24. The Hospital

24. The Hospital

(a brief history of Fairfield State Hospital)

Dr. Waldo Desmond had just turned thirty years old when he opened his general practice, in the fall of 1925. He was a native of Connecticut, and had just graduated from Yale University Medical School, after a two-year residency at Connecticut State Hospital for the Insane — but he was ready to move on from treating the mind, and to turn his focus to the body. So he moved to Newtown, bought a house on Main Street — right next to the old crossroads — and set up shop.

It was the era of the third flagpole, when only 2,800 people lived in Newtown, and when most families still supported themselves by farming, or with a job at the rubber mill in Sandy Hook. There were as many horses as there were cars, and light bulbs were still something of a novelty.

* * *

One day, in the summer of 1928, Dr. Desmond came home to find a visitor waiting on his porch: his old boss from Connecticut State Hospital, Dr. Roy Leak. Desmond’s old mentor told him that he needed his help in a matter of great importance: the old asylum in Middletown had always been overcrowded — even during Desmond’s tenure — but just in the three years since his departure, things had grown significantly worse. And the state’s only other mental hospital, in Norwich, was just as bad. Something had to change. Connecticut needed to build another asylum, and they had hired Dr. Leak to help them choose a site.

The state’s needs were simple: they were searching for a spot with “at least six hundred acres of fairly good agricultural land, an abundant supply of pure water, and some proximity to a railway,” along with access to the state’s highways. And they had finally found just such a spot, right there in Newtown: on a hill at the south end of the village, where a wide area of meadows and farmland was fed by the waters of the Pootatuck river, and the locomotives rolled by on the nearby tracks like clockwork. It was just what Connecticut was looking for, and they were ready to buy; now, they just had to sell the townspeople on the idea.

Dr. Desmond tried to envision it; the people of Middletown had welcomed Connecticut State Hospital when it was built there in 1887, and Norwich had followed suit in accepting their own asylum in 1902 — “We had but to signify our wishes, and they were granted” the Governor had said then — so the state could have been forgiven for thinking their path would be clear for a third time. But Newtown was going to be different. Even a latecomer like Desmond could see that: the townspeople had always resisted growth, choosing to retain the atmosphere of a parochial village well into the 20th century. By the late 1920’s, Newtown had matured into a bucolic, vacation-home town; a new hospital campus was not going to be a natural fit.

Even before Dr.’s Desmond and Leak could commence with any official planning, rumors started circulating in Newtown: about a new mental asylum being built, up in the hills. Controversy soon followed. As expected, the citizens worried about Newtown’s reputation, and especially its economy; as a member of the town’s Board of Trustees would recall telling Desmond, of his constituents, “Their idea of a hospital was founded on the ancient traditions of a mad house, a bedlam, and a hospital that was little less than a pest house.”

* * *

It came down to a vote, at a town meeting on December 15, 1928. Expecting a large turnout for such a momentous decision, Newtown opted to hold the meeting in the auditorium of the brand new Hawley School, on Church Hill Road.

When Dr. Desmond arrived that afternoon, he would later write, the auditorium was crowded, and, “The atmosphere was tense and brittle.” He could hear a woman in the audience who was vocally opposed to the deal with Connecticut, predicting that if the hospital were built up in the southern hills, “Newtown will become a ‘ghost town,’ and across the valley will come the moans and screams of patients in padded cells!”

The town fathers agreed. The president of Newtown Savings Bank predicted that an asylum’s presence there would hurt business, and that bank deposits would stall.

He was echoed by a prominent realtor, who stood and proclaimed that “property values would, at least, drop fifty percent.”

Next, a council member warned that the population of the town would dwindle — perhaps to just 1,000 souls — with tax revenue collapsing in-kind; they weren’t just voting on a hospital that day, but the town’s very survival.

Still, the asylum was not without its supporters. In particular, the farmers at the south end of town were eager to sign deals with the state; this time (unlike at Norwich or Middletown), the local land owners would not be giving their property to Connecticut for free. The farmers stood to profit handsomely.

Agreeing with the farmers, many of the younger men in town saw employment potential if the deal went through: both in building the new hospital in the near future, and keeping it staffed in the decades to come.

The debate filled the auditorium, and then splintered into smaller conversations, until finally, a voice in the crowd shouted, “I’d like to hear what Miss Hawley thinks!”

Everyone turned to Newtown’s wealthy and benevolent heiress, seated there among them in the new, modern school she had so generously funded. (Down the street, her latest gift, Edmond Town Hall, had just begun construction.) But as charitable as Mrs. Hawley’s reputation was, something still troubled her about the prospect of living next door to an insane asylum. “I don’t know how to express my feelings,” Hawley said, “but I do know I don’t like it.”

Dr. Desmond watched from the back of the room. Some of the townspeople recognized him in their midst, and began nudging him forward, toward the stage. He started to panic inside, not knowing what he could say to appeal to his still-new neighbors. But somehow, by the time he reached the stage, he had found his voice.

Dr. Desmond waited for the crowd to fall silent, and then calmly told them: the state had no plans to build an insane asylum in Newtown; their plans were for a mental hospital.

To illustrate the nuance, Dr. Desmond shared that as part of his general practice, he had just visited the bedside of a man who had barely survived a bout of lobar pneumonia. “For three days this patient had seen cows in the trees,” Desmond said. “And if one considers the delirium which often comes with high fevers, then the majority of the people in this room have been at these times as mentally ill as the patients in a mental hospital.”

Desmond then addressed each of the town fathers’ concerns directly: to the banker, he predicted that the hospital would bring such growth to Newtown that it would actually become a “two bank town” in ten to fifteen years. To the realtor, he cited statistics showing that property values during that time would not go down, but in fact double. And as to population, the doctor predicted that Newtown would not drift into the ghost-town abyss, but instead grow to over 10,000 souls.

Casting his gaze over the faces of the gathered townspeople, he remembered years later, “I then concluded my speech by saying that new methods of treatments promised more than just custodial treatment, that padded cells were abolished, that new research was so promising that we in Newtown might indeed be privileged and thrilled to be a part of the advancing knowledge of the prevention and cure of the mentally ill.”

His pitch finished, Dr. Desmond strode back the way he came, down the aisle to the rear of the auditorium. He heard scattered detractors cursing him — “You’re through in this town!” and “Carpetbagger!” — but louder, over his shoulder, he heard the votes as they were called: a consensus, building to an ovation. The doctor smiled to himself, as his neighbors officially welcomed Fairfield State Hospital into being, and changed the face of Newtown forever.

ON THE HILLSIDE

Dr. Desmond was there to see the cornerstone lain on June 10, 1931. Presiding over the ceremony was his mentor — and the man who would be the hospital’s first superintendent — Dr. Leak.

Standing in the meadow with them were 200 of Newtown’s citizens, a crowd who followed behind the two doctors as they roamed the hillside and pontificated, visualizing the facilities that would soon appear: Dr. Desmond foresaw a ring of buildings — the psychiatric wards — arrayed in an oval shape, with kitchen and administration buildings in the center. There would be large recreation areas too, and the buildings would be sufficiently spaced so that on a clear day, the sunlight would touch every window.

