In Kirkbride on Kirkbrides

Challenges Pandemics Present to Psychiatric Hospitals and the Risks of Repressing Histories

The Covid-19 pandemic has wrought havoc at scales that are simultaneously global, national, communal and personal. The challenges presented to our mental well-being are profound, and the consequences of the 1918 Influenza pandemic suggest that we will be addressing the psychical impacts of our current crisis for years to come. Are we prepared?

In my ongoing research on Kirkbride Plan Psychiatric Hospitals I’ve encountered fascinating and troubling news about the dilemmas faced by current asylums, such as Oregon State Hospital, in Salem, OR.

Oregon State Hospital is one of the few surviving Kirkbride Plan Hospitals west of the Mississippi River. Built in 1883 by inmates of the adjacent prison, OSH was preserved and adapted from 2007-13 and continues to operate in its original role as part of the Oregon penal system, supporting forensic psychiatry. OSH also has a special place in our collective memory as the filming location for the 1975 film of Ken Kesey’s “One Flew Over the Cuckoo’s Nest.” Interestingly, the OSH museum has become an international pilgrimage site for Russian students of filmmaking. (There is a link below for more on my 2016 visit to OSH)

As reflected in the shared article, OSH faces acute staffing and resource shortages as a direct consequence of the pandemic. While this is true of many healthcare facilities, these shortages were already a concern, pre-pandemic, especially at psychiatric hospitals.

Yet this concern is even more complex at OSH. Since this particular Kirkbride Hospital is part of Oregon’s penal system, there are also state laws requiring OSH to admit new patients awaiting forensic analysis/treatment as part of their legal cases, within a specific timeline. These laws were designed to protect the rights of patients, and provide psychiatric support while their cases moved through the state legal processes, and yet the constraints of staffing and resources created an untenable condition for absorbing new patients.

There has been a constant flow of articles from Spring 2021 that are both sympathetic and chastising toward OSH and its administrators. To put it succinctly, OSH is between a rock and a hard place – a predicament that psychiatric care facilities know all too well. Historically, such existential conditions directly contributed to the closure and erasure of many psychiatric hospitals, nationwide.

Yet there are also notable and illuminating differences between the experiences of psychiatric facilities during the 1918-19 influenza pandemic and the 2020-22 pandemic. For one, many of the Kirkbride Hospitals were self-contained, self-sustaining communities in 1918 – supplying their own power, food sources, employee housing, etc. As a result, some of the Kirkbride Hospitals were somewhat protected during the 1918 pandemic. According to Worcester State Hospital’s 1918 annual report: “When the epidemic of […] influenza first broke out in our district, the institution was placed under a fairly strict quarantine. As the disease first appeared on the receiving wards, we believe it was brought to us by newly admitted patients. It spread somewhat to other parts of the institution but at no time reached serious proportions. There was a total of 140 cases with 2 deaths from influenza and 31 due to complications from pneumonia.”

Meanwhile, other facilities were not as fortunate, as a result of open admissions policies: “Public mental hospitals in the United States in 1918 were self-contained communities, but this relative isolation did not spare them from the pandemic. Many hospitals remained open to admissions, providing a source of infection.” (Soreff SM, Bazemore PH. When state hospitals were communities. Behavioral Health Management 2005; 25 (4):10–12.)

This tension – between the rights of patients and the rights of staff – places our institutions and communities in remarkably difficult positions. In a world that aims to promote transparent access to information and fair treatment and no longer abides by the opacity of self-contained communities, there are no simple solutions. In recent months, the National Guard was called upon to support the beleaguered staff at OSH.

One pattern, however, is remarkably clear.

When we ignore history, or suppress it, we learn nothing and place ourselves at risk. I say that not only because of our commitment at PreservationWorks group to remembering, respecting and retaining the remaining Kirkbride Plan Hospitals as invaluable three-dimensional documents of complex histories. I say it also because as a species we often forget “unpleasant topics” and collectively “bury them” – whether by scapegoating and erasing the buildings of a failed mental health care system, or by willfully erasing histories of holocausts, racism and criminal abuses. Or pandemics. These buried histories remain in shallow graves, and they inevitably resurface.

Such repressive habits are short-sighted. All too often, collective erasure means we are poorly prepared when those histories do, eventually, pay us a return visit.

A cautionary example is offered in the article, “The Forgotten Flu,” published in 2/1/2008 after the SARS pandemic in Asia (Soreff and Bazemore: HMP Global Learning Network, Psychiatry and Behavioral Health Learning Network:

In it the authors note, chillingly: “The 1918 pandemic offers important lessons for the next influenza outbreak. […] the government needs to be honest and open to achieve positive results. It’s important to note that in many instances quarantine did reduce morbidity and mortality. Yet it’s remarkable how little the pandemic of 1918 is noted or discussed today, particularly outside academic circles. If not for the current concern about the avian flu, one has to wonder if this historic event would have continued to be neglected. After all, the human ability to forget, deny, and avoid unpleasant topics and memories is extraordinary. Langer’s An Encyclopedia of World History, published just 40 years after the [1918] pandemic, fails to note it and the 50 to 100 million people who died.”

That article was written in 2008 – offering a stark reminder of why histories matter, to prepare us for the eternal return of our pasts. It is also a reminder why buildings matter, fortifying our capacity to remember, and adapt ourselves to the dynamic circumstances at hand.

As promised, here is the link to my previous report on visiting Oregon State Hospital, and some of the remarkable work their community undertook to respect its own complex histories.

Part 1:

Part 2: