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SPEAKER_08: This is 99% invisible. I'm Delaney Hall, filling in for Roman Mars. Maybe you've heard a story like this. How once upon a time on the outskirts of the town where someone grew up, or where they went to school, on the edge of the woods, there was a scary old asylum.
SPEAKER_09: Over the last few years, so many people have told me versions of this story.
SPEAKER_08: That's writer Sandy Allen. I wrote a book called A Kind of Miraculous Paradise about mental health care in America.
SPEAKER_09: And often when somebody learns that I write about mental health, they will launch into their old asylum story. How they used to break into one with their friends, or how someone they knew saw a ghost there. The details vary.
SPEAKER_08: But the one detail that almost never varies, the thing that seems to make an asylum story an asylum story, is that the asylum is nearly always abandoned.
SPEAKER_09: The former Buffalo State Asylum for the Insane is an imposing stone structure on the north side of Buffalo, New York. It's nearly 150 years old, and its resident historian, Corey Fabian Barrett, recently took me inside. This is pretty much what happens when you leave a building by itself for 40 years. The interior was everything you would expect from an old abandoned asylum, with boarded up windows and long derelict corridors. You've got all the paint crumbling off the walls.
SPEAKER_02: You've got the paint crumbling off of the tin ceiling.
SPEAKER_09: Graffiti that says get out now. Yeah, that's one of the Buffalo State College student shenanigans.
SPEAKER_09: All of the doors had been taken off their hinges. Parts of the building were charred black by fire. Yeah, there have been many fires here.
SPEAKER_02: So this fire actually took place in 1975, right after the patients moved out. But it didn't take the whole building? Nope, nope. The fire department responded in the nick of time. Also, these buildings are built like medieval castles.
SPEAKER_09: And that's not an exaggeration. Even though the building was falling apart, it was clear that back in the day, it hadn't just been imposing, but fancy. The floors had been laid with designer tile imported from England. The exterior was made with Medina sandstone. Buckingham Palace is faced in Medina sandstone.
SPEAKER_02: The Brooklyn Bridge, Medina sandstone. They did not skimp at all.
SPEAKER_09: But more than anything else, the main thing that stood out about the asylum at Buffalo State was its size. The building was huge, over a third of a mile long. It boasted its own subway passage, so carriages could take people from one side of the building to the other.
SPEAKER_08: Today, there are more than 100 abandoned asylums in the United States, many of them not all that different from Buffalo State. It's one of the reasons we're all so familiar with the idea of the big empty asylum in the woods. Few, however, stop to wonder where all these structures came from.
SPEAKER_09: But in fact, the massive building, the impressive grounds, the fine materials, all of this was part of a treatment regimen developed by a singular Philadelphia doctor. A physician who was obsessed with architecture and how it could be harnessed therapeutically
SPEAKER_08: to cure those who'd gone insane. Dr. Thomas Dory Kirkbride.
SPEAKER_02: Dr. Kirkbride was an amazing man.
SPEAKER_09: When Corey Fabian Barrett speaks about Kirkbride, you cannot help but notice she is a fan.
SPEAKER_02: He was one of the first people in America to say there's something better we could be doing for people with mental illness. That it was something that could potentially be treated and cured, that it wasn't just a condition where you would lock somebody up in the basement and throw away the key. Thomas Kirkbride was a Quaker, born in the Pennsylvania countryside in 1809.
SPEAKER_08: His father was a farmer, but young Kirkbride discovered early on that he wasn't suited to farming, and he decided to become a doctor. At first he wanted to be a surgeon. Then he got kind of randomly talked into working instead at a Quaker-run insane asylum outside of Philadelphia. A quick note about language.
SPEAKER_09: Historically, words that may sound offensive now like insane or lunatic would have been commonplace in the late 18th and early 19th century, even used by medical professionals. So for clarity's sake, we'll be using the terminology that Kirkbride would have used.
SPEAKER_08: And back then, when someone was deemed insane, it was often thought to be the person's own fault.
SPEAKER_11: The assumption was they were forsaken by God, or they were possessed by demons, or they had done something to deserve to be in such a desperate condition.