The inaugural Chairman of the Board gave a brief address, formally dedicating the new hospital’s mission:

For the care and, so far as may be possible, the cure of those unfortunate people whose minds have become deranged with strange fancies and who have lost control over their thoughts and emotions. Here we hope that the pure air and sunshine and the cheerful outlook on nature so abundantly available on this beautiful hillside, combined with modern equipment and skillful treatment, may make it possible to restore to mental health many who have been groping in the fogs of despondency or hallucinations, and that at least some of the gloom and suffering may be driven from the mind of the incurable.

The ceremony ended with a benediction, given by a reverend from St. Rose of Lima Church. Then the townspeople went back to their homes, from where, as the days passed, they witnessed the walls of the mental hospital rise in the southern hills: red-brick with limestone trim (in a colonial style of architecture designed to resemble the campus buildings of Harvard University).

Activity at first centered on just a small section of the oval, as Connecticut was determined to finish construction on the first two patient wards quickly, and get them into operation while the rest of the “ring” was still in the planning stages. Meanwhile, under the surface, crews were digging: there would be a network of tunnels connecting each building’s foundation, hidden underground, so that patients could be moved to and fro in private, according to their needs.

* * *

On June 23rd, 1933, a single motorized bus crested the long hill to the new campus, bearing Fairfield State Hospital’s very first patients: 32 adult males, transferred from Middletown. The schizophrenic or depressive among them were to be treated with techniques that were modern for the era: irritative therapy (medicine is administered that brings convulsions in the patient); insulin therapy (hypoglycemic shock induced by an injection); and hydrotherapy (the patient lies in a “continuous bath” of cold, cycling water, wrapped with wet sheets, and hopefully is calmed as their body cools).

The less-severe cases, meanwhile, would spend time in occupational therapy: there was a sewing room for the women, and a carpentry shop for the men. But the most popular station for both groups was out on the farm; every spring and summer, the people of Newtown would see trucks passing on the streets, filled with patients in overalls and straw hats: men and women on their way to work the fields. The patients looked forward to the harvest all year, and in the fall, visitors to the hospital’s kitchen could see dozens of them seated at long tables, husking corn and shelling peas. There was even a picturesque old colonial-era farmhouse out there, across the meadow, visible from one of the hospital wards; several of the patients found it soothing to paint the scene.

As Dr. Desmond had promised, there were no padded cells installed at Fairfield State Hospital. But a patient would still be put in restraints when things got bad — and if necessary, there were “seclusion rooms”: empty cells, with only a “rough blanket” on the floor, and a single window with a wire screen over it. A patient put in the seclusion room was stripped of all clothing, and the cell door had an unbreakable glass panel, so that the staff could check the patient’s welfare from outside. Meals would be delivered on paper plates, nudged around the briefly-cracked door. The seclusion would often last for many hours. Restraints were similarly harsh, binding the patient by the wrists and ankles. Such measures were considered a last resort, to be applied in two situations: when a patient was going to hurt themselves, or hurt others.

At the other end of the treatment spectrum, there was a “parole unit,” which housed only two kinds of prisoners: those who were about to be discharged, needing only minimal supervision, and those “who, although considered well-adjusted within the protected environment of the hospital, could not adapt to the stress of community life.”

The least-restricted patient status of all was an “extended home visit”: a one-year purgatory outside the hospital walls, but not yet a formal return to society, during which the patient would stay with their family, and be visited by social workers periodically to track their progress. If the patient was healthy after a year, they were discharged.

Some of these patients spent their twelve months in a boarding house, supported with funds that were allocated to the hospital by the state of Connecticut. The state considered this a worthwhile expense; it was the ones who needed to stay in the hospital indefinitely that were the real drain on resources. Each one could occupy a bed for decades.

* * *

Within two years of opening Fairfield State Hospital, Connecticut was asking Dr. Leak to increase capacity by 500 beds; new wards were already set to open around the oval soon, but the overcrowding at Norwich and Middletown could not go on any longer. They would have to find space. So, Dr. Leak ordered beds moved into the cafeterias, onto porches, and even the sewing room — the only buildings on campus they wouldn’t be moving patients into were the employee dormitories.

The new wards opened that spring, but the extra capacity didn’t last. By 1937, all three hospitals in Connecticut were again overflowing, so the legislature appropriated money to build still more wards at Fairfield State — enough for 2,000 more patients — as well as a staffing increase. This expansion brought marked benefits for the patients: Dr. Leak instituted a psychiatric nursing program, staffed with graduate students on loan from local hospitals for three months at a time. The nurses would live on campus, and work closely with their patients every day.

But the expansion came at the cost of a small tragedy for some longtime patients: in order to clear more land, Fairfield would have to tear down the scenic old farmhouse out on the meadow. When the day came, as the bulldozer approached, one patient stood by and read a short verse aloud, expressing sorrow over the loss.

BEDLAM

With the outbreak of World War II, Fairfield State Hospital became a designated emergency shelter. If Newtown were ever bombed, the tunnels under the wards could serve as bunkers. And once the dust settled, any intact buildings would be converted into conventional hospital stations, to treat the town’s wounded.

The draft notices came next. Suddenly, many of the hospital’s male staff members were disappearing from its halls. At the same time, many of the doctors and administrators were leaving to take on positions in the defense industry. To refill its ranks, the hospital had to hire more nursing staff, and began allowing their female orderlies to be assigned to the male wards for the first time. The Selective Service Administration also approved Fairfield State as a facility where conscientious objectors could work in lieu of military service (which also had the fortunate side benefit of easing the hospital’s payroll).

During these years, the patients said that the quality of care at the hospital generally improved. And the range of treatments continued to expand; electric shock therapy was first used at the hospital in 1941, and though controversial at first, the practice gradually came to be relied upon as one of the most effective treatments for depressed patients.

The first military casualties came in 1942. They were the draftees who had been found mentally ill during basic training, men that the war effort could not use. But following soon after would be the combat casualties — men who had gone off to fight overseas, and came back haunted by the battlefield, exhibiting the Post-Traumatic Stress Disorder (PTSD) that was then known most commonly as “shell-shock.”

* * *

Overcrowding continued to be a thorn in the hospital’s side, at great consequence. By 1944, several patients had even died at the hands of other patients; every time, the state’s investigators attributed the security lapse to inadequate supervision, something the state’s voters had given them no money to address.

Bad publicity followed, and public opinion in Newtown began to turn against Fairfield State Hospital. Dr. Leak had expected this: “Never, despite improvement in the past three to four decades, have public mental hospitals really enjoyed good standing in the community,” he told the hospital’s Board of Trustees. “The barrier is psychological and related to persisting distorted concepts of mental disease which accentuate the unpleasant aspects, but fail to recognize the social and economic values in maintaining mental health and restoring the maladjusted.”

After the war ended, Newtown’s men came back to their posts at Fairfield State Hospital. Conscientious objectors were phased out. Meanwhile, in Washington, Congress sought to build domestically upon the lessons that the military clinicians had learned while mobilized for the conflict. They passed legislation that established the National Institute of Mental Health (NIMH), to “provide for, foster, and aid in coordinating research relating to neuropsychiatric disorders.” Soon, it would be up to NIMH to respond to the rapidly growing post-war population of mentally ill Americans.

* * *

Late in 1945, a patient from Boston Psychopathic Hospital was transferred to Fairfield State, having undergone a new and potentially groundbreaking procedure: the frontal lobotomy. Doctors at Fairfield were amazed at the patient’s recovery; once considered severely mentally ill, he was now declared “cured,” and was successfully discharged within one year. Soon, Fairfield began performing lobotomies regularly: a total of 107 patients over the next two years. (Of this number, 35% were subsequently discharged, another 35% were considered “slightly improved,” and 26% percent were “unimproved.” The remaining 4% did not survive the procedure.)

