Inside A “Cuckoo’s Nest”

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It has been a long odyssey in this country for the institutions used to treat and house our mentally ill.

From constructing “lunatic” asylums in the 1800’s to current plans for updating and re-expanding our inadequate and archaic mental institutions, the path to better treatment of the mentally ill has been one of promise and horror, both often experienced within the history of individual facilities. One such facility is the main state psychiatric hospital in Virginia, known as Central State.

During the Civil War in the south, many slaves were institutionalized by their owners as “insane” for simply trying to escape captivity. After the Civil War, Central State Hospital (known then as the Central Lunatic Asylum) formed to exclusively treat the African American population. In 1870, Virginia assumed full ownership of the facility when it housed 123 “insane persons” and 100 paupers.

By 1950 the facilities were expanded, but that didn’t keep up with the burgeoning inpatient population of almost 5,000, creating overcrowding and unsafe conditions. The treatments used during this time were as archaic as the facilities themselves. After the Civil Rights Act of 1964, the by then named Central State Hospital began accepting patients of all races.

Another horrible chapter in both the hospital’s and state’s history involved the sterilization of patients without their knowledge. As recently as 1980 there were almost 2,000 patients sterilized. Aided by the American Civil Liberties Union, 4 of the more than 7,000 sterilized in Virginia filed a class action lawsuit requiring the state to notify all patients sterilized, dating back to 1924, and to reverse the procedures.

As we entered the 1990’s and more patients were pushed to outpatient settings or simply not treated at all, the hospitalized patient numbers began to decline, the buildings decayed, and many were simply boarded up.

One of the many abandoned buildings at Central State Hospital in VA, photo by Jeff Campbell

It was understandable that society did not want to subject the mentally ill to the inhumane treatments offered inside mental hospitals. What was overlooked, however, was that the inpatient part was not the problem. The problem was the inadequate facilities and treatments received while in the inpatient setting. Consequently, we began to see a surge in the mentally ill population becoming imprisoned or homeless.

Currently, with an increased focus on mental health, the pendulum is swinging back. At Central State Hospital alone, the admissions from TDO’s (Temporary Detention Orders) has increased more than 1,000 percent over the last five years. The aging hospital facilities are still not equipped to handle the influx. Nurse Cadiecya Brown (a recent recruit from Jamaica) noted during one staff meeting, “Never would I have imagined that in the United States of America, I would witness patients sleeping on a mattress on the floor.”

Virginia is finally formulating plans to replace the antiquated hospital, but that will take years to complete. In the meantime, in Virginia, like in much of the country, the mentally ill will continue to suffer from inadequate treatment in often inhumane conditions, if they are lucky enough receive treatment at all.


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