Care for the indigent poor, infirm, disabled, and mentally ill has been a controversial subject in Washington since long before statehood was achieved in 1889. Prior to 1854, most mentally ill persons living on their own in Washington Territory retained their freedom and autonomy, but attitudes toward mental illness shifted in the rapidly expanding Northwestern frontier. The concern over the growing number of "paupers" in Washington Territory culminated in 1854 when the first Territorial Legislature authored the Act Relating to the Support of the Poor -- commonly known as The Poor Law -- which recognized that those who experienced misfortune by "consequence of bodily infirmity, idiocy, lunacy or other causes" required greater support within the community ("An Act Relating to Support of the Poor"). The new law placed the burden of care for all "insane persons" upon the individual counties. Each county was given the authority to fine families who failed to support their "needy kin," and to build workhouses or provide other forms of aid. Funds were to be drawn from the county treasuries, and each county commissioner "may either make a contract for the necessary maintenance of the poor or appoint such agents as they may deem necessary to oversee and provide for the same" ("An Act Relating to Support of the Poor").
Care and Keeping of the 'Insane'
Mental illness, or "mental hygiene" as it was often called, became a growing concern as the region's population increased following the Civil War. There was little uniformity or consistency in the way "insanity" was regarded, diagnosed, or treated in Washington Territory. Wrote Charles Prosch, a pioneer and historian of early Washington:
"There are many forms of insanity. Sometimes it is called by one name, sometimes by another. There are hallucinations and alienations, aberrations and abstractions, phantasms and lunacy, dementia and delirium. Hypochondria and kleptomania -- only the wealthy are subject to the last form of insanity; when developed in others it is called petit or grand larceny -- monomaniacs and Anglo-maniacs, hysteria and various morbid nervous disorders, the victims of which are regarded as more or less demented" (C. Prosch, 87).
Prosch recognized the inherent issue of class in determining an individual's diagnosis. Those with money or influence might be considered eccentric, but those without were more likely to be considered criminals. For those who could afford it, the nearest insane asylum was located in Stockton, California. Others were expected to be cared for by family, or be left at the mercy of the systems in place in their county.
Larger counties buckled under the expense attributed to caring for the "unfriended insane" within their jurisdiction. There were incidents of people being brought from outside county or territorial lines and left to be cared for, possibly due to the reputation of more humane treatment than their residency would otherwise dictate. In The Poor Law passed in 1854, great trouble was taken to define a pauper's residence, the county's liability, and the grounds and method of removing someone deemed ineligible. Nothing was outlined in detail regarding the standard of treatment or quality of life for these individuals, leaving the spectrum of care recklessly broad.
In 1855, the county commissioners of King and Pierce counties submitted a joint appeal for reimbursement, claiming that the total cost of care for one abandoned and delirious sailor amounted to $1,659, which exceeded the governments' revenue for the year. The appeal was denied. It was clear that the task (and price tag) was greater than expected and that the territory as a whole had to assume more responsibility.
Because the territory couldn't afford to build an asylum from the ground up, the use of an existing facility was the obvious solution. The law allowed for the territory to entertain a host of bids from established business properties and select the most cost-effective and beneficial arrangement. In 1862, three bids were offered for the care, keeping, and medical treatment of the territory's insane. Two Oregon physicians offered $12 a week, a Seattle doctor offered to do the job for $8 a week, and The Sisters of Charity of Vancouver offered to do it for $6 a week. A three-year contract was awarded to the Sisters of Charity.
Problems with the contract system soon became apparent. The Sisters of Charity, who established the St. John Lunatic Asylum in conjunction with the already established St. John's Hospital, sought payment in gold coin but were instead compensated in Greenbacks (paper money), which were basically worthless due to deflation following the Civil War. Ethical concerns also were raised, like those voiced by Territorial Governor Marshall Moore in his message to Congress in 1867:
"I would specially call your attention to the importance of making some different provision for our insane and idiotic. The present system of providing for the care of this class of unfortunates by contract, let to the lowest bidder, is wrong in principle and cruel in practice. Those who take the contract, do so, it is presumed, for the purpose of pecuniary gain. As the contract, under existing laws, is let only for a limited period, and may be annulled, for cause, at any time, the contractors would hardly be justified in making permanent accommodations of such character as these patients require" (Gates, 135).
Disputes over restitution between the Sisters of Charity and the legislature continued. When their contract expired in October 1865, bids were received for a new five-year contract. Despite their dissatisfaction working with the territory, The Sisters of Charity bid once again for the charge. They were outbid and the contract was awarded elsewhere with the territorial government still in their debt. "There is no doubt that the sisters performed, as they always do, their part of the contract strictly and conscientiously," Moore said in his message to Congress. "I am confident that you will be disposed to do in the premises whatever is necessary to discharge the legal and equitable obligations of the Territory to them" (Gates, 136).
