 Governor’s Advisory Council on Mental Health, 261 Governor’s Conference on Care and Treatment of Senile Patients, 240 Governor’s Continuing Committee on Mental Health, 219 Great Depression, 8, 153, 173, 175, 177, 180, 181, 212 Group for the Advancement of Psychiatry (GAP), 224

347

Guards, 73 H Haight, Henry, 45, 89 Halfway houses, 221, 230, 249 Handicapped, 10, 75, 140, 192, 195, 215, 287, 311, 320 Harrison Act (Harrison Narcotic Law), 148, 149 Haynes, John Randolph, 142 Heffner, Dora Shaw, 187, 209, 220 Highland State Asylum. See Patton State Hopsital Hill-Burton program, 262 Home for the Care and Training of Feeble-Minded Children. See Sonoma State Hospital Homeless, unhoused, 322 Hope Development Home, 110–112, 119, 247 Hospital Council of Southern California, 262 Howe, Samuel Gridley, 76, 93, 94 Human Betterment Foundation, 139, 140, 142, 162 Hume, Portia Belle, 69, 92, 208, 210, 220, 222, 253, 294, 315 I Idiots. See Disabled, developmentally Imbeciles. See Disabled, developmentally Immigrants, foreign-born, 60 Indians. See Indigenous Indigenous, 14, 21, 46, 136 Indigent or Pauper Act (1901), 64, 174, 180 Individuals with Disabilities Education Act [IDEA], 320 Industrial Home for the Adult Blind, 84

348

INDEX

Insanity. See Disabled, mentally Institutionalization, 2–4, 8, 14, 30, 58, 60, 64, 78, 82, 88, 102, 103, 106, 115, 131, 142, 143, 151, 153, 173, 193, 194, 205, 233, 238, 269, 271, 291, 319, 323 Involuntary treatment, 286

J James, Mrs. W.S., 100, 103–105, 112, 142 Japanese, 203 Jensen, Earl E., 154 Jews (Hebrews), 45, 222, 292 Joyce, Thomas F., 149, 179 Joyce, T.P., 151, 153 Judah, Julia M., 78 Juvenile Probation Law, 83

K Karesh, Arthur H., 281 Kennedy, John F., 215, 252, 265 Kerlin, Issac N., 81, 82, 90, 95 Kirkbride, Thomas Story, 18, 32, 47, 65, 175 Kolb, Lawrence, 220, 253

L Langdon, Samuel, 36, 38, 39, 56, 60 Langley Porter Clinic. See Langley Porter Neuropsychiatric Institute Langley Porter Neuropsychiatric Institute, 226 Lanterman Mental Retardation Services Act, 226 Lanterman Regional Development Center. See Pacific State Hopsital Lanterman State Hospital. See Pacific State Hopsital

Lanterman, Frank, 161, 272–276, 279–284, 287, 288, 290, 292, 294–299, 301, 303, 305–311, 313–315, 317, 322, 324, 325 Lanterman-Petris-Short (LPS), 3, 284–286, 290, 296, 298, 306, 308, 309, 322, 324 Lawlor, W.M., 81 Lobotomy, 185, 186, 209, 237, 242, 244, 286 Los Angeles Board of Supervisors, 70, 230 Los Angeles County General Hospital, 126, 129, 165, 245, 249, 276, 323 Los Angeles County Poor Farm, 71, 72, 112, 173, 175 Los Angeles County Psychiatric Hospital, 246 Los Angeles County Public Welfare Commission, 110 Los Angeles County’s Welfare Planning Council, 198 Los Angeles District of the Vocational Rehabilitation Bureau, 184 Los Angeles Free Dispensary, 70 Los Angeles Police Department, 248, 301 Los Angeles Psychological Association (LAPA), 113 Los Angeles Psychopathic Association (LAPA), 8, 100, 103–105, 107, 110, 112, 117, 142 Lowry, James, 282, 296 Lunacy Law, 30, 86, 119, 125, 159 Lunatic. See Disabled, mentally Lutgens, Harry, 176–179, 182, 200, 201, 206, 207, 213 M MacGregor, Helen, 187, 209, 221 Mad, 10, 16, 47, 51, 80