SPEAKER_09: Carla Yanni is an architectural historian at Rutgers who wrote a book called The Architecture of Madness. And she says that what happened to someone who was labeled insane in the early 19th century would have depended mostly on their class. Healthy families often kept insane relatives at home or paid for them to live in private madhouses. Poorer people fared worse.
SPEAKER_11: Some of them were kind of cast out to walk along roads. A lot of them ended up in county jails. A lot of them ended up in some kind of, you know, small privately run almshouse.
SPEAKER_09: What madhouses did exist were more like prisons, largely focused on confining and often torturing people. Some, such as England's infamous Bedlam, the public could even pay to come gawk and laugh at those kept inside.
SPEAKER_11: People would go and look at the patients as if they were animals in a zoo.
SPEAKER_08: But at the Quaker asylum outside Philadelphia, called the Friends Asylum, Thomas Kirkbride was exposed to something very different. A newer, gentler philosophy of how to manage the people in their care. It was called moral treatment.
SPEAKER_11: And the starting idea was that the mentally ill person was not responsible for his or her illness. Pioneered by a small handful of asylums in Europe, moral treatment was part of a growing
SPEAKER_08: trend among professional physicians who believed that patients didn't have to be confined indefinitely. Instead, they could be treated, even cured.
SPEAKER_11: That meant the person should get enough rest, should sleep on a regular schedule, should eat healthy food, should go for walks and get exercise, should go out and experience nature. All of those things were built into treatment.
SPEAKER_09: Kirkbride worked a few years at the Friends Asylum, learning and practicing moral treatment. Then in 1840, he became superintendent of his own asylum, the Pennsylvania Hospital for the Insane. And it was here that he began thinking about another way to treat insanity.
SPEAKER_08: More specifically, he started thinking a lot about the environment where patients were treated.
SPEAKER_11: Because there was a ward for the mentally ill in the basement, patients were kept in very small cells and I think they were given food, maybe blankets, but not much more than that. And it was in a spirit of reforming that basement ward that Kirkbride tried to think about a new way to treat people.
SPEAKER_09: As part of a push to get patients out of that prison-like basement, the hospital had already commissioned a brighter, more spacious building in the countryside. But Kirkbride came to believe that even this wasn't enough. Specifically, he wished an asylum superintendent like him, who actually treated insanity, had been consulted when the building had been designed.
SPEAKER_08: So a few years later, when he was finally given the opportunity to construct his own facility for the hospital, Kirkbride began to experiment. The architecture of the building, the landscaping of its grounds, the efficiency of its operation, even the demeanor of the staff. Nothing was left to chance. And when he was done, he set down everything he learned in an extremely detailed book called
SPEAKER_09: On the Construction, Organization and General Arrangements of Hospitals for the Insane with some remarks on insanity and its treatment. And it's a how-to book.
SPEAKER_08: A book on how to construct the perfect asylum.
SPEAKER_11: There's an illustration of the model asylum. There are pages and pages about how to design the heating system, what to do about running water. There are descriptions of how to design the windows so that they look like ordinary windows,
SPEAKER_09: but also so they would prevent patient suicides.
SPEAKER_08: Most patients of this era were committed by their families and wouldn't be free to go. But Kirkbride didn't want people to feel like they were in a jail. So the fence around the asylum was also disguised.
SPEAKER_11: So he recommends building a trench, kind of slowly slopes down. Then you put the wall in the trench and then you build it back up on the other side.
SPEAKER_09: That way it still wouldn't be possible for a patient to escape.
SPEAKER_11: Or the word they used was elope. It's not possible for a patient to elope, but you can't see a big looming giant wall from inside the hospital.
SPEAKER_08: But the most striking aspect of Kirkbride's plan for this asylum slash hospital of the future wasn't the windows or the fences or the plumbing. It was the building shape. A shallow V shape like a row of birds in flight.
SPEAKER_09: The V consisted of two diverging series of wards or pavilions. New arrivals would arrive at the administrative building in the center of the V. From there, patients would be first segregated by gender, men going to one side, women to the other.
