75 Years Apart, Elizabeth and I Visit Buffalo

Note: For the complete list of posts, go HERE.

The first thing you notice coming up the drive to the Henry Hotel Resort Conference Center in Buffalo are two tall Romanesque red brick towers, each capped with green copper roofing. This impressive building — part of a larger campus — was designed by H.H. Richardson and constructed in 1870. According to Wikipedia, H.H. Richardson was “a prominent American architect, best known for his work in a style that became known as Richardsonian Romanesque.”

Richardson, Louis Sullivan, and Frank Lloyd Wright are considered the Holy Trinity of American architecture. They are pretty heady stuff in architectural circles. And Richardson wasn’t enough on his own to make the place preservation-worthy, the grounds were designed by the famed landscape team of Frederick Law Olmsted (the guy who created New York City’s Central Park) and Calvert Vaux.

The building was abandoned and in decline until 2006, when the Richardson Center Corporation was formed with a mandate to save the buildings and bring the Campus back to life. After a period of political wrangling and stabilizing the building, the Hotel Henry — featuring the central building with the two Richardson towers and the two flanking buildings — opened in 2016.

And that’s where I’m staying on my trip to Buffalo to give a speech.

Walking to my room, I notice a beautiful mosaic floor — original to the building, my guide tells me — in a curious curved connector that leads to a beautifully wide hallway, adorned with a variety of original art. Room 215 is big and spacious and has all of those precious design details that I’m sure make it a favorite of the Architectural Design set. Very fancy.

Of course, the Hotel Henry Resort second life of the property is not what has drawn me here, as fascinating as that is. It’s the original life of the property as the Buffalo State Asylum for the Insane.

The 99% Invisible podcast starts a story about the Buffalo State Hospital with these words:

Maybe you have a story like this. How once upon a time, on the outskirts of the town where you grew up, or where you went to school, on the edge of the woods, there was a scary old asylum. But the one detail that almost never varies, the thing that seems to make an asylum story an asylum story, is that the asylum is nearly always… abandoned.

If you look beyond the restored center Richardson towers and the two connecting buildings, there are four additional buildings on each side. The entire design of the place was considered a bit of a revolution at the time, built in the “Kirkbride design,” named after mental health innovator Thomas Story Kirkbride.

The concept was that environment and exposure to natural light and air circulation were crucial to the treatment of mental illness. Wikipedia notes, “The hospitals built according to the Kirkbride Plan would adopt various architectural styles, but had in common the bat wing style floor plan, housing numerous wings that sprawl outward from the center.” The men were located on one wing, and the women on the other. The reason for the wide hallways is to encourage patients to congregate outside of their rooms as part of their recovery.

Kirkbride facilities like the Buffalo Asylum were self-contained communities:

Many Kirkbrides contained working farms — with vegetable gardens, greenhouses, dairies, livestock, and bakeries. Kirkbride believed that patients being occupied was key to their recovery. Patients therefore aided in farm work, and other tasks regarding the daily operation of the asylum, often according to their previous occupation. Doing work was part of moral treatment, but so was amusement. Kirkbrides had ballrooms, bowling alleys, and baseball diamonds. One even had a pre-electricity roller-coaster. (99% Invisible Podcast).

Once you get beyond the two pavilions immediately connected to the central administrative tower, the Architectural Design quotient of the campus declines precipitously. The buildings are still mostly in the condition in which they were abandoned, albeit with some structural reinforcement to keep them stable. It would be a crazy place to spend Halloween.

Glass half empty folks would note with some justification that the still abandoned buildings convey the feeling that the ghosts of patients could still be roaming the hallways.

Given that I usually try to operate as a glass half full person, I prefer to view things this way — Not everyone who has a grandmother who lived a significant portion of her life at a National Historic Landmark.

I don’t yet know exactly how Elizabeth wound up at the Buffalo Asylum, but I am guessing it was because of overcrowding at the Rockland facility, where we last sighted her in 1940. I also don’t know how long she was in Buffalo, but I assume it was for a significant portion of her life.

Elizabeth arrived in the Buffalo State Hospital — the future home of the Henry Hotel Resort Conference Center — sometime between 1940 (when, per the Census, she was at the Rockland Asylum) and 1944.

