Many want a piece of Lakeshore Mental Health
Institute, the priceless scenic campus on the Tennessee River.
Can they all live together?
by Joe Tarr
When the East Tennessee Asylum for the Insane opened in 1886, Knoxvillians flocked to the scenic farmland to get a glimpse of the curious "lunatics" who were moving in.
Hundreds of spectators watched the first 100 patients delivered by train from the overcrowded asylum in Nashville. And on weekends, the brick fortress was a popular destination for people taking a ride in the country.
The Daily Chronicle urged restraint: "...The asylum practically becomes a cheap side show, while each patient, with a nature probably more sensitive to his besetting weakness than one supposed to be in his right mind, is thus forced to stand and be humiliated by the heartless or thoughtless critical comments of outsiders, who simply go to the institution from the motives of idle curiosity."
Today, the public is welcome at what is now called Lakeshore Mental Health Institute, where a third of the land is devoted to baseball and soccer fields. A 2-1/4 mile track is probably the most popular in the county for a jog or walk.
The hospital isn't closed, however. On any given night, there are more than 200 patients sleeping at the state hospital. Knox County rents two cottages here, offering drunks a place other than jail to dry out. And in a building not far from where kids boot soccer balls and swing bats is a little-known facility for youthful sex offenders. Other service agencies rent office space here as well.
Lakeshore the park and Lakeshore the hospital and Lakeshore the rental space have not suffered much from these contradictions. Nor has its mystique.
The hospital may no longer spook kids the way it used to. But an obscurity still lingers over it, a confusion about what goes on here, and what the place is for. And so too remain the debates and fantasies over what could happen with Knoxville's most valuable 300-acre tract of land.
"The Train of Lunatics"
In 1874, Tennessee purchased a 300-acre farm owned by the Lyons family for $19,500 in order to build the state's second insane asylum, as they were then called. A main selling point was that it had a spring that could provide enough water for 1,000 patients. Construction started that year, but a lack of money and political wrangling delayed its completion until 1886. The original castle-like structure cost $250,000 to build and could hold 250 patients. A central building of offices separated its massive wings, one for women, one for men. The first year's budget was $44,000.
Its pristine surroundings on the banks of the Tennessee River made the hospital seem an ideal place for "lunatics" to recover.
"One of the reasons it was selected was because it was far enough away from the city that it wouldn't be bothered," says Lea Acuff, who was chaplain at the hospital from 1953 until 1990. With only a cardigan sweater to protect him on this chilly February morning, Acuff stands outside the hospital's administration building, eager to talk about the hospital's history. "Another reason was the pure airit wasn't contaminated."
Crowds waited at the train station as the first men and women were transferred to horse-drawn buses and taken to their new home. They behaved themselves better than sane men, the Daily Chronicle observed. "Several of them showed in their faces and manners the most acute types of insanity. They were all dressed neatly and some were very particular about getting dust on their clothes. All of them, with perhaps a half dozen exceptions, were emaciated and showed that they have been poorly fed or locked up in ill-ventilated rooms."
Of the hospital's first patients, the newspaper reported: "There are many who are under treatment for some special eccentricity, and who are altogether sane on all other subjects. For instance, here is a man who labors under the delusion that he is the president of the United States. Another feels he is the Savior, and another yet believes that he is a prophet sent into the world by the Almighty, to bring about a new millennium. All sorts of curious delusions are entertained by these poor unfortunates, whose ideas on all other subjects are just as rational as those of people who walk our streets day after day."
Almost as soon as it was open, administrators were complaining about over-crowding. New buildings sprouted up all around the main hospital. And all the while, the bed count continued to growpeaking at nearly 3,000 in the '60s.
Dr. Bedford F. Petersonwho was superintendent for 24 yearsoversaw the most novel building project. The $2 million Therapeutic Village of 12 cottages, a church, shops, and swimming pool was opened in 1960. The first of its kind in the United States, the mini community was designed to prepare patients for life outside the hospital.