SPEAKER_08: They would then be segregated by condition, according to four distinct levels of need. Corey Fabian Barrett says that patients requiring the most care would be kept in the pavilions furthest from the center, which meant that as you improved, you'd literally move towards the exit.
SPEAKER_02: So the kind of optimistic philosophy there is you'd show up in terrible shape, you need so much help, you're sent to the fifth building. The magical curative powers of the architecture and the Kirkbride plan and keeping active would make you a little bit better and you'd go to four and then three, two, one, and then you'd walk out the front doors.
SPEAKER_09: Since each of the pavilions would be set back slightly from the last, attendants could easily open windows on all four sides, aiding in ventilation. The narrowed points of contact between sections also protected against fire, making it easier to seal off any one part of the facility from the others.
SPEAKER_08: Nature itself was thought to be curative, and so Kirkbride called for the asylum to be surrounded by parkland. That meant as you walked down the building's tiered corridors with their tall ceilings, in almost every direction you turned, you would see towering landscapes of greenery and sky.
SPEAKER_09: The idea was for the asylum to feel like a Victorian home.
SPEAKER_02: And each ward was supposed to be structured like an ideal Victorian family unit. So they all do everything together. The doctor has meals with them at the head of the table to model an ideal Victorian fatherhood. The nurse, the matron is at the other end of the table, is the mother, and they're all acting like this family.
SPEAKER_08: And if that scene strikes you as a bit paternalistic, that wasn't unusual for the time. A whole moral reform movement was building around the idea that society had a duty to provide care for the less fortunate, much like a father should provide for his children. One of the most famous reformers was a teacher from Massachusetts named Dorothea Dix.
SPEAKER_09: Dix toured the country, counting and writing reports on the condition of what she called the insane poor. She wrote powerful speeches she'd then have men deliver on her behalf. As a woman, she was barred from speaking herself to state legislatures. Nonetheless, one by one, she got 20 states to fund public asylums.
SPEAKER_11: And so they were paid for with taxpayers' dollars. And this was a time when American states didn't pay for much of anything. They barely paid for roads.
SPEAKER_09: Kirkbride and Dix corresponded frequently, allies in the battle to fund asylums. He even included a section in his book addressed to the same officials Dix would have been lobbying. He reminded them that anyone, including them, could go insane. It didn't matter their race or creed or class. Kirkbride called insanity the great leveler.
SPEAKER_08: So when the elegantly titled On the Construction, Organization and General Arrangement of Hospitals for the Insane, with some remarks on insanity and its treatment, hit the stands.
SPEAKER_02: It was wildly popular. It's super dense, if you read it today you can't believe that this was popular, but it was 1854 and people loved it.
SPEAKER_08: Asylums began popping up all across the country. In 1840, the United States had just 18. By 1880, there were 139. Most of them were built with state funds, and were designed in accordance with the Kirkbride Plan. The plan gave an architect everything they'd need to build a beautiful, optimally functional asylum. With their distinctive V-shape, they were soon known simply as Kirkbrides.
SPEAKER_09: Which is how the city of Buffalo, New York ended up with that giant Kirkbride that Corey Fabian Barrett was showing me around earlier.
SPEAKER_02: This building was a result of intense competition.
SPEAKER_09: Any self-respecting American town desperately wanted its own Kirkbride. It would be seen as a source of jobs and prestige. So when the New York Legislature agreed to fund a new asylum in 1865 to serve the western half of the state. There's a huge competition throughout western New York region about where this hospital
SPEAKER_02: is going to go. Batavia, Lockport, Buffalo, a few other smaller towns are all jostling for the bid. Buffalo ends up winning, huzzah, by offering a perpetual supply of free water to the hospital.
