In 1956, as part of my rotation as a Student Nurse, a group of us were sent to Napa State Hospital for our 3 month Psychiatric training. We lived upstairs in a cottage that had patients below, who were judged to be stable enough to be out on the grounds during the day. At that time Napa State Hospital, or Imola as it was called, was a small city unto itself. There was a farm, a cannery, and other places where the inmates could work, like the laundry, or in kitchen prepping food. There was a small store where people could buy candy, magazines, and trinkets. There was a large auditorium that was used for various purposes, church services on Sundays, and once a week it was turned into a roller skating rink. All kinds of people were there for all kinds of reasons. They still had the old locked wards for the most severely psychotic. The "snake pit" wards, where they still had the old restraining boxes that they "didn't use" any more. These were coffin sized boxes with wire mesh panels on the sides and the lid which was locked over the patient. Body wrap restraints like muslin body bags were still used. And they did use cold water on people wrapped to "calm them down". What I saw there that troubled me the most was the ECT/EST- electro shock therapy. Although there were patients who said it helped them. One woman who was manic depressive always let the staff know when she felt a manic phase coming on, and would be given shock therapy. Others said it helped stop the voices in their heads, or stop painful memories that haunted them. But it was difficult to watch. As part of our Psych education, we sat in on patient conferences. Psychiatry was very Freudian oriented then and there was always some "sexually repressed" parent (usually the mother) who was blamed for the patient's condition, especially schizophrenia. One of their prize patients was a woman who had been lobotomized. She was considered one of their success stories. I no longer remember what her original diagnosis was, but she told us in flat tones, with an expressionless face that she was "much better now." And who knows, she might have been. This was a new type of psych training for Nursing students. We were the first class, (along with some students from UCSF) who stayed at the facility. After a two week orientation we were assigned individual patients to work with. I was assigned a 16 year old schizophrenic girl, who was lost in her own world, and didn't talk. I took her out for walks every day. She wasn't allowed out on her own. We would walk to the little store and get a candy bar, then take a walk around one of the little lakes by the farm. On Thursdays I took her roller skating. I always did all the talking, telling her about my life and family, and things I did on the weekends at home. I began telling her before I was due to leave that I was going, and that another student would come to be her new friend. She never said a word until my last day, and then asked what she would do without me. I assured her that in a couple of weeks she would meet someone new to be her friend. I heard later, that having the students assigned to her helped her to start communicating again, and within a year was well enough to go home on weekend passes. There were similar stories for some of the other patients assigned to students. There were wards for all kinds of people. There were children who were seriously disturbed, and there were a couple of wards for teens. One for psychotic and violent, and the other for teens with emotional problems. And there were all kinds of people there--including some who shouldn't have been. I remember one sweet grandmotherly lady whose family sent her because they said she went crazy after "The Change." The staff knew she was perfectly normal, but kept her because she had no where else to go. And there were others like her-- women sent because of supposedly becoming strange, or depressed while going through menopause. Most were depressed, either from the effects of menopause, or for being committed. Another I remember was a cute 15 year old girl from a ranching family in another county. She had been repeatedly molested by members of the family, who when she resisted and fought back, said she was crazy and violent and had her committed. The staff kept her there for protective custody. There was no way for her to be put into foster care, because the family was prominent and had too much pull to be charged with the molestations. Another young man was from a prominent wine country family who had been in an auto accident and had suffered severe trauma to his head. He was "not right" and so the family had him committed. Apparently he had occasional seizures or violent episodes. Now some of these people, including the youngsters, were truly severely disturbed, and even today with medications could not be cared for at home. And that is where the hospitals served the best. People who could not live in "normal" society had a place that was essentially safe, had clothing, food and shelter, and didn't have to live under a bridge somewhere. Yes, they were forced to stay there, and yes, as medications became available for treatment, they were forced to take their meds. In fact, they had little choice in whatever treatment was deemed necessary. Now in a way we are back to where we were before the hospitals were established. Communities do not have enough money to take care of their own people with psychiatric needs. When I worked for a local county health department, mental health funds were the first to be chopped. There was eventually no place in our county for children with mental health problems that needed in-patient care, and the adults didn't fare much better. I don't know what the answer is.