Located on 1,340 acres of central Maryland farmland, Springfield State Hospital was for decades a self-contained, almost feudal institution that grew much of its food, operated its own police force and was ruled by a superintendent who lived in a mansion on a hill overlooking its Victorian brick buildings.
In 1958, when 18-year-old Sandy W. was committed indefinitely to Springfield, a trip to Maryland's largest state mental hospital was often one-way.
For Sandy's parents, the hospital 60 miles north of Washington was the last resort. Their oldest son had spent more than a year on a locked ward at Johns Hopkins Hospital, where the illness diagnosed as schizophrenia had worsened. They had tried private psychiatrists and special schools, none of which helped. With two other small children at home in Bethesda, they believed that they had no choice but to send him to a place where long-term care was assured.
The doctor who examined Sandy shortly after his arrival at 11 a.m. on Jan. 13, 1958, described him as "thin, well-developed and nice looking," a tall, black-haired teen-ager who "had the look of a person of good intelligence."
Twenty-two years later, another psychiatrist described someone quite different. Sandy shuffled with a pronounced stoop. His finger tips were singed from the cigarettes he chain-smoked. At times he drooled from too much medication. His hair was long and matted. Many of his teeth were missing, one punched out by a patient in a fight, most removed after they abscessed.
"He shows the stigmata of institutionalization," the doctor wrote in his chart. "He is quite dependent on nursing staff as he cannot care for himself."
The change in Sandy's condition was not surprising. Studies have consistently shown that the result of long-term hospitalization is, in many cases, devastating deterioration. Treatment, which often consisted of years sitting slumped in a chair smoking cigarettes, surrounded by other disturbed patients, was found to be as damaging as the disease itself.
The fate of thousands like Sandy fueled the massive movement of patients out of state hospitals and into communities that became known as deinstitutionalization. The change in approach to treating mental illness demanded a new role of mammoth state hospitals that made their 19th century architecture and rural isolation seem anachronistic.
"In the '50s we could only look at the issue of safety, and if someone wasn't safe they had to be here and that was it," said Dr. Jonathan D. Book, Springfield's 35-year-old superintendent. "Now we can look beyond safety, toward preparing people to return to the community with the highest level of functioning and the best enjoyment of life. The hospital is the starting point."
For Sandy W., the place that had seemed an end eventually offered a new beginning. The mental hospital he entered as a teen-ager would begin preparing him, as a middle-aged man, for a new life outside. The obstacles he and the staff encountered in the process reflected the difficulties of trying to undo decades of damage -- a problem faced by doctors, nurses and social workers throughout the country in the effort to prepare long-term patients for release.
When Christine Muzyk Disher, Michael Wayne Allen and Frank K. went to Springfield in the late 1970s, even its name had been changed -- from Springfield State Hospital to Springfield Hospital Center -- to reflect its role as a temporary residence.
For them, as for most state hospital patients today, the problems would be quite different. The goal of hospitalization was not cure, because none exists for schizophrenia, but control, accomplished through medication and therapy.
The aim was to diagnose their illnesses, moderate their most bizarre and disabling symptoms, try a smorgasbord of therapies and discharge them as quickly as possible in reasonable -- though not optimum -- shape.
In some cases that meant making educated guesses that turned out to be wrong. In June 1978 Christy Disher left Springfield after four months for a halfway house in Takoma Park. She immediately stopped taking her medication and within 10 days was back in the hospital where she felt safe.
"Sometimes it may be better to try that than make the person feel they are too delicate to cope," said William B. Snyder III, the psychologist who treated her.
"A lot of people condemn the state hospital for a lack of beautiful surroundings, but you don't want to deprive people so much that it's punitive and you don't want to make it so comfortable that they stay forever," said Mary Gayle Lewis, a veteran Springfield nurse.
A generation ago, staying forever was seen as an acceptable alternative.
Springfield in 1958 was a cloistered colony where the isolation of its 3,300 patients was reinforced in the smallest of ways.
When Sandy was admitted to Hubner, a foreboding white-columned building overlooking the epileptic colony, his clothes were taken from him and he was issued gray cotton clothing, a uniform that immediately marked him as a mental patient.
He told the doctor who admitted him that he was 70 years old and that his parents, who had accompanied him to the hospital, were dead. "The prognosis is very poor," the doctor wrote.
All the treatments tried at Hopkins without success were repeated at Springfield because, as one doctor wrote, they comprised "everything known to medicine."
Sandy was immediately started on high doses of Thorazine, the powerful antipsychotic drug that had recently been introduced in state hospitals. Electroshock, a controversial procedure now used sparingly, was then popular because doctors believed that convulsions might cure schizophrenia, a theory since discounted.
Ten days after he was admitted, Sandy, a towel stuffed in his mouth to prevent chipped teeth, began a series of 16 shock treatments similar to the 24 he had undergone at Hopkins.
