—Eloise psychiatrist Milton Erickson, in a speech to doctors in training at the hospital, April 24, 1940. Two days later, Annie is admitted.
On the cool, clear morning of April 26, 1940, armed with the temporary detention order that Judge Patrick O’Brien had signed the day before, Wayne County deputy sheriff John McLean arrived at Detroit’s Receiving Hospital to take Annie from the life she knew into a life unknown. What was she thinking during the fifteen-mile drive to Eloise? Did she even look up to see where she was heading when the gatehouse attendant waved them through the finely wrought iron gates with “Eloise” in the arched grillwork at the top? Whatever was going through her head, it’s safe to say that she had no idea her temporary commitment to this unfamiliar place would never end. How could she? Everything had happened so fast. It had been only fourteen days since her mother had signed the petition that had led, unavoidably, to this moment.
The attendant probably paid little attention to the bewildered young woman, one day shy of her twenty-first birthday, as she passed him on her way to D Building, the starting point for all admissions to Eloise. Two or three new patients arrived almost every day, often in the company of a sheriff’s deputy; three times a day, departing patients—or parolees, as they were still known—went through the gates and back into the outside world. To call Eloise a busy place in 1940 was to engage in gross understatement; it was as large as a small city, with more than ten thousand people—patients and police officers, doctors and custodians, nurses and engineers, farmers and firefighters, butchers and bakers. For several dozen employees, Eloise was both home and office; they lived on the grounds, either alone or with their families.
The ancient Greeks called ten thousand a myriad, and feeding this particular myriad amounted to a feat of epic proportions. Unlike today’s hospitals, Eloise produced a large quantity of its food, from field to table. In 1940, Eloise’s herd of cows sent more than 120,000 gallons of milk to Eloise’s state-of-the-art pasteurizing plant; Eloise’s slaughterhouse furnished 110,000 pounds of pork, 4,000 pounds of beef, and 2,500 pounds of veal to Eloise’s kitchens; Eloise’s cannery processed 65 tons of fruits and vegetables a month during the growing season; Eloise’s new ovens turned out 1,800 loaves of bread an hour, powered by electricity from the dynamos in Eloise’s own power plant.
All these enterprises combined to produce a level of noise that one employee would describe to me, years later, as a kind of constant hum, like the idling motor of a car. Early in the morning, the aroma of fresh bread would lure the Eloise employees’ children to the bakery, where Mr. Prosser, the baker, might reward them with a treat. Ed Missavage lived in N Building, near the dairy, and he remembers the pungent odors of hay, manure, and silage wafting through the large apartment that he and his wife (a psychiatrist he met at the hospital) shared the summer after their marriage in 1950.
Like any small city, work and play went on simultaneously. During the day, at any given moment somewhere on the vast grounds, Eloise’s more capable patients might be repairing drapes in the sewing room, or folding sheets in the huge laundry room, or reading a book in the Eloise branch of the Wayne County Library system, or watching a movie in the new auditorium, or attending one of the group therapy sessions that noted Eloise psychiatrist Ira Altshuler had started three years before, or undergoing the grueling ordeal of insulin shock, prematurely described in a 1937 Eloise annual report as a “remarkable new treatment” for schizophrenia. (Eventually, Eloise and other psychiatric hospitals would abandon insulin shock—a labor-intensive therapy that required a large commitment of staff to make sure the convulsions didn’t send patients from temporary comas into irreversible ones—as too expensive and too erratic in its effectiveness.)
Many patients, unable or unwilling to engage in the world around them, rarely strayed far from their ward. Like Annie, the vast majority had been committed involuntarily, and if they wanted to leave—and certainly some did—they were not free to go, not until their doctors said so. Locked doors kept them from wandering off the wards without permission, while inside those doors, privacy was next to impossible. A photograph of a female unit from the time shows four rows of 12 beds each, not even a few feet apart, in the “open” style of the era. With every bed occupied, the sheer mass of humanity generated a buzz that faded only when the lights went out, and sometimes not even then.