The electroshock therapy program was also expanded, treating 275 patients on an at least weekly basis — some of them, every day. The practice was fine-tuned by then, incorporating muscle relaxants and anesthetic to reduce the pain from the shocks. The treatment was observed to be effective in controlling the behavior of disturbed patients, and it helped many chronically ill patients return to a level of functioning where they could care for themselves.

These more advanced practices would steadily replace the insulin and irritative therapies at FSH. The hospital began rapidly to modernize, attracting more professionals. Medical students passed through in groups of ten, assigned from Yale Medical School to experience a real clinical setting, with modern treatment methods. But unfortunately, the more advanced the procedure, the more nursing staff it required, and consequently, the more modernized that FSH became, the more its resources would be diverted away from day-to-day contact with the patients in its wards.

* * *

On May 3, LIFE magazine printed a bombshell article, “Bedlam 1946.” It was an exposé on the conditions at many state mental hospitals, based on observations from conscientious objectors during the war years. All three Connecticut hospitals came under fire: in one section, the article reported that two FSH guards had been “charged with complicity in two separate beatings of patients, one of whom died.” But it was the overall living conditions observed at the hospitals that shocked readers most.

Connecticut’s mental health system was thrown into a national scandal. In a public letter to the Governor, the United States Representative from Fairfield County made reference to the Nuremberg trials then-ongoing, arguing, “If one-half of the indictments made in this article is true, then we are harboring in our midst institutions that are as unforgivable in civilized communities as Buchenwald and Belsen.” He railed against “inhuman pinch-penny appropriations” in the state budget, and urged funding “in order that our state may not be included among those which have brought shame to our country in the treatment of the helpless victims of insanity.”

In Newtown, the head of the Student Nursing program went to the FSH Board of Trustees, to bring the staffing issues to light herself. She reported that, with the scarce headcount at FSH, even the basic operations of the hospital were under strain. Patients who could not manage their own hygiene showed an unkempt appearance, the length of their hair and fingernails a testament to their neglect. Meanwhile, when the kitchen was behind, some patients did not get breakfast; if they transferred workers from the laundry to make up for it, soon patients were seen sleeping in the same day-clothes, for weeks.

Then there were the truly regrettable measures taken; patients were locked in single rooms, or in “mass seclusion” halls along with several other disturbed patients, without supervision. The Head Nurse told the Board that she viewed the conditions of FSH to run counter to the fundamental practices of nursing: “The test of such service is not whether patients are being secure in locked buildings, but whether they are being given the benefit of care designed to improve their mental health.”

In response to the bad press, administrators at Fairfield Hospital did not waver in their stance: that the patients’ families knew best, and that the vast majority of them said they were satisfied with the care their loved one was receiving at the hospital. And in any case, they couldn’t increase staffing without an increase in taxes, and that would be up to the voters.

The wave of public uproar eventually passed — but not without leaving Americans’ esteem for their mental health system badly damaged. (The only reaction documented coming from the people of Newtown at this time was that they were not so much concerned with the treatment of the patients, as much as they were with ensuring that the patients did not wander from the campus.)

* * *

In 1949, Connecticut’s General Assembly authorized voluntary admissions at all state mental hospitals. Under this statute, a patient could legally sign themselves into the hospital — so that when they wanted to leave, they would just have to give their physician a written notice of their intent to do so. From that point, the doctor would have ten days to — if warranted by the patient’s condition — certify the need to keep them hospitalized, or to initiate probate court proceedings to have them ordered to stay. Otherwise, they were free to check themselves out just as easily as they checked themselves in. t was an arrangement designed to, as much as was possible, shorten the amount of time that a patient occupied a state-funded bed.

THE CURE

In 1954, a revolution came to Fairfield State Hospital. It started in two wards for disturbed women, after a visiting doctor from London was brought on staff: he was there to conduct a research study for a new drug, Reserpine, and his doing so would be the first time in Connecticut that the state authorized a tranquilizer to be used in the treatment of patients.

The doctor chose 80 chronically ill schizophrenics for the study — patients considered by the nursing staff to be difficult to manage, and who had proven unresponsive to other therapies. The results of the study were dramatic: the most responsive patients, 25% of them, were “very much improved” from taking the medicine; another 50% showed varying, but notable, degrees of improvement; only 25% of the patients still didn’t respond.

One staff member wrote of the astonishing change happening before his eyes, after the medicine was administered:

The research wards became quieter and cleaner; in fact, the atmosphere was so changed that they were no longer recognizable as wards for very disturbed schizophrenics. Activities such as church attendance, tea parties, sewing groups, walks, movies, and even bingo parties were now participated in by patients who were previously so disturbed and hyperactive that they required sedation and seclusion. For the first time in many years, they were able to relax and enjoy what they were doing.

The hospital itself began to change into a more home-like atmosphere, with curtains rather than cages on the windows, and upholstered chairs replacing the heavy wooden benches that were once bolted to the floors. The behavior of the patients improved so much that some of the staff called Reserpine the “miracle drug.”

It was indeed Fairfield’s harbinger of a new era, just as lithium carbonate would be in Norwich — a trend that would shortly spread throughout the nation (particularly in the form of chlorpromazine, a tranquilizer sold under the trade name Thorazine); with such medicine available, for the first time, Americans began to embrace the idea that mental illness was something that could be treated effectively… maybe even cured.

The pills reduced the need for more drastic kinds of therapy, too; at Fairfield State Hospital, the use of electroshock therapy began to drop. Patient discharges, and parole placements in the community, went up.

However, even as more patients were being discharged, the still-rising rate of admissions was outpacing them. In the mid-1950s, Dr. Leak made a request to all FSH physicians: that as many patients as possible be changed to a “voluntary” status, the first step in an effort to discharge as many such patients as they could. But no matter what they did, the hospital was always overflowing. The source of the phenomenon seemed to be somewhere outside the hospital’s walls, beyond what the doctors could control.

The congestion at the hospital was aggravated further as psychotropic drugs became the norm, and the logistics of medicating so many patients, multiple times a day, became a nightmare to manage; medicine closets bulged with pill bottles as new drugs came to market, and untrained staff members were responsible for administering medication to upwards of fifty patients apiece. Interns arriving at Fairfield were appalled to see nurses preparing hundreds of doses of medications in the evening, to be administered by another staff member the following day — each dose a violation of a basic nursing principle: that whoever prepares medication be responsible for both administering it, and observing its effect. But the same nurses, as time went on, would confess that this was the only way such a massive amount of medication could be distributed from a central location.

ROSEMARY’S LEGACY

The patient population in America’s public psychiatric hospitals peaked in 1955, at more than 560,000. The overcrowding at Fairfield Hills was not exceptional compared to other states, and it was a situation that could not be ignored any longer. The American Psychiatric Association called for a national commission to “study current conditions and develop a national mental health program,” and legislation answering their call was brought to Congress later that year, co-sponsored by a senator from Massachusetts: John F. Kennedy.

