Saturday, November 17, 2012

Utah State Mental Hospital

Photo Essay of the Utah State Hospital (featured in Utah Historical Quarterly, Spring 2010, Volume 78, Number 2)
Written by Janina Chilton, Utah State Hospital Historian   
Monday, 19 July 2010 14:03
USHThe following photographs represent a brief visual history of the Utah State Hospital beginning in 1885. Included are pictures that are at times exemplary and at other times disturbing. The history portrayed in these images parallels treatment in usage at institutions across America.  Even the architectural style of the buildings echoes the style of other mental health institutions.  Many of the photos have not been seen for decades and most have never been published. They come from a variety of sources but many were found in old cabinets or boxes in forgotten closets during the demolition of buildings at the hospital. Most were taken by unknown photographers, and few were dated. They are rare portraits of some of Utah's forgotten citizens and of the compassionate and exceptional people who provided care to those citizens.
There are many quality works for the reader desiring a detailed history of mental health treatment. A noteworthy history specific to Utah is Charles McKell's October 1955 Historical Quarterly article, “History of the Utah State Hospital.  This essay is not intended as a comprehensive telling of the hospital's history, but is rather a glimpse into one of Utah's oldest and often misunderstood institutions.

It was likely that the need to care for mentally ill persons in Utah had existed since pioneers first came West in 1847.  However, it was not until February 20, 1880 that an  act to establish a Territorial Insane Asylum was passed by the Utah Territorial Legislature.  In 1881, Provo was selected as the new site for the asylum. The site was selected due both to the ample supply of spring water and because it was located far from the center of town.   In keeping with attitudes of the era, Provo City was protected from the asylum by both a swamp and the trash dump.

The original Utah Insane Asylum taken just before the opening on July 15, 1885.
The original Utah Insane Asylum taken just before the opening on July 15, 1885. (Utah State Hospital Museum Collection)
The original asylum building was dedicated on July 15, 1885 and five days later, the first patients were admitted. The asylum would become the primary care facility for those with a mental illness for the next eighty three years.  In 1967, Utah's first community mental health center opened, gradually ten more would follow.  Today, the Hospital is one part of the continuum of care for Utah's mentally ill citizens.

Historical Quarterly 2 Main building - circa 1900
The Utah Territorial Insane Asylum with the addition of the north wing and administration portion of the building. c. 1900. (Courtesy of Allen's Camera)
As more patients arrived, the need for more space increased at the Asylum.  In 1890, a new north wing was added and the original building became the south wing of the growing complex. In 1891, the Administration building was added which provided no new patient housing but provided additional office space as well as new living quarters for staff.

Historical Quarterly-3 main building-c.1936 hospital 1930's
The original building after extensive remodeling. c. 1936. (Used by permission, Utah State Historical Society, all rights reserved)
The main building as it appeared in the 1930's had undergone a dramatic renovation. The old gothic style of architecture had given way to a more modern and sleek look. The name of the institution also changed with the changing attitudes about mental illness.  In 1896, Utah achieved statehood; consequently the Asylum became the Utah State Insane Asylum. In 1903, it became the Utah State Mental Hospital, and in 1927, the Utah State Hospital.
Over the years, additional buildings were added to accommodate the ever growing population.  Each new building represented the best thinking of the time.  Two cottages built in 1901 were a radical change from large wards and multi floors. Both were single wards designed to house thirty patients and consisted of only one floor.  The Milton Hardy building, constructed in 1908 consisted of two floors and was most likely a compromise between the original building and the cottage plan.
By the time the George Hyde Memorial Building was competed in 1922 and the Frederick Dunn building in l932, multiple floors and large dorms were again back in vogue. The difference between the two buildings reflected the treatment philosophy around patients need for recreation. The Hyde Building contained a billiards room, one lane bowling alley and swimming pool. The Dunn building, completed during the depression contained no such amenities. Hospital buildings constructed in recent years reflect a patient's need for privacy and space. All of the wards provide one and two bed room dorms, a number of day rooms and open court yards.  Beginning with the Milton Hardy building in 1908, each new building would be named after the superintendent in office at the time of construction.  This practice would be discontinued in 1951 with the construction of the student nurses home.

