This is part 22 of a series. To go back to the very beginning, start with part one. To go back to the start of this section, start with part fifteen.
Today, involuntary holds are generally limited to 72 hours. Insurance plans and the cost of treatment all but ensure in-patient hospital stays are short. I can't imagine a scenario in the US where someone could be hospitalized for their mental health and end up spending the rest of their life with a foster family in a city far away, a city they can't legally leave.
The closest analogy would be come from Alaskan history. Prior to 1960 there were no facilities in Alaska to care for people who were deemed to be mentally ill or intellectually disabled, so patients were sent to Oregon. From 1901, patients were sent to the Oregon State Insane Asylum in Salem. The asylum became too crowded and refused to accept more patients, despite dramatically increasing the charge for each patient. From 1904, patients were directed to Morningside Hospital in Portland. Both institutions followed the farm colony model.
The Alaska State Mental Health Trust tells us that “At the time, mental illness was considered a crime. People with any sort of mental disability who were unable to care for themselves or who could not be cared for by a family member or guardian were charged and convicted as “an insane person at large.”
Those accused of being insane were transported to the nearest court, which could require weeks or months of travel and waiting. They were held in jail until the trial had concluded. A jury of six people determined who was sent to the asylum. Decisions regarding estates, guardianships, adoptions and sanity were all made by the same court. Those convicted were held in jail until they could be transferred to Oregon. There were delays because of frozen waterways. There were delays because of the requirement to hire deputies to make the trip. There were delays because of the need to obtain a convict transportation permit.
Despite patients at Morningside having been convicted of a crime and banished thousands of miles from home, hospital publicity suggested they were cared for:
“The treatment philosophy (therapeutic community) described in the article is rather forward-thinking for 1964. The article noted that Morningside looked more like a farm than a hospital, there were no uniforms for the patients or staff, patients were encouraged to participate in education/work and recreation, and the goal for most patients was self-sufficiency and discharge.”
Patients were not sorted by their believed curability, like they were in Belgium. A former patient reports never being told his formal diagnosis. The hospital functioned as a community, as many employees lived in apartments on the grounds.
When the hospital in Valdez, Alaska, was rebuilt following the 1964 earthquake, it was expanded to include facilities for patients with mental health issues and intellectual disabilities. This ended the practice of sending people to Oregon. Most patients were returned to Alaska in 1960 when the state contract ended, while others were transferred to other custodial care facilities in Oregon. Morningside closed in 1968, as it was not financially viable without the Alaskan patients. The last patient sent from Alaska died in Oregon in 1994.
The records of who was transported to Alaska, kept at Morningside, and their fates after 1964 were lost. Volunteers have spent over a decade piecing together the fate of their lost friends and family with a database of patients.
The explanation for why patients were sent to Oregon is a beautiful example of how bureaucracy leads to irrational decisions. One explanation is that:
“Although Portland is somewhat remote from Alaska, it is to be remembered that Alaska, with some 3000 miles of water frontage, has no central point. A patient from the north would have to come to Seattle and be shipped back to the lower part of Alaska, if there was an institution in that region, and vice versa.”
That’s not quite why things happened the way they did.
Alaska was purchased by the US in 1867 and was managed by the military until 1884. The military and federal government weren’t particularly interested in how those who needed care were provided for. Prior to the 1901 contract, the insane were sent to Napa, California and Washington, DC on a case by case basis. Mostly, though, the government ignored the concerns of its agents in Alaska and avoided paying for the care of those deemed to be insane. Because no funding was available for care, the most troublesome were held in jail while the rest were ignored.
Ultimately, Alaskan settlers found a solution in making it illegal to be considered incompetent:
“Unable to secure legislation which would provide for the treatment of the noncriminal insane in mental institutions, and compelled to maintain these unfortunate people in jails without recompense from the federal government, Alaskan judicial officials concocted a scheme to force the national government to assume responsibility for all of Alaska's indigent insane. According to this scheme, before a mentally ill person was adjudged insane, he was convicted of a misdemeanor and sentenced to jail. Shortly after he began serving his sentence, he was pronounced insane. This practice obliged the Justice Department, under United States law, to provide care for the insane prisoner at the Government Hospital. And, since the insane person was a criminal, the federal government was forced to assume all medical and maintenance costs until the mentally ill prisoner could be transported to Washington, D.C. Alaskan administrators resented having to resort to such legal devices.”
This is how it came to be that it was illegal to be insane in Alaska.
Alaska was finally provided with a civil code in 1900. This included the requirement to accept the lowest bid from an asylum or sanitarium west of the Rocky Mountains. The first round of advertisements resulted in zero bids. After reaching out to institutions directly, they received a total of two bids. From then on patients were sent to Oregon.
The process of convicting people of insanity was incredibly slow. Keeping people in jail for so many months was both inhumane and very expensive for the local government. The Nelson Act was the solution:
“1905, the Nelson Act enabled commissioners "to commit ... all persons adjudged insane in their districts to the asylum or sanitarium provided for the care and keeping of the insane of the district of Alaska." Moreover, they were to "impanel a jury of six male adults, residents of the district, to inquire, try, and determine whether the person so complained of is really insane." The person accused of insanity would be represented at the trial, and one or more physicians would give testimony as to his mental condition. Upon a unanimous verdict of the jury and the approval of the commissioner, the insane victim would be committed to the proper mental institution.”
Before we get worked up about this injustice, in Oregon a doctor was consulted to make an insanity diagnosis and the list of reasons for admittance to the asylum aren’t any better. A 1923 inspection found that 25% of patients had syphilis, which can lead to symptoms of mental illness. It noted three patients who were not considered insane.
From 1922 on, children with congenital disorders and intellectual disabilities in Alaska were declared legally insane and transported to Morningside. This was the era when children who were considered to lack adequate family support were “boarded out” with local families or “placed out” in far away farming communities. This includes the orphan train programs that have been romanticized, such as the Canadian Anne of Green Gables, as well as outing programs for children in American residential schools.
At this point children who were considered feebleminded were not viewed as suitable for boarding out, at least in England and Wales. The aged who were not able to live independently and who did not have family to care for them were boarded out in other regions of the US which did not have an almshouse, poor house, or poor farm to ship them to.
It’s not clear whether any residents of Alaska with chronic incurable conditions were boarded out, in Alaska or through the asylum in Oregon. It’s clear there were candidates, as patients worked within the institution and on the farm. At least one patient who had been institutionalized for decades later had his sister successfully petition for his release into her care. He successfully integrated into the community, including paid employment and volunteer work.
The insane were criminalized as a way to shift responsibility for payment onto the federal government, as poor relief (such as paying for boarding out) was typically a local responsibility. It’s also clear that the federal government viewed Alaska as an inherently unhealthy place to live. These considerations were intertwined with the fact that many settlements were new and composed of people chasing get rich quick schemes, who lacked community ties and likely led to an abundance of certain personality types. There is also the factor of the discrimination against native populations that led to children being forced into residential schools.
In 1904 and 1909 FL Goddard, former medical superintendent of the Western Washington Hospital for the Insane, had his bids to care for the insane in Juneau, Alaska rejected. Other proposals for care within Alaska were rejected as well.
“Congress, in fact, was so convinced that it was unwise – economically and medically – to treat the insane in an institution located in Alaska that it refused to extend home rule over the mentally ill to Alaskans when they were granted territorial status in 1912. Indeed, this goal was not achieved until 1956.”
While those convicted of insanity were removed from Alaska, the Sitka Pioneer Home provided residential care for the elderly in Sitka, Alaska, beginning in 1913 and is still in operation today.