INDEX

McCarthy, Leo, 307 Medicaid, 266, 306 Medical Assistance to the Aged (MAA), 265 Medical schools, 57, 90, 257 Medi-Cal, 276, 292, 295, 304, 306 Medicare, 265, 266 Mendocino Plan, 282 Mental Health Association of Los Angeles, 262 Mental Health Bill of Rights, 239 Mental Health Committee of the California Medical Association (CMA), 275 Mental hygiene, 68, 127, 158, 187, 188, 190, 196, 199, 200, 202–204, 227–230, 288, 309 Mental retardation. See Disabled, developmentally Mentally disordered. See Disabled, mentally; disabled, developmentally Mentally ill. See Disabled, mentally Merriam, Frank, 171, 176, 201, 213 Mexican American, 38, 136, 144, 181, 267, 318 Mining, gold rush, 20–21 Minors, 1, 5, 10, 198, 211 Moral, morality, 2, 22, 32, 81, 137, 139, 147 Moron. See Disabled, developmentally N Napa State Asylum. See Napa State Hospital Napa State Hospital, 91, 96, 148, 169, 183, 185, 204, 207–209, 219, 242, 258, 259, 292 Narcotic Research Association, 152 Narcotics (See specific drugs: Morphine; Marijuana; Marihuana; Opium; Heroine; cocaine), 149

349

National Association for Retarded Citizens (NARC), 265 National Committee for Mental Hygiene, 188 National Institute of Mental Health, 221, 240 National Institute of Public Health, 225 National Mental Health Act, 202, 221, 278 National Society for Autistic Children, 199 Nerves, 69, 173 Network Against Psychiatric Assault, 320 Neurologists, 11, 69, 103, 183 New Deal (See specifics agencies: Civil Works Administration, State Emergency Relief Administration, PWA, WPA, Social Security Act), 179 Norwalk State Hospital, 175, 248, 273

O O’Conner v. Donaldson, 320 Olive View Sanatorium, 75, 246, 276 Orbison, Thomas, 103, 142 Osborne, Luther, 169–172, 204–206, 213 Outdoor or home relief, 63 Outpatient, 8, 69, 70, 194, 200–204, 228–230, 238, 243, 247, 250, 258, 271–274, 276, 277, 285, 288, 289

P Pacific Colony for the Feeble-Minded. See Pacific State Hospital

350

INDEX

Pacific State Hospital, 145, 192, 215, 216, 224, 231, 238, 239, 250–252, 256, 270, 292, 311 Parents, 8, 69, 76, 79, 84, 85, 108, 113, 116, 140, 141, 143, 144, 173, 180, 187, 189–193, 197–199, 216, 226, 235, 267, 269, 289, 305 Paresis, 170, 171 Parole officer, 125, 147, 149, 159, 230 Parole, 123–125, 131–133, 147, 154, 158, 159, 166, 182, 230, 270 Patton State Hospital, 74, 132, 145, 151, 175, 185, 218, 248, 264, 291, 302 Petris, Nicholas, 279, 280, 281, 284–288, 290, 295–298, 309, 310, 312, 315, 317, 322, 324 Philanthropy, charity, 190, 199 Pioneer Pension, 63 Police, sherriff, law enforcement, 301 Poor farms or county farms, 28 Poor Law of 1855, 27 Popenoe, Paul, 139, 141, 142, 147, 162, 163 Porterville State Hospital, 228, 237, 245 Post-traumatic stress disorder (PTSD), 241 Poverty, 21, 61, 106, 204 Praslow, J., 15, 23, 46–49 Pregnancy, 118, 141, 154 President’s Panel on Mental Retardation, 238 Press, journalism, 5 Preston School of Industry, 83, 253 Prison, juvenile detention, 5 Privacy, 1, 5, 56 Probation, 104

