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Viewpoints: Many people with mental illness still fall through cracks

By Laurence T. Beahan, M.D.

I’ve been invited to lunch at “The Henry,” the boutique hotel being developed out of the old Buffalo State Asylum for the Insane or, as it was known locally and fearfully, “Forest Avenue.”

In the old days, your doctor’s invitation to go there was worse than your mother’s threat to send you to Father Baker’s, another of our city’s architectural gems.

Buffalo News photos of the Richardson Complex’s medieval, copper-clad spires and the fearsome red Medina sandstone walls trigger troublesome recollections.

In 1953, I spent a one-month medical school elective in psychiatry there. That year, treatment of people with mental illness was at low ebb.

On approach, Frederick Law Olmsted’s planned lawns, with their ancient shade trees, softened Henry Hobson Richardson’s fortress appearance. I climbed the sandstone steps into a vast carpeted lobby. A magnificent stairway, lined by great polished mahogany bannisters, soared upward out of the lobby. To the left was the superintendent’s office with its shining mile-long mahogany table.

What a shock then, to be led by my mentor from this grand reception area to rounds on the floors of shabby, crowded wards that stretched in wings from that distinguished main building.

Walls needed paint; rooms were filled far beyond capacity. Patients slept in hallways. Most were dressed in tan cotton pajamas and robes.

They stood about aimlessly, except for the few who approached our white coats begging, “Doctor, help me.”

The doctor I accompanied was burdened by a metal ring heavily laden with keys, through which he sorted, as we negotiated locked door after locked door.

He explained that the hospital had 3,000 resident patients, many times more than it was designed for. There wasn’t any real program. There was barely enough medical staff to keep up with physical problems, let alone treat psychiatric illness.

He said, “This hospital was modeled on the ideal of moral treatment,” the humane and psychological management of mental illness, inspired by reformers like Dorothea Dix in this country in the 1800s and Philippe Pinel in France in the 1700s. “But the place was inundated with patients. There was never enough money. So it’s nothing but a warehouse.”

The most disturbing image I came away with was a gymnasium-sized room with long tables that was crowded with patients clad in those tan uniform robes. They walked en masse around the perimeter of the room. The doctor shrugged. “Exercise time,” he said.

White-clad attendants rolled in carts piled with dinner trays. I don’t recall the food, but there were no dishes, only trays, with compartments pressed into them, and no utensils except tablespoons.

That was 1953 and it was just about then that antipsychotic drugs were introduced. Many of these fear-ridden, sad, confused people benefited from these drugs and were discharged. Hospital populations dropped.

In the reform period that followed, I attended a patient-staff ward meeting on K2 at the E.J. Meyer Memorial Hospital, when an old woman dramatically spread a ragged blanket on the floor.

“Try to keep warm with that,” she said. “And the bathroom mirror is like putting on lipstick looking into a pie plate.”

Care improved. “Community treatment” was begun, but has largely failed for a lack of funds. Many people fall through the cracks. They wander the streets, sleep under bridges and populate our prisons and jails.

Maybe lunch in these once-grim surroundings, now restored to romantic magnificence, will make diners think of the original generous impulse that led to the construction of this refuge. Good things may come of it – think universal mental health care, even blankets without holes.

The food may even be good. The best homemade bread and apple pie I have ever been served was at Manhattan State Hospital.

Laurence T. Beahan, M.D., a retired psychiatrist, lives in Amherst.

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