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By Thomas Goldsmith
As the 308-acre Raleigh campus of Dorothea Dix Hospital is being transformed into a destination park, former employees remember it not only as a haven for people with mental illness but also as a nearly self-sufficient small town.
Their memories detail many instances of caring treatment by Dix professionals. But the Dix veterans interviewed didn’t shy from recalling techniques and medications, many now discarded, which led them to question whether they were really helping patients.
Newly elected Mayor Mary Ann Baldwin called the future park on a hill overlooking the west side of downtown the “crown jewel of Raleigh” in a swearing-in address which also called for a major bond issue to fund projects including development of the Dix campus. Former employees such as Louise Humphrey, 88, want to make sure that park visitors receive a comprehensive picture of the role that the hospital played in the lives of both behavioral-health patients and workers.
“No one can ever, I think, acquire the compassionate feeling that you get from having been in the facilities and realizing that everybody’s not perfect and that different people have different challenges,” Humphrey said. “And you learn to respect the person as well as their challenge.”
Louise and husband Melvin, 89, and other former employees talked to North Carolina Health News as part of a public-private effort to preserve memories of the site. Former hospital nurse Marjorie O’Rorke, author of the hospital history Haven on the Hill, said that people with mental illness often received lamentable treatment at home with families, making Dix a better alternative in many cases.
“It was a place of harbor actually, to care for them,” O’Rorke said of patients. “That’s why I called it a haven.”
The hospital that accepted its first patients in 1856 grew to house more than 2,000 during the Humphreys’ tenure there. That number would eventually exceed 3,000 before dwindling for years before the state closed Dix in 2012.
Kate Pearce, senior planner for the park with Raleigh city government, noted that its master plan calls for honoring the legacy of Dorothea Dix by “creating park spaces and programs that support the wellness of visitors.”
“It was this place of healing, this place of therapy,” Pearce said in a phone interview.
“And I think a lot of those themes actually translate really well into its future as a park. “It’s one of the things that we’re very intentional about — not only learning about the past but understanding how that past influences the future.”
A well-supplied campus
Melvin Humphrey, 89, remained at Dix until 1978, serving as assistant director of therapeutic activities and setting up a sheltered workshop for patients. He and wife Louise described various amenities on the grounds — rows of shotgun housing, a power plant, a reservoir, greenhouses. “The governor’s mansion was furnished flowers every week from the hospital gardens,” Louise Humphrey said.
Especially in the case of Louise, who was born on the property in 1930, Dix felt like a small town, with playmates and a state-owned, non-denominational church within walking distance.
Jimmy Pierce, of Clayton, son of Dix general manager R.P. Pierce and wife Lois, remembers the all-encompassing nature of the Dix operations in the day.
“It was a self-contained city,” Jimmy Pierce said. “They raised their own food, had their own entertainment, had their own electricity, their own water supply.”
The former hospital chapel is among sites that the city is preparing for the display of information about the hospital and its evolving treatment of people with mental illness, Pearce said. People who worked at the hospital for decades beginning in the 1940s said that Dix jobs represented stable state employment and offered a closeup look at that evolution of attitude toward patients.
Franklin Pearce, 82, and wife Sylvia, 80, of tiny Brogden, N.C., had long careers as employees. “It didn’t pay a lot of money, but it was a good place to work and you had some benefits,” Franklin said.
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Sylvia started as an aide but spent the bulk of her career in the nursing education department, working with students from nearby three-year nursing schools. Both she and Frank were exposed to the often disturbing realities of mental health treatment in decades past.
“I saw people getting electric shock treatments,” Sylvia said. “In fact, I helped with that.”
Former employees said that shock treatment was a worrying procedure. During this therapy, as many eight staff people stood by to restrain the patient, who had seizures when an electric shock was administered. (Electroconvulsive therapy is still employed, but with lower levels of current and medication to control seizures.)
Well meant, but severe
Betty Cannady, of Raleigh, is a registered nurse who worked at Dix off and on from the late 1940s until the mid-1980s. She remembers several modes of behavioral-health treatment at Dix that were widely accepted at the time, but in many cases are no longer in use.