For a few months he met with a psychologist frequently for individual therapy sessions. Mostly Sandy paced and smoked, sometimes confiding his intense loneliness.
"He would have liked to have friends but did not know how and was afraid to try . . . ," the psychologist wrote. "It appears that when he starts to think rationally about his problems, he becomes despondent and close to tears. He appears aware of the unrealness of these hallucinations yet he continues to cling to them for the support they give him." Deep Into a Private World
Because they seemed to have little effect, shock treatments and therapy were soon discontinued. For the next decade Sandy slid deeper into his private psychotic world, which revolved around food, cigarettes and his own fantasies.
Very little was expected of him. Nurses combed his hair and an attendant shaved him. His memories of those days are limited mostly to the exact dates when he was moved to a new ward and a few staff members, including a nurse patients called "Bull Durham."
Monthly notes in his chart were sometimes limited to two words: "No change." Also chronicled were the 11 times Sandy ran away from the hospital.
Because he was occasionally violent and considered chronic -- then synonymous with hopeless -- he was transferred to a locked ward. He remained there for more than a decade.
With its fenced concrete yard and small, airless day hall with too few chairs for the 50 patients who spent their time milling around in menacing confusion, E ward was the worst back ward at Springfield.
"Sandy was easily lost in the shuffle," said Dr. William T. Butterbaugh, who became his psychiatrist in 1975. "When you have two feet of space, you live inside yourself."
Despite maximum doses of drugs, Sandy apparently fantasized a lot, sometimes calling himself Betty Grable.
He did have one asset almost no other patient on E ward possessed: a devoted family. Every week for 27 years his father made the two-hour round-trip drive between Bethesda and Sykesville. Sometimes Sandy's mother came, but she found weekly visits intolerably painful.
Usually his father, a trim, erudite man, took Sandy to lunch. It was his father's interest, doctors say, that may have made it possible for Sandy to leave Springfield. Because of those outings he remained connected, however tenuously, to the world he longed to rejoin.
But in 1978, two weeks after he learned that his mother had died, Sandy began setting fires. Once he set his hair on fire; another time he set fire to a patient who angered him by leaving a newspaper on his chair. Both fires were extinguished before they could cause serious damage, but it seemed he was too unpredictable and dangerous ever to be released.
"One has the impression of being up against a massive void," a doctor wrote in 1980, "a shell shadow of a man who simply failed to develop into anything but a caricature of a normal person." A Vastly Different Place
By the late 1970s, when Disher, Allen and Frank were admitted to Springfield, the institution Sandy had entered 20 years earlier was a vastly different place.
There were half the number of patients and more than double the number of staff. Gone were the uniforms and the epileptic colony. Therapy consisted of discussions of finance and relationships, not raising chickens or serving in the nurses' dining hall. Some things had not changed. Being a mental patient still meant no privacy, a plethora of rules governing life's most intimate details and endless hours in front of a TV set.
For doctors, the first task was a tentative diagnosis. In the case of Allen and Frank K., as with thousands of young patients admitted in the past decade, that was greatly complicated by their use of drugs.
Doctors believed that all three were schizophrenic, the predominant diagnosis in state mental hospitals. Treatment was similar: Each was started on powerful tranquilizers to blunt the hallucinations and other "positive" symptoms of schizophrenia. There were different therapies -- group, art, occupational -- for the more intractable "negative" symptoms such as paralyzing depression, loneliness and low self-esteem. Allen and Disher received individual therapy, a rarity in state hospitals.
They were admitted to Lane, a locked one-story building with highly buffed beige floors and long, windowless cinder block corridors that serves as the Montgomery County admissions ward.
Each was assigned to a treatment team headed by a psychiatrist who could discharge them at any time. When the team decided they were not actively dangerous and that beds were available, they were transferred to the unlocked three-story "cottages" across the road. Getting moved meant participating in activities and complying with a regimen that included four weekly showers taken between 8:30 and 10 p.m., getting out of bed by 6:30 a.m. and not returning to the bedrooms, locked at 7:15 a.m. to prevent patients from sleeping all day, until 9:30 p.m.
For those who wanted to earn money, there were workshops where patients were paid to assemble wire baskets or floor polishing kits and where it was hoped they would pick up or relearn job skills.
The trio presented similar problems for social workers who started planning their discharge the day they were admitted. They were unemployed, they needed therapy in Montgomery County and they could not live with their families.
"Many families come in with the idea of, 'You fix this person, you cure this person,' " said social worker Sherry Seal. "They feel blamed, they feel guilty. I used to feel like I had to fix it and fix it all. But this is just the beginning step. I think of myself as an enabler, to enable a patient to become more functional and more productive."
In June 1982, when he came to Springfield for the third time in four years, Michael Allen was neither functional nor productive.
He was overwhelmed by visions of demons he believed made him scream obscenities at strangers. He was so desperate to escape the voices, he told a doctor as he smiled incongruously, that he had considered killing himself. He had attempted suicide before by swallowing 50 aspirin tablets.