When the work of the Joint Commission on Mental Illness and Health was complete, the experts recommended sweeping changes to the nation’s mental health care system. To reduce both costs and overcrowding, they pushed for a shift away from treatment, and toward prevention — promoting “mental health,” rather than simply treating “mental illness.”

An entirely new infrastructure would be necessary for the vision to become reality; “If the development of more serious mental breakdowns is to be prevented,” the commission wrote, they would require “one fully-staffed, full-time mental health clinic available to each 50,000 of the population.” For such a system to be effective, a clinic would also have to be located in a given patient’s community; at the time, this equated to some 3,000 new clinics being built across the country, with the goal to treat patients “in the community” as often as possible.

The commission took six years to produce their final report, Action for Mental Health. But part of the delay was intentional; the Washington D.C. doctors on the commission wanted to wait until after the 1960 presidential election, anticipating that John F. Kennedy might take the Oval Office — and knowing that if so, he would be particularly compelled to act on their recommendations.

It was widely known, by then, that Kennedy’s oldest sister, Rosemary, was mentally impaired in some way, usually cited as “mental retardation.” However, what was not as widely known was that Rosemary had also been mentally ill; and still another secret, even more closely protected, was that Rosemary had undergone a lobotomy in the fall of 1941. The procedure had been a disaster; the surgeon, having cut too deep, left her worse than before, and thereafter Rosemary would spend her life unable to care for herself, nearly catatonic.

The director of NIMH — who was also responsible for drafting the mental health commission’s recommendations — was among the very few who knew all of this.

On February 5, 1963, President Kennedy delivered a televised “special message to Congress,” broadcast from the Roosevelt Room of the White House. He challenged each legislator to take up the recommendations from Action for Mental Health. “Nearly half of the 530 thousand patients in our State mental hospitals are in institutions with over 3,000 patients, where individual care and consideration are almost impossible,” the president said. “It has been demonstrated that 2 out 3 schizophrenics — our largest category of mentally ill — can be treated and released within 6 months, but under the conditions that prevail today the average stay for schizophrenia is 11 years.”

The new system wouldn’t just be cheaper; it would enable the mentally ill to get better in their own communities. The president predicted that when the recommendations were carried out, it would bring an end to “confining patients in an institution to wither away,” and that “reliance on the cold mercy of custodial isolation will be supplanted by the open warmth of community concern and capability.”

Congress met his challenge, and President Kennedy signed the Mental Retardation Facilities and Community Mental Health Centers Construction Act, in the Oval Office, on Halloween day 1963. This marked the beginning of a process, whereby the federal government took control over what it viewed as a failed state-based mental health care system. With pen in hand, JFK declared:

It was said, in an earlier age, that the mind of a man is a far country which can neither be approached nor explored. But, today, under present conditions of scientific achievement, it will be possible for a nation as rich in human and material resources as ours to make the remote reaches of the mind accessible. The mentally ill and the mentally retarded need no longer be alien to our affections, or beyond the help of our communities.

It was the last public bill signing that President Kennedy would host. Twenty-two days later, he was struck down by an assassin’s bullet while visiting Dallas.

* * *

Whatever vision the late president had for the way the Community Mental Health Centers (CMHCs) were supposed to work, in light of how they turned out, it can safely be presumed that his dream did not come true.

The new system was fundamentally flawed, in that it financially encouraged the closing of state mental hospitals — but did not provide any actionable plan for what would happen to the discharged patients once they were back on the street. And most glaringly ignored were the patients who would refuse to take medicine that was necessary for controlling their condition, and who would now have no watchful presence making sure they took their doses, “in the community.”

Finally, the act paid to build the CMHCs, but it did not fund the centers long-term, and so each state would either have to appropriate new funding, or divert money from their existing mental health budget — away from the state hospitals. The end result for places like Fairfield State Hospital was that beds and staff would continue to disappear, while the discharged patients being ushered out the door would all find themselves the latest subjects in NIMH’s grand community science experiment.

FAIRFIELD HILLS

Forty years after he sold Fairfield State Hospital to the people of Newtown, Dr. Desmond retired from practicing medicine. In the decades since that afternoon at the Hawley School, the “carpetbagger” predictions from of his detractors had been proven wrong. Desmond instead became a local fixture, delivering more than 3,000 babies for Newtown’s families in his private practice, while also serving for more than thirty years as the staff epidemiologist at FSH. And he had watched as his own predictions from 1928 were tested by the passing years, with each coming to fruition: the town’s population had just passed the 10,000 mark, and property values had doubled years ago. All the while, the hospital had never ruined Newtown’s good name; the stigma was as strong as ever, but it stayed largely up on the hillside, with the patients.

For his retirement years, Dr. Desmond chose to remain in Newtown. From his home he would witness further changes unfold, up in the hills.

* * *

Early in the 1960’s, families in Newtown each received a survey in the mail, asking what they thought about renaming Fairfield State Hospital; with the lingering negative aura around state institutions after the “Bedlam” stories, together with the shift from state to federal management of mental health, Connecticut’s legislature had authorized all the state hospitals to change their titles. Connecticut State Hospital was now Connecticut Valley Hospital; Norwich State Hospital had become, simply, Norwich Hospital.

Following in Norwich’s footsteps, FSH’s superintendent (Dr. Leak’s successor) suggested they change the name of Newtown’s hospital to simply “Fairfield Hospital” — that way, they wouldn’t have to spend money on new signs, and stationery; funds were more scarce than ever.

Meanwhile, the surveys they got back from the townspeople weren’t much help; most residents didn’t care what they called the place — as long as it wasn’t “Newtown Hospital,” or anything else with the town’s name in it.

Eventually, the Board voted to rename the facility to Fairfield Hills Hospital.

* * *

NIMH held a conference in Connecticut in 1964, inviting staff from all three of the state’s mental institutions. There, the administrators from newly-christened Fairfield Hills learned that, in order to adapt to their decrease in funding after the 1963 CMHC bill, they would need to fundamentally change how their hospital functioned — and as a consequence, the style of care their patients received.

Ever since the very first busload of new admissions crested Mile Hill Road thirty years before, the hospital in Newtown had functioned by sorting patients into different wards based on four factors: the length of their illness, the degree of their illness, their behavior, and their gender. There was a ward for disturbed women, and another for alcoholic men, and another for geriatrics, and so on, as necessary. The wards for disturbed patients were further segregated, by a graduating order of wellness: a new patient might be considered “acute,” and put in a higher-security locked ward, but as their behavior improved, they would be moved to what the staff informally called the “semi-disturbed ward,” and then to a “quiet ward,” and then finally to an “open ward,” with practically no security, in anticipation of their discharge and release into the community. If at any point their behavior faltered, the patient could be sent back a level, until they could demonstrate improvement again.

This time-trusted approach had its advantages, but its key shortcoming — what made it obsolete in the Community-based era of mental health care — was that it simply took too long. It was too gradual. There weren’t enough beds to sustain it, and there weren’t enough staff. Going forward, it would be vitally important that the hospital get their patients back out the door, as soon as they could.

Under the system NIMH was recommending, wards would be sorted by location: the population of a given building would be determined almost entirely by the county in Connecticut where the patient originated from, without regard for other factors. This meant that disturbed patients, not-so-disturbed, and convalescents would all be in the same wards. And accordingly, all wards would have to be locked.

