Asleep: The Forgotten Epidemic That Remains One of Medicine's Greatest Mysteries (16 page)

For all their later faults, at the turn of the twentieth century, farm asylums were the progressive answer to the care and health of the mentally ill. In 1920, asylums throughout the United States, Kings Park included, began seeing patients of a different kind arrive: children.

Insanity was considered an adult’s disease, so few accommodations existed for children suffering the same. And sharing the same wards was, as one benefactor said, “undesirable for the adult and frequently ruinous for the child.” Kings Park became the only state-sanctioned asylum to help care for the child victims of epidemic encephalitis.

In the overcrowded city hospitals, children were often confused with psychopathic children, but the doctors and nurses at Kings Park noticed a few marked differences among the postencephalitic children: “But as compared to the psychopathic child their behavior is more simple, open, impulsive and without malice, cunning, or regard for consequences.... These children have few friends and seldom belong to gangs, but are avoided and called crazy by their fellows.” When the children first arrived, the difference between the two was immediately apparent. Whereas a psychopathic child is withdrawn, quiet, and slow in getting acquainted with people, the postencephalitic child shows a “marvelous ability to remember names, and is in close contact with the life about him.”

If psychopaths and postencephalitics were easily defined, not all mental illnesses were. One disease encephalitis lethargica may have been confused with was schizophrenia. One modern medical historian, Mary Boyle, believes that in the confusing, blurred lines between psychiatry and neurology during the 1920s, many patients with behavior disorders were seen by psychiatrists, not neurologists. As a result, Boyle believes a number of cases diagnosed as schizophrenia were actually survivors of encephalitis lethargica.

The tragic distinction among these children was that they were completely unfit for society—but they were not insane. They lived in a world where terror came not from outside dangers, but from within their own mind.

M
adness is as old as time. Archaeologists have located skulls dating as far back as 5000 B.C. with holes bored through them to allow the evil spirits to escape. In the Bible, madness was punishment from God. India’s Hindus blamed madness on a dog demon, planting the idea of werewolves and the expression “black dog” for depression. Greek myths described insanity, and Shakespeare wrote about madness in twenty of his thirty-eight plays.

As long as there has been madness, there has been the struggle to handle it.

Even into the nineteenth century, insane family members could be found chained to the wall or caged in a hole in the ground. These “fools” or “village idiots” were the responsibility of the family, and the family was not always compassionate. One sixteen-year-old boy, found in a pigpen, had been there so long that he had lost the use of his limbs and had to lap his food from a bowl. And it wasn’t only children at the mercy of their families. One wife chained her husband to the wall until his legs withered.

Obviously, the church or the government needed to provide help for some of these cases, and the idea of a hospital for the insane was born. The first was actually built by a religious order outside of London in the thirteenth century; it was called Bethlehem. Over time, people rushed the pronunciation until it became “
Bedlam.
” Under Henry VIII, when most of those benevolent monasteries were dissolved by the laws separating church and state, the mentally ill became the wards of the state. They also became tourist attractions—sort of a human zoo—and they were especially popular on weekends and holidays. Londoners paid for tickets, came drunk, threw food, and sometimes assaulted patients.

Private madhouses began sprouting up throughout the country, and when a family could afford it, that was certainly the better alternative. It was in this era that the hospitals for the insane first began across the pond. Colonial America built small dwellings in the middle of town to confine the mentally ill, and as one historian wrote, in that sense, “confinement” goes back as far as colonial times in the United States.

By the early 1800s, the United States had only two hospitals for the mentally ill, one in Pennsylvania, one in New York. The New York Hospital opened the first psychiatric building designated a “lunatic asylum.”

During the Enlightenment, physicians began a movement toward a more compassionate and practical solution, but the sheer numbers of the insane made that difficult, if not impossible. Toward the end of the nineteenth century, there had been a sharp rise in insanity, one that most likely emerged from a reclassification of diseases. Syphilis, a common plague of the time, led to neurosis. Alcoholism was considered a mental illness, and during that time period it seemed almost epidemic thanks to unsafe drinking water, which led people to drink ale or wine, whose processing killed bacteria. With no retirement or nursing homes, the elderly were crowded into the class of mentally ill as well. And the industrial age had created an atmosphere of less sunlight and poor nutrition. The result was a condition known as rickets, a softening of the bone, which made childbirth more difficult. So, birth injuries added infants and children to the long list of the mentally impaired.