SPEAKER_09: The state spared no expense. They hired Frederick Law Olmsted, the co-designer of Central Park, to surround the facility with hundreds of landscaped acres. And one of the great architects of the 19th century, H.H. Richardson, designed the building's exterior, topping it off with two enormous copper-sided towers, almost like the towers of a cathedral. As for what they were for…
SPEAKER_02: That's one of the top questions I get about those towers. Like, what was up there? Like, what were they doing in those towers? And nothing. They were purely decorative from day one. And it is hard, as hard as it is to believe that a state project would spend all that money and effort on two massive decorative towers, that is exactly what they did in the 1870s.
SPEAKER_08: But the exterior grandeur of the Buffalo Asylum was nothing compared to what was going on inside. Hospitals operated almost as towns.
SPEAKER_11: They were cities in microcosm. They had a full complement of everything a small town would need. Kirkbride believed that patients being occupied was key to their recovery, so many asylums
SPEAKER_09: contained full working farms staffed in part by patients.
SPEAKER_02: Cows, pigs, horses, chickens. Yeah, like was it self-sustaining to a certain degree? It was, yeah.
SPEAKER_08: Kirkbrides had bowling alleys, dance halls, and baseball diamonds. One even had a kind of pre-electric roller coaster.
SPEAKER_11: The asylum in Poughkeepsie had a nine-hole golf course.
SPEAKER_09: People could even purchase postcards featuring a lovely drawing of the area's Kirkbride. Like Miss You Darling?
SPEAKER_08: Here's a pastel of a lunatic asylum.
SPEAKER_09: Like literally yes. Asylums had become symbols of civic and social achievement, all resting on the belief in insanity's possible cure.
SPEAKER_08: But from their inception, there was a gap between society's ambitions for these buildings and how the buildings actually functioned. For one thing, the very size of many of the state asylums built in the late 19th century ended up working against them.
SPEAKER_09: Kirkbride had been adamant a superintendent should be able to visit each and every patient so that an asylum should be 250 patients maximum.
SPEAKER_08: But asylum superintendents were under financial pressure. They wanted to increase the maximum asylum size to 600 to take on more paying patients. So at the superintendent's annual meeting, they held a vote.
SPEAKER_09: Kirkbride voted against the measure, but it passed anyway.
SPEAKER_08: So when H.H. Richardson designed the Buffalo Hospital for the Insane in the early 1870s, he designed it for the maximum 600.
SPEAKER_11: So there were never enough attendants, there weren't enough nurses, which ruins all of the aspects of the moral treatment.
SPEAKER_08: But the larger problem was that many patients staying at Kirkbride's didn't leave. From the beginning, the idea had been that patients in any one Kirkbride hospital would soon be cured, continually making room for new patients.
SPEAKER_02: So you're supposed to come here, be here, take in the Kirkbridey goodness for no more than a year, and then you're cured and you go home. This is not how it works in practice at all.
SPEAKER_09: Kirkbride himself claimed that his asylum in Philadelphia had an 80% cure rate. Other superintendents claimed rates as high as 90 or even 100%. But the doctors had been collecting and reporting their own data. So a person who died in an asylum might be counted as cured, while a patient who required a second visit might be counted as two people cured.
SPEAKER_08: The result was that once a Kirkbride asylum opened, it quickly filled up and stayed that way.
SPEAKER_02: People are staying here much, much longer, and they realize that within two or three years of the hospital opening. They're like, you know what, this doesn't work as an acute care facility. We're a long-term care place, and we don't have enough space to be that.
SPEAKER_11: So they became places where people who were very poor and very sick ended up living their entire lives, 20, 30, 40 years.
SPEAKER_09: By the mid-20th century, the buildings had become overcrowded with far more patients than Kirkbride would have ever dreamed. Buffalo's asylum, for example, which recall was designed for 600. At the height of this hospital, which was in the 1950s, there were 3,600 patients living here.
SPEAKER_08: The state mental hospitals constructed during the early 20th century grew even larger, and there resembled institutional buildings like prisons. This was the very thing Kirkbride had wanted to avoid. The largest, Pilgrim State Hospital on Long Island, at its apex, housed over 14,000 patients.
SPEAKER_09: By 1955, more than half a million Americans were confined in state mental hospitals.
SPEAKER_11: So they became warehouses for humans, and they were criticized for causing insanity rather than curing it.