"Many patients had been here for years and had no concept of what it was like to be outside," says Acuff. "They were given money, which they bought food with, and prepared it. Families were invited to come visit."
So rich is the mystique of Lakeshore, that it has found its way into various literary works. The main character in Cormac McCarthy's Child of God is a necrophiliac who dies at the asylum. Lyons View, as Lakeshore was often called, also figures in Peter Taylor's In the Tennessee Country. Tennessee Williams' sister was given a lobotomy at Lakeshore, and the playwright may very well have modeled his fictional "Lion's View" asylum in New Orleans in Suddenly Last Summer on Knoxville's Lyons View.
Lobotomies weren't common practice at Lakeshore (too expensive, Acuff explains). But the hospital utilized many treatments that have been in vogue over the past century, including hydrotherapy, hyperthermia, electric shock, drugssome of which have been abolished, others which are now used only sparingly.
Acuff pulls an old denim straight jacket from the back seat of his car, a relic from the pre-tranquilizer days of psychiatry. With their arms pulled around behind them, the patients could be tied to a bench or a wall and their tantrums kept in check, Acuff explains. "The one problem is if I'm tied down and have to go to the bathroom, what happens? Well, that's what happens," he says. Feces and urine would spill through the hardwood floors, attracting maggots and leaving a lingering stench.
Over the years, Lakeshore has been the subject of numerous muckraking newspaper stories and government investigations. The first came just a year after it opened, when an assistant physician accused the superintendent of incompetence (he was exonerated).
Reading newspaper clips from the past century, conditions at the hospital often seem harsh, due primarily to over-crowding and underfunding. However, many of the investigations were politically motivated, Acuff says, as politicians tried to get their names in the paper and make opponents look bad.
In 1965, the News-Sentinel's Pete Prince reported that the hospital was being used as a dumping ground for the elderly. "The windows are barred, doors locked, plaster peeling off the towering ceilings. The ventilation is poor. It was hot in there on that winter day. It is really hot in the summer, I'm told," he wrote. "I saw hundreds of elderly men and women in this multiple-story building, just sitting around waiting and wanting to die."
The most spectacular scandal struck in 1971, when the Knoxville Journal and state Rep. Richard Krieg paid a midnight visit to Lakeshore. (They had actually gotten a complete tour earlier in the day, but came back that night for melodramatic effect, Acuff says). The paper reported rat and cockroach infestations (so bad that the rats ate three cats brought in to kill them and the bugs were found crawling into patients' bandages), filthy toilets with no seats, patients sleeping on the floors and urinating in the hallways, dangerous psychopaths locked in rooms secured with only a bent spoon, and severe fire hazards.
A formal state inquiry followed, which brought out charges from employees of widespread drug and alcohol abuse (the hospital was apparently so understaffed that cabs would deliver booze to patients at night, undeterred by guards or nurses), an orgy among the staff, and teen-age patients being given pot and beer and taken to a X-rated movie (which an administrator later testified was the concert film Woodstock). There were claims of physical abuse and neglect, with frail, elderly patients allegedly being denied a meal a day for two weeks, and teens locked in 4-by-5 foot "time-out" rooms for two days straight. Many patients were locked up inside 24 hours a day. The death rate here was high273 patients, or about 10 percent, died there in 1970and some died under circumstances suggesting hospital negligence.
The institution's top two administrators were removed. The ancient, over-crowded wings of the original hospital building were finally torn down (all that remains is the center, where Lakeshore's administrative offices are now located). The new superintendent, Dr. John Marshall, made it his mission to get the hospital accredited, a goal he accomplished in 1974.
The '80s brought talk of privatization and closing the facility. The bed counts dropped to mere hundreds, as the country de-institutionalized its psychiatric hospitals. And, people wondered, what would happen to 300 acres of gorgeous lakefront property just a short drive from downtown in the heart of the city's most exclusive neighborhoods?
A New Park
Imagine what would happen if someone tried to open a massive hospital complex for the mentally ill in the middle of a well-to-do riverfront community? They'd be strung up for even suggesting it.