Historical Quarterly-4 staff-c.1900
This turn of the century photo of Asylum personnel included Superintendent Dr. Milton Hardy, who is seated center front. c. 1900. (Utah State Hospital Museum)
Early employees lived on the Asylum campus, worked six ½ days per week and were responsible for every aspect of patient care. The work was hard, the hours long and by today's standards, the salaries seem low.  However, before the turn of the century they were considered adequate.  Salaries in 1885 ranged from $125 per month for Medical Superintendent Dr. Walter Pike, to the third female attendant who received $17.50 per month.  Interestingly, the male attendant made $25 per month and the male supervisor made $37.50, $4.17 more a month than the matron who received $33.33 per month. [1] It would be well into the 20th century before female and male employees were paid the same salary and everyone worked a 40 hour week.

Historical Quarterly 5-First pharmacy c1900
The Asylums first pharmacy adjoined the office of Superintendent, Dr Milton H. Hardy who is seated on the left. c. 1900 (Utah State Hospital Museum Collection)
The Asylum's first pharmacy was called the dispensary and adjoined the Superintendent's Office. The first recorded inventory of the Dispensary can be found in the asylum's Biennial Report in 1886.  It consisted of 130 items, including an odd array of pills, powders and herbs.  Some of the more unusual items included; 1 gallon of bourbon, whiskey, sherry wine, powdered rhubarb and Jamaica ginger. [2] The first effective medicines for the treatment of mental illness would not be developed until the 1950's with the discovery of a new group of medicines know as the phenothiazines.

Historical Quarterly 6 Utica crib Shown is a restraint known as the Utica Crib. The crib, patterned after a child's crib, was approximately six feet long, weighed about one hundred and fifty pounds and had a hinged top that could be fastened at night thus restricting movement and supposedly enforcing rest. It was believed that some types of mental illnesses required rest as a therapeutic measure.  It was first used in 1846 in Eastern asylums and records show that it was used at the Utah Territorial Insane Asylum when it opened in 1885; it was discontinued in the 1920's when more humane restraints were developed. (Utah State Hospital Museum Collection)

Historical Quarterly -7 straight jacke-1954
A patient shown wearing a canvas straight jacket in 1954. The straight jacket was a common type of restraint used at hospitals across the country. It was used extensively at the hospital until the late 1950's. (Courtesy of the Provo Daily Herald)
For the first 70 years of the institution's history, care remained primarily custodial. Therapeutic care was almost unknown in those early years. Over the years various forms of ‘‘treatment'' were used including the Utica crib, straight jacket and a variety of other devices which by today's standards would be considered punishment rather than treatment. However, from the beginning no restraint could be used without a doctor's order and earliest records indicate that superintendents continued to make an effort to minimize their use.  Superintendent, Dr. Walter Pike noted in his first Biennial Report to the Governor in 1888, “We have endeavored to carry out the “non-restrain” principle as far as possible, consistent with the safety of the patients, but have found ourselves obliged to make use of some restraint to prevent patients, while violent, from harming their fellow patients.  We endeavor to get along with as little display of restraint in any form, as possible.  But these evils cannot be avoided until we are able to classify”. [3] Most restraints were used to contain patients, especially those diagnosed with mania.

Historical Quarterly 8-Hydrotherapy-1918-
This photo taken in 1918, shows a patient receiving a form of hydrotherapy known as a tonic “douche”, as sprays were called at the time.  A number of different sprays were used depending on the need of the patient. (Photo from the-Report of the Board of Insanity and Superintendent of the State Mental Hospital: For the Biennial Period Ending November 30, 1918: 11)

Historical Quarterly-9 Hydrotherapy1918
This 1918 photos depicts another form of hydrotherapy in which tubs were used instead of sprays. In this version patients were placed in warm tubs filled with warm water, canvas cover were placed over the tubs to retain the heat and keep the patient in the tub. (Photo from the Report of the Board of Insanity and Superintendent of the State Mental Hospital: For the Biennial Period Ending November 30, 1918: 12)

