Annie's Ghosts

by Steve Luxenberg

  In 1929, the same year that Gruber had reviewed Eloise’s building plans and found them inadequate to meet the hospital’s expected growth, the Michigan legislature approved a major new construction program to increase the number of state mental hospital beds by about 25 percent, aiming at an eventual total of 250 per 100,000 population. Four years later, in the depths of the Depression, the legislature rescinded the measure, settling for 182 beds per 100,000. A collective groan went up from the harried superintendents of the state’s mental hospitals and three training schools for the feeble-minded, who had envisioned 375 beds per 100,000 as the right number to eliminate overcrowding and handle the growth that they anticipated in the next ten years.

  As Michigan’s largest county, Wayne had the most mentally ill patients, and the state had always relied on Eloise to take care of the bulk of the Wayne county caseload. Essentially, a partnership had evolved, a partnership that benefited both parties, at least on paper: For decades, Michigan law had treated Eloise as a state facility for all intents and purposes, subject to the same regulations, and because Eloise was providing a service that would otherwise fall to the state, Wayne County received a reimbursement for patients who remained at Eloise longer than a year. Other counties weren’t taking care of their long-term mentally ill, the thinking ran, so why should Wayne County?

  But the reimbursement never quite matched the cost, and when the Depression hit, Gruber and his staff feared that at the very moment when Eloise needed more resources—for various critical improvements and to take care of the city’s swelling homeless population—money would begin to dry up. Eloise officials recognized early on that the Depression, as devastating as it was, could be a boon; the Roosevelt administration was determined to put the country back to work, and it was handing out money, lots of it, for public works projects. Eloise and Wayne County set out to capture some of that New Deal cash, and succeeded. By 1937, Gruber could report the completion of more than three dozen projects, including new water and sewer lines, an addition to the dairy barn, alterations to the Rouge River to prevent flooding, and repairs to the underground tunnels that ran, labyrinth-like, beneath much of the complex. The cost of these improvements? More than $1.2 million, with the federal government picking up nearly 80 percent of the tab.

  By the dawn of the 1940s, though, with the national economy improving and the war in Europe occupying the Roosevelt administration’s attention, the amount of public works money coming from Washington had dwindled to almost nothing. Eloise needed to look elsewhere for help in paying for the upkeep of its now enormous campus. Eloise continued to chafe at the state’s reimbursement rate for the 3,500 or so mentally ill patients who had been at the hospital longer than a year. The rate kept rising—from 95 cents a day in 1940, when Annie arrived, to $2.35 by July 1945—but it was never enough to match the actual cost, the hospital contended. Eloise tried to send more patients into the state system, but those institutions were just as crowded.

  There was one bright spot: Eloise’s infirmary and homeless population had declined, the result of the improving economy and a tighter admissions policy, allowing the hospital to convert Ward 106 of N Building into four hundred psychiatric beds to help accommodate the ever-growing numbers coming from the emergency psychiatric wards of Detroit’s Receiving Hospital. It wasn’t enough, though: By 1944, the crisis that had loomed for so long finally arrived in force. Within a few months and for much of the next seven years, psychiatric patients would be sleeping wherever the staff could wedge an extra bed, like steerage passengers on the S.S. Patricia.

  The disruption brought turmoil to nearly every ward, large or small. Annie could not have escaped it. By 1945, the overcrowding would have impinged on whatever privacy or sense of home she possessed after five years at Eloise. One female ward, designed for 18, had 45 patients; several others, built for 100, had 140. When no more ward space could be found for female patients, the staff began a nightly ritual of clearing the heavy dining hall tables to make way for temporary cots. The next morning, patients had to be rousted from bed early so that the dining tables could be returned in time for breakfast. It was unsafe, and more to the point, it violated the spirit of the state’s declared philosophy of providing humane care for society’s least fortunate.