SPEAKER_08: Meanwhile, psychiatrists had turned their focus to curing what were now termed mental illnesses. They focused on physical interventions like lobotomies, insulin comas, electroshock treatments, and eventually chemicals marketed as psychiatric drugs.
SPEAKER_09: In the 1960s, new laws prohibited psychiatric patients from working. Without the contribution of patient labor, many hospitals' infrastructures were brought to a halt. In the 1970s, American state mental hospitals were largely defunded, emptied and shuttered during what was called deinstitutionalization.
SPEAKER_08: The Kirkbride and Buffalo was finally shut down in 1974. Its few remaining patients transferred to a smaller facility next door. By that time, almost everything about the original purpose of these buildings, and others like them, had been forgotten. Asylums were reduced to the role of a pop culture trope, one built entirely out of their last gruesome chapter. Welcome to Arkham, Batman.
SPEAKER_09: Take Batman's Arkham Asylum, sitting just outside Gotham, alone on a hill, with its grand gothic architecture. Don't bother screaming for help.
SPEAKER_01: The white coats can't hear you.
SPEAKER_09: Or the terrifying institutional nightmare of one flew over the cuckoo's nest. May I have my cigarettes please, Miss Ratched?
SPEAKER_09: Which was incidentally filmed in a Kirkbride in Oregon, featuring many actual patients as extras. I heard your question, Mr. Cheswick.
SPEAKER_05: And I will answer your question as soon as you've calmed down.
SPEAKER_08: And then there's pretty much anything from season two of the FX Ryan Murphy show, American Horror Story, Asylum. Please help me, I don't belong here. Is electro shock therapy something you would suggest?
SPEAKER_06: You know what bothers me is when they try to get you to admit that they're creepy places.
SPEAKER_09: Chris Payne is a photographer who's probably been inside more Kirkbrides than anybody else. He photographed 70 abandoned mental hospitals in 30 states for a book called Asylum, inside the closed world of state mental hospitals.
SPEAKER_06: That's a question that gets asked endlessly is, you know, what was it like inside? Was it creepy? Did you see any ghosts? And I didn't find them creepy. And at the very opposite, I felt lucky to be in them and to be able to photograph them.
SPEAKER_09: Before he was a photographer, Chris Payne was actually an architect. So to him that these places used architecture itself as treatment was all the more impressive.
SPEAKER_06: I think that, you know, when you go to architecture school, every architect dreams that their design or their building is going to sway someone, you know, move someone on that level, you know, change their lifestyle, change their mind.
SPEAKER_09: The power these buildings once had to change people's minds, that was part of what Chris wanted to capture.
SPEAKER_06: Because once something's been abandoned for 30, 40 years, and once you vandalize it, once you strip things out, and once things start to fall in on each other, it could be any abandoned building, could be anything. So it was very hard to find those moments that were still intact and that were very specific to this way of life. And so I spent hours, days inside them taking pictures.
SPEAKER_08: And what Chris found is that despite decades of disrepair, the buildings were still beautiful. The light still flooded in through the stately windows. The trees planted 130 years ago had grown tall and graceful. But he also found evidence of what had made Kirkbride self-sustaining. That's for making sauerkraut, a beauty parlor, three dresses handmade by patients.
SPEAKER_09: Seeing his photos helped me imagine a little what life might have been like at these institutions when they were truly operational. They gave me a little glimmer of a group of people whose silence in this historical narrative is always very loud to me, the patients themselves. There's this one photograph of Chris's I keep thinking about. There was a cabinet of toothbrushes at Hudson River State Hospital in Poughkeepsie.
SPEAKER_09: Like dozens of toothbrushes, orange, red, green, blue, pink, each carefully labeled.
SPEAKER_06: And for some reason, when they emptied out the ward, they left this cabinet of this cupboard of toothbrushes, each with the patient's name on them.
SPEAKER_09: The image says, that's how many people once called this place home. That's how many people once hung their toothbrush here. And it says that this is how hastily this space was abandoned. Like wherever these folks went next, they didn't get to bring their toothbrush.