More aggressive patients lived in seclusion rooms on the ground floor of several buildings, while the “Red Star” ward in N Building housed the hospital’s most dangerous patients, about sixty or so designated as sexual deviants or homicidal. Superintendent Gruber had created this special segregated ward in response to a public outcry over the horrifying murder of an eleven-year-old girl. Her killer had a previous record of attacking young girls; twice, after police had arrested him, he was sent “for observation” to Ohio’s institution for the criminally insane and then released. In 1938, as the legislature debated a new “criminal psychopathics” law, Gruber directed the hospital staff to stamp any such patient’s records with a large red star, “designed to alert hospital personnel to the need for special vigilance and maximum security measures,” in the words of one scholarly study.
All this activity swirled around Annie, but from her vantage point in D Building, she saw little of it. Within a month or two, she would be assigned to one of the eight buildings that housed female psychiatric patients, but for the time being, with her state of mind in question and her legal status unsettled, she would stay on D5, the female admissions ward, giving the psychiatric and social work staffs ample opportunity to evaluate their new patient.
This is where she first saw Mona Evans and where, on May 13, she would meet with Peter Bolewicki, the psychiatrist assigned by Judge O’Brien to provide the tie-breaking opinion in her case. Until Bolewicki delivered, she was merely a temporary Eloise resident, patient number 17205, the latest in a line that stretched back to a previous century and a history that makes the evolution of Eloise all the more remarkable.
Her name was Bridget Hughes, but everyone knew her as Biddy, and on March 22, 1841, she became patient number 1, the first person registered as a “crazy person” on the rolls of Wayne County’s poorhouse and thus the first officially insane person in the young state of Michigan, admitted to the union only four years before.
Biddy was anything but fortunate to be there. Alvin Clark’s 1982 official history describes the second Wayne County poorhouse as “the only excuse for an asylum in the State of Michigan…In those days, the only division of the patients was by sex. Otherwise, babies, children, old men, blind people, the idiotic, the rational and the crazy were all huddled together in a miscellaneous unit. The Keeper and his wife, assisted by two or three attendants, often used chains to segregate the ‘crazies’ from the rational people—the only recourse left to them.”
Perhaps the best thing that could be said about the second County House is that it wasn’t the first. The first County House, a rickety two-story wooden structure on farmland a few miles beyond the city’s northeast boundaries, began operation in January 1833; within a year, it “had become almost uninhabitable and the inmates greatly neglected,” according to Clark’s history. On March 4, 1834, under pressure from prominent citizens and a Catholic relief organization, the county’s board of supervisors created a new authority with the apt, if paternalistic, name, the Superintendents of the Poor, to take over the operation and its fifty or so “inmates.”
By 1838, the Superintendents were searching for a site to build a new and larger poorhouse, and Superintendent Ammon Brown urged them to consider land near his home in rural Nankin Township, nearly a day’s ride from the city center, on the main stagecoach route between Detroit and Chicago. In early 1839, the Superintendents agreed, buying 280 acres and the Black Horse Tavern, a log cabin on the property that served travelers on the Chicago Road. The single-story tavern became the keeper’s quarters, while the inmates of the first County House found themselves in a hastily constructed addition.
But not all the inmates—in fact, not even most of them.
“Records show that 35 persons were transferred,” Clark’s history reported, “while 111 refused to go to that ‘awful wilderness.’”
The Superintendents made no pretense that they were doing anything for the insane in “that awful wilderness” other than housing them. As early as 1843, the Superintendents implored the state legislature to create an asylum exclusively for the insane, a call that other states, particularly in the East, were hearing as well. The 1848 legislature finally agreed, but it took another ten years for the first state asylum to open its doors in Kalamazoo, in the far western part of the state.
This was the dawn of the so-called “golden age” of asylums, the result of a reform movement that had its roots in the pioneering efforts of Dorothea Dix. Horrified by the conditions in the poorhouses and jails of Massachusetts, Dix campaigned to remove the mentally ill from their chains and cells. Other reformers expanded on Dix’s work, pushing for new institutions in bucolic settings, away from the unhealthy influences of urban life. Fresh air was their mantra, and asylum was their concept, a place of peaceful refuge where the mentally ill might regain their balance.