  With its wards bursting to overflowing, Eloise took the costly step of sending more than two hundred patients to five private psychiatric hospitals. That let a little air out of the bulging balloon, but not enough. On many days, Eloise had to hang the equivalent of a NO VACANCY sign on its front gates, producing a ripple effect at Detroit’s Receiving Hospital, which had space for 110 emergency psychiatric patients but, at any given time, found itself with an additional 50 to 150 awaiting transfer to Eloise. When county officials visited Receiving in June 1945, they made sure to bring along the local press for a first-hand glimpse of patients sleeping in hallways.

  Something had to be done. The governor, Harry Kelly, had been given plenty of warning about the crisis. Soon after taking office in January 1943, Kelly received a welcome-to-reality letter from Frank L. McAvinchey, a judge from Genesee County and chairman of the Michigan Association of Probate Judges’ legislative committee. McAvinchey warned that “in spite of increased facilities for the mental cases of Michigan, our state hospitals soon again will be overcrowded.” Two weeks later, the State Hospital Commission chairman, Fred C. Striffler, urged Kelly to set aside money for a new hospital near Detroit, both to relieve the congestion and to reduce the state’s reimbursement costs at Eloise.

  In the summer of 1943, the hospital commission issued a report remarkable for its candor. “It is a clear, undisputed fact that Michigan has been negligent in providing for the hospitalization of its mentally ill, feeble-minded and epileptic population,” the board declared. “This negligence is not of recent origin.” But the board’s foresight did not match its forthrightness. It blamed the overcrowding on Michigan’s tremendous population growth and the state’s “sporadic attention” to the problem, without explaining how this could lead to a doubling of the number of institutionalized mentally ill since 1934, far outpacing the state’s 10 percent rise in population during that same period.

  Kelly promised to act, but he wanted to wait until after the war. Inaction, of course, did nothing to alter the relentless flow of new patients. By 1945, letters were flying back and forth between Wayne County officials and the State Hospital Commission, emergency meetings were hastily convened, and pressure mounted on the governor to act. In the governor’s files at the State Archives, there’s a June 19, 1945, news photo of the overcrowding at Receiving Hospital. Across the photo, an irate reader wrote in all capital letters that Michigan and Detroit should be ashamed. “How about the GRAND HOTEL for our afflicted?” the reader suggested, a not-so-subtle reference to the famous resort on Mackinac Island in Michigan’s Upper Peninsula, a favorite vacation and conference site for the wealthy, the powerful, and the political.

  Instead of the Grand Hotel, the State Hospital Commission had secured something approaching the opposite—a recently vacated military barracks on the mainland, in nearby Sault Ste. Marie, leased with the aim of housing five hundred patients there by the end of 1945. The federal government had declared the base as surplus and had offered to rent it cheaply. The makeshift hospital opened to its first patients in March 1945, with the bulk of the patients expected to arrive in the summer.

  While the price was right, the location was more than a bit inconvenient. The “Soo,” as everyone in Michigan called it (a nod to the city’s French origins), was 340 miles from Eloise and so far north that the next stop up the road was in Canada. If families in Detroit objected—and it’s not clear from available records whether they had any say in the matter—they would have needed to make their case right away, before the transfer. The distance and difficulties of the trip were too great for the state to shuttle patients back and forth: Getting to the Upper Peninsula in those days required a two-hour boat ride across the straits of Mackina
c—if you could get on. The fleet of nine ferries carried as many as nine thousand vehicles a day, but the summer backup could stretch as long as 16 miles, an unavoidable logjam until the Mackinac Bridge opened in 1957.

  County officials didn’t like the Soo plan. Too far away, too few beds, too little impact on Eloise, which in July 1945 counted 4,612 psychiatric patients as its responsibility, including 255 at private hospitals and those stuck at Receiving. Gruber and Frank E. Kelley, chairman of Eloise’s board (and later the state’s long-time attorney general), pushed the governor to sign off on a new 3,500-bed state hospital for the Detroit area. The state legislature had authorized $150,000 to buy a site, but had not set aside any money for construction. County officials urged Kelly to call a special legislative session and earmark $2 million immediately.

