Harlem Valley: a nine month stay

The sky was the bleak and gray was of February; the brown fields had patches of dirty snow. Looming darker against the sky was the smokestack from the Harlem Valley Power Plant. That belching stack was visible for miles as I traveled south on highway 22. All of that gave me a tinge of foreboding as I approached Wingdale, NY. The discomfort became more intense as I pulled into the campus of Harlem Valley Psychiatric Center. For the next nine months of 1988, I would work and live at the institution.

The New York State institution was located on the eastern tier of New York in the town of Dover Plains.

Ornate brick buildings, described as castle-like, set in the pastoral southern Taconic hills. This campus comprise Harlem Valley Psychiatric Center. Remote from major centers, though New York City is slightly more than an hour away using the Metro North train from the facility. The Appalachian Trail lies a short distance east and south of the campus. Seeing white tailed deer foraging on the facility grounds in the early morning light was a common sight. Power Plant Harlem Valley

Yet, in spite of a near idyllic setting, no sign in front was needed for one to realize that this is a psychiatric institution. Even without seeing any on the grounds, Metal bars in the windows and locked doors in all buildings gave the hint that abnormal people lived in this place.

History

Harlem Valley Psychiatric Center was already in decline by my start in March, 1988. In it's heyday, the institution housed over 5,000 patients. By 1988, the census was under 1000. In an effort to cut costs, patients were placed in group homes. Others were placed in other State mental institutions; the plan was to consolidate State Mental Hospitals. Harlem Valley closed in 1993. Some buildings were converted to a Division for Youth (DFY) – prison for, usually violent, youthful offenders – bringing Harlem Valley back to its origins. The prison is now closed too. Currently, buildings are going to ruin. A developer has been rumored to buy the property from the State and convert the buildings to apartments.

From Wingdale Prison, Harlem Valley became a state asylum or Hospital in 1924. It is perhaps no coincidence that the hospital was placed in a desolate area. What normal person wants a demented lunatic living next door? Dormitories, still in use in 1988, were erected to house staff and prison guards from Green Haven. An intricate tunnel system connecting all buildings, allowed for ease of staff movement during inclement weather.The tunnels were still in use in 1988, excpt access were blocked in the prison unit for youths [DFY].

The institution was designed to be self-sufficient. The power plant provided heat, a reservoir provided drinking water, and the patients maintained a working farm through the 1960s. Patients cultivated and Harlem Valley Psychiatric Centerharvested the land or cared for livestock. The farm was abandoned in the 1960s; the former farmland became a golf course in 1988. Patient were recruited as caddies for physician golfers. One given reason the farm was abandoned was the concern of forcing patients to work doing forced labor. Perhaps allowing them to sit in psychotropic drools with nothing to do was better?

Until the advent in 1952 of chlorpromazine (Thorazine®) little was available to control the violent mentally ill. Reports were common concerning patients  being chained to walls in order to protect them from monsters unseen by others. In order not to discomfort normals, people exhibiting severe mental illness were locked away out of sight. 

Harlem Valley was a pioneer for innovative treatment of schizophrenic patients. Harlem Valley was the first institution in the United States to try insulin shock treatment in the 30s. During World War II, the institution initiated electric shock therapy. The most controversial treatment, though, was surgical frontal lobotomies. Harlem Valley was the leading State institution in performing procedure.

The then state of the art medical-surgical, Sullivan Tower or known by us as "building 85," was erected in the late 1960s. The surgical suite, abandoned in later years except for storage of surgical supplies, was used to perform lobotomies in the late 60s. The procedure, cutting into the prefrontal cortex using a glorified ice pick. Lobotomies were used to treat major depression or schizophrenia. Cutting out pieces of brain was supposed to bring calm to an agitated  patient or relief to the severely depressed. A few survivors of the procedure were still inpatients years later and from what I saw lobotomies did not cure their illnesses. In fact many lobotomy survivors were prone to seizures. Some victims of lobotomies were still housed in the facility while I was there; most became more dysfunctional after the procedure.

