Research shows that 185 patients of the Oregon Hospital for the Insane were buried in Lone Fir Cemetery, many in unmarked graves. For many patients, their final resting place came after journeys in which their conduct and care was publicly debated in terms of economics, justice, politics, and medical practice. And yet they themselves rarely had any say in those debates.
Building a new kind of hospital
As early as the mid-1800s, Oregonians were discussing how to care for the state’s mentally ill. In 1843, the state’s new provisional government established a system to manage people legally determined to be unable to care for themselves. At first, these individuals were housed in the homes of private citizens, who were paid a stipend by the state to keep them. By the late 1850s, many of these individuals were sent to Multnomah County’s first poor farm, located in the west hills of Portland. It was overseen by Dr. James Hawthorne, a physician who had recently come from California. Hawthorne began advocating for a public institution to care for the mentally ill.
According to Inside Oregon State Hospital: a History of Tragedy and Triumph by Diane L. Goeres-Gardener, Hawthorne and Dr. Abraham Loryea first opened what would become the Oregon Hospital for the Insane in 1861 at a temporary location in downtown Portland on Taylor Street and First Avenue. Within a year the hospital had moved to a larger building near what is now Southeast Hawthorne Boulevard and 12th Avenue, constructed on land donated by Loryea’s father-in-law, James P. Stephens. At the time, the location was outside city limits, in keeping with the idea that country air and scenery were beneficial to patients’ recovery.
The OHI opened at a time when Western understanding of mental illness was shifting dramatically. Just a few decades previously, the mentally ill were chained in “madhouses,” a spectacle for the ticket-buying public. But in the 19th century, people began to view insanity as an illness – and therefore potentially curable. Hospitals sprang up based on the concept of “moral therapy,” which involved fresh air, engaging activities, and regular schedules. Even the term used to describe these facilities – “asylum” – suggested a refuge away from the stress and hardship of city living.
Hawthorne toured some of the most progressive mental hospitals in the country before opening the OHI (originally called the Hawthorne Asylum) and became convinced of the benefit of moral treatment. The two-story facility was surrounded by a tall wooden fence, inside of which patients were encouraged to play games, walk, and work in the garden.
The life of the patients
Initially the hospital cared for just 12 patients, but that number grew quickly. Patients were diagnosed with a range of illnesses, including dementia, epilepsy, “melancholia,” various “manias,” and addiction to opium or alcohol. Some patients were not mentally ill, but rather developmentally disabled, as the distinction between the two categories had not yet been defined. Still others suffered from age-related dementia.
The majority of the patients admitted to the OHI were white and male. However, according to an 1880 census report, 43 percent of patients were foreign-born, even though only 17.5 percent of Oregon’s overall population were immigrants; 21 patients were Chinese. The youngest patient was 9 years old, the oldest was 87. Most were from the working class, with “laborer” the most common occupation listed for patients.
According to Inside Oregon State Hospital, some of the OHI’s first patients came from the prison system, as well as from the county poor farm. Others were committed by family members. A few were private patients, their care paid for by family, but the majority were charges of the state.
No first-person accounts of life inside the OHI’s walls remain, so ideas of patients’ experiences are based on newspaper stories, reports from visiting inspectors, and hospital records. Most of these describe a clean and orderly facility. Patients lived in single-sex dorms; the violent were housed in private rooms. The hospital included a chapel, a library, and a billiard room. Noted mental health care advocate Dorothea Dix visited and considered the hospital to be a model facility for the nation.
Patients were expected to work, if they could. Almost all the patients’ clothing was sewn by female patients. Male patients worked on the facility’s farm and garden, which helped supply food for meals.
Nineteenth-century medicine had little idea of how to treat mental illness, beyond encouraging wholesome activities and diets (“wholesome” being defined by the standards of Victorian-era, white dominant culture). Due to a belief that purging the body of impurities could heal the mind, patients were often fed laxatives. Bad behavior was punished; good behavior was rewarded. Discipline was enforced through the use of solitary confinement or revoking of privileges, rather than the brutal physical punishment of older institutions. Straightjackets were used to protect patients from hurting themselves. The doctors served as powerful patriarchs overseeing their patients, who were often viewed as childlike.
In this environment, some patients were able to recover and be released within months. But more than half the patients spent years, if not the remainder of their lives, in the OHI’s custody. Every year, some patients died from old age, disease, suicide, or other causes. When they did, they were often buried at Lone Fir Cemetery.
The connection to Lone Fir Cemetery
In 2021, as part of preparation for a memorial garden to be built at Lone Fir, Metro hired a research firm to investigate the history of OHI patient burials. That research has uncovered new information about this piece of Oregon history.
Cemetery records list 180 OHI patients buried in Lone Fir, but the new research has brought that number up to 185.
In January 1867, the first recorded OHI patient was buried at the cemetery. The OHI had a contract with the cemetery to bury deceased patients who were unclaimed by family. It is believed that Hawthorne personally paid for 132 patients to be buried within Lone Fir, when family could or would not pay for burial.
Other patients had families who paid for burial in the cemetery; many of their stone headstones can still be seen today, though none acknowledge their connection to the hospital. Numerous patients were buried with wooden grave markers, which were lost to either decay or fires.
Due to irregular record-keeping, only 61 of the patients’ burial locations can be identified, with 54 of these patients being buried in Block 10.
Due to an 1887 article of The Sunday Oregonian, it has been believed that patients were buried on the eastern edge of Block 14, where at least 1,131 Chinese immigrants were buried. However, beyond that article, no evidence has been found that OHI patients were ever buried in Block 14, and recent research has shown that Block 10 was regularly called “the asylum block” during the late 1800s.
The end of the Hawthorne era
From the very beginning, conversations about how to care for the mentally ill were closely tied to the economics of that care. By July 1877, the OHI housed 230 patients, and it was costing the state about $70,000 a year, paid in gold – 42 percent of Oregon’s yearly tax base. Grumbling began in the State Legislature that Dr. Hawthorne was overcharging the state for his hospital’s services. A plan was approved to build a new mental hospital outside Salem, to be run by the state.
In 1883, the OHI’s 370 patients were all moved to the new hospital. Dr. Hawthorne did not live to see it; he died in 1881 of a brain hemorrhage and is buried in Lone Fir. Within a decade of the move, the new state-run Oregon Hospital for the Insane became embroiled in scandal due to overcrowding, allegations of abuse, and political favoritism. The era of moral therapy was over.
In 1889, the old Hawthorne Asylum building burned to the ground, leaving few records of the patients who – whether willingly or unwillingly – called it home for so many decades.
Today, little is known of the OHI patients beyond their names. With the memorial garden project at Block 14, there is an opportunity to honor the lives and legacies of these patients.