From the Inside – The Forest Haven Asylum, is available for order right now for $27 from Amazon.com (Here!). It will be available from all major book sellers shortly. The photo essay book takes the reader on an immersive journey through the facility with 120 carefully composed and selected photos that had been taken over a three day span.
The Forest Haven Asylum, established in 1925, is located in Laurel, Maryland. It was abandoned in 1991 due to court orders resulting from class action lawsuits brought against the facility for rampant cases of abuse and neglect. Numerous suspicious deaths had occurred at the facility with the bodies often unceremoniously buried on the premises in numbered graves. The facility was first ordered to close in 1978 by Judge Pratt in District Court, but the logistics of closing such a massive institution filled with so many difficult-to-place mentally challenged patients were staggering. It took thirteen years before the last patients and staff left the premises. When they were gone, many personal artifacts were left behind, resting where they were dropped. These belongings can still be found scattered throughout the institution—along with work logs and patient records.
Institutions like Forest Haven were originally an attempt to provide care for those believed to be too mentally ill and unstable to live on their own or function in society. The intent of asylum care was purely humanitarian, but the social commitment to fund the experiment soon dried up and became economically unfeasible. Financial corners were cut in all aspects of patient care. At one point, Forest Haven had only two social workers for its 1,300 residents. Overcrowding and poor care became the norm. This led to a dangerous environment with both patients and staff being pushed well beyond the human ability to cope. Even today, when entering the abandoned facility, you can feel the oppressive hell that it had been for anyone trapped within these walls.
During the early 1970s, US policy shifted dramatically with respect to treating the mentally ill. Mostly under the guise of patient rights, large institutions were closed under the policy of deinstitutionalization. High profile cases of unjustified commitments and/or forced lobotomies as happened to movie actress Frances Farmer often became representative of the whole institutionalized population and took a front seat to the diverse reality of the majority of people being treated in US mental institutions. For many, there was nowhere else to go and no other resources to help them.
The stated plan for deinstitutionalization was to offload patients from centralized institutions like Forest Haven into community based halfway houses. While deinstitutionalization varied greatly from state to state, the shift was initially set in motion with the passage of the Mental Retardation and Community Mental Health Centers Construction Act of 1963 which had been championed by then president John F. Kennedy. Kennedy had established the President’s Panel of Mental Retardation shortly after being inaugurated. Kennedy’s sister, Rosemary, had been lobotomized at the age of 23 at the request of her father, so this was an important personal issue for him.
Kennedy’s presidential panel was responsible for the recommendations for determining how federal funding could help better transition the nation’s outdated asylum system into a modern community based system. However, having to deal with both the Vietnam War and the 1960 recession, Kennedy was never able to adequately fund the proposed programs, and the new halfway houses suffered the same lack of financial support as the historical asylums had. Without having a viable replacement, asylums were being closed across the country. Then with the passage of Medicaid in 1965, states were given further incentives to move patients out of state mental hospitals and into underfunded halfway houses, nursing homes, general hospitals or the streets. This was because Medicaid excluded coverage for people in “institutions for mental diseases,” so there was often no one left to bill for their services.
The biggest push toward implementing deinstituionalization came in 1967 when then governor of California, Ronald Reagan signed the bi-partisan Lanterman-Petris-Short Act into law. This law was intended to be a patient’s rights act, but it provided no safety nets or transition plans for those leaving the asylums. The end result was basically releasing thousands of mentally ill patients with no plans for assimilation or rehabilitation. They often simply ended up on the street and had to fend for themselves. At very least, this law was a socially irresponsible, even if well meaning, act.