  In the meantime, the Soo would have to do. Charles Wagg, the State Hospital Commission’s executive director, asked Gruber to send only “comfortable and tidy patients” capable of caring for themselves. Gruber grumbled at Wagg’s request; handing over his best patients would, essentially, raise Eloise’s per capita cost by increasing the hospital’s overall percentage of difficult cases. But after putting the governor on the spot with their demands for relief and their well-publicized visit to Receiving, the county and Eloise were in no position to resist the Soo conversion.

  On July 24, 1945, sometime after 7 A.M., two Greyhound buses left Eloise for the day-long trip to the Upper Peninsula with two doctors, several attendants, and sixty-four patients, all women and all supposedly meeting Wagg’s stated requirements.

  To my great surprise, Annie was among them.

  In her excitement, Jo Johnson almost can’t get the words out fast enough. “I found something on your aunt,” the overseer of the Eloise museum says over the phone. “A janitor discovered a box of old Eloise records in the Beard building.” That’s where I had attended the Friends of Eloise meeting and heard about the Eloise cemetery; the building also houses several Wayne County offices. “He called me right away. Mostly financial records and Gruber correspondence. I was going through the box, and there’s a letter that mentions Annie.”

  A box of old records? It’s been more than twenty years since Eloise closed down. How is it possible this box went unseen until now? I question Jo about the discovery, but like any good historical commission chairman, she’s more interested in the material itself.

  “I put the letter in the mail,” she says. “I’m just so pleased to find something for you.”

  It’s quite a find. It’s only one sentence of a longer letter, but in context, it reveals plenty about Annie’s status after five years at Eloise and how she came to board that Greyhound bus. Gruber sent the letter, on July 19, 1945, to head off any complaints from Wagg and the State Hospital Commission about Eloise’s choice of the first sixty-four patients for reassignment to the Soo. “There is one other woman, Annie Cohen,” Gruber wrote, “who has only one leg; however, she gets about the institution, up and down stairs, very admirably with this one leg and is able to take care of herself.”

  Not just able to get around, not just “comfortable and tidy,” but able to take care of herself. Was that possible? Or was this nothing more than bureaucratic gamesmanship, Gruber saying what he thought necessary to avert the inevitable questions from the State Hospital Commission when it learned that the arrivals from Eloise included a woman with a wooden leg—after Wagg had specifically asked for the easiest patients?

  I read on. “There is another patient, Mary Mundy, who has two artificial limbs; however, she can walk fairly well and can get to and from her meals, and can look after herself and is not disturbed.”

  So Annie was the better off of the two, based on Gruber’s subtle distinctions: Annie could go up and down stairs—“admirably”—while Mary Mundy could only walk “fairly” well. Annie could “take care of herself,” while Mary could only “look after herself.” Annie’s mental condition merited no mention at all, while Gruber took special care to note that Mary Mundy was “not disturbed.” (I suppose that could imply that Annie was disturbed in some way, but wouldn’t that implication create doubt about her ability to care for herself? Gruber had no interest in doing that.)

  I marvel at the system’s chameleon-like ability to adapt to the circumstances. Five years earlier, Gruber had sent a form letter to the Probate Court, stating categorically that Annie was too sick to attend her own hearing, a hearing not scheduled to take place for several weeks. Now, Annie was climbing stairs and taking care of herself, which made her a suitable candidate for transfer to an impromptu hospital rising on the deserted grounds of a former military base.

  What to believe?

  I had concluded earlier that Gruber’s form letter in 1940 had little to do with Annie’s actual condition, that the style and timing of that letter—sent the day after her admission—strongly suggested that it was automatic, part of an overall strategy to control the cost and inconvenience of transporting patients downtown and back. Gruber’s letter on the Soo patients had a similar feel: There was no other evidence that Annie’s five years at Eloise had transformed her from a frightened young woman too scared to leave her apartment into someone capable of caring for herself. If Gruber’s rosy assessment were true, why hadn’t she been sent home, at least for a trial period, to see how she might do?