A new statute in Washington Territory -- The Act Relating to the Care and Keeping of Insane Persons of 1867 -- brought about a renewed commitment to the cause, with a new asylum, quarterly inspections, and a board of inspectors to report on overall conditions and oversee the discharge of patients. The board of inspectors consisted of a judge probate, selected by the governor, and two citizens of the county where the asylum was located. The five-year contract for the Insane Asylum of Washington Territory was bid upon and won by a well-regarded pair of businessmen, Huntington and Son, from Monticello in Cowlitz County.
A New Asylum at Monticello
James Huntington and his son-in-law, W. W. Hays, had no experience with the insane, nor did their property have facilities in place to keep them. Because they had a five-year contract, it was believed that they would have plenty of time to put them in place. "They were to get a dollar a day for each idiotic or insane patient, in paper money, and were to furnish land, house, board, clothing, medical treatment -- everything" (Thomas Prosch, 8). Accounts of the number of patients that came to Monticello from Vancouver varied from nine to 11, but the total in November 1868 was 19, a dramatic increase from just two years earlier. "That the Asylum is somewhat fuller than when it came into our hands is a fact, but we have room where we could keep others if it were necessary" ("A Letter").
Huntington and Son reported major improvements including a "commodious" new kitchen, additions for single-occupancy rooms, and segregated spaces to keep the men and women apart. Reports drawn up by the board of inspectors seemed satisfied with the arrangement, which "probably reflected community expectations for the asylum when they reported that the building was clean, the food adequate, the sexes segregated and the patients clean and seen periodically by a physician" (Hollander, 6). Less favorable impressions, however, were written in between the lines. There was mention of Mrs. C. Spinning, a patient who had become pregnant and given birth while housed at the asylum. The inspectors merely mention it as her current state of physical health and later report she had, indeed, given birth and was "quite restored to health and mind" ("Inspectors -- New Board of Commissioners"). They added that no additional money was required from the territory for the "maintenance of Mrs. Spinning's child while it remains at the asylum" ("Inspectors").
The buildings of the asylum were revealed by the elements to be merely temporary. In his history of the region, Hubert Howe Bancroft surmised that the accommodations opposite Monticello on the Cowlitz River were inadequate. So much so that an event of melting snow from Mt. Rainier brought on an "unusual flood" in December 1867, in which "the improvements were swept away" (Bancroft, 274). Huntington's hastily-built buildings were now needing to be hastily salvaged and rebuilt to maintain their part of the contract. They published a letter addressing community concerns about their facility, claiming that they too were victims of the territory not fulfilling its part of the agreement. "The Territory must meet the expenses as per contract [...] We only ask that our money be paid when due" ("A Letter").
Dorothea Dix Leads a National Movement
In 1854, at the same time the new Washington Territory was grappling with how to support the needs of the indigent, esteemed activist and philanthropist Dorothea Dix (1802-1887) was petitioning the federal government for the means to support the mentally ill population of the entire country. Known as the "Ten Million Acre Bill," Dix proposed the sale of 10 million acres of public lands, the funds of which would go toward funding adequate care for the insane by awarding each state with a federally-funded asylum.
In her travels, Dix had found that states either couldn't or wouldn't set aside the necessary funds. President Franklin Pierce vetoed the bill, worried it might upset the fragile balance between northern and southern states. Pierce was openly unsupportive of legislation he believed to be sentimental. Deeply discouraged by its defeat, Dix spent the years following the Civil War traveling throughout the country, petitioning individual state governments to put in place humane facilities on their own. In late summer of 1869, while on a visit to Oregon's Hospital for the Insane, she was petitioned by attendees of her lecture to look into the facility funded by Washington Territory near Monticello. Wrote Dix:
"Just as I was prepared to leave for California, I first learned from some military officers and reliable civilians your territory was responsible for a rightly intended provision for certain unfriended insane men and women ... It being impossible to visit the place referred to myself, I earnestly requested an experienced medical man and a carefully judging citizen of Oregon to see if the statements ... were borne by facts, as they understood right care for this helpless, irresponsible class of sufferers" ("Miss Dix on the Insane").
Their findings confirmed her suspicions. There were patients doing all of the cooking and washing for the asylum, with others never being permitted to leave their cells. The report described "varying levels of filthiness." Wrote Dix:
"The patients sleep in bunks, in cells, in a coarsely finished unplastered building, parts of which are described to me as very little better than a barn ... the visitors added that, judging from any efficient and proper standard, they could not consider the institution otherwise than inadequately provided both for care and cure of the insane ... badly maintained by parties in charge, who possibly may know no better ... The Doctor and inspectors are parties interested in perpetuating the present system; the 'one by his salary easily earned, the others by trade'" ("Insane Asylum").