The superintendents of these new institutions saw themselves as engaged in a more enlightened enterprise than their predecessors. In 1844, thirteen of them came together in Philadelphia to form an organization of mutual support. They were a distinguished group, all physicians and all dedicated to the idea that sharing their experiences would lead to improvements in treatment. They chose an unwieldy but descriptive name, the Association of Medical Superintendents of American Institutions for the Insane (forerunner of today’s American Psychiatric Association), and the inclusion of “Medical” was no accident. They wanted to emphasize that their institutions had nothing to do with the poorhouses of the past, that only treatment rooted in medical and scientific principles had any chance of helping those suffering from these mysterious disorders of the brain.
At first, only asylum superintendents could join, which meant that Michigan, which had no asylum until 1858, had no representative. But the association had a significant impact on Michigan nonetheless; the Kalamazoo asylum was built to the specifications of the Kirkbride plan, named for one of the association’s thirteen founders. Thomas Kirkbride, a Philadelphia physician and superintendent of the Pennsylvania Hospital for the Insane, believed so strongly in the curative powers of fresh air and sunlight that, in 1853, he incorporated those principles into a building design that served for the rest of the nineteenth century as the model for the public asylum. Dozens of Kirkbride-influenced buildings, including some architectural showpieces with extensive grounds, sprouted up on farmland throughout the United States. Among them was the Western Michigan Asylum for the Insane, in Kalamazoo.
Anticipating that the population of insane people would grow, Kirkbride and his colleagues at the association sought to limit the size of new asylums, arguing steadfastly for a ceiling of 250 residents. But in 1866, after New York expanded the capacity at the State Lunatic Asylum in Utica to six hundred, the association’s board adopted that larger number as its standard—only to look on in dismay three years later, when New York, determined to empty its dreadful county poorhouses, opened the fifteen-hundred-bed Willard Asylum for the Insane. It would not be the last time that one humane goal would require the sacrifice of another in the pursuit of better mental health treatment.
The Kalamazoo asylum, while adhering to the Kirkbride plan, was too distant and too small to do Wayne County and Detroit much good. Not only was the facility on the other side of the state—largely inaccessible in that pre-automobile era—but the asylum keepers also restricted admission to a limited number of “curable” patients. There was no place in the Kalamazoo asylum for a long-term resident like Biddy Hughes. In 1868, the Superintendents of the Poor decided that Wayne County had no choice but to construct an asylum of its own. As Clark put it in his 1982 Eloise history, “If the State of Michigan had provided ample quarters for the insane at the Michigan Asylum in Kalamazoo, the Wayne County Asylum would never have been built.” But built it was, and Wayne County would stay in the asylum business for the next 111 years, long past the time when those duties had become a state responsibility nearly everywhere else in the country.
The patient records from those 111 years, at least the ones that still exist, reside today in a Detroit warehouse, managed by a company called Iron Mountain. As I began my reporting in 2006, Iron Mountain seemed as impregnable as Fort Knox. On a cool spring day, I take a ride to the public entrance to the fortress, which is not the warehouse itself, but a nondescript county building where Patricia Waterman has her office.
Waterman is the Wayne County Department of Health’s record information management consultant, and the gateway to the Eloise records. She looks at my Letters of Authority and immediately we’re at odds. She challenges the letter, telling me that by putting “Obtain medical records” under the “Restrictions/Limitations” section, the court has restricted me from obtaining medical records. She says she wants to refer the matter to the department’s lawyer.
“Don’t do that, please,” I say. “There’s no need to get into a legal battle.” If an ambiguity exists, I say—and for the sake of clearing it up, I’m happy to concede that one does—why not just call the Probate Court for clarification?
But try as I might, I can’t persuade her to make the call. If I had to read her mind, I would say that she doesn’t want to get backed into a corner from which she can’t escape. Would she be willing to talk with someone at the court, if I can reach someone? She hedges, but doesn’t say no.