Progressive, 8, 100, 101, 103, 104, 106, 117, 126, 142, 173–175, 180, 289, 302, 311 Progressive Era, 8, 79, 100, 104, 106, 115, 126, 173, 175, 180 Proposition 13, 308 Protestant, 45 Psychiatry, 18, 68, 69, 174, 183, 191, 201–203, 217, 224, 225, 234, 266, 270, 306 Psychopathic Parole Society, 131, 132, 160 Public Law 113 (Barde-La Folete Act), 184 Public schools for deaf, 196 Public schools for mental disordered, San Francisco Industrial School, 196 Psychology, 57, 90, 105, 188, 203 R Race, racial, Jim Crow, 22, 61, 100, 106, 124, 131, 132, 136, 139, 140, 143, 203, 247, 318 Ramsey, James, 160 Ramsey, Sara, 73, 74, 130, 155 Rappaport, Walter, 242, 273, 294, 311 Reagan, Ronald, 281, 289, 296, 297, 299, 302, 307, 313, 314 Reform, 4, 8, 69, 81, 83, 100, 139, 157, 239, 280, 281, 302 Rehabilitation, 81, 132, 174, 184, 185, 193, 219, 230, 238, 241, 262, 276, 285, 288, 303, 308 Reid, Robert K., 34–39, 52 Religion, religious, 45 Republican, GOP, 275 Research and researchers, 57, 62, 70, 127, 139, 143, 148, 164, 170, 174, 187, 190, 191, 198, 200, 201, 215, 219, 224, 226, 228,

INDEX

230–233, 238, 242, 243, 269, 270, 279, 285, 322 Resthaven Sanitarium, 132 Restraint, 33, 138, 170, 174, 235 Restraint, use of, 81, 235 Richardson, Friend W., 176 Rights: legal; social; medical; Bill of, 126, 286 Rockhaven Sanitarium, 132, 133, 323 Roman Catholic, Sisters of Charity, 75 Rosanoff, Aaron J., 179, 182, 183, 200, 208, 220 Rubens, Alma, 123, 145, 150, 158, 160, 164, 166, 167

S Sacramento State Hospital, 25 San Quentin Prison, 105 Sanitarium Association of California, 262 Sanity (sane), 32, 39, 67 Saul, J.B., 35 Schizophrenia, 133, 221, 246 Segregated system. See College plan Seguin, Edouard, 77, 93 Self Advocates Becoming Empowered, 7, 11, 321, 325 Senility. See Demetia Sexuality (Sex): Celibacy, Masturbation, 23 Sheriff, 27, 55, 131, 169, 178, 249 Sheriff’s departments, 49, 248, 301 Short, Alan, 241, 242, 244 Short-Doyle Act, 275–280, 284–286, 294–298, 302, 305, 306, 308, 309 Shriver, Eunice Kennedy, 215, 252, 265 Shurtleff, G. A., 44, 62 Skae, David, 58 Social Welfare Committee, 272, 273

351

Social work, 123, 144, 147, 155, 163, 174, 182, 187, 190, 191, 202, 222, 225, 237, 249, 271, 278–280, 285, 289 Society for the Instruction and Maintenance of the Indigent Deaf and Dumb and the Blind, 83 Society for the Prevention of Cruelty to Children, 80 Sonoma, 1, 79, 80–82, 87, 107, 110, 114, 115, 136, 179, 183, 193, 195, 198, 200, 202, 225, 226, 228, 229, 231, 235–238, 245, 261, 268, 279, 303, 311, 312 Sonoma State Home, 79, 86, 108, 113, 137, 144, 152, 231, 237. See also Sonoma State Hospital Sonoma State Hospital, 145, 231, 293 Souder v. Brennan, 319 Southern California Asylum for the Insane. See Stockton State Hopsital Southern California Hospital for the Insane and Inebriates, 74 Southern California State Hospital. See Patton State Hospital Spadra (Pomona), 107, 114, 149, 150–154, 179. See also Pacific State Hospital; Southern California Hospital for the Insane and Inebriates Special education, 194, 195, 199 Sproul, Robert G., 201 Stanford Revision of the Binet-Simon Intelligence Scale, 105 State Board of Medical Examiners, 148 State Board of Prisons, 88 State Commission in Lunacy, 86, 147 State Department of Public Health, 195, 262