Curiously though, Lakeshore Institute never fazed the people who developed the opulent neighborhoods and million-dollar mansions that now surround it.
"Apparently, [the hospital] just doesn't bother anything," says an appraiser, who asked not to be named. "That's the bottom line." And it means the land that Lakeshore sits on is now worth a fortune.
Since the property is government-owned, the city has never assessed its value for tax purposes. The appraiser estimated it would be worth $15 million. "It's on the lake. The lake is magic," he says.
Downsizing in the '80s left the hospital with far more land than it needed, says Lee Thomas, Lakeshore's current superintendent. "We were spending $40,000 a year just to keep the grass mowed," he says.
In the early '90s, Knox Youth Sports, a non-profit group that organizes youth recreation programs, approached the state with the idea of opening up the land for ball fields for children's recreational programs. With the help of Mayor Victor Ashe and then Gov. Ned McWherther, the group got its wish in 1994.
"We knew Lakeshore Hospital was downsizing. The issue was, what's going to happen to this land," says Ashe. "The general thought was it had been in public hands for 110 years and should be maintained in public hands for perhaps different and complementary purposes."
The state gave the city 20 acres of the land, in exchange for demolishing three dilapidated buildings on it. And the city has a free, 30-year lease on another 60 acres of the property. Knox Youth Sports manages the land, free of charge. The city pitches in with maintenance work and covers the youth programs on its insurance.
Knox Youth Sports raised thousands through private donors to build six baseball/softball fields, which are used by 1,000 children aged 4 to 14 every spring, and another 400 kids in the fall, says Wayne Christensen, Knox Youth Sports' executive director. The park's three soccer fields have recently been renovated, and will be open again this springbenefiting 300 kids.
Running the perimeter of the Lakeshore complex is a 2-1/4 mile track, which Christensen calls the "energy center of the park."
"You come by here on the first nice day of the year, you won't be able to find a parking place." Christensen says.
There is more Christensen would like to see here, but he says Knox Youth Sports has filled up its share of Lakeshore. "We would love to have a gym of our own, and more playing fields," he says. "Those are a long way off."
Still in Business
Recently, a psychiatrist was visiting Knoxville while interviewing for a job at Lakeshore Institute. When he told the clerk at his hotel why he was in town, the clerk answered, "Oh, I thought that place was closed."
"It's gotten to the point that people think there's no mental hospital here anymore," says Thomas, Lakeshore's superintendent. "We are the premier psychiatric hospital in the community. But the problem is we can't convince anybody of that. We're not closed."
Although it has shrunk greatly, the hospital is indeed still up and running, employing 520 people, including 13 physicians and psychiatrists, six psychologists, 11 social workers, and 75 nurses.
The hospital can take a maximum of 250 patients, but its bed count averages 205 to 215, Thomas says. These are broken down into three groups: children and teen-agers, adults, and geriatrics.
Although a few patients have been here for 10 years, most stay only a few days or weekslong enough to be stabilized and entered into out-patient programs. Gone are the days when people could easily admit themselves, or when people would be dropped off out front by their families. Gone too, are the times when people would check in and never leave. (Acuff remembers discovering in the '50s that a patient had been dropped off by police for vagrancy, got a job in the butcher shop and simply stayed. He was never examined by doctors, and lived there for 17 years before the discovery.)
Today, people are admitted only when they are in danger of hurting themselves or others. Typically, they're brought to a hospital emergency room by their families or the police, then transferred to Lakeshore, Thomas says. To keep patients longer than five days, Lakeshore administrators must get a judge's permission.
Lakeshore generally treats the uninsured and worst case scenariosthe people that private hospitals are unwilling to care for.
"The private sector is going after more of our population to compete. We're at the will of what the private sector will and will not take. We're the safety net," Thomas says.
Still, the superintendent says he's seen a noticeable jump in patients since last May, when the hospital's bed count was running about 170. "I cannot give you a reason why," he says of the increase in demand.
