Renowned Research Unit a Study in Closure

There is little left of the clinical research unit at Camarillo State Hospital that reshaped the world of psychiatric care.

Nothing here that hints at the work that helped propel the treatment of mental illness out of the dark ages of asylums and lobotomies into an era of wonder drugs for schizophrenia and other disorders.

Nothing that gives a clue of the research that went beyond drugs to radical new behavior therapies--incredibly simple but effective breakthroughs such as humming to quiet hallucinatory voices.

In fact, only stacks of spare furniture, old psychiatric textbooks and a collection of black and white portraits are reminders of the giants of mental health who worked on Unit 45 and who boosted the state hospital to worldwide prominence.

They include Dr. Philip R. A. May, whose research in the 1950s and 1960s led to the widespread acceptance of the generation of drugs now used to treat schizophrenia.

While May’s work had a revolutionary effect on the field, hospital officials say, it was Dr. Robert P. Liberman who pushed the boundaries of psychiatric care, pioneering treatments now used around the globe that focus on managing incurable mental illness.

Liberman, a UCLA professor of psychiatry who took over the unit in 1970 when the university became an equal partner in the hospital’s research, devoted his life’s work to battling the demons of mental illness.

He insisted that each member of his staff spend at least one 24-hour period as a patient on the unit to gain empathy for those wallowing in institutional care. He celebrated New Year’s Eve and other holidays on the ward, often delighting patients with his talent as a concert violinist.

Together, he and his team plumbed the depths of mental illness, publishing hundreds of articles while traveling around the world to