“The treatment at first, now that I look back on it, was pretty severe,” she said. “I saw that we did indeed progress.”
Prescriptions of the relatively new drug Thorazine meant patients acted less violent but also became less animated to the point of being “like zombies,” she said. “It wasn’t living.”
Cannady also described a procedure during which patients thought to be unmanageable or violent were wrapped in nine ice-cold sheets and left encased, sometimes screaming, until they relaxed, grew warm, and went to sleep, she said.
Other patients, not diabetics, were deliberately put into insulin shock and into straitjackets so that they wouldn’t hurt themselves when they recovered. A patient thus treated had to be closely monitored to make sure he still had a corneal reflex.
Cannady said she and other nurses sometimes asked themselves whether the treatments actually helped patients, even though they knew the processes were meant to keep patients from harming themselves or others. Many employees, including some psychiatrists, lived on the campus, and relationships among patients and staff emerge in their accounts as close and caring.
Jimmy Pierce remembered knowing at least 90 percent of the hospital’s patients by name. He and other former employees recalled changes in the buildings where patients were housed based on their conditions. For example, there was one building for men with epilepsy and another for patients judged “criminally insane.”
Then administrators imposed a system of keeping patients together by county, which led to conflict among patients functioning at different levels. Occasional fights took place among patients, as well as violence against patients by staff who were fired if discovered, Melvin Humphreys said.
‘Our last resort’
Dix also cared for people with developmental disabilities and those with substance abuse problems, requiring a variety of treatments and levels of security.
The state closed the hospital based on several factors: general decay in its physical plant, more expense for upkeep, and the general premise that people with mental illness would be better served in newer facilities or in the community. The move toward closing was pushed by legislators who in the early 2000s advanced the idea that community-based services could lessen the need for inpatient treatment. But the resources necessary for independent living and comprehensive outpatient treatment have not matched the demand.
Retired staffer John Milner worked in the forensic unit at Dix from 1978 to 1998 and in 1998 became director of safety and health. It was an important post in which he initially faced some resistance, partly because of his race, said Milner, who is African American.
“In some areas in which I went and gave directives, as I was leaving, I would hear them say, ‘Well, I’m never going to do that.’” Firm, consistent responses from Milner brought an end to that attitude.
Milner and his staff had to know the count of inmates and their locations, dealing with between 80 and 120 forensic patients at once. Law enforcement officials let staff know the nature of charges against the inmates who were transported to Dix for evaluation of their competency to stand trial.
Staff looking after patients had to deal with their patients’ occasional difficulty with impulse control. They might fly off the handle for no apparent reason, Milner said. He said staff responded by placing hands on the patients, talking to them, or trying to move them to a different place.
“Hands on was our last resort, but we were able to put hands on in a therapeutic manner,” he said.
They learned techniques such as PIT, for preventive intervention techniques, or later NCI, for North Carolina Intervention. Another technique, called a show of force, found as many as six people involved in restraining a patient if necessary. Sometimes another patient would unofficially be taking part.
State records show that means to deal with difficult patient behaviors have undergone a decades-long series of refinements leading in 2012 to the North Carolina Intervention program. “Since 1974, the state of North Carolina has recognized the need to train its workforce on techniques for dealing with crisis situations,” wrote Al Delia, Secretary of Health and Human Services, in 2012. “The main focus has always been to prevent injury to the people we serve and the workforce while including methods that prevent and control crises as they occur.”
Like several others of the former Dix staff interviewed, Milner said he’d like to see a mental-health facility on the property even after it is turned into a park. Such a hospital would keep the idea of mental health treatment in the public eye, as well as serving as an on-site medical resource for park visitors if needed, he said.
In response, Pearce, with the City of Raleigh, said that Dix Park will still have the ability to serve as a place where people can improve their mental and physical health.
“If you think about things that play a role in modern-day society, like nature deficit disorder, or obesity, or hypertension, the park can become a prescription to the community and continue this legacy of healing, but just in a different way,” she said.