SPEAKER_08: Of the few dozen Kirkbride buildings that are still standing, many are in the process of slowly decaying. They're regarded as public nuisances or expensive headaches. A handful have managed to stay open, though often in a very diminished capacity. A small portion of the building used for some administrative function, while the rest is abandoned.
SPEAKER_09: Some Kirkbrides have been or are being transformed into condos. Another one in Sydney, Australia, became home to an art school.
SPEAKER_08: And then there's the Kirkbride in Washington, D.C., St. Elizabeth's. It's about to become the headquarters for Homeland Security.
SPEAKER_09: As for the Kirkbride in Buffalo, it's not entirely abandoned either. Part of it is now a luxury hotel. Corey Fabian Barrett told me it's an especially popular spot to get married, sometimes because the couple is interested in the history of the asylum. Although other times, she says, they just want a place that looks like Hogwarts.
SPEAKER_09: Strolling the hotel's long, bright hallways, I could sometimes catch a glimpse of the still-abandoned part of the asylum just one wing over. On the building's front were these somewhat menacing-looking, caged-in porches. I'd noticed them when I first arrived, although actually standing in one had been nothing at all like I'd expected. We can go out on the porch, actually.
SPEAKER_02: Oh, this is a porch? Yeah.
SPEAKER_02: Whoa! It's one of my favorite places. Oh! I love it out here. Yeah, so this is a terrace.
SPEAKER_02: Right.
SPEAKER_09: It's not a cage. Yeah, so this is one of my favorite places to bring people on tours because they—I'm
SPEAKER_02: the first one to admit they look terrible from the outside. They do look like a cage. But once you actually stand in them and get out in them, you get a totally different perspective. And you're like, oh, yeah, this would have been a nice spot.
SPEAKER_02: Yeah. This place is cool. Yeah. Wow.
SPEAKER_08: When we come back, we'll talk with writer and reporter Sandy Allen about one small way in which Kirkbride's ideas have remained alive, only this time in a place that is most definitely not abandoned. Stay with us.
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SPEAKER_08: So a few years ago, Sandy Allen came across a story related to Kirkbride's legacy today. And they found it in a place you might not expect, which was at the big annual meeting of the American Psychiatric Association. So a little background, the APA was actually co-founded by Thomas Kirkbride in 1844. And at first it was about a dozen asylum superintendents who would come together to swap information about how to best use their buildings to cure patients. Today the organization is totally different. There are about 40,000 psychiatrists who are members, and they've become pretty entangled with the pharmaceutical industry. So Sandy was at their annual conference, which that year they were having in San Diego.
SPEAKER_09: And they were actually having it at the big convention hall where they do Comic-Con. So it was kind of like going to Comic-Con, except it was all about psych meds. Like on the sales floor, you know, it's like these huge banners, floor to ceiling, like big rotating displays with flashing lights and the logos of this pill and this pill and this pill and this pill and all these nice pretty people trying to talk to you and hand you sweet treats and so on. And you know, it was all this sort of stuff that's focused on how do we like change that one individual who's, you know, perceived as being somehow like errant.
SPEAKER_08: So very different from what we heard about in the story about Kirkbride, which is about moral treatment and this idea that altering a person's environment can really help.
SPEAKER_09: Yeah, exactly. Like and of all the things I saw that day at the APA Fair, there was one little something that did remind me of that older idea of that different approach. It was unlike everything else I saw and it really stuck with me, perhaps literally because I ate it. It was a piece of cheese. And a couple of months later, I went to meet the man who helps make it.
SPEAKER_05: I'm Jose Villegas, originally from Caracas, Venezuela.
SPEAKER_09: So Jose lives and makes cheese at this place called Gould Farm in Massachusetts. And if the APA meeting represents kind of the mainstream thinking in modern psychiatric treatment, then Gould Farm is a great example of how Kirkbrideian ideas remain alive anyway.
SPEAKER_08: So tell us more about Gould and how it has kept some of those ideas alive.