I make the call, and hand Waterman my cell phone. She takes it and soon an agreement is struck: The court will fax over a new letter confirming and clarifying my authority to seek medical records. Meanwhile, I fill out the necessary paperwork asking to see Annie’s file, and Waterman says my request will be reviewed. In a month or so, I’ll get a letter informing me of the department’s decision.
Eager to leave as good an impression as I can, I tell her a bit about my detective work, but it’s not helping. Trying to determine how long it might take to retrieve any existing records, I ask her about the warehouse’s location. “I can’t tell you that,” she says. Then, confirming my fears about what she thinks of me, she interjects, “I hope you’re not planning to go there.”
Right, I think to myself. I’m going to break into the warehouse, Mission Impossible–style, to find one patient’s file out of, what, forty thousand? Fifty thousand? More?
But I don’t say that, of course. “No,” I say politely, “I was just curious. Please let me know as soon as you can if you have the records.”
The newly built asylum that became home, in 1868, to Biddy Hughes and her fellow inmates—somewhere between sixty and seventy, as best as I can determine from available records—was no Kirkbride model. The two-story structure was made of brick rather than wood, but the keepers’ philosophy about the insane hadn’t changed much from the poorhouse days, as proved by the shackles built into the new asylum’s walls. The main purpose was to keep the insane segregated, not to give them a better life or make Dorothea Dix, Thomas Kirkbride, and their fellow reformers proud.
The Wayne County asylum didn’t take long to achieve the same dark reputation as the poorhouse. An 1878 editorial in the Detroit Lancet, a medical journal, castigated the asylum for “sickening circumstances of inhumanity.” But change was on the way, in part because articles like the one in the Lancet reflected a growing discontent in the medical community with the asylum system, nationally as well as locally. In 1881, the Superintendents of the Poor voted to require the asylum’s keeper to have a medical college degree; soon after, the first of those professionally certified physicians, Ebenezer O. Bennett, “permanently removed the chains, shackles and dim cells in which the patients had been housed,” according to the 1982 history.
By the time Biddy Hughes died in 1895, after fifty-
four years as a ward of the county, the Wayne County asylum had grown to more than a dozen buildings, including an infirmary, a power plant, an icehouse, and a new administrative headquarters for Superintendent Bennett and his staff. This modest building boom, however, would soon be dwarfed by the remarkable transformation that would turn the modest-sized asylum into a leviathan-sized complex with too many patients and too few places to put them.
In late April, a week after my visit to Patricia Waterman’s office, a form letter arrives at my house, informing me that my request cannot be processed because “we find no record of the above named patient receiving treatment at this institution for the date(s) requested.” I’m floored. I realize that it’s just bureaucratese for “we can’t find any records,” but somehow, the form letter’s wording seems appropriate. Not only was Annie a secret, but the county that ran the institution where she lived for thirty-one years had no official record that she was ever there. I could find out more about Bridget Hughes than I could find out about Annie Cohen.
By the end of the nineteenth century, asylums and their superintendents were under attack from inside and out, and in a very public way that would have a profound effect on the evolution of mental health treatment in the United States. Neurologists, members of that relatively new branch of medicine, were challenging the essence of what the superintendents were doing, accusing them of making life worse rather than better for asylum patients. The neurologists saw most mental illnesses as curable, and they saw themselves as the scientists who would discover the physical causes that would lead to those cures. They regarded the superintendents, and their asylums, as impediments to progress.
To be fair, the neurologists were competitors as well as critics. They had ambitions of their own, and one goal was to break the stranglehold that the superintendents had on treatment of the insane. The neurologists, without a place for themselves in the asylum world, had formed their own association in 1875, barring the superintendents from membership. Criticism of the asylums soon appeared in the neurologists’ new publication, the Journal of Nervous and Mental Disease, and this “open warfare” (as one historian called it) continued until 1892, when the superintendents voted to open up their asylum association to new blood. To reflect the change, the superintendents adopted a hybrid name: the American Medico-Psychological Association.
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