The good news about “decentralization” was, it would allow the hospital to watch over a greater number of patients, while keeping fewer attendees on staff. Escapees were becoming a concern down the hill in Newtown; that same year, three patients had escaped together and abducted a man from his home, forcing him to drive them to New Jersey. But they were caught shortly after, and fortunately, no one was harmed.

THE PENDULUM

While the patients of Fairfield Hills slept behind their barred windows, the events that dictated the paths of their treatment, and their lives, played out mostly in courtrooms in the nation’s capital.

One night in the fall of 1962, a 60-year-old woman, Catherine Lake, was found wandering the streets of Washington D.C., confused and disoriented. The police picked her up, and took her to D.C. General Hospital for an evaluation; the doctors there found that physically, she was fine — she was just “aged,” and suffering from a “chronic brain syndrome associated with arteriosclerosis.” And, she had a habit of wandering.

A judge ruled that she was “of unsound mind” and ordered her committed to the local mental hospital, St. Elizabeths, against her will. Ms. Lake appealed the ruling, arguing that she was not a danger to anyone, nor herself. She wanted to be released.

Four years later, in a landmark decision, the Chief Judge on the D.C. Circuit Court of Appeals ruled that St. Elizabeths could only keep Lake there if the state had attempted to find a “less restrictive” placement (such as a halfway house, nursing home, outpatient clinic, etc.) for her, in the community, without success. With that, the concept of the “least restrictive environment” entered the legal lexicon. Still to this day, any psychiatrist performing an emergency evaluation of a new “non-dangerous” patient is legally required to recommend them to the least restrictive level of treatment that will be suitable to meet their needs. The same doctrine is followed in institutions of every sort, from public schools to prisons.

* * *

On another night in D.C., in 1962, an 18-year-old petty criminal named Charles Rouse was spotted by a police patrol. He was standing on a street corner, carrying a heavy suitcase, and the officers recognized him from previous arrests. They stopped Rouse, and searched him (which Rouse would later argue was unlawful) and discovered he was carrying a fully-loaded .45 semi-automatic pistol. Inside the suitcase, they found more than 500 rounds of ammunition.

They arrested Rouse under the charge of possession of an unlicensed pistol, which carried a sentence of up to one year in prison. But doctors determined he was “suffering from a passive-aggressive personality disorder,” and that the gun offense was “a product of this mental illness” — so Rouse avoided prison, and got committed to St. Elizabeths Hospital instead.

This might have seemed, initially, like a light sentence — except there was no term to serve. Hospital stays were indefinite.

Years passed, but Rouse couldn’t get discharged. He filed a petition for habeas corpus, and when the case again came to a hearing, the judges on the higher court were sympathetic to his plight:

Of course I strongly disapprove of anybody carrying a .45 automatic unless he is in uniform and on duty, and of anybody carrying 500 rounds of ammunition, but, certainly, that is not a symptom of insanity, Doctor, because many sane people do those things. […] You know, we just couldn’t accept any psychiatric testimony or theory to the effect that the commission of a crime is a sign of mental disease, because if we accepted that our whole system of criminal law would have to break down.

Still, the court found that Rouse was indeed mentally ill. No, he wasn’t getting better, but that was beside the point. He was denied habeas corpus, and sent back to St. Elizabeths. But Rouse would then appeal that decision all the way to D.C.’s federal court — and the same judge who had ruled on the Lake case.

This time, the judge ruled that every confined patient had a “right to treatment” — if the hospital couldn’t treat Rouse, then they also could not hold him against his will.

The consequences of this decision, for the country, soon became apparent: there really would be no more “custodial care.” Hospitals would either treat their patients, with measurable results, or they would have to let them go. But as staffing levels continued to dwindle, rather than ensuring effective treatment of the mentally ill, the “right to treatment” encouraged hospitals to simply release the patients who were most resistant to treatment — the ones who, in another era, were deemed to need custodial care the most.

* * *

In 1965, Congress took under consideration a series of amendments to the Social Security Act that would create a new sub-program, called Medicare. It was to be completely funded by the federal government, to provide care for citizens over the age of 65. (The very notion of such a program was highly controversial at the time, considered by critics to be “socialized medicine.”)

Late in the process of passing the amendments, one senator, from Arkansas, tacked on what seemed like an insignificant addition: the “Grants to States for Medical Assistance Programs” — usually referred to thereafter as Medicaid. Arkansas was one of the poorer states, and this program would arrange for the federal government to match the state’s funds when they paid for their citizens to receive care — regardless of their age, unlike Medicare — if the patients did not have the resources to pay for it on their own.

Medicaid was never intended to pay for mental health care. In fact, the bill’s author specifically tried to rule that out, designating the federal funds to only be paid out for nursing costs “other than services in an institution for mental diseases.” At the same time, this definition meant that Medicaid could still pay for “community-based” care — and so, the incentive to move chronically ill patients out of the hospital, a trend already gathering momentum, grew even stronger: every day that a Medicaid patient spent in the ward was one that the state would have to pay for, but once they were discharged, the patient would become the federal government’s responsibility.

* * *

States tried to find ways to adapt to the new era. Alabama paid for their Medicaid-exempted patients through a special tax on cigarettes, and that proved effective at keeping their hospitals staffed for years — right up until 1970, when the state decided that cigarettes had gotten to be too expensive, and cut the tax. Soon after, hundreds of psychologists and other State hospital employees were getting laid off.

In response, the staff at Bryce State Hospital in Tuscaloosa filed a class-action lawsuit against the state of Alabama, on behalf of a 15-year old patient at the hospital, named Ricky Wyatt. He was a “juvenile delinquent,” whose probation officer had decided he should be committed, but the hospital argued they were not able to provide him adequate care with their reduced staffing levels — one nurse for every 250 patients.

The judge from Alabama agreed, and the resulting Wyatt v. Stickney decision would again shake the foundation of the state mental hospital system in America: it held, for the first time, that the “right to treatment” meant that every single involuntarily committed patient was entitled to care that would “give each of them a realistic opportunity to be cured or to improve his or her mental condition.” The basis for this ruling was found in the Constitution, the judge wrote, because, “To deprive any citizen of his or her liberty upon the altruistic theory that the confinement is for humane therapeutic reasons, and then fail to provide adequate treatment, violates the very fundamentals of due process.”

His decision went on to establish, in detail, exactly what the “minimum standard” of care was that hospitals were obligated to provide: there was to be one toilet for every eight patients, and a shower for every fifteen. There were dietary requirements for the food, temperature ranges for the heat and air conditioning (“not to exceed 83°F nor fall below 68°F”), and a minimum number of doctors, orderlies, typists, dentists, repairmen, cooks, and more, for every 250 patients. And going forward, each patient, in every hospital, would have to have an individualized treatment plan.

To the hospitals, what this all meant was that care, per-patient, was going to get much more expensive, or else it was going to be nearly impossible to confine someone — unless they were considered a danger to others, or to themselves. And unless the states found more money to run the hospitals, there was still only one surefire way to reduce costs without reducing the standard of care: discharge more patients.

DOWNHILL

In Newtown, by the 1970’s, it was becoming apparent to residents that something was wrong up at the old hospital. The kinds of patients coming down from Fairfield Hills seemed to be changing; escapees, always a concern, suddenly carried more frightening implications.

In 1971, a patient wandered off the campus, and into a Newtown home. He encountered a teenage girl in her bedroom, and held her at knife-point, demanding money and transportation.