SPEAKER_09: Well, first Gould Farm is a real farm. They've got 700 acres in this super beautiful part of western Massachusetts called the Berkshires. And it was started over a century ago in 1913 by a guy named Will Gould. So this is 30 years after Kirkbride's death. And Will Gould was really Christian and really into the idea that having a place in the countryside that was welcoming toward people who were being outcast from society, that that was his divine mission. And fast forward a century and Gould Farm is really different in some senses. It's much larger, it's better established, it's secular, but it's still today totally focused on that original idea. Having a farm where people with severe psychiatric challenges can stay and work and hopefully recover. So the cheesemonger, Jose, had had a tough life. He had experienced abuse as a kid. He moved to the East Coast about 35 years ago and as an adult he'd been in and out of psych hospitals and he'd ended up very isolated. And eventually a doctor tells him about this farm and initially he was really skeptical.
SPEAKER_05: I was totally a city person and I never thought that I could survive in a place like this.
SPEAKER_09: But when he got to Gould Farm, right away he could tell it was different than other institutions where he'd stayed. So for one, at a regular mental health care facility, usually doctors and staff would be wearing uniforms and at Gould Farm everybody was just wearing regular clothes. There's no khakis and walkie talkies as Lisanne Finston puts it. She's the director of Gould Farm.
SPEAKER_07: We have protocols, we have policies that enable us to respond quickly in an emergency or crisis, to de-escalate. We're licensed by the State Department of Mental Health, but to look around we don't wear all of those things on our sleeve.
SPEAKER_09: Or something else you'd never see at a regular psych hospital.
SPEAKER_07: None of our doors are ever locked. I frankly don't have a key to my office. Our cars are never locked and that goes for all of us.
SPEAKER_09: Lisanne explained Gould Farm is a community and communities are all about trust. So it's definitely not the big iron fence philosophy of mental health care.
SPEAKER_09: Right, definitely not.
SPEAKER_08: So what happens after Jose arrives? He notices it all looks very different, it feels very different, and then what happens next with him?
SPEAKER_09: Well, Jose is a really tall guy and back then he was also really heavy and he'd become really afraid of even trying simple things because he was afraid he might break something or drop something and people might think he was a klutz.
SPEAKER_05: I never had confidence to not even bring dishes from the kitchen into the dining room.
SPEAKER_09: But when a new guest like Jose arrives at the farm, they're immediately absorbed into the farm's daily working life. So maybe they're on the nursery crew, maybe they're in the forest and grounds crew clearing paths.
SPEAKER_07: It might be winter and it's sap season and so you'll be out in the woods tapping trees and hanging buckets and collecting sap and boiling it down into maple syrup.
SPEAKER_09: So everyone at Gould Farm has a job and the entire staff lives there and works there too. Lisanne and her family live on the farm as do the roughly 40 staff members.
SPEAKER_08: And how big is the farm? Like how many patients live there?
SPEAKER_09: Well, for one thing, they're not called patients while they're there. They're called guests, which is a very deliberate choice they've made with the language. So about 40 guests live at the farm at any given time.
SPEAKER_07: The people who come here include people who are managing mental health challenges like schizophrenia, schizoaffective disorder, bipolar, major depression.
SPEAKER_09: These are typically folks who've experienced plenty of the traditional American mental health care system and still, like Jose, have found themselves struggling. But for him, everything changed when he got to Gould Farm and started getting curious about cheese.
SPEAKER_05: You know, at some point I said, can I start making cheese?
SPEAKER_09: He tried it, he liked it, and he got really into it. And cheese takes some commitment.
SPEAKER_05: Getting up at four o'clock in the morning because at that time we used to pasteurize the milk and make the cheese.
SPEAKER_09: For Jose, it was when he was learning to make cheese and gaining the confidence to walk a plate across the dining room or learning to do dishes or learning to cook and taking walks and making friends and just being in this beautiful, natural place that all these things, his self-image started to fundamentally change.
SPEAKER_05: And I started to develop a lot more confidence in myself. I didn't see myself as a klutz anymore or as a social reject.