Dix made a point to discredit the inspectors for their conflicts of interest, preserving a system in which they directly benefited. She raised concerns not only about the implementation of contracts by management, but also the lack of incentives by the system to ensure ethical oversight.
From Washington, D.C. on October 20, 1869, Dix penned two letters to authorities in Washington Territory; one to Governor Alvan Flanders and one to then former Gov. Elwood Evans. The tone of the latter betrayed a familiarity and candor that implied their shared acquaintance and view of how this population should be cared for. "At this distance I can only write to you, sir, knowing your sense of pity for these poor creatures will induce early and, I hope, personal attention to their condition" ("Insane Asylum").
An Expensive Failure
While it is not known which appeal reaped the greatest attention and benefit for the cause, Flanders, in his 1869 message to the Territorial Legislature, acknowledged the substandard conditions at the Territorial Asylum near Monticello. He also took action to commission a local bill for the land as well as a federal appeal for the buildings of the retired Fort Steilacoom (The federal government owned the buildings but not the land), to be dedicated as the new site for the Territorial Asylum. Steilacoom was "known to be a place of beautiful surroundings, easy of access, dry, healthful and pleasant, situated less than two miles from the wharf at Steilacoom" (Gates, 149). The governor had hoped the federal government would grant the territory these abandoned structures and sent a committee to the nation's capital to solicit Congress for its ownership and use.
The committee report, also known as the Status of Territorial Provision for the Insane, was published along with the reprint of Dix's letter to Evans in the Daily Tribune on November 26, 1869. Their report reiterated that the current "system for the government and care of the insane is wholly inadequate for this purpose, and is an expensive failure" ("Insane Asylum"). They worried about the national ramifications of such a failure, made even more apparent by Dix's involvement. "Her letter advises us of the fact that the fame and shame of this institution have a wider range than we were before aware of, and may and will detract seriously from the rising reputation of our Territory and our people" ("Insane Asylum").
The request for a grant of the facilities found on Fort Steilacoom was denied by the federal government, which instead agreed upon a price, $825 for the fort, which was very fair and accepted by the territory. A separate committee was assigned by the legislative assembly to travel to Steilacoom and inspect the buildings, as well as observe the general climate and reception for the facility. Olympia's Washington Standard reported, "[It] seems that all were much pleased with the excursion, pleased with themselves, pleased with what they saw and learned, and especially delighted with their cordial reception by the citizens of Steilacoom" ("Excursion to Steilacoom). The red carpet was laid out with a lavish meal and an impromptu ball held in honor of the inspectors, and the prospect of being the future home of the Territorial Asylum.
In 1870, patients were removed from the Monticello site to Steilacoom. Fort housing and buildings were repurposed. Barracks soon became wards; officers' housing now housed the contractors, staff, and the attending physician. While sentiment toward the contract system had soured, it must have been difficult to avoid. For the asylum at Steilacoom, a kind of compromise was reached. In 1871, the new asylum would have co-superintendents -- a private contractor in the form of a local hotel man, Hill Harmon, to see to the business and keeping of the mentally ill, and a physician superintendent to oversee the care of the patients. This arrangement, too, would become controversial and raise concerns about the ethical nature of contracts governing care for the insane.
Some have been critical of the superficial nature of Dix's involvement advocating for mental-health policy in Washington, proposing that she may have had more influence in shaping the new asylum to meet the standards of the Association of Superintendents of American Institutions For the Insane had she been more invested in the territory itself. However, shortly after her letters were written concerning the state of the Monticello asylum, she contracted malaria in 1870. She became a resident of the hospital she had founded 40 years earlier in Trenton, New Jersey, until her death in 1887. The tragedy in Washington Territory was that much of the political activism that organized around Dix and her work dissolved in her absence.
An investigation in January 1875 of the Steilacoom institution was carried out after two attending physicians, Dr. Hemenway and Dr. Willison, raised concerns of abuse and neglect. They placed the blame for such conditions on poorly-trained staff and on Harmon, who they asserted, aimed to save money at the expense of patient welfare. The charges were deemed unfounded by the investigating committee but did result in yet another overhaul in management of the institution, with the territory assuming control and consolidating the superintendent role under one resident physician. "Upon the retirement of contractor Harmon, the Territory assumed, through its regular salaried agents, all the care and expense connected with these unfortunates among our people" (Thomas Prosch, 8).
While progress was slow, public sentiment seemed to always favor the "cause of humanity" -- the most compassionate circumstances for Washington's mentally ill. In each instance where abuses were revealed, officials rose to hold substandard management accountable, but without "outsider" insights, the knowledge of such conditions would have gone undiscovered or otherwise tolerated. Dorothea Dix and concerned citizens of the territory, whose questioning and communication with the public played a critical part in this history, were crucial to reform and a reminder of our collective contract to ensure dignity and ethical treatment for all.