In 1972, a just-discharged patient came down the hill and raped a 15-year-old schoolgirl.

Later that year, a few more patients broke out — just to jump onto the train tracks when they heard the locomotive coming. The rails had gone by the campus ever since opening day, but it wasn’t until 1972 that the hospital had to install a high fence, to stop anymore such “incidents.”

In 1973, a patient in her twenties was found dead in one of the wards, having rolled her nightgown into a rope, which she then tied around a window-hook.

As stories continued to fill the newspapers, the townspeople started demanding answers. What was going on up there?

A representative from the hospital employees’ union spoke to Connecticut’s Sunday Herald, and blamed it all on the chronically low staffing levels. “Security at the hospital should be at a maximum, not at a minimum as it is operating now,” he said, highlighting the danger that was only now becoming evident to the outside world:

It’s a very peculiar situation there. The administration says it is mixing the assaultive patients with the non-assaultive patients on the premise that some of the good points of the better patients will wear off on the worse patients. But in fact, in my experience it seems to be working in reverse, and the bad is wearing off on the good… Most of the wards are very dangerous now, both for patients and employees because of the inter-mixing of different types of patients.

In response to the latest round of bad press, and the outcry from the community, the Superintendent of Fairfield Hills held a joint press conference with Newtown’s first selectman, and the two men pledged a number of security upgrades. First, they would establish a phone system for the townspeople, to alert the hospital of any “wandering patients,” and the operators would be trained to watch for “disguised calls” (ones coming from captive residents, who have an escapee in their house watching them, and have to pretend to be cancelling plans with a friend or some other ruse). The hospital would also shift some of its budget to hire more guards, who would run patrols around the campus in a station wagon at night, rounding up any escapees they spotted.

The town’s first selectman, for his part, made five of the senior security guards into honorary Town Constables; under the state’s regulations, until then, the guards had no authority outside of the campus boundaries, and so had no power to retrieve patients who made it all the way into town. The title of Constable allowing them to cross the threshold from the hospital into the community, and bring the wandering patients back up the hill.

* * *

In Florida, a retired couple was enjoying a rare visit from their 48-year-old son — a man named Kenneth Donaldson, who had been diagnosed with paranoid schizophrenia many years before. He hadn’t had any sort of episode in a long time, and seemed to be supporting himself just fine — but midway through the visit, he started mumbling about his neighbors poisoning his food, or plotting to slander him. The stuff he used to talk about during the bad times.

Concerned, his father called the police, and signed an “inquisition of incompetency,” authorizing them to arrest his son. Donaldson was committed to Florida State Hospital, and re-diagnosed as a paranoid schizophrenic; the judge who signed this commission order stated that Donaldson was “being sent to the hospital for a few weeks to take some of this new medication,” and that he was sure Donaldson would be “alright soon.”

15 years later, Donaldson was still trying to get out. Florida State Hospital was dangerously understaffed (the minimum standards established by Wyatt taking years to be fully implemented), and he was put in a ward with over 1,000 patients — many of them violent criminals — with only one doctor to treat all of them.

From the day he arrived, Donaldson demanded to speak to a lawyer, insisting that he was no longer mentally ill, and that even if he was, Florida was not providing him any treatment for it anyway. He wasn’t dangerous, so they had to let him go. But the hospital rejected him at every turn; while they admitted they were not providing him any treatment during his confinement, they argued that the mere condition of being confined — the “therapeutic milieu” of the hospital — was itself a form of treatment. Donaldson was trapped.

O’Connor v. Donaldson made it to the United States Supreme Court in 1975. The court’s decision on the case was unanimous, affirming that a diagnosis of mental illness, alone, “cannot justify a State’s locking a person up against his will and keeping him indefinitely in simple custodial confinement.” It didn’t matter if the diagnosis was accurate or not; “There is still no constitutional basis for confining such persons involuntarily if they are dangerous to no one and can live safely in freedom,” the court ruled.

To clarify their decision, the justices volunteered an answer to a question they immediately anticipated would arise from the lower courts:

Q. May the State fence in the harmless mentally ill solely to save its citizens from exposure to those whose ways are different?

A. One might as well ask if the State, to avoid public unease, could incarcerate all who are physically unattractive or socially eccentric. Mere public intolerance or animosity cannot constitutionally justify the deprivation of a person’s physical liberty. In short, a State cannot constitutionally confine, without more, a nondangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends.

The state courts would be left to interpret the meaning of the clause “without more” for the next 40 years.

THE ASSASSIN

On the morning of August 13, 1981, President Reagan sat down to a table outside of his California residence, Rancho del Cielo — “Heaven’s Ranch.” With his black dog Lucky at his side, he signed the latest Omnibus Budget Reconciliation Act into law, and thus implemented historic tax cuts.

A thick fog bank had just rolled across the Santa Ynez Mountains, and through the haze enveloping all of them, the president said to reporters that the sweeping changes he had just made to the federal budget were “a turnaround of almost a half a century of a course this country’s been on,” and marked “an end to the excessive growth in government bureaucracy, government spending, government taxing.”

One major feature of the new budget was that it completely overhauled the federal funding of mental health care in the United States; it took all of the funds normally allocated to the Community Mental Health Centers, and — after first slashing it by 26% — simply block-granted the remaining cash to the states, for them to spend on services however they saw fit. Reagan’s signature that foggy morning thus marked the end of JFK’s vision; the new era, that had begun not twenty years before with Kennedy’s vision to “make the remote reaches of the mind accessible,” was already dead. Instead, Rosemary’s legacy had amounted mostly to a drawn-out mass-closure of state hospitals, and a steady movement of patients into the community, where they would rely on a threadbare net of mental health services that varied from state to state: “de-institutionalization.” The modern era of American mental health care had arrived.

As the ink dried on his signature, President Reagan took questions, handling the back-and-forth with ease; five months had passed since he was shot outside the Hilton, but he had been back on the job after just two weeks. His friend Jim Brady would have a much longer road to travel.

* * *

The gunman who was arrested outside the Hilton pleaded not guilty by reason of insanity, and news coverage of his trial would be, for many Americans, their first exposure to how their criminal courts dealt with issues of mental illness.

In one session, the shooter’s mother took the stand, and fought back tears as she recounted how her son kept failing to make it in the real world, moving back home again and again, his spirits darkening with each turning of the cycle. Though his parents didn’t know the details of his interior world at the time — like his obsession with the actress from Taxi Driver — they could see him falling apart. “He just seemed to be going downhill, downhill, downhill and becoming more withdrawn, more and more antisocial, more depressed, and so down on himself,” his mother sobbed. “We didn’t know what was wrong, but we knew something was not right.”

The defense explained how the young man’s family had sent him to a psychiatrist in their community, and how when that doctor asked him how he felt, the young man replied that he suffered from “severe anxiety attacks” and “unparalleled emotional exhaustion” — and that recently, “[his] mind was on the breaking point.” Separately, his mother had told the doctor she was worried about her son, worried that he might take his own life, and that she wanted to have him committed to a mental hospital.

“No, don’t do it,” the community psychiatrist told her. “It will really make a cripple out of [him] if you put him in an institution.” He told the woman that her son didn’t have any serious mental illness; he was just depressed, and what he actually needed was to get his life together, and move out of her house. He said she should give her son an ultimatum: if he isn’t working and saving for an apartment by the time her chosen deadline came, she would throw him out on the street.