SPEAKER_09: Jose eventually even worked at Gould Farms' roadside diner, which is another thing that's really unique about this place. So at the diner, guests are servers and cooks. They are dealing with the public, topping off coffees, selling homemade bagels and these big gigantic pancakes. And you can, I think, really hear an echo back to Kirkbride in that idea of giving people meaningful work, helping someone feel like they're competent and useful. It's so unlike the mental health care status quo where people are being shut up in some institutional building, told to wear pajamas all day and play cards. Here instead you've got people who are presently receiving residential psychiatric treatment being given this tremendous challenge of running a restaurant and they are totally kicking butt at it.
SPEAKER_08: And so what's up with Jose now? Is he still a guest at Gould Farm?
SPEAKER_09: He's actually, today he's a staff member at the farm and he's also what's called a certified peer specialist. So he's someone who's done this training and he has this firsthand experience with psychiatric diagnosis, being in treatment, that kind of stuff. And he's lending that expertise to other people who are presently figuring out their own recoveries. So Jose talked to me about how he used to feel like such an outsider, but now he's part of that community. And it's not just the Gould Farm community, but the wider community. There's this relationship between the farm and the town, which also feels very Kirkbridey. You know, locals have histories with the farm. They've had family and friends who've stayed there, worked there. I mean, some people even just go by the cafe for their morning coffee.
SPEAKER_07: There's a way in which the town's history is really intertwined with the farm's history and the farm's history is intertwined with the town.
SPEAKER_09: And I think it matters that people who are in psychiatric treatment and those who aren't are integrated, you know, that we have opportunities to be reminded of one another's humanity. I think it matters whether people who need mental health care have access to tools like supportive environments, opportunities to grow, to work, to socialize, to be outside.
SPEAKER_07: So in a way, what we do here is as old as time. And it's also the case that we know through contemporary research and studies that what we do here is important and makes a difference.
SPEAKER_08: So in the scheme of things, how rare is a place like Gould Farm?
SPEAKER_09: In America, really, really rare. You know, there's Gould Farm and a few others like it, some of which were directly based on Gould. We the taxpayers do spend a lot of money on mental health care, but it is not going towards studying or funding approaches like this.
SPEAKER_07: We don't receive any government funding and there's really no insurance reimbursements for people in a residential program.
SPEAKER_09: They're a nonprofit and therefore reliant on constant fundraising. This is expensive care to provide. That said, the folks I met at Gould seemed really committed to their path. It isn't necessarily easy, but they do feel strongly it's right. And I'm not going to lie, when the situation regarding mental health care in America right now can feel pretty hopeless. So when I get to eat something as special as a piece of Gould Farm cheddar, I'm glad to feel a little bit of hope.
SPEAKER_08: Well, thanks so much, Sandi.
SPEAKER_09: Thank you.
SPEAKER_08: For much more from Sandi about mental health care in America, read their book, A Kind of Miraculous Paradise, a True Story About Schizophrenia. It was published by Scribner and is now out in paperback. We also recommend you check out Sandi's new podcast, Mad Chat. The show unpacks what our pop culture is telling us about madness and mental health. Their latest episode is actually about Batman, the animated series. It's somehow fascinating and funny and important all at the same time. 99% Invisible was produced this week by Sandi Allen and edited by Joe Rosenberg. Mix and technical production by Sharif Youssef. Music by Sean Real. Katie Mingle is the senior producer. The rest of the team is me, Delaney Hall, Avery Truffleman, Emmett Fitzgerald, Vivien Li, Sophia Klatsker, and Roman Mars. We are a project of 91.7 KALW in San Francisco and were produced on Radio Row in beautiful downtown Oakland, California. I cannot do that as well as Roman. 99% Invisible is a member of Radio-Topia from PRX, a fiercely independent collective of the most innovative shows in all of podcasting. Find them all at radiotopia.fm. You can find the show and join discussions about the show on Facebook. You can tweet Roman Mars at Roman Mars. You can tweet me at DAP Hall. You can tweet the show at 99PIORG. We're on Instagram and Reddit too. We have links and pictures of some of the Kirkbrides we talked about at 99pi.org.
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