Moving Beyond Mayview

When the state Department of Welfare announced last year that it would close Mayview State Hospital by Dec. 31, 2008, officials explained what would happen to the remaining 200 patients and said the closure would allow patients to receive community-based care.

But lost in the desire to look forward was any look back at the hospital’s monumental history, one that reaches back 200 years, nearly to the beginning of Pittsburgh and Allegheny County, and serves as a primer on the history of treating the mentally ill.

Mayview went from being Pittsburgh’s city-owned poorhouse, warehousing the poor and mentally ill alike, to using treatments that now seem barbaric and strange—such as lobotomies or hydrotherapy—to hoping that living in the country alone would cure what ailed the industrial-age mind. It became controlled by the state as part of a larger system and witnessed the introduction of powerful tranquilizers and psychotropic drugs, some of which were first tested inside its walls. 

The closure is seen as part of that continuum, too, even if the result is the end of Mayview itself.

“Moving patients into community settings is putting ourselves out of business, really,” said Dr. Jonathan Bear, chief of psychiatry at Mayview. “But we’re still participating in the advancement of psychiatric medication, and that’s what Mayview has always been about.”

A look back at Mayview and its circuitous, ever-changing history, and the people who made it and lived it, reveals an institution that largely avoided the kind of scandals that long ago left people with horrifying images of state-sponsored mental health care made indelible by the 1948 movie “Snake Pit” and again in the 1975 movie “One Flew Over the Cuckoo’s Nest.” It may not have been Bedlam, the notorious London hospital, but Mayview had its problems along the way.

At times, people were wrongly committed and forced to stay longer than necessary. Some patients received treatments that were known to rarely work. Employees in the 1970s picketed or struck several times when their numbers dwindled so low that it was almost impossible to call what they did for patients “care.”

But for most of its history, Mayview managed to stay on the forward edge of care for a variety of society’s forgotten groups—not just the poor and “insane” but later those with mental retardation, tuberculosis and deafness.  The group also grew to include criminals.

“You have to understand, those people who worked there even in the 1800s were just as concerned about treating the mentally ill and everyone else as we are today,” said Father George T. DeVille, a former chaplain at Mayview, who wrote its official history in 1994.

State officials routinely refer to Mayview’s first year of operation as 1897, when the current campus officially opened on nearly 1,000 acres in South Fayette Township near Bridgeville. But it really started with more inauspicious beginnings in 1804, according to Father DeVille’s history.

The hospital’s then-superintendent castigated Father DeVille for writing about one of the hospital’s darker chapters— when a man in the forensic unit, Kevin Cooper, escaped in 1982 and eight months later murdered four people.  Father DeVille had worked for 28 years at Woodville State Hospital until it closed in 1992 and then spent two years at Mayview.  “I loved the work and loved the people and the patients. A lot of people couldn’t stand to be around them. I’d take priests through there, and they couldn’t wait to get out. But the vast majority of employees were like me: It was in your blood.”

His history places Mayview’s 1804 beginnings in what was then downtown Pittsburgh, which had only officially become a borough a decade earlier. The borough realized that among its 1,500 residents living on the western frontier’s edge were a growing number of poor. The post of overseer was created to collect taxes to be used for the poor and needy “in their idleness.”

The city’s first pauper’s house, or almshouse, was created on the south side of Virgin Alley, now known as Oliver Avenue, near Wood Street. It held five people. At the time, there was no place to house people considered to be “lunatics,” and they likely ended up on Virgin Alley with the poor if they needed help—two stigmatized groups brought together by scorn.

Across Europe and North America, mental health institutions “often evolved from other welfare institutions, whether it was an almshouse or a prison first,” said Dr. David Wright, a professor in psychiatry and history at McMaster University in Hamilton, Ontario, Canada.  “And it’s not surprising that a certain percentage of the poor suffered from mental illness in Pittsburgh or anywhere else; that’s still the case.” 

The need for a larger pauper’s house would grow with the city. It would be moved twice over the next 50 years, first to a site for 30 people along Ohio Lane, now known as Pennsylvania Avenue, in what is now the North Side, and then to 190 acres in Mifflin Township on the south side of the Monongahela River. When it opened there in 1852, it became known as the Pittsburgh Home, or the City Poor Farm, and the three-story brick building held 300 residents, many of whom were moved there by barge up the Monongahela. It was there that the hospital’s history shows the first references to treating the “insane.” Records from 1870 counted 59 insane residents, though they were not yet kept separately from other, simply poor residents.

There was no real treatment available to them—the superintendent at the time said treatment of “inmates” should be “kind, but just” and regimented, but largely without restraints. Only mild, chronic cases of insanity were allowed. It was hoped that a generally calm environment, regular meals and good, hard work would cure what ailed both the poor and the insane.