She followed the advice, and her son stormed out. When the deadline came, she turned on the television, and saw him shooting the president.

The gunman’s defense team would significantly blame this community psychiatrist for what happened, calling his guidance “totally inappropriate, [and] in fact harmful… an absolute calamity.” Meanwhile, they hired four of their own doctors to examine the shooter; though they all came back with a different diagnosis, all four could agree on one thing: he was insane at the time of the shooting. That meant he could not go to prison for it.

* * *

Of course, the prosecution argued that this was all hogwash; that the community psychiatrist had in fact been correct in his assessment all along, and the assassination attempt had only proven it. Plus, the prosecutors had their own expert witness, one who had interviewed the shooter several times in his prison cell: a forensic psychiatrist named Dr. Park Dietz.

In Dietz’s expert opinion, the gunman’s real motive was simply his “longstanding interest in becoming famous without working.” He had been obsessed with assassins since he was nine years old — when his family lived in Dallas on the day JFK was shot — and now he “liked the idea of fame without following rules… [He] didn’t want to be an accountant or an insurance salesman.”

Reviewing the shooter’s life choices, Dr. Dietz had to concede, “These are not the reasonable acts of a completely rational individual” — but that was still a far cry from being outright delusional. His own diagnosis of the shooter amounted to several relatively common mental disorders — foremost among them, Narcissistic Personality Disorder. Dietz said that this amounted to “falling in love with oneself,” and “preoccupations with fantasies of success and fame,” along with a lack of empathy. Meanwhile, the young man was not truly “schizophrenic,” but more likely showed a “schizoid personality disorder,” or what Dietz called “the loneliness disorder.” It manifested as a marked lack of friendships throughout life, an inability to interact, and “emotional coldness and aloofness.” He said this disorder was quite common among “cowboys, forest rangers, and others who choose solitary occupations.”

The gunman’s other disorders fell along these same lines; nothing that would impair anyone’s understanding of right and wrong. Dietz then introduced one last aspect of the crime that demonstrated the gunman was in fact sane — simply that, despite not taking anyone’s life, his plan had been successful. After all, the shooter had left for the Hilton that morning knowing that “no crime carries as much publicity as the assassination of the President of the United States,” and the fame he achieved in those 1.7 seconds, “is by no means a delusion, it really happened. He did indeed become a famous criminal.” His objectives were “odd, and in the lay sense, crazy,” but still his goal “was indeed reasonable, because he accomplished it.”

The gunman had even told Dietz as much, himself. “It worked,” he said from his prison cell in the days after the attack. “You know, actually, I accomplished everything I was going for there. I should feel good, because I accomplished everything on a grand scale.”

As Dr. Dietz was testifying, across the courtroom, at the defense table, he could see the shooter, locking eyes with him and silently mouthing curses. The reporter for the New York Times could see it too. Everyone could.

The prosecution wrapped up. In their view, it wasn’t even all that complicated a concept: some people are willing to do evil things for fame, and that does not make them crazy. It makes them evil.

* * *

The jurors looked visibly exhausted as they went into seclusion. By the end, they had watched a total of seven different psychiatrists take the stand, each of them saying that another of their colleagues was dead-wrong; at times, the very practice of psychiatry itself would appear to be the real entity on trial. Even the judge sounded overwhelmed, remarking, “I think there is either enough to guide the jury, or to confuse the jury.”

After four days of deliberations, they had a verdict: not guilty, by reason of insanity. The gunman was to be committed to St. Elizabeths Hospital, where he would remain until he was no longer considered a danger to himself or others; and if that day ever came, he would be released, a free man.

The courtroom, and the nation, were stunned.

Shock soon gave way to anger; almost immediately after the verdict, lawmakers started talking about raising the bar for the insanity defense. There were Senate hearings, where the jurors from the case expressed frustration about the position they were put in, saying the shooter “contradicted himself so much and made fools out of a lot of psychiatrists, so how are we going to figure out what was his problem?”

Trying to defend their profession, the American Psychiatric Association announced their support for reforming the insanity defense, reminding that, “Psychiatrists are experts in medicine, not law,” and that “insanity is a legal construct, not a medical concept. It is a label that says society wants this person institutionalized. Society, not psychiatrists, should make such judgments.”

A committee came up with a new version of the law, which would establish that an “insane” defendant had to be “unable to appreciate the nature and quality or the wrongfulness of his acts,” and then specifically stated that “mental disease or defect does not otherwise constitute a defense.” The new law also shifted the burden of proof — off of the prosecution, onto the defense.

When the legislation was ready, President Reagan introduced it from the briefing room of the White House: “These measures will simplify the justice system and make it more likely that those who commit crimes pay a price. The American people want a system of justice they can understand and they can have confidence in. That is our goal as well.”

A reporter asked if the verdict itself, against the president’s own attempted assassin, played any role in his endorsement of the bill. Reagan — who had just stated that he would not be answering questions on that particular afternoon — simply grinned, and shook his head “no.” The bill became law soon after.

* * *

President Reagan contacted the superintendent of St. Elizabeths in 1983, hoping to forgive his attempted assassin in person. However, he said, he did not want to do anything that was not in the patient’s best interest.

In response, a hospital official told the president that it would be best if he stayed away; the gunman had been diagnosed with paranoid schizophrenia, after all, and such a meeting was not going to help him in recognizing his delusions of grandeur.

Six years later, on Reagan’s final day in office, aboard the plane usually called Air Force One, as it shuttled him to a surprise welcome rally on a tarmac in Los Angeles, Reagan reflected on the troubled young man who had thrown his life away, just to harm him: “My thoughts about him after he did it was when I was praying for my own recovery. I prayed that he’d recover too, that whatever caused him to be that way, that he would be cured.” Reagan added with regret, “I don’t know that he has been; I understand he’s still in the hospital.”

LAST DAYS

In 1988, the United States Congress passed an amendment to the Social Security Act, narrowing the “Medicaid exception” so that the program would not pay for “a hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care and related services.”

It was just one last blow to the system; by the late 1980’s, state hospitals were disappearing.

Fairfield Hills held on longer than most, adapting to house tuberculosis patients, or alcoholics, or drug addicts in its final years — whatever they could find funding for. But it was a losing battle; for a facility as big as Fairfield Hills, the best that Connecticut could do was to delay the inevitable.

As funding disappeared, wards along the oval started to close, and the state resorted to using some of the retired buildings as office space. One of the tenants to pass through was a team of land inspectors: the townspeople saw them wading down to the aquifers of the Pootatuck River, and scooping water into test tubes, evaluating the suitability of a leftover portion of the land that Connecticut had bought from Newtown back in the 1920’s. It was a spot across the long meadow, and down the eastern slope from where Fairfield Hills’ cornerstone was lain; the state’s Department of Corrections had plans for a building site there.

Newtown didn’t want a prison, and many of its citizens were outraged at the proposed site’s proximity to Fairfield Hills. The townspeople held a protest rally at the site, where the Newtown High School marching band played, as more than 500 citizens chanted “Mental health and jails don’t mix, Fairfield Hills is not the fix!”

One of the organizers read a letter to the crowd, written by “Michael,” a patient at Fairfield Hills. “I stand here alone, rejecting my confidentiality and my stigma to present my thoughts,” said the man in the hospital up on the hill. “As the mentally ill, we are already prisoners. Prisoners of our minds. The jail comes too close to our fear that we are bad. At Fairfield Hills, we will put forth the effort to get well. Please, no jail.”