Historical Quarterly 10-hydrotherapy-c.1950
This last version of hydrotherapy included a consol that could produce a variety of different spray and also included a heat lamp.  c. 1950 (Utah State Hospital Museum Collection)
A new treatment known as hydrotherapy began at the hospital in 1910. The practice of hydrotherapy began in state hospitals around 1890 and was based on the medical use of water for other illness such as the immersion in cold water for the treatment of a high fever. Perhaps its use was also based on the popularity of spas during that era. Hydrotherapy included saline baths, sitz baths, hot and cold wet packs, and hot and cold baths. Cold wet sheet packs were often used as sedatives for excited patients instead of the old forms of mechanical restraints.  Warm baths were used to simulate those patients who were depressed or catatonic (a phase of schizophrenia in which the patient is unresponsive).While the method of hydrotherapy may seem simple, the technique of administering it was not. Care had to be used in both the application of cold and hot water in order to prevent serious injuries.
By today's standards hydrotherapy may seem old fashioned and more like a restraint but at the time it was widely used in state hospitals as well as in general hospitals for other illnesses. It is that doubtful that hydrotherapy was ever in its self a cure; at best it was most effective as a sedative, tonic or as stimulation with only temporary benefits. The use of hydrotherapy was phased out with the advent of medications in the 1950's.

Historical Quarterly-11- insulin shock therapy-c.1950
A patient being prepared for insulin shock therapy-c. 1950. (Utah State Hospital Museum Collection)
In 1934, a new treatment known as convulsion therapy was added to the growing list of new therapies being introduced at state hospitals therapy the drug Metrozol was administered to produce the required convulsions that the therapy required. In 1937, Hypoglycemic therapy, more commonly known as insulin shock therapy was introduced at the Hospital and Metrozol therapy was slowly discontinued. Insulin shock therapy patients were given large doses of insulin, this lowered the sugar content of blood and produced a diabetic coma. The object was to place the patient in an unconscious state for several hours. The usual treatment schedule was five times a week with up to 50 or 60 treatments. Insulin shock therapy was used to help restless or agitated patients become calm and tranquil. Both convulsive and hypoglycemic therapies were considered dangerous and were eventually discontinued as other more effective treatments were developed.

Historical Quarterly-12 Kr. Kivler-ECT-1955
Dr. C.V. Kivler administering Electro Convulsive Therapy (ECT) with the Reiter machine in 1955. (Utah State Hospital Museum Collection)
Electro Convulsive Therapy or ECT, which was introduced at the hospital in 1947, would become the most common of all the convulsive therapies. The earliest method of ECT could produce a rather violent convulsion so care was given to make sure that no injuries occurred.  According to treatment protocol convulsion therapy was administered three times a week and included from five to fifteen treatments.
Today, ECT is still considered a viable and effective treatment for severe depression. New methods have made the procedure considerably safer and it is only used with patients consent.
By 1950, the list of treatment options at the Hospital had grown to include hypoglycemic therapy, electroshock therapy, hydrotherapy, psychoanalysis, group therapy and narcoanalysis (a form of psychotherapy in which barbiturates are used to put the patient into a light anesthesia to help them talk about events that might be suppressed). Although some of the early therapies seem ineffective when compared with current treatment options, they were considered a standard practice for state hospitals. When medications were developed in the 1950's that were considered safer and more effective than earlier treatment modalities, nearly all of the other forms of therapies were discontinued. Today, the hospital provides a broad array of therapeutic programs including recreation, vocational, rehabilitation and physical therapy.

Historical Quarterly Photo-13-Surgery room-
This surgical room was located on the first floor of the main building until a modern Medical Surgical Building was completed in 1955.  c. 1910. (Utah State Hospital Museum Collection)
Surgeries were performed at the asylum from the time it opened in 1885 until the mid-1970's when it became too costly to maintain current surgical equipment. Nearly every surgery that was available at a general hospital was available at the Utah State Hospital, including the birth of a few babies. Today patients who need surgical care are referred to local hospitals.
Along with a discussion of early treatment modalities it is interesting to note the variety of reason that people were committed to the institution in the early years.  Some of the more interesting ones were: reading novels, solar heat exposure, spiritualism, financial embarrassment, disappointment, mental strain, overwork, fear of poverty, religious excitement, fright, remorse, sedentary life, over study in school, hypnotism and sheep herder. By today's standards those are flimsy reasons for years of hospitalization.

