Prior to the late 1970s, people with schizophrenia often spent their lives in and out of hospitals. By law, they could be institutionalized against their will. They were clothed, medicated, and cared for until a doctor dispatched them or somebody came to collect them. The people with power over them were counted upon to be reasonable and just, but sometimes they weren’t.
Inevitably, involuntary hospitalizations led to incidents of abuse, and the most sensational cases came to define psychiatric care in the eyes of most Americans. In 1965, Robert Kennedy toured state hospitals and issued the following report: “I’ve visited the state institutions for the mentally retarded, and I think particularly at Willowbrook, we have a situation that borders on a snake pit.”
Willowbrook State School was a psychiatric hospital for the intellectually challenged. In 1972, Geraldo Rivera snuck into the hospital with a camera crew and found naked patients sitting in total darkness, covered in their own feces, rocking back and forth to self-soothe. In his televised broadcast from the basement of Willowbrook, Rivera sounded pained. “This is what it looked like, this is what it sounded like. But how can I tell you about the smell?” Later, in an interview with PBS, he recalled the conditions at Willowbrook and wept.
Images from Rivera’s broadcast burned themselves into the public consciousness, becoming inextricably entwined with perceptions of psychiatric treatment in general. The nail in the coffin came three years later, when Jack Nicholson starred in the film adaptation of One Flew over the Cuckoo’s Nest. He played an iconoclastic man who ends up in a mental hospital, where his renegade attitude is pathologized. Nurse Ratched, the film’s villain, has him lobotomized, and her name has become a symbol of conformity gone mad.
“It was a couple things,” Dr. Ken Robbins later testified at one of Morgan’s hearings, describing the dissolution of the American mental health care system. “One was that there was a view that we were not humanely treating people—that we were restricting their freedom and forcing them to lead fairly empty lives. There were some scandals—people who were being mistreated at these large institutions. So, that was one piece of it, and the other piece—there was so much cost associated with these programs.”
In the wake of scandals like Willowbrook, politicians campaigned to shut down publicly funded psychiatric hospitals, arguing that such institutions were not only craven but also an immense burden on taxpayers. They promised to funnel the money that was being spent on hospitals into less expensive outpatient treatment facilities. But the resources meant to follow patients into the community never materialized. Instead, psychiatric hospitals were converted into prisons, which provided more jobs to the community, and psychiatric patients with incurable, degenerative illnesses like schizophrenia were forgotten and left to fend for themselves. Many became homeless. Sprawling encampments cropped up under overpasses. Without access to kitchens or indoor plumbing, unhoused people hoarded food and relieved themselves outdoors. Rats thrived. Typhoid spread. Defunding of psychiatric hospitals ensured that whatever beds remained be reserved for the most serious cases—that is, individuals found not guilty by reason of insanity (NGRI), known as “forensic patients.” In other words, to receive free psychiatric care, many people living with mental illness first needed to commit a crime.
“So what’s ended up happening is what some people call ‘trans-institutionalization,’” Robbins explained. “People with mental illnesses have ended up in prisons, instead of in mental hospitals. So, we have more people with schizophrenia who are in prisons now than we ever had in mental hospitals.”
In the United States, adults cannot be hospitalized against their will, even in cases where their loved ones have documented threats of suicide or homicide. By law, when the police are called to intervene in cases of extreme psychosis, they must ask the person with mental illness, “Are you a danger to yourself or others?” If the individual in psychosis says no, he or she is free to go.
Robbins concluded, “It hasn’t been an outcome to be terribly proud of.”
Dr. Darold Treffert was Winnebago’s last superintendent with a medical degree. His empathic approach to mental health treatment made him ill prepared for the shifting political tides that coincided with his tenure in the 1970s. He considered increasingly strict protocols around institutionalizing people with a severe mental illness (“Are you a danger to yourself or others?”) to be extremely harmful. What some considered a progressive new movement, Treffert described as, “Dying with your rights on.”
As nationwide defunding of mental health hospitals led to extreme budget cuts, and Winnebago began selling portions of its land to the Wisconsin prison system, Treffert began to feel more like a prison warden than a psychiatrist and quit his position, leaving the hospital to be run by high school graduates and government administrators. By 2014, the patient population, which had once included civilians, now comprised solely criminal offenders—but because of ever-decreasing funding, the only noticeable security precaution was a man named Dan who wore a bulletproof vest and orbited campus in a beige minivan. He was once seen stopping a visitor to ask, “Are you planning an escape?”
“No,” the visitor replied.
“I believe you,” Dan said, and walked back to his van.
When Morgan arrived in the summer of 2014, the once illustrious grounds of Winnebago were in disrepair. The hospital’s oldest and most beautiful structure, Kempster Hall, sat abandoned because of asbestos that one employee described as reaching “all the way down to its glue.” When state officials arrived unannounced, they found patients wandering the corridors unsupervised. The bulk of patient care was provided by “psychiatric care technicians (PCTs), entry-level applicants who worked up to seventeen hours a day and made sixteen dollars an hour. A PCT’s job was grueling and thankless; many worked back-to-back overtime shifts, and arrived to work trembling from exhaustion and too much caffeine. Some patients complained that PCTs talked to themselves, fell asleep in the hallways, and acted more like patients than patients did. Understaffing led to negligence and increased risk of harm to patients. Between the years 2005 and 2006, three mysterious deaths and one rape occurred at Winnebago. Years later, a patient struck his head and lay unconscious for fourteen hours before staff finally called an ambulance, because the unit’s doctor had decided the man was “acting out.” (Seventeen days later, that patient slipped out of his coma and was pronounced dead at the hospital.) Limited surveillance of the surrounding property allowed opportunistic hunters to build illegal deer stands in the woods surrounding campus. One-hundred-foot oaks leaned precariously overhead, poised to come crashing down at any moment.