“The one interesting thing is that in the later half of the 19th century, there were a large number of patients who were discharged from these places, a good 50 percent,” said Wright. “Many were coming out of their illnesses on their own, but many were simply very poor, and the conditions alone—regular meals, a place to sleep, work —did help many of them.”

The first place in the region to accept more serious cases of insanity was the Western Pennsylvania Hospital of Pittsburgh in 1852, which was later usurped when Dixmont Hospital opened in Kilbuck Township in 1861.

But with the city growing so rapidly—it nearly doubled to 86,000 residents from 1850 to 1870—it became clear that Dixmont alone would not be able to serve the residents of the city and growing Allegheny County. And in 1879, the Pittsburgh Home added a second, three-story brick building to house 150 insane people. The admitted men were expected to work on the farm, and the women were kept busy making clothing for inmates.

Four years later, the first physician dedicated to the treatment of the insane was assigned, but the day-to-day care of the insane was still left to the “inmates,” that is, the poor who also lived at the home; there were no trained nurses, as would later become the norm.

Two related factors would soon spell the end of time along the Monongahela, barely a decade after the house for the insane was built. Between 1870 and 1890, Pittsburgh nearly tripled to 238,000 people.  And the steel mill Andrew Carnegie had built next door to the home was growing, too. With the growth of the Homestead plant, which would become the most productive steel mill in the world, came tremendous pollution and the forced bisection of the Pittsburgh Home campus by railroad tracks.

So in 1890, the city agreed to sell its 190 acres to Carnegie and bought a 243-acre farm 13 miles west, in rural South Fayette Township. Given the home’s origins as an almshouse, and with no apparent regard for the stigma attached to the name, the new complex was dubbed Marshalsea. It was a reference to the notorious prison in London that for 500 years housed England’s debtors, including, for a time, novelist Charles Dickens’s father. Dickens, who had to take a job in a factory at 12 years old when his father was imprisoned, would later immortalize the place, making it a central scene in his novel, “Little Dorrit.”

In more enlightened times, 25 years later, someone would realize the stigma attached to the name and a new name was sought. Among the suggestions were Ridgeland, Goodlawn, Montview and, finally, Mayview, which officially became the campus name in 1916. And though there are still several buildings left from the Marshalsea era, the name is nowhere to be found. “When they decided to change the name, they got rid of it as much as possible,” said Rich Kuppelweiser, the hospital’s retired chief executive officer and now part-time chief operating officer.

The new setting, nestled on either side of a small creek valley and along a railroad line, was planned as a bucolic utopia for the poor and mentally ill, removed from the strain of the sooty, urban, industrial life that was believed to be the cause of much of both groups’ problems. To that end, Marshalsea/Mayview was designed to be self-sustaining for the patients, inmates and staff. It became a virtual town of its own, with police, fire, a church, a hospital, ball fields, a swimming pool and housing for employees.

One quirk and mystery of Mayview’s history is that, unlike most other self-contained state hospitals such as Dixmont, which left behind a 2-acre cemetery with more than 1,000 graves, Mayview buried few patients on its property, perhaps as few as three. This despite having about 1,000 acres after additional land was purchased. No one knows why, and the common practice seems to have been to send the dead to paupers’ grave sites around the county.

To sustain it all, Mayview built a 900-acre farm on the hillsides above the valley where the campus stood. It produced, raised, butchered and canned everything a small town could need: pigs, chickens, cows, corn, wheat, tomatoes, carrots and more.

“We produced a LOT of food there,” said Edgar Krug, who managed the farm for the 20 years before it closed in 1981. In addition to providing sustenance, the farm was a main outlet for daily work for the hundreds of patients during the growing season. “The main reason for the farm in those days was to keep them busy and occupied so they could sleep at night,” recalled Krug, now 75 and retired.

When Krug started in 1961, roughly 5,000 people lived and ate at Mayview. Farm production included about 500 gallons of milk a day from a herd of nearly 200 Holstein cows. And the operation grew 28 different vegetables (chosen in consultation with the hospital dietitian), took in 1,000 bushels of apples every fall and gathered 3,000 quarts of strawberries in season.

And with that amount of work, labor was a necessary element, though Krug said patients “were never forced to work.” Perhaps not, but the work at the farm and other jobs around campus, including maintenance, came to the attention of social advocates who saw it as a form of coerced work by people who couldn’t by definition make judgments for themselves. During his exploration of Mayview’s history, Father DeVille was told that one of the unfortunate results of the work requirement was that during some predischarge meetings, when a patient’s chances of being released were discussed, sometimes it was said: “You can’t discharge that patient, he is such a good worker.”