352

INDEX

State Department of Public Welfare, renamed again in 1927 as the Department of Social Welfare, 88 State Home for Adult Blind, 179 State Hospital for the Insane, 102, 132, 137 State Insane Asylum, California. See Stockton State Hospital State Institution for the Deaf, Dumb, and Blind, 78 State Mental Health Coordinating Committee, 228 Sterilization, 6, 8, 82, 124, 135–147, 154, 155, 162–164, 170, 177, 267, 268, 292, 293, 320 Stockton Asylum. See Stockton State Asylum Stockton State Asylum, 29, 30, 32, 34, 35, 44, 49, 50, 52, 56, 59, 60, 62, 65, 70, 77, 90, 100 Stockton State Hospital, 176, 185, 186, 209 Substance abuse. See Addiction Suicide, 23, 24, 33, 43, 151 Superintendents, 1, 17–20, 29, 32–35, 38–42, 44, 47, 49, 50, 55, 57, 62, 65, 66, 69, 70, 74, 75, 81, 82, 86, 87, 89, 90, 100, 103, 104, 112, 116, 132, 135, 147, 149, 151, 152, 163, 170, 174, 178, 194, 197, 198, 222, 224, 228, 231, 267, 268, 274 Surgery, 186, 238, 267 Syphilis, 25, 77, 115, 170, 205, 242, 293

T Tallman, Frank, 220, 222, 233, 253–256, 258, 262, 267, 274, 288, 291, 298 Tarentino, Amelia, 80, 94

Tarjan, George, 143–145, 163, 164, 192–194, 211, 216, 222, 224, 225, 233, 234, 238, 239, 252–254, 257, 266–270, 287, 291–293, 317 Taxes, 27, 71, 308 Terman, Lewis M., 105, 106, 138 Therapy (therapies)(see)specific entries Electroshock therapy (ECT); occupational; recreational; speech; music; (therapies), insulin; therapeutics; treatments; industrial, 170, 185, 228 Tilden, W.P., 41–44 Torres, Art, 320

U University of California Los Angeles (UCLA), 203, 225 University of California Medical School, 201, 202 University of California, Berkeley, 44, 92, 189, 190, 201, 206, 209, 269, 294 University of Southern California (USC), 71, 129, 189, 203, 213, 306, 323 Unruh, Jesse, 284 US Public Health Service, 220

V Veteran’s Administration (VA), 125, 242, 243 Violence, 33, 48, 87, 227 Voluntary treatment, 285

W Waite, Edwin G., 36 Waldie, Jerome, 279, 281, 288

INDEX

Warren, Earl, 92, 187, 204, 206, 209, 219–222, 253, 254, 275, 294 Welfare and Institutions Code, 128, 159–160, 166, 180, 227, 298 Welfare Planning Council of the Los Angeles Region, 50, 245, 247, 262, 277, 291 White House Conference on Children, 174 White, native-born, 61 Whitter State School, 105, 191 Wilder, Dudley Raymond (D.R.), 217, 218, 263, 264, 291 Wilkins, E.T., 57–62, 65, 69, 89, 90, 106 Wilkinson, Warring, 78, 84–86

353

Wilmesmeier, Frank, 38 Wilson, Wilma, 9, 123, 130, 131, 133, 146, 154, 156–158, 160, 161, 164, 166, 167, 177, 206, 256, 315 Work (labor): the block, industrial therapy, shortages, 170, 185, 201, 217, 222, 226, 231, 235, 236, 250, 322 World War I, 115, 154, 160, 200, 208 World War II, 8, 136, 173, 174, 183, 187, 191, 196, 201, 204, 212, 217, 222, 223, 231, 232, 236, 237, 241, 292, 302, 320 Wyatt v. Stickney (1972), 319