Aside from the changing political directives coming from both the federal government and some state governments, public opinion on mental illness was also shifting dramatically in the 1970s. The influential 1972 television broadcast from inside a New York institution, Willowbrook: The Last Great Disgrace from the Willowbrook State School, outraged viewers when they saw for the first time what was happening inside our asylums. This broadcast was followed by the 1975 award-winning film, One Flew Over the Cuckoo’s Nest, which sent another strong message regarding the rights of those involuntarily institutionalized. In 1975, the U.S. Supreme Court made a ruling that restricted the rights of states to incarcerate anyone who was nonviolent. This was followed by a 1978 ruling further restricting states from confining anyone for mental illness against their will.
The halfway house concept sounds great on paper as it appears to provide a viable route for re-entry into society, but it often doesn’t provide adequate care for patients with serious mental health issues. Many halfway houses are no better than the nation’s historical asylums. They are also often plagued by the same dilemmas when it comes to providing quality care while trying to get by on insufficient funding. Also, with halfway houses being less centralized and more dispersed across states and the nation as a whole, government oversight and regulation are often harder to enforce. Mostly run in private homes or small facilities, halfway houses are not generally designed to address the need for the highly secured care required by many of the most extreme cases of the mentally ill.
In 1980, President Jimmy Carter attempted to follow Kennedy’s lead and address the mental health under-funding problem and better define federal guidelines for providing treatment paths for mental illness. His policies were implemented in the aggressively humanitarian Mental Health Systems Act. Unfortunately, shortly after its passage, Ronald Reagan took office as president and abolished the act. In 1982 it was replaced with the Omnibus Budget Reconciliation Act which merged money for mental health programs into block grants. In the bigger picture, states were given fewer dollars to spend while the federal government allowed them to spend them however they chose. The pretense for this was the president’s concept of a New Federalism where taxes were cut, especially for the wealthy. Spending was reduced while also reducing the federal government’s influence. This left the important decisions on issues such has how to deal with mental health treatments to the states. The reality was that financial institutions were given greater protections than the most needy human beings.
Another unforeseen outcome of the deinstitutionalization movement of the 1970’s and 1980’s was the transfer of care for the mentally ill from institutions specifically set up to treat them—such as Forest Haven—to placing them into the care of the criminal justice system. It is estimated that at least 20% of all male inmates currently held in US jails are severely mentally ill. These unjustly incarcerated patients are not only getting no treatment for their illness while in jail, but they are being punished for their illness by both staff and fellow inmates. Sometimes this is far worse than the historic mistreatment that had occurred inside traditional mental asylums such as Forest Haven.
When not inside an institution, many of the mentally ill end up being homeless. Drug and alcohol abuse among the mentally ill is epidemic and becomes the main form of self-medication. Some of the patients released to the streets suffer from extreme mental illness, and these patients can be unpredictable, threatening and violent. Walk through any large metropolitan city, and you are likely to cross paths with troubled souls visibly fighting with their internal demons while on the ready to lash out at those they perceive as threatening in the outside world. The mentally ill left to roam the streets often stir mixed emotions in us: empathy, fear, hopelessness. Our hearts may go out to them, but very few of us are in a position to be of any real help. These suffering people need focused and professional care, not a Good Samaritan handing them a dollar for food or booze or a cop cracking them over the head with a billy club.
Through the Eyes of a Child
I was a kid living in Maryland during the mid-1970s. We heard whispers of the horrible things going on in Forest Haven and at other local asylums. It captured our imaginations. It fueled unspecified fears. The definition of madness and the possibility of involuntary confinement can trigger conflicting emotions in most of us. This is why we photograph and ponder the ruined remnants of institutions like Forest Haven. We want to find the answers to difficult questions about sanity, existence and what it means to be a whole healthy person. These emotions that I experienced as a child were rekindled when I went back to the asylum nearly 40 years later. These unanswerable questions about the human soul and sanity are what lead so many of us to become fascinated by places like Forest Haven.