Starting in 1975, and following a nationwide pattern, patients could only work voluntarily in select areas but not the farm, a move that was a death blow to the operation. Even with mechanization, it needed more hands than the state was willing to pay for. It was closed for good in 1981, also following a national trend.

“A lot of them would come to me because they were angry and say, ‘Why can’t I come out to the farm?’ And they blamed me,” Krug said. “I’d tell them that was the law, that the social service people just believed they shouldn’t be made to go out and do labor, but it upset many patients.”

Many doctors now believe that the loss of the low-stress, outdoor farm work, in particular, was a blow to therapy at Mayview. “A lot of good came out of those structured work-like settings,” said Dr. K.N. Roy Chengappa, chief of the mental illness research unit at Western Psychiatric Institute and Clinic, who worked in the now-closed research lab at Mayview in the 1980s and 1990s.

Krug, who lived on the farm with his family until 1973, was the one who oversaw the sale of its prized dairy cow herd in 1981. They went to farmers from all over the country, who bid $4,000 to $5,000 for the best of the lot. “That was a sad day. I spent 20 years building up the herd through selective breeding, turned it into one of the best in the state, and then had to watch it get sold off.” All that remains of the farm today is the main dairy barn and two wing barns. Much of the site will soon become a recreation center and ball fields for Upper St. Clair.

In 1941, after a state commission found that the care of the mentally ill was floundering in an array of locally run hospitals statewide, Pennsylvania took control of Mayview and a dozen other hospitals. State control and funding ushered in rapid growth, advances in treatment and changes in culture that were solidified in 1958 when the indigent were finally moved from the hospital grounds.

As Mayview grew, it needed a more professional staff and began teaching its own nurses. One who was drawn there was Betty Roncovitz, 87, who started there in 1949 as a registered nurse when there were 2,500 patients. She stayed until 1984, when it had less than 1,000 and was beginning to take fewer and fewer people. She ended her career as the supervisor of the medical center.

“I wanted to help people,” she said. “And I needed Mayview, and Mayview apparently needed me.” Among her fondest memories was her daily reminder to the nursing staff: “I don’t care what you do once your assigned work is done, but you put your arms around those patients and tell them you love them, because most of them probably haven’t heard that recently.”

In a hospital where every staffer was familiar with more than their share of patients who would seemingly never improve, staying upbeat was a survival skill.  “It could be tough there,” Roncovitz said.  When she started, patients were regularly subjected to hydrotherapy—they would either be wrapped in cold towels or put in a heat box to calm them down—or electroshock therapy. Lobotomies were also performed.

“Some of the patients responded very well to lobotomies, but many others were just sort of very dull and sluggish after them and not able to respond to anything at all,” she said, noting that the lobotomized patients were easy to spot, with an unusual smooth spot on the side of their skull.

When she left, new psychotropic drugs were about to be tested with remarkable results, including Clozapine, which did more than just numb the patients—as the tranquilizers and 140 proof alcohol had in the 1940s and 1950s. “There was so much change,” she said. “I just can’t believe they’ll close it down and that will be the end of it, because it was home for so many of the patients.”

Kuppelweiser, the part-time chief operating officer who started his career at Mayview in the 1970s, still finds it hard to believe how much has changed. Walking through what was once one of the main ward buildings, a hulking, 100-year-old red brick structure that held hundreds of male patients, he said, “In rooms like this, there would have been just bed after bed after bed, with just two feet between them. It was just warehousing. People had a place to sleep. But mental health care then wasn’t what it is today, with a lot more one-on-one care.”

Even in the 1970s—which were a vast improvement on the conditions of the first half of the 20th century and even more so in the 19th century—there might have been 700 employees to deal with upwards of 3,000 patients. Now, the goal is two employees for every one patient in most facilities.

“Sometimes I look now and think: What is it we’re not seeing that we will 25 years in the future?”

Dick Jevons, a former Alcoa executive and longtime patient advocate, hopes the change is just as dramatic as it has been over the last 25 years. “Let’s be frank, until recently, there were no treatments,” said Jevons, who has a relative who has had several stays at Mayview for treatment since the 1970s. “They’ve finally gone from custodial care to treatment. You could take exception and say there were lobotomies, electroshock and sedatives. But none of those went to the heart of the matter—the problem with the gray matter in here,” he said, knocking on his own head.

And as much as he appreciates the work that his relative has received in recent years, Jevons said it’s all too obvious to most patients’ family members where they’re best served, and that’s in smaller, community settings. “My view of Mayview or any institutional setting is that they are obsolete for the vast majority of people with a mental illness. That’s why Mayview is closing. It’s a necessary progression in the treatment of patients. And that’s not a bad thing.”