The area in which the pharmacy of 1988 housed in Building 85 had once been pathology. Preserved in formaldehyde various body parts were stored in labeled, sealed, jars all around the rooms. Many of those jars contained the brains of the lobotomized. Obviously lobotomies cure were too often permanent.

My stay in 1988

Rarely a day passes, even now almost years later, that I don't think about my experience at Harlem Valley. With the remoteness of the hospital campus, and the high price of scarce real estate in the region, I lived as a dormer on campus, sharing an apartment with two other pharmacists. There were times that I thought the in-patients were in better mental health than the three of us!

The apartments were little better that in-patient fare, but the State charged us very little rent; $22 per week. Prices for apartments in neighboring Pawling, Wingdale, or Dover were much higher. The cold, stone, institutional floors did add a nice homey touch. Again because of the remoteness of the facility, much of the staff, which included physicians, nurses and aids stayed on campus. Though physicians had somewhat better quarters with a nice view of the razor wire fencing around the DFY unit.

The institution was converting to unit dose, meaning that each drug dose is packaged in individual blisters or containers. Historically, patient aids were responsible for pouring patient doses out of stock bottles. The stock bottles became a temptation for an aid who wanted to have a patient sleep through the night and allowing semi-trained individual to calculate and pour out doses was a source of error, sometimes with grave consequences. 

Hard to get used to was the heavy skeleton key issued to all employees. The key allowed employee access to tunnels, wards, and other area patients were not allowed. However, given the number of staff and employees, lapses were bound to occur. While Harlem Valley did house a limited number criminally insane on a couple secure lock-ups in building 27. The institution did have some patients with violent tendencies. Most inpatients were locked in their own units. Some units were more secure than others. To differentiate themselves from patients, staff had to wear picture IDs. Without identification long term staff, those working 15 years or more, could barely be differentiated from the certified loonies. Especially for those who worked closely with inpatients in the most securely locked units, I found the staff to take on many, unfavorable, patient characteristics.

It was not unusual for a patient to "fertilize" and "water" the campus lawn. Stairwells had the delightful scent of stale urine. Commodities, such as a match or a cup of coffee (even coffee grounds,) were highly valued by in-patients. So, it was not unusual for sexual intercourse to occur in the tunnels or on the lawn as payment for those precious items.

Because of the remoteness of the psych center, it was easy to form close friendships. I fondly remember the pharmacy staff taking me in quickly as one "of their own." The amount of compassion and dedication most staff displayed toward the patients was very impressive. However, since the facility was operated by the State of New York, we had to contend with impressive absurdities...

What amazed me most of all was how the State ignored rules, it imposed on private sector hospitals. I often wondered if the officials in Albany creating policy were the real mentally ill!

Most of my work was in Building 85, high up on the hill, where the main pharmacy was located. There we dispensed individual drug doses for each patient in 85, where the mentally ill, many elderly, patients with acute or chronic physical diseases resided. Some of the units on building 85 resembled those in skilled nursing facilities. The main pharmacy also prepared individual doses for satellite pharmacies in the "lower" buildings where the inpatient population was generally younger and physically healthier.

Eventually, I was assigned a pharmacy satellite in building 26. We filled drug carts with unit dose medication, mainly heavy tranquillizers, for the patients housed in 26. Patients were housed on 6 units on three floors.The most severe schizophrenics were on the top floor with least severe on the first floor. Which led to one question, "why would the most severely ill patients, the ones most apt to harm themselves or others, be at the top floor of the building?"

Being schizophrenic is not the same as being stupid! Many patients, whose good behavior earned a pass, often stopped by the satellite pharmacy. Their conversations were more clear and lucid that most "normal" people I know!

Patients who were well controlled earned passes to leave their units for a set period of time. In addition may patients received a small stipend to spend. One enterprising person opened a liquor store adjacent to State property, and since most patients had abuse problems, the temptation was too great to ignore. On "pay day" a path of discarded liquor bottles could easily lead one to the store.