When I was twelve years old, I spent many afternoons at a public pool in nearby Columbia, Maryland. The moms would take us there and let us run wild for several hours while they sunned themselves and gossiped. On one of these days, two vans pulled up filled with special needs kids presumably from one of the local institutions. For all I know, they had come from Forest Haven, but they also could have easily come from one of the new halfway houses. Before the young people were let out of the vans, everyone at the pool was alerted to the fact that these kids, while being supervised, should not be approached. Their handlers all carried electronic cattle prods. Whenever one of the kids started getting out of line, they were threatened with the devices. We could see the terror in the children’s eyes. They obviously had great fear of their handlers.
We were told to stay on one side of the pool while we watched these kids being lined up and forced to jump into the water. In one instance, a boy was so terrified that it took using the cattle prod on his wet back to get him to jump in. The memory of his screams and contorted body as he jumped away from the cattle prod haunts me to this day. Being a smart aleck and mouthy kid myself, I shouted out at the handler that she couldn’t do that to the poor kid. She came over to me and asked if I wanted to know what it felt like as she waved the cattle prod in my face. I wasn’t usually afraid of adults, but she made me back off. I saw something dark inside her eyes that made me aware that under her calm socially controlled demeanor lurked the potential for brutal acts.
When the kids were finished swimming and went into the locker room to change into their street clothes, I made the excuse that I had to go to the bathroom so I could follow them in. My curiosity got the best of me. I found the kid who I watched get prodded into the water. I felt a need to say something nice to him. I don’t really know why, but at some level I think I wanted to find something in him that I could relate to and maybe give him some kind of consoling for his mistreatment.
“You have fun today?” I asked.
He got excited by my attention and started madly trying to form comprehensible words with his distorted mouth. We ended up just laughing. This got a few of the other boys interested, and they all surrounded me. I have always had a strong sense of personal space, and these boys immediately violated it. In their excitement, they started grabbing and pinching me in inappropriate ways.
“Hey! Leave me alone!” I cried out, but they all just circled around me tighter, laughed and grabbed me harder.
They seemed really excited to have an outsider in their midst. I couldn’t get away from them. Claustrophobia kicked in, and I started to panic and scream out. Finally, one of the male handlers came in shouting at everyone. The boys froze when he lifted up his cattle prod. A wave of palpable fear swept through the entire locker room.
“What are you doing in here?” the handler demanded from me.
“Just had to go to the bathroom,” I said, shaken.
“Well, get out of here! You have no business being with these boys,” he yelled.
I left and was just relieved to get out.
I was visibly upset when I returned to my friends in the pool.
“What happened with the retards, Mark?” My friends asked.
I made up something funny and tried to play it off as a joke.
On the drive back home, I told the moms how the boy had been mistreated and how I thought they should call someone to report it. The moms passed it off saying, “You don’t know how it is. At least they got to get out for the day.”
Wandering the Halls
It’s impossible not to feel trapped while walking through the abandoned halls inside Forest Haven. The original play equipment in the cement walled courtyard that had been provided for the young patients made me recognize how important a trip outside this place could have been for the patients. Seeing these horrific confines reminded me of the kids from my past and prompted me to consider that the boys I had seen at the pool were probably the best behaved and most stable of all the patients here.
The tormented cries coming from the most violent and disturbed patients during Forest Haven’s operation had to be horrific to witness. We’re all human beings and share the same primitive emotions. At some level, the cries of the insane are the same cries we all have inside us. They’re attached to the same overwhelming feelings we have to squash down inside ourselves when life feels like it’s just too much to handle. We are drawn to places like Forest Haven because somehow they trigger recognition of our inner fears. Perhaps we find reassurance in the fact that we are able to walk away from them afterward.
As an artist entering this facility, I first and foremost wanted to do more than just document the artifacts of a historic tragedy. Instead, I was looking to create images that are both new and universally moving while respecting the suffering that has occurred inside these walls. Throughout the history of humankind, suffering and injustice have been part of our existence. We often have to ignore the reality of how quickly our imagined security, stability and freedom can be turned upside down. Walking down the halls of the Forest Haven Asylum reminded me just how fragile our social existence is. It made me question just what part of our deep internal selves enables us to live sanely in a seemingly insane world. What is the true line between sanity and insanity? Is it a matter of control or a matter of letting go of control?
