Under the Red Roof: One Hundred Years at Northern State Hospital

Northern State Hospital in northwestern Washington State was commissioned by the legislature in the first years of the 20th century. Centrally planned by John Charles Olmsted—son of the famed architect Frederick Law Olmsted—the design embodies a balance between the power inherent in civil commitment and the hope that a hospital would become a community of meaningful lives beyond the tragic and disabling circumstances of those who sought asylum or were compelled to live there. Under the Red Roof was written and published by an interested citizen in the county, who is involved in planning community health services. On its face, it appears to be a coffee-table history, filled with retired staff’s personal anecdotes, archival hospital census forms, and newspaper excerpts of the time. But the book’s accounts from patients and staff members raise issues about how state hospitals, at their best, provided a recovery environment for their patients not always available to today’s ill population.

One anecdote that captures the spirit of both the institution and its time:

The doctor said, “Hello Jim, What are you doing here?” Jim said, “They have me hogtied here all day on this bench and I want to get out and go to work. Any man would go stark mad to have to sit here tied all day.” To our surprise, he gave Jim an axe the next day, promoted him to straw boss of the crew and sent him to clear the entrance of the grounds from the gate to the county road. (p. 33)

Patients like Jim, about half the population over the years, worked on the farm growing produce and raising livestock, clearing and maintaining land, preparing meals in the kitchens, sewing clothing in shops, and serving domestically in the wards and staff facilities. A minority were too disabled to work, and an even smaller few confined to locked units for safety.

As medication and state reforms in the 1960s began to winnow the population at Northern State, the book chronicles in a more rigorous manner the efforts in Skagit County to create a community mental health system and in parallel to adapt the remaining hospital facility to a recovery model. One can feel the author’s anguish in these pages, knowing the inevitability of closure that will come, while talking with retired nurses about the development of a recovery model and the revelation of patients who recover from major mental illness within a therapeutic community that finally has a range of robust treatments. Some staff noted the unfortunate contrast with other state hospitals, in which the culture of institutionalization did not accommodate recovery and discharge.

The eventual closure of Northern State in 1973 was a political decision driven by tight budgets and a focus on forensic populations in the other state hospitals. The occasion was marked by a busload of elderly, institutionalized, chronically mentally ill people delivered to the streets of Seattle with only their original belongings and hospital-issued clothing. What became of them may be in a sense unknowable once they were divorced of a community able to care for them.

The daughter of a staff member in the 1950s, who spent her childhood on the hospital grounds, eloquently recalls the best manifestations of the asylum: “When I think back on Northern State Hospital, the place offered sick people a protected environment; the jobs gave them a sense of purpose; the community gave them roots” (p. 74). One of the staff psychiatrists of that era, an immigrant from Europe after World War II who himself sought the asylum of safety and steady employment, opines on the larger questions the asylum poses: “Society will continue to ask what is the most rational, economic, and humane way to treat mentally ill patients. It is a challenge without end” (p. 90). Indeed.