Some of the more clever patients, used the stipend to create a small black market. Caffeine seemed to provide some relief from the psychotropic drugs (tranquillizers.) While the drugs provided control of major depression or schizophrenia, they had nasty side effects; patients felt worse taking their medication. While vending machines were available, none were stocked with caffeinated products. Strong coffee was especially valued by patients. Patients would chew coffee grounds.

A few patients wandered too far or too long on pass; many simply got lost. Usually,those patients were punished and had to earn their passes again. Only rarely, did the patients get into real trouble; one broke into a residence and did extensive damage. Another patient to escape his invisible tormentors stepped in the path of a moving Metro North train. I am not sure how staff accounted for those patients on pass. One patient boarded the Metro-North train and made his way to Washington DC, where he was fetched by hospital staff person.

One very smart and pleasant lady, in her 60s, was a very sad case. She had severe postpartum depression and was locked away by her husband. She was still an inpatient in 1988! The woman ran her own black market operation for other inpatients. Very little effort is needed to get someone committed to a funny farm! My view of the mentally ill changed drastically after my experience in building 26. I suspect some patients were at facility because they caused discomfort to family members.

A strict prohibition was enforced banning sex between staff and patients. Employees who violated this rule faced certain dismissal and the threat of criminal prosecution. However, no prohibitions existed for inpatients and there were women inpatients who became pregnant since coming to Harlem Valley. Sex was used as payment for desired commodities (cigarettes, matches, coffee, drugs etc. )

No cafeteria was available for employees.Actually, with the stench of institutional food, I doubt many employees would eat patient fare. One patient seemed to enjoy our cooking as he was sitting inside a dumpster greedily devouring the food from garbage bags left by us and other dormers on a hot, fly infested, July day. (Funny, I did not care much for my roommates' cooking!)

Some inpatient residents of Harlem Valley were violent and had to be locked up. The majority, however, were the incompetent or people who could not live outside the structured life provided by the facility. Many were painfully tortured by tormentors no one else could see. Drugs and alcohol numb the pain, and most patients had drug abuse problems in addition to their invisible torments.

My favorite anecdote comes while working in Building 26. The pharmacy window had a clear view of the courtyard. One day while looking out after cleaning his glasses a colleague, Peter, yells,"Look at that!" A mixed couple — the woman was dark large and heavy while the male was light, small, and skinny — had their clothes thrown aside on the ground. The woman was on top! I am still amazed how the guy on the bottom didn't get flattened into the ground. The courtyard was visible to half of the population of our building and half of another. Peter and I cheered the happy couple on! Not ten feet away on a park bench sat a patient staring fixedly into space while all this commotion was going on in front of him. We, pharmacists in prime mental health, booed the social worker who broke up the happy couple. The two participants simply clothed and went in separate directions. Now, years later, I remembered the liaison far longer than those two patients!

gate of heaven A short walk up, east of building 85 and past the reservoir, lies an unkempt field. An archway was erected there labeled "Gate of Heaven." Past the rusty archway is the cemetery for those patients who died at Harlem Valley. No names mark the graves. We, the normals, could not bear to look at these mentally ill patients while alive. Indeed the mentally ill are removed from us  normals. Even in death, we dare not even mention their names. We certainly cannot embarrass the families. 

The photo on the right was taken in 1988. As the cemetery was in a state of neglect while the facility was in operation, I can only imagine the condition of cemetery, since the site was abandoned for years.

Since my experience at Harlem Valley, I have often wondered at how one is defined as mentally ill, while the rest of us are mentally healthy?

Despite the close knit group at the HVPC pharmacy, I found the desolation for a single guy in his thirties overbearing. On weekends, I went to my parents' home. Real estate was expensive in that region of Duchess County and nearby Lichfield County, Connecticut was far worse. As the facility was continuing to move patients to group homes or other State Hospitals, it was clear to me Harlem Valley would close. By the end of 1993, all remaining patient and staff were merged into the facility near Poughkeepsie.

Shortly after the first snowstorm in late 1988, I left Wingdale. Though, the facility has not left me.

Don