Cities all over the world built grand hospitals to house these patients, a sanctimonious gesture by enlightened societies who at last believed the mentally ill were in need of decent care, and the Industrial Revolution allowed for these mammoth hospitals to be built. Medicine, too, acknowledged the mentally ill, even hoping to cure them in some cases—although often the cure was far worse than the disorder.

A
s the world became more civilized, society more sympathetic, and medicine more progressive, mental hospitals of a softer kind came into vogue. Asylums were first intended to be just that—an “asylum” from the hectic, fast-paced world of the city. Asylums would be places in the countryside where people who suffered from frazzled nerves could recover in peace; they were sanitariums where sanity could be restored.

In the United States, the person who led the fight to reform treatment of the mentally ill and to develop asylums was Dorothea Dix. Often neglected in history, Dix was a nurse who was teaching a Sunday school class at a local prison in 1841 when she noticed mentally ill patients chained to the walls. She fought for government intervention in treatment of the mentally ill—at the time, a radical idea. She even proposed legislation that the federal government set aside several million acres for asylums—the bill was passed by both houses, but vetoed by President Franklin Pierce.

City hospitals in America and elsewhere were brimming with patients who needed long-term care, and the idea of the farm asylum materialized. Toward the end of the nineteenth century, these farm asylums and sanitariums appeared throughout the world. But, as idyllic as they sound, farm asylums began showing their cracks shortly after World War I. More and more buildings had to be built to accommodate patients. More and more nurses and physicians were needed to treat the growing number of patients. “The reformers were defeated,” one historian noted, “not by the faulty nature of their concept but by the pressure of numbers.”

Part of the problem was the very nature of mental illness—chronic. Some of those patients would live out their lives in these asylums, without hope of a cure. One neurologist working in a New York City asylum complained that there were three hundred patients per doctor. It was also not a field many doctors were drawn to—it was dark, depressing, and exasperating work with little hope of patient recovery.

During the 1920s, however, when the farm asylums were still functioning well and had not yet turned into the warehouses for the insane they would one day become, they offered a humane alternative, at least for a while, to the children who had survived the sleeping sickness epidemic.

I
n 1924, Kings Park built a colony for these children. Although the cottages were intended for any juvenile with mental illness, it was epidemic encephalitis that prompted the building of the colony. Of the first fifty-eight patients, forty-one were survivors of the encephalitis lethargica epidemic. As soon as the colony opened, children arrived from hospitals in Manhattan, Brooklyn, and elsewhere on Long Island.

The cottages were located along the main, tree-lined avenue beside Wisteria Hall, amusingly called Hysteria Hall by the staff. To the back of the colony were the train station, the apple orchard, and an engineer’s shed. The cottages were meant to be as much like a home as possible. They were two-story, redbrick buildings that had been painted white with dormer windows—without bars. They featured day rooms and screened porches for summer and several fireplaces for winter. There was even a metal swing set outside.

From the first, the children were a challenge for hospital staff. Children with postencephalitic problems were remarkably similar in their behavior, marked by emotional instability, quarrelsomeness, irritability, tantrums, and breathing tics. The aim for the hospital staff was to retrain these children to show emotional control and social adjustment, and in the best cases, they hoped to be able to send children home. The first days, according to one occupational therapist, were the worst: “Days of fighting, biting, scratching, lying and tale telling . . . These were hourly or half-hourly events.” The staff was close to tears from frustration and exhaustion. The therapist added, “There seemed to be nothing normal about these children. They either grabbed all food in sight or wanted no food at all; they slept half the day and stayed awake half the night; homosexual practices and masturbation were prevalent with both boys and girls.”

The staff constantly reminded themselves that they were dealing with manifestations of a disease and not wanton misbehavior. Their first glimmer of hope was that the children themselves seemed to want to do better.

The children adhered to a strict schedule:

Added to the schedule were weekly plans for singing lessons, marching, games, and dancing. On Wednesdays they watched moving pictures, and on Saturdays during the summer months, they played baseball.

In all, there were two cottages, one designated for the girls and one for the boys. Inside, their home life was to include the daily chores any child would have. With so many children under the age of sixteen, the vast majority of whom had their intellect still very much intact, the nurses set up a schoolroom to educate the children as well. When they did misbehave, small privileges were revoked.

The results were remarkable. The children showed healthy appetites, good manners, improved personal appearance, and evident physical improvement. The nurse wrote, “This training has been so well handled and the granting and withholding of small privileges so effective in encouraging the children to greater efforts at self-control that the problem of their management has been materially reduced.... Emotional stability is not entirely established but they show themselves susceptible to training and there are now many instances of great self-control.”