In November 1920, the 22-year-old daughter of a Russian immigrant was sent to the institution then known as Springfield State Hospital for the Insane.
She is still there.
Now 87, she has arteriosclerosis and cataracts. Her psychiatric diagnosis, unchanged in 65 years: chronic undifferentiated schizophrenia.
She lives with 30 other women on F-2, one of the few remaining locked back wards of Maryland's largest state mental hospital.
Precisely why the Baltimore woman came to Springfield is a mystery. Records show that she was first admitted to a mental hospital in 1915 after she piled things on her dresser, hid in her bedroom and at times did not speak.
Her story, although unusual because of the length of her hospitalization, is not unique. Dr. Jonathan D. Book, Springfield's superintendent, says that about one-third of the 900 patients at the hospital are over age 65. Some came to Springfield when they got old and developed psychiatric problems. Others were sent there generations ago and never left, having outlived families who long ago abandoned them. For them, Springfield is home.
Half of the women on F-2, for example, have been at Springfield for at least 30 years. They spend their days sitting mute in a day room that smells of disinfectant and stewed vegetables. Some, who are tied in chairs, stare vacantly at a blaring television while others doze. Most are diagnosed as schizophrenic. Because they were deemed aggressive or unmanageable, four underwent lobotomies in the 1950s, which rendered them incapable of ever leaving the hospital.
"You say to yourself, 'Gee, in this day and age they would have been admitted into the hospital, treated and released.' But it seems in those days once a person was in, that was it," said Mary Gayle Lewis, until recently the head nurse on F-2.
"I really feel that a lot of patients who have been here for 20 or 30 years were brought here at a time when people had a very low tolerance for unconventional behavior," she said. "They got caught up in the system and they were here. If you have somebody on a ward where all the other patients are acting out and regressed . . . the natural state of affairs is to blend in to survive."
Many of those who never left are now nursing home candidates. Because these patients are poor and receive Medicare benefits, nursing homes are reluctant to take them, especially since they carry a diagnosis of serious mental illness.
The so-called "long-term chronics" live on various wards. About 100 live in the Geriatrics Building atop a hill surrounded by a mass of boarded-up buildings, evidence of the deinstitutionalization that did not affect them. They sleep in barracks-style dormitories at the end of long, yellow-walled corridors incongruously decorated with airline travel posters depicting couples young enough to be their grandchildren basking on Caribbean beaches.
Sometimes, despite decades of hospitalization and the oppressive lack of privacy, patients assert themselves in small ways. Every morning when a cart of clean laundry is delivered to the Geriatrics Building, one tiny 89-year-old woman, a patient since the 1930s, stands in the hallway for hours carefully refolding each piece. She has told the staff she does not think the hospital laundry does a proper job.
The last stop for many geriatrics is "M&S," the Medical-Surgical Building that is Springfield's equivalent of a nursing home. M&S is also where patients with relatively minor physical illnesses are treated and where shock treatments are administered.
Not all those who remain at Springfield are old. Some are simply too sick to leave because they are deemed acutely suicidal or dangerous. State officials say that about half of Springfield's patients could leave within a year, but only with a level of care rarely available outside a hospital.
Many of the younger, long-term patients are housed in the Center for Behavioral Management under a highly regimented behavior modification program in which they earn points used to "buy" candy and cigarettes. More than half are Montgomery County residents, many in their twenties and thirties, whose illnesses -- primarily schizophrenia -- have not responded to drugs and other therapies.
Some may never leave. In other cases an enigmatic combination of personal strength, timing, an interested staff member and support could make the difference.
"It always amazes me that people who have been here can get back into the community and reintegrate and survive there," said Lewis. "Often patients lose their self-esteem and self-worth and feel hopeless and helpless. The longer people are in here, the stronger that grows."