During five weeks at Springfield, Allen mostly watched TV and paced the halls, complaining of shooting pains in his legs inflicted by the demons. Doctors tried several medications. One seemed to work because his references to demons became less frequent.
He earned privileges to walk the grounds and go to the canteen, where the staff seldom ventures. Plans were under way to move him to a cottage. However, when his therapist, a first-year medical student to whom he was very attached, left Springfield, Allen ran away while on ground privileges. His parents were notified.
Two days later, Allen's grandmother called from Florida. He had shown up at her house and she was willing to let him stay with her. The hospital staff mailed his few belongings and then officially discharged him.
Christy Disher's five hospitalizations at Springfield did not end so abruptly.
By March 1977, when her parents committed her, Disher had been in and out of mental hospitals for six years. Her hospitalizations followed a pattern: She would break up with a man or get fired from a job, stop taking medication and deteriorate to the point where she needed to be hospitalized. Her life outside the hospital was a series of dreary apartments, boring jobs and inappropriate older men.
Because of a physical condition, she could not be medicated for several months, so she was often put in seclusion. Because she had been in therapy before, she began individual sessions with a clinical psychologist. Often she was silent, sometimes nibbling on small pieces of paper.
In seven months she improved enough to be discharged to a halfway house, the first of several that did not work out. "I didn't have any friends, I weighed 215 pounds and I was so fat and depressed I just didn't care about anything," she said. She spent the next three years "running back to Springfield" because she missed her psychiatrist and life on the outside seemed scary.
"It was like my second home," she said. "I knew the ropes." Once she walked into the gym and spotted her oldest brother, who she had not known was there. "I was so happy to see him I ran over and hugged him and gave him all my cigarettes."
For Disher's parents, the illness of two of their four children was devastating. In 1964 schizophrenia had forced their oldest son to drop out of college. Disher's illness, diagnosed in 1971 weeks after she graduated from Boston College, was too much for her mother, who became seriously depressed.
"When Chris got sick it was unbelievable," recalled Evelyn Muzyk. "These were the two top kids in the family; they were in the honor society, they were our extracurricular kids who had shown signs of leadership. We were neanderthals as far as our knowledge of mental illness was concerned, as far as our coping or helping. We didn't know where to turn."
In February 1980, Disher left Springfield feeling shaky but not psychotic. She was given a month's supply of medication and a referral to a county mental health clinic. Her prognosis, her doctor said, was fair, provided she stopped drinking, took medication and went to therapy.
Frank K. was given similar advice, which he largely ignored.
In December 1983, when he arrived at Springfield from the Montgomery County jail, Frank was well known: He abused drugs, he did not show up for therapy and he was in legal trouble.
He had been at Springfield four times before for psychiatric problems apparently related to his Crohn's disease, which had resulted in the removal of much of his small intestine. Six months earlier he had been arrested by an undercover Maryland State Police officer after he attempted to sell her $160 worth of opium prescribed for the chronic diarrhea caused by the disease.
Jail officials, concerned by his sudden habit of communicating by handing them papers containing words copied from the labels of vitamin jars, had sent him to Springfield for a competency evaluation.
At first doctors decided he was incompetent to stand trial. He improved after several weeks of treatment with antipsychotic drugs, although he still carried his papers and sometimes his answers did not make sense. He returned to jail a month before his trial. Doctors at Springfield decided that he was competent and that they had done all they could.
"I think the county looks at mental institutions to do something, to correct these people because they are a nuisance intermittently," said Dr. Garry Seligman, who treated him. "People tend to blur the mental illness aspects and the legal involvement of the person. But I think when a person repeatedly breaks the law and is not mentally ill to a degree that would interfere, then he should pay the consequences." Heading for a New Life
In Sandy's case discharge took years, not weeks. In 1983, when E ward was being closed, he was transferred to the Montgomery County unit. The problem was that he had no place to go. Living with his father was not an option. He applied for two halfway house programs, which rejected him because he needed round-the-clock care. At the time there was nothing available in Montgomery County.
Last year Threshold, a group composed of relatives of the mentally ill, made Springfield an offer. They agreed to open a halfway house in Rockville with continuous supervision if Springfield would pick and prepare eight people who would otherwise never leave. Sandy, a favorite of the staff because he was friendly and cooperative, was chosen to be part of the house. For the next several months he attended special community preparation classes, which included preparing simple meals, going on trips to Baltimore, reading newspapers and discussing current events.
"He had a very rocky course," recalled social worker Anita Fitzgerald. "He was very childish and immature, and because he'd been in the hospital so long he'd do things like stuff all the food in his mouth at once. But he was motivated to leave the hospital even after 27 years."
On Dec. 12, 1984, Sandy packed his stamp collection and his clothes and left Springfield for a split-level house in a Rockville subdivision. At age 45, he was rejoining the community he had left at 16.
Next: Life on the outside