The presence of the people who resided in these walls lives on through the personal objects left behind. A single cup collecting dust contains the ghosts of hands holding a hot cup of coffee, as perhaps the last person who drank from it did before the facility was abandoned. Chairs are everywhere. You can sit in these chairs and think about the last person who sat in them. Through sharing the same physical space, you feel like you have a direct connection to the people who spent their lives in these walls.
In the administration offices, you have to wonder how it would have felt had you been a patient being threatened or reprimanded by the staff administrator while you sat on the wrong side of the desk. What thoughts went through your mind while you talked with someone who you knew was able to leave the facility each night? How would you envision the freedom to go home to a quiet house at the end of the day, knowing you would be left to hear the din of tortured screams throughout each and every night? What would be the long-term trauma from witnessing the violence of orderlies trying to maintain order in this place when, at its core, there was no order?
Conversely, how would it feel to be the person on the other side of the desk? How would it feel having to deal with often unstable and abusive people who you knew had no hope of ever getting better? How would it feel being in the presence of people who had to be restrained so they wouldn’t fling their own feces at you or even try to eat it themselves? How could you deal with this daily pain without becoming completely desensitized to the individuals inside the facility? How could you reconcile the line between the people on the inside and the people on the outside? What would be the personal toll on everyone working here? How did they compartmentalize the insanity they dealt with on a daily basis and the sanity they tried to occupy while not at work? How could workers hold onto hope that some of the patients would get well, when there was not one bit of evidence showing anyone at Forest Haven got better? Were the staff able to convince themselves that they were doing something good?
Once committed to Forest Haven, the only way out is to die.
– Betty Evans, mother of Joy Evans, who died in the facility of aspirational pneumonia at age 17 in 1976.
Piles of suitcases with name tags still on them are lined up in closets. It is as if they were being stored for when the patient was going to leave the institution after receiving successful treatment. Sadly, there were essentially no successful treatments. The patients all either died in Forest Haven or remained until they were transferred to a halfway house or were let free to live on the streets (where most ultimately died). The suitcases are all empty. You know that they were full when they arrived. You have to wonder who was tasked with packing these suitcases before a patient was taken to Forest Haven. What difficult emotions got packed in with the belongings? Was it distraught family members who had to finally accept that they could no longer care for their child or spouse—or was it the patients themselves who packed the bags not exactly understanding where they were going?
All that is known is that someone carried these suitcases into the facility. Their hands held onto these handles before they were taken by the Forest Haven staff. Once the suitcases were stored in closets, it became a matter of how many doors stood between the patient, their families, and freedom. For people on the outside, the doors shut out the horrors of what occurred within these walls. For the patients locked inside, the doors shut them inside these walls where they were forced to live the horrors of Forest Haven for the rest of their lives.
In the end, we are all living on the inside in one way or another. No one is free. Our lives depend on conforming to the world around us. When we are no longer able to conform, we once were sent to places like Forest Haven. Now, if we don’t conform, we’re confined to cells in privately run for-profit prisons or perhaps end up to living under a bridge and shunning social interactions. As brutal as facilities like Forest Haven were, we as a society, have to reassess whether we have made humanitarian progress in shutting them down. I can’t help but wonder why our priorities in the U.S. always seem to be law enforcement and war instead of caring for those most in need of help. While our historic asylum system was flawed and outdated, given the will and adequate support, we could certainly have made it better.
I spent three days inside this facility taking photographs. The experience changed my life. The emotions stirred up in me were deep and conflicted. I suppose this is all part of the process of getting into better touch with my inner self. Given different circumstances or if I had I been born in a different time, I’m sure I could have “lost my mind” and ended up here. What keeps any of us on the outside? Maybe it’s a question that has no answer, but I wish I had the answers for how we could create a more caring world, especially for those suffering from mental illness.