Asylum for the Insane: A History of Kalamazoo State Hospital

by William A. Decker, M.D.

ISBN978-1-9333926-04-9

Hardcover - 400 pages - $50.00

From The Kalamazoo Gazette

Monday, December 03, 2007

Decker's book examines history of

Kalamazoo Psychiatric Hospital

BY LINDA S. MAH

lmah@kalamazoogazette.com

KALAMAZOO -- For 33 years, Dr. William A. Decker had a prime spot from which to watch the world of psychiatry evolve.

He worked at what is now the Kalamazoo Psychiatric Hospital from 1953 to 1987, serving as medical superintendent of the facility for his last 13 years there.

In his new book ``Asylum for the Insane: A History of the Kalamazoo State Hospital,'' he explores not only the history of the hospital and the role it played in state and local history, but the history of psychiatry.

``There has been so much misunderstanding of the mentally ill and what went on in the hospital,'' said Decker, 86, during an interview at his house on Whites Road. ``I thought someone with firsthand knowledge and who lived in the hospital with patients should record his observations.''

In some ways, society has reverted to where it was before the advent of modern psychiatric hospitals, he said.

Although Decker is proud of the advances made in psychiatry and said that much good has come from placing patients back in their communities, he also said we have gone too far in the dismantling of our psychiatric hospital network.

Today, state hospitals still exist, but they serve primarily forensic patients -- those who are found by the courts to be not guilty of crimes by reason of insanity, Decker said.

For those found guilty but mentally ill, the only option is prison with court-ordered therapies.

``Unfortunately, many of these people are very severely ill and are in with the general population in institutions that are ill-equipped to deal with their needs,'' Decker said. ``Those people need to be in a hospital, not a jail or prison.''

Likewise, he said, there are patients who simply need long-term care because they are unable to function in a community mental-health system. For those patients, there is a need for small, state-supported psychiatric hospitals, he said.

Although such measures would be expensive, Decker said, they are also necessary to continue what he sees as the mental-health system's long history of ``dedicated and compassionate care'' of the mentally ill.

How asylum came to be

In working on his book, which was published by Arbutus Press in Traverse City, Decker not only relied on his own recollections of the local hospital, but spent about three years combing through state records and reports and local historical archives.

He launches the book with a discussion of the history of attitudes toward and treatment of the mentally ill in Great Britain and the colonies.

In the early 1700s, Quakers began the first asylums for the mentally ill. They were called asylums because they provided refuge from the harsh conditions of prisons and poorhouses.

In the mid-1800s, teacher Dorothea Lynde Dix became an advocate on behalf of the mentally ill after seeing how the insane were housed in a jail. By 1852, she persuaded officials in 11 states to establish public asylums.

Riding this wave of reform, Michigan became one of the first states to build a state asylum.

The choice of Kalamazoo as the location for the Michigan Asylum at Kalamazoo was helped by the fact that the governor was Epaphroditus Ransom, who once resided in Kalamazoo, said Tom Dietz, who is curator of the Kalamazoo Valley Museum and recently gave a lecture on the early history of the asylum. And the man Ransom chose to head the site-selection committee was his former law partner, Charles Stuart, a Kalamazoo lawyer.

Although the asylum was originally planned for a site in what is now the Stuart neighborhood, it was decided that this location was too close to downtown. So planners instead chose to place the hospital ``far out in the country, where they would never be bothered by these people,'' Decker said.

That location was on what is now Oakland Drive, where the hospital is still located.

Farm land, limited options

The asylum was on the cutting edge of many forms of treatment. Through its close proximity to town, it was able to establish an innovative outpatient clinic in 1916 as well as a unique ``family-care'' program that placed patients in certified homes.

The hospital also made use of colony farms, adjunct properties on which patients with milder illnesses -- and those who today might be considered developmentally delayed -- lived in familial farm settings. (One of these was near Kalamazoo's Asylum Lake.) They often raised livestock and produce for use at the hospital.

Decker said that the farms are examples of the limited treatment options for the mentally ill that were available before the 1950s. Electroshock therapy, insulin-induced comas and some barbiturate drugs resulted in limited reversals in thoughts and behavior of patients, he said.

``Beyond (those measures), there wasn't much that could be done other than containment,'' he said.

A sea change in treatment

Then the world began to change. Decker remembers listening in 1955 to a salesman's pitch for some drug that was irrelevant to the patients at what was then called the Kalamazoo State Hospital.

After the man finished, Decker told him, ``What we really need is something to change the thinking and feeling states of our patients.''

The salesman hesitated, then suggested he might have what Decker wanted, and he offered him samples of something called Serpasil, which was not being marketed yet.

Decker said he was treating a farmer from Wayland who was in the hospital in a state of catatonic schizophrenia. He was not eating, drinking or washing himself. The staff crushed the pills and put them in his feeding tube.

Within three days the man was out of bed, talking and cooperating with his treatment. He was back with his family three weeks later. ``It was a miracle,'' Decker said. ``We had never seen anything like that.''

It was the first in a line of neuroleptic or antipsychotic drugs, such as Thorazine, that would revolutionize psychiatric treatment and the role of psychiatric hospitals in society.

Patients who had been in the hospital for decades were suddenly responsive, able to care for themselves, and moving back to live with their families.

When Decker began working at the Kalamazoo Regional Psychiatric Hospital, there were 3,600 patients. By the time he retired In 1987, the number of patients had dropped to 550.

``The drugs made it possible -- along with the recognition by the Department of Social Security that people with mental disorders had a disability the same as people with physical disorders -- for people to become eligible for Social Security benefits,'' Decker said.

Dismantling the system

In response to a 1963 congressional joint commission on mental health, states began looking at ways to dismantle large psychiatric hospitals in favor of a community-based mental health system. Michigan established its mental health code in 1974.

With these medical and social changes, the Kalamazoo hospital began to literally recede on the community horizon. Buildings were closed, then razed. The hospital campus was once home to almost 80 buildings. Today, fewer than a dozen buildings exist -- a sign of the dismantling of the psychiatric system that Decker is concerned about.

Hospital history

1854 -- Construction of the Michigan Asylum at Kalamazoo begins.

1859 -- The Michigan Asylum formally opens on Aug. 29.

1888 -- The Colony Farm System for the mentally ill is established, with Brook Farm on Douglas Avenue the first farm colony in America.

1910 -- Mechanical restraints are abolished, and occupational therapy is recognized as a treatment program.

1911 -- The name is changed to Kalamazoo State Hospital.

1916 -- An outpatient clinic is established at Vine Street School.

1931 -- Public Act 281 of 1929 directs the sterilization of patients as a measure for preventing mental illness. Sterilizations are performed that year.

1958 -- Farming operations are discontinued, and patients are transferred to the main hospital buildings.

1960 -- The number of patients begins a rapid decline because of the introduction of neuroleptic drugs and the move toward community care and treatment.

1974 -- Michigan Mental Health Code is enacted.

1976 -- Name of hospital is changed to Kalamazoo Regional Psychiatric Hospital.

1995 -- Name of hospital is changed to Kalamazoo Psychiatric Hospital.

2007 -- All but about 100 acres of the nearly 1,500 acres of land once owned by the hospital's main campus and Brook Colony Farm are transferred to Western Michigan University.

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