Historical Quarterly 14-wicker furniture c.1930
Hundreds of pieces of beautiful wicker furniture were made by patients and staff. c. 1930 (Utah State Hospital Museum Collection)

Historical Quarterly-15 greenhouse-circa 1950
A Patient working in the hospital greenhouse c. 1940's. The farm and dairy provided nearly all of the food used by the institution. (Utah State Hospital Museum Collection)

Historical Quarterly 16-cannery.c.1938
In 1938, patients and staff canned over “329,340 quarts of fruits and vegetables”. c. 1920's [4] (Utah State Hospital Museum Collection)

Historical Quarterly-17 broom making 1940
Employees and patients working together made a number of different items including brooms, scrubbing brushes, dressers, screen doors, just to name a few. c. 1930 (Utah State Hospital Museum Collection)
From the opening of the Asylum in 1885, patient labor was important to the operation of the facility. Every conceivable item was made including, tin cans, mattresses, and wicker furniture, shoes, clothing, towels, blankets, etc. Patients worked in the sewing room, laundry, kitchen, boiler house, farm and dairy. Patients were also involved in the construction of every new building until 1955. Superintendent Walter Pike noted in 1887 “That the employment of patients in pursuits which occupy the mind, and for the time being distract them from dwelling upon their delusions and insane ideas, is one of the most powerful aids to treatment and every means should be used to furtherance of such employment”. [5]
The farm was an important part of the treatment program as well as the fiscal efficiency of the hospital. In the 1924 Biennial report, Dr. Frederick Dunn noted in his report on the progress of the farm, “That with more land added to our present holdings, this Institution will have made the long step toward self support”. [6] By the 1930's, the farm complex included hogs, chickens, turkeys, cattle, horses and an apiary. However, it was not until 1956, a professionally directed industrial therapy program was introduced that began to coordinate the labor needs of the hospital with the treatment needs of the patient. The farm program was phased out in the 1960's and nearly all of the original industrial programs have been discontinued. Today, the hospital no longer relies on patient labor; the mission of the hospital is to aid patients in life skills and to return them to their communities as soon as possible.

Historical Quaterly- 18 kitchen staff
The hospital kitchen staff c. 1900. All most all of the food was grown at the hospital and all the meals were prepared by staff and patients.  It wasn't until 1937 that the coal stoves were replaced with gas. (Utah State Hospital Museum Collection)

Historical Quarterly 19-food carts
The food was transported from the kitchen to the various wards on these hand-pulled carts until the late 1950's. c.1940. (Utah State Hospital Museum Collection)
In the early years patients ate family style on their respective wards. They were allowed cups, saucers, a tin bowl, knives and forks. As overcrowding became problem knives and forks were seen as potential weapons and soon a metal spoon was the only utensil provided. It was not until the late 1950's that knives and forks reappeared.

Historical Quarterly -20 Crowded ward-1950
A typical crowded ward- c. 1950.  (Utah State Hospital Museum Collection)

Historical Quarterly-21-Patient in hall-1940's
Beds in the hall of the men's ward-c. 1940's (Utah State Hospital Museum Collection)

Historical Quarterly 22- womens ward
A women's ward –c. 1930's (Utah State Hospital Museum Collection)

Historical Quarterly 23- mens day room
A men's ward day room- c. 1940's (Utah State Hospital Museum Collection)

Historical Quarterly-24 Strong Room-c.1940
The strong room- c. 1940's (Utah State Hospital Museum Collection)

Historical Quarterly 25- womens ward birdbath
A women's ward “birdbath”- c. 1940's (Utah State Hospital Museum Collection)
Due to the constant problem of overcrowding and budget restrictions, many inhumane conditions existed at the hospital. A typical patient dorm area from the 1920's through the late 1950's housed between twenty and as many as fifty patients, which resulted in a total lack of privacy. There were neither dressers nor mirrors and patients were allowed to keep very few personal belongings, any they did manage to have had to be tucked under their mattress or hidden in their clothing.
Patients were allowed one bath per-week; during the rest of the week they would wash in large sinks know as bird baths. Bathrooms also allowed little privacy and until the 1950's there were no toilet paper dispensers. Patients would be required to ask a staff member for toilet paper.
By the 1940's, wards had became so crowded that beds were placed in alcoves and ha1ls. In 1955, the hospital population peaked at 1,500 patients, which was nearly 200 over capacity. In 1957, the State Legislature doubled the funding for the hospital. With the extra funding and the leadership of Superintendent Dr. Owen P. Heninger, the hospital was divided into small treatment units each with its own treatment team. This allowed for individual treatment plans and more personal care.
When Dr. Heninger became the superintendent in 1942, he was determined to remove an area in the hospital known as the strong room. The strong room, erected in 1932, was built to house criminally insane men who were considered dangerous. The room consisted of four jail cells and the men who were placed in them were never let out. It took him eight years but in May, 1950, the cells were finally removed. Interestingly, the four men who were moved from these cells into the general hospital population never caused another problem.