Looking at the annual reports for the Hospital, I am guessing that she arrived in 1943. This is based on the fact that the number of transfers “from other institutions for the insane” was 20–25 per year for most of the early 1940s, but spiked to 55 men and 87 women — a total of 142 — in 1943.

Part of the reason for this spike was the fact that the mental health system in New York did a good deal of shuffling during World War Two. The forward-looking aspirations of the Kirkbride Plan died in a tidal wave of understaffing and overcrowding. “For the fifth consecutive year, the medical work of the hospital has been handicapped by the universal manpower shortage and the increased demands for psychiatric service caused by the World War.”

Kirkbride had originally designed the place with a goal of 600 patients. The capacity of the hospital in 1944, as certified by the Department of Mental Hygiene, was 809 men and 1,133 women, a total of 1,942. In reality, there were 1052 men and 1,510 women at Buffalo when Elizabeth arrived, an overcrowding of 243 men (30% over certification) and 377 women (33% over).

And understaffed.

And dependent upon the vicissitudes of politics and the willingness of politicians to fund care. Even the heady first years of the Buffalo Asylum reveal the tension. When the cornerstone was laid for the Buffalo State Asylum in 1872, Governor Hoffman touted it as a “monument to State charity.” Three years later? Governor Tilden was elected and had this perspective on funding for the facility: “Why are we building palaces for lunatics?”

So why were these people institutionalized? Here’s the list from the 1944 Annual Report.

Poring a bit more over the annual report, I am drawn to the heading “Electroshock Therapy.” Jack Nicholson in One Flew Over the Cuckoo’s Nest comes to mind.

It appears that a typical round of treatment consisted not of one shock, but a series of 20 shocks. The annual report notes that in 1944, “Treatments were completed on 345; 127 men and 218 women. 113 men had one series, 11 had two series, and 3 had three series. 194 women had one series, 22 had two series, 1 had three series, and 1 had four series.”

Apparently the numbers were up over the previous year because insulin shock therapy was discontinued in 1944 “due to staff shortages” and increase electroshock therapy filled in the gaps. According to Wikipedia, “Insulin shock therapy or insulin coma therapy (ICT) was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks.”

Insulin coma therapy was a labour-intensive treatment that required trained staff and a special unit. Patients, who were almost invariably diagnosed with schizophrenia, were selected on the basis of having a good prognosis and the physical strength to withstand an arduous treatment. There were no standard guidelines for treatment. Different hospitals and psychiatrists developed their own protocols. Typically, injections were administered six days a week for about two months.

The daily insulin dose was gradually increased to 100–150 units until comas were produced, at which point the dose would be levelled out. Occasionally doses of up to 450 units were used. After about 50 or 60 comas, or earlier if the psychiatrist thought that maximum benefit had been achieved, the dose of insulin was rapidly reduced before treatment was stopped. Courses of up to 2 years have been documented.

After the insulin injection patients would experience various symptoms of decreased blood glucose: flushing, pallor, perspiration, salivation, drowsiness or restlessness. Sopor and coma — if the dose was high enough — would follow. Each coma would last for up to an hour and be terminated by intravenous glucose or via naso-gastric tube. Seizures sometimes occurred before or during the coma. Many would be tossing, rolling, moaning, twitching, spasming or thrashing around.

An attendant from the 1960s offers this description in Buffalo State Hospital: A History of the Institution in Light and Shadow:

They were still doing electric shock when I first went there. They were doing raw shock, and we held the clients down, they didn’t give them any sort of sedative. The attendants were assigned to hold the patient down. Lobotomies were not going on at that point, that ended I think in the 1950s, although we did have patients who had had lobotomies.

I know after reading many commentaries on places like Buffalo that it wasn’t all a horror movie. I know that there were many people working on behalf of the patients, dealing with crippling patient ratios and crowded conditions that were never intended. That there was benefit in the self-contained nature of these communities, providing places to work for people who just couldn’t manage on the outside. That before we get all 21st century self-righteous about this kind of structure, we might reflect a bit on how future critics will view our societal decision to simply deinstitutionalize the mentally ill, pretend they don’t exist, and throw so many of them out on the streets.

But I keep coming back to the number of people who were simply warehoused in these asylums in the 30s and 40s and 50s — for a lifetime — because they were poor or mentally ill or recent immigrants caught in a system they didn’t understand or misdiagnosed (or all of the above).

And forgotten.

Including Elizabeth and Frank.