  No, I think Ed Missavage had it right, when I asked him earlier why Annie had never been paroled. She had too many strikes against her and too little support from her family. I remember his words: From our point of view, she’s a custodial patient from the outset. She’s the type that we don’t ever think is going home.

  While there was an undeniable logic to the State Hospital Commission’s criteria—the Soo did not yet have the resources to treat the toughest patients, and never would—the stipulations also confirmed that this improvised arrangement favored the state’s needs, not the patient’s. I can imagine the conversation with Annie:

  Annie, you’ve been a good patient, not much trouble, even with your wooden leg. Your reward? We’re transferring you to a rural county, a nice place—no, it’s nothing like Eloise, it’s actually a converted military barracks, and if your mom had a hard time visiting you before, she probably won’t make it to the Soo, it’s hundreds of miles and a ferry ride away. But as soon as we get this overcrowding crisis under control, we’ll bring you back to Eloise, and everything will be just like it was before…

  Fourteen months. That’s how long Annie stayed at the Soo, fourteen months and nine days, if she or anyone in Detroit kept count. What brought her back? Did she turn out to be not so tidy? Did the layout of the Soo hospital make it difficult for her to get around? Did she miss her family so much that she regressed and became, despite Gruber’s optimism, unable to care for herself? Did the conversation that Medji overheard in Mom’s apartment, the one about “Chanaleh,” have anything to do with Annie’s return? Many questions, no answers.

  She didn’t come back because the overcrowding crisis was over, that’s certain. The female wards remained as packed as ever, with the sun porches and dining halls still playing host to the overflow patients. The number of Eloise patients in private hospitals was still rising, peaking at 477 during 1947. Eloise’s 1950 annual report described Receiving’s conditions as “inhuman,” 330 occupants jammed into the 111-bed facility.

  The Soo hospital remained a small and inadequate release valve for another four years, only shutting down in June 1950 because the federal government wanted the base back. Two major developments finally eased the overcrowding. In 1952, the state completed the new 1,200-bed hospital first authorized in 1945 (Northville) and in 1954, the introduction of revolutionary new medications for schizophrenia and other mental illnesses allowed some patients to be treated at home, outside the institutional walls.

  For the patients who remained, another revolutionary advance altered what Ira Altshuler had called “the ghastly habit of inertia so prevalent” on the wards: the installation of televisions.
Instead of staring off into space for hours, some patients now stared at the TV; Ed Missavage recalls with some amazement the calming effect that television had on some aggressive patients. “It was a godsend,” he says.

  Irene Waryas, an Eloise social worker and graduate student at Wayne University (before it added State to its name), took a look around her in the late 1940s and concluded the obvious: The state could not afford the system that it had created. It was all well and good for the state to assume responsibility for the institutional care of the mentally ill—but, as the thirty-four-year-old Waryas pointed out in her 1950 master’s thesis, the reality never matched the rhetoric, nor could it. More institutional patients meant more institutions, and more institutions required a bottomless budget commitment, which had neither political nor public support.

  If the state couldn’t keep building hospitals, what could it do? Waryas’s thesis proposed a major expansion of the state’s small “family care” program and the placement of a limited number of carefully selected patients with foster families, much like the current foster care system for neglected children. Her proposal was informed by her own experience; in the summer of 1950, Eloise had assigned Waryas to place up to twenty-five capable patients in private homes. By December, she had placed five. The Michigan Society for Mental Hygiene supported the family care concept as a cost-saving and humane alternative. “We believe that approximately 1,200 of the 29,680 now in mental hospitals could be released to an expanded Family Care program,” the society observed in the spring 1950 edition of the “Mental Hygiene Bulletin.”