Historical Quarterly26-Patients on walk-1940's
The large number of men on this walk is indicative of how overcrowded the hospital was in the 1940's. For many these walks were the only opportunity to escape the crowded wards- c. 1940. (Utah State Hospital Museum Collection)

Historical Quarterly 27-Dunn Courtyard-1949
This courtyard was located behind the Dunn Building and was modeled after a prison exercise yard, without the armed guards- c. 1935. (Utah State Hospital Museum Collection)

Historical Quarterly-28 Fourth of July party-
Patient enjoy a Forth of July Celebration on the hospital lawn- c. 1940. (Utah State Hospital Museum Collection)

Historical Quarterly--29 Gray Ladies with dog
The Red Cross Gray Ladies and patients enjoy a visit from Leta, the dog-1960. (Courtesy of the Provo Daily Herald)
Recreational activities for patients varied over time and were often dependent on volunteers and the availability of staff and resources. Movies were shown when available and community groups would often provide entertainment. Christmas and Fourth of July celebrations were held each year along with frequent dances. In the 1950's, the Red Cross Gray Ladies began to provide a number of regular activities for patients, they were also involved with the establishment of a new patient recreation center that included games, ping pong tables, books, magazines, a radio, phonograph and records. By the 1960's patients were routinely allowed to go off campus for recreational activities.
Today, patients enjoy many community activities as well as campus recreation facilities. Recreation provided on campus include a modern library, gym, swimming pool, weight room, ropes course, fish pond and on ground camping facility. However, volunteers are still an integral and valued part of the recreational as well as religious programs available to patients

Historical Quarterly-30-original building demolished-1981
Demolition of the last remaining part of the original building- 1981
With the advent of community mental health centers in the 1970's the hospital population began to decline and the large old fashioned wings of the original building were no longer needed. They were demolished in 1976 and the remaining portion was demolished in 1981. Most of the old buildings have now been replaced with modern new facilities that provide both a therapeutic environment with a comfortable living arrangement that includes both private and semi-private bedrooms.
Gone are the large custodial intuitions of the past. The Hospital has moved from a custodial asylum to a hospital in every sense of the word. It is no longer the only mental health facility in the state, but rather serves a supporting role to a broad community mental health system Today, most people needing treatment for a mental illness will remain in their communities. Individuals needing more intensive treatment are referred to the hospital from one of eleven community mental health centers. The hospital currently employs 800 staff who provide a full array of services to 354 individuals including children ages 6-18; adults ages 18 and up and forensic patients committed through the Criminal Courts. However, as former Superintendent Dr. Owen P. Heninger noted in an evaluation report to the Welfare Commission in October, 1951 “It is a mistake to center our attention on either the good or bad to the exclusion of the other. The hospital record is neither black nor white; it is a mixture of both, which results in a variable shade of gray, that on occasions is lighter or darker, depending upon the will of the citizens and officials to who they gave responsibility. There may have been some excuse for the neglect of past years when society knew no better, but future generations will not be so generous in their evaluation unless advantage is taken of the knowledge now available”. [7]
The progress is not complete. The Hospital history is still being written.

1-Biennial Report of the Board of Directors and the Annual Report of the Superintendent and Treasurer of the Insane Asylum of Utah Territory-1888: 51. 2-Biennial Report of the Board of Directors and the Annual Report of the Superintendent and Treasurer of the Insane Asylum of Utah Territory-1886: 58-60.
3-Biennial Report of the Board of Directors and the Annual Report of the Superintendent and Treasurer of the Insane Asylum of Utah Territory-1888: 27.
4- Report of the Board of Trustees and the Superintendent of the Utah State Hospital: For the Biennial Period Ending June 30 1938: 31
5- Biennial Report of the Board of Directors and the Annual Report of the Superintendent and Treasurer of the Insane Asylum of Utah Territory-1888: 26.
6- Report of the State Board of Insanity and the Superintendent of the State Mental Hospital: For the Biennial Period Ending November 30, 1924: 7
7-Charles McKell, “The Utah State Hospital: A study in the Care of the Mentally Ill”, Utah Historical Quarterly, Vol. XXIII (October, 1955): 323.
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Last Updated on Tuesday, 27 July 2010 05:45