The rally’s organizer then turned to the crowd and promised: “The state is going have a fight on their hands.” Soon, the townspeople voted to set aside $150,000 in tax revenue to take Connecticut to court, and to do whatever they could to block the prison’s construction. As their representative in the state senate told the New York Times, “If they are totally incensed, hell hath no fury like the people of Newtown.”

But the state wasn’t intimidated. “Lawsuits can do anything,” one official said, “but we don’t think anyone could dispel the fact that the state needs new prisons.”

* * *

By the end of 1989, two thirds of Newtown’s legal war chest had vanished. Meanwhile, Connecticut had only sweetened their offer: the state agreed to pay for a new sewer system and police cars for Newtown, and to subsidize a new nursing home, if only they could abide a state prison in their midst. But the town still said no.

This time, the state ignored them, and starting moving ahead with construction anyway.

Desperate to stall, Newtown’s first selectman ordered emergency repairs of the access road leading to the prison’s construction site — the resulting traffic detour blocked the path of the cement trucks the state had hired, thus buying Newtown one more day. But it was no use.

Out of legal options, Newtown cut a deal. The prison — Garner Correctional Facility, officially — would be built after all, right where Connecticut said it would be, in the shadow of Fairfield Hills. But in exchange, the state would give Newtown a million dollars a year (in lieu of property taxes). The town would get its infrastructure upgrades, too. And then, a cherry on top: nineteen acres of land right at the north end of the Fairfield Hills campus, where Mile Hill Road turned into Wasserman Way. The area was mostly just a sloping, empty field, but now, the village could do with it as it wished.

As for the remainder of the land Connecticut had bought so long ago, and the old hospital built on top of it, Newtown would get the right of first refusal, so that one day, when the state inevitably put the assets back up for sale, Newtown might reclaim its southern hills.

* * *

The nursing staff looked on, as the last of their patients boarded the final bus out of Fairfield Hills. Across the half-mile meadow, and down the hill, the barbed-wire-strung walls of Garner Correctional Facility were already rising.

The staff knew that some of their patients would be transferred, sent off to join the remaining state population at Connecticut Valley Hospital, while other patients were just heading home, to their families and support communities — but as for the rest, the nurses weren’t sure just where they would end up.

Finally, on December 8, 1995, Fairfield Hills Hospital — formerly Fairfield State Hospital — closed its doors for good.

* * *

The old hospital stood vacant, vines of ivy curling through its boarded windows. Every once in awhile, a movie production would come to town and set up their gear at Fairfield Hills, when they needed a scene in a spooky old mental institution. And Connecticut still posted guards on its property, just to keep out the curious teenagers and occasional ghost hunters. But their patrolling flashlights at night were the only regular activity to be seen. On most days, the oval with the red brick buildings was just a part of Newtown that passed by a car’s window from up on the hillside, stuck in time: a lingering memory, waiting to be forgotten.

THE FUTURE OF NEWTOWN

The organizers of the June 6, 2001 town meeting knew there was going to be a big turnout; instead of the old meeting house, they opted to hold the event in the auditorium at Newtown High School, so that everyone could be there to cast their vote. Sure enough, when it was called to order, that town meeting turned out to be the biggest crowd most anyone in town could remember. And although there would be only two issues on the ballot that night, together they amounted to answering just one question, the one everyone wanted a say in answering: What should become of Fairfield Hills?

Months before, Connecticut had finally notified Newtown that they were ready to sell. As the townspeoples’ representative in Congress told the New York Times, the oval campus was “like a pearl right in the middle of town — a big one.” Accordingly, the price tag they were voting on was quite large for such a small community — $21 million.

But, as the first selectman explained it to the crowd in the auditorium, Newtown wasn’t quite so small anymore. The fact that they had outgrown their infrastructure was most evident at Edmond Town Hall, the nerve-center of local government that Mary Hawley had gifted them 70 years before; today, they were on the verge of having to shut it down unless they got the building back up to code. And the overcrowding in their public schools was illustrated vividly on the town’s ball fields, where the sod was shredded from the constant traffic of cleats. The town needed to invest in its future now — so the first selectman told them — and the $21-million-dollar package wouldn’t just cover the land purchase; it would chart Newtown’s path into the 21st century, a course that could pass right through Fairfield Hills, if enough townspeople supported it. Once they bought it back, the land could be retrofitted into whatever the town needed — and besides, if Newtown didn’t buy Fairfield Hills, someone else eventually would: “The most important thing for people to think about is that this allows us to control our destiny by controlling what happens on that campus,” the first selectman concluded, handing over his microphone.

The townspeople started debating, passing around the mic. It looked like the proceedings could go on for hours.

But the fate of Fairfield Hills had already been argued around every corner in town, for years; it was time to make a choice. After a few more voiced their positions, the mic was passed to a young woman from Sandy Hook with dark hair, who said simply, “We don’t wanna be here ‘til midnight.” She motioned for the vote to be counted, then and there. And it was.

Narrowly, the town approved the first selectman’s plan. All of the acreage that Connecticut had purchased from the farmers in the 1920s came back into the village’s hands. The pearl was finally restored, and Newtown’s path to the future was set.

* * *

The other vote that night concerned the land just across from Fairfield Hills — a small parcel that the town already got back from Connecticut, as part of the deal when they finally let the state build the prison down the hill.

The plan for it was put together by the long-serving Superintendent of Newtown School District, Dr. John Reed. The price tag Reed had submitted — $27 million — was even higher than the one for Fairfield Hills, but the more significant difference was, nobody in the auditorium could dare deny that this one was urgent: Newtown needed a new school.

The town’s reputation as a “great place to raise kids” had spread so far and so wide that it had become a burden; their four elementary schools were all over-capacity, and every year, all four sent another batch of kids to crowd the halls together at Newtown Middle School — the town’s only public school for 6th, 7th, and 8th graders.

Dr. Reed’s plan was to build a bridge: an intermediate school that taught all of the town’s 5th and 6th graders. It would ease the students’ always-fraught social transition to middle school, while at the same time alleviating the crowding at both ends of the bridge.

Some doubted the plan’s effectiveness. They preferred building a second middle school, or expanding one of the existing elementary buildings. Something less disruptive. In the lead-up to the town meeting, one such justification for a scaled-back solution was advanced by a Newtown Bee “Letter to the Editor”:

We realize this is not as efficient as putting all 5th and 6th graders in one school, but we think one of the many lessons from Columbine is that our children are not cars and our schools are not factories. They need a sense of community to thrive. They need to feel that they belong. They need to spend their days in a place where they are known. It’s hard to get these things when their 5th grade class is one of nineteen 5th grade classes in a building that they are only in for two years.

Dr. Reed had been around a long time. He was the longest-serving school superintendent in the state, and he had learned to be patient with Newtown. But at the last moment, even he was experiencing doubts about the town’s acceptance of his vision.

When the votes were called, and his plan was approved, Dr. Reed sprang to his feet, overcome by the fulfillment of his wish, and he embraced everyone around him, from the school board members, to the voters, to even a reporter from the Newtown Bee. “Now we have to go out and get a wonderful school built,” he told the local journalist, as written in the next morning’s edition. “I’m euphoric, but we’ve got 18 big months ahead of us.”