by Diane L. Goeres-Gardner
foreword by John Terry

The History Press, Charleston, South Carolina, 2013.
Illustrations, tables, notes, index. 334 pages. $21.99 paper.

During the 1960s and 1970s, policies of deinstitutionalization emptied state hospitals across the nation. Subsequent changes in federal funding and state budget cuts led to such neglect of Oregon State Hospital (OSH) that it was nearly wiped off the map. Thanks to Oregonians who care about their historic buildings, a portion of the 1883 "J" building was saved from demolition and now houses the Museum of Mental Health.

Inside Oregon State Hospital likewise compiles and preserves the history of the 130-year-old institution—including the buildings on the 140-acre campus and the recently completed hospital adjacent to the "J" building, as well as photographs and case histories that illustrate the hospital's sometimes contradictory role in patient care.

The history of Oregon State Hospital is the evolution of mental health policy in Oregon. Mental illness is a colloquial term used to encompass many diverse and complex conditions. Society's response to those conditions has been to stigmatize, leading the medical field to experiment with many different solutions. The stigma of mental illness has, at times, extended to the institutions responsible for treating it. Diane L. Goeres-Gardner's even-handed and well-documented approach makes it difficult to paint patients or institutions with a broad brush.

For scholars, the author provides copious footnotes at the end of each chapter. Her references include state archives, newspaper articles, admission and death records, biennial reports from the hospital to the legislature, correspondence between hospital administrators and the Board of Control, personal papers of superintendents, and recent interviews. For more casual readers, the well-researched details and frequent photographs bring history to life.

Especially helpful is a map of the hospital campus as it appeared before demolition (2010) and after reconstruction (2012), a list of superintendents and their terms of employment, and a timeline of significant events from 1843 to 2012. Also included are the original blueprints of the "J" building and descriptions of the tunnel system and the Cottage Farm and dairy.

The chapters are built around the case histories of people who would become patients, the aspirations and innovations of the physicians who would supervise them, and the legislation that would affect them. Progressing more or less chronologically, the chapters reveal the evolution of treatment philosophies and modalities from moral management to milieu therapy and psychoanalysis to shock therapies, eugenics, and finally lobotomies to psychotropic medication.

Evident throughout the chapters is the dilemma that may be intrinsic to publicly supported institutions: how to accommodate an ever-increasing census while keeping costs as low as possible. That struggle plays out repeatedly as each superintendent takes steps to increase discharges or to limit admissions. Cost containment also takes the form of low employee wages, long days, and low staff-to-patient ratios. At times, severe overcrowding leads to security problems and the increased use of mechanical restraints.

In her introduction, Goeres-Gardner makes the argument that "asylums were the epitome of the patriarchal system" and that "as the superintendent used his authority over the patients, the state used its authority over the superintendents" (p. 15). She goes on to say that "this power structure led ultimately to the Eugenics Movement… the various shock treatments and the permanent cure, lobotomy" (p. 15). While this is no doubt true, cultural influences and public opinion should not be ignored or underestimated. The eugenics movement philosophy, popular nationally during the mid 1920s through 1940s, appeared in Oregon newspapers as early as 1907 and was officially recognized in Oregon by the Board of Eugenics in 1917. In 2002, Gov. John Kitzhaber apologized on behalf of the state for the outcomes of its eugenics policies that affected thousands of Oregonians (p. 167).

In chapter 10, "In and Out of the Cuckoo's Nest," the author documents the effects of another cultural movement—deinstitutionalization. The late Dr. Dean Brooks, superintendent of the Oregon State Hospital from 1955 to 1981, was influential during the post-WWII era in improving state mental health facilities and treating veterans suffering from mental illness. During his term of employment, the hospital's population shrank from 3,800 in 1958 to 650 in 1980, a rate Goeres-Gardner argues was too rapid to absorb the mentally ill who were released back into the community.

It is ironic that a movement to liberate people from institutions lacked the money to provide alternate care and led to "a system full of chaos and huge increase in abuse similar to those last seen in the eighteenth century" (p. 16). Abuse of the mentally ill is, after all, what sparked the movement—championed by Dorothea Dix in the mid nineteenth century—to build "large state asylums… these monuments to prosperity and modernity represented the best civilization had to offer" (p. 15).
Oregon newspapers, nevertheless, once again focused on the public's attentions on the problems at OSH and as a result the legislature awarded contracts for two new hospitals that were completed in 2011.

Inside Oregon State Hospital is a gift to Oregonians, a fascinating, comprehensive, and thorough retrospective, which should guide our efforts into the future.

C.L. Brown
Eugene, Oregon

Oregon Historical Quarterly vol. 115, no. 2, pages 267-8

Reprinted by permission of the OHQ.

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