Several of Lakeshore's older buildingscontaminated with asbestos and designed for outdated treatment methodssit vacant, waiting for the state money to tear them down. Most conspicuous is Lonas Hall, which faces the administration building. Constructed in the 1950s, the 400-bed men's facility is reminiscent of the One Flew Over the Cuckoo's Nest era of mental health, Thomas says.
Lakeshore has become something of landlord, renting out the still usable vacant buildings to social service agencies.
The state Department of Mental Health and Retardation rents office space here.
Knox County rents two cottages for its Detoxification Center for Public Inebriates. Established in 1991, one cottage is for people picked up for public drunkenness. An alternative to jail, they are kept here for eight to 12 hours, says Patti Hall, the program's coordinator. There is a longer five- to seven-day program in the other cottage. "It's really an entry point into the rest of the alcohol and drug treatment program," Hall says.
Of those who go through the longer program, 52 to 58 percent remain sober six months later. With 28 employees, the program costs $725,000 a year.
Another tenant is a private company called Reflections, which operates a secure treatment program for youthful sex offenders in the old Jane Keller building. It has a capacity of about 40.
Dr. Jean Schaid, who runs the program, referred questions to the company's corporate headquarters in Maryland. However, a spokesman there did not return numerous phone calls over the past week. The program is contracted through the state's Department of Children Services.
"We try to keep a low profile. That's been purposeful. I think even the neighbors don't really know that we're here," Schaid did say. "We have real good security, and haven't had any problems."
Everybody Wants Lakeshore
When Lea Acuff looks down the hill that Lakeshore was built on, he can see spots where buildings used to stand. Inside the administration building, he points out where desks and offices used to be, where a keg of aspirin and a jug of castor (all that was once in the hospital's arsenal of medications) were once kept.
A chaplain here for nearly 40 years, Acuff's seen all kinds of changes, and he knows more are in the works.
"Developers originally wanted to latch on to it. You'd get lots $50,000 a piece, at a minimum," Acuff muses.
But no one really knows what will become of old Tom Lyons' farm.
Thomas would like to see a modern psychiatric hospital built.
"I know we're going to be in the business. We serve an important role for the community. The private sector can take some of the business, it won't take it all. Certainly, we don't need 200 acres. We probably need 30 acres," Thomas says.
State Rep. Joe Armstrong, chairman of the House's Health and Human Resources Committee, says the state is paying a private architect to put together a masterplandue in three to four monthsfor the property. The group is trying to identify what exactly the state will need in the future, both for the mental institute and the neighboring veterans cemetery, Armstrong says.
"I think that we should preserve our options and not give away land that one day the state has to come and take back," Armstrong says. "We need to make sure we satisfy the future needs of the state, and then look at providing recreational options."
"Everybody seems to want the property at Lakeshore," says Melanie Hampton, assistant commissioner for Tennessee's Mental Health Department. The problem the department has, is it doesn't really know how much land it will need in the future, she says.
"At any given time, we can't say we're only going to run 50 beds. If the demand is there, we still have to meet the demand. That's probably why there hasn't been any decisions made as to what Lakeshore's going to be when it grows up," Hampton says. "Every time we get around the table thinking about that, something in the system will change and the demand will change."
One option is for the state to hold onto any extra land, but let it be used as public space and recreation, Armstrong says. Then if needed down the road, it could reclaim the land, he says.
Armstrong doubts any of the land would be sold for private development. "If I thought that any of it would go to private development rather than recreation, I would definitely encourage the state just to hold on to it," he says.
For now, sharing land with the park has created some problems, though none of them major ones. The institution's roads, not designed for heavy traffic, have taken a beating. And busy park days can be a headache. Thomas would like a new road system, one that separates the park and hospital distinctly.
Ashe, too, admits there have been some problems, but nobody thinks the new arrangement was a mistake.
And it's hard to dispute Lakeshore's popularity. If people are still leery about the hospital, you wouldn't know it.
"What I see is hundreds of families coming over here and having a great time. Year after year, more people are using the trails," Christensen says. "I don't know what goes on with the people who don't come over here. Whatever people think about it, essentially they're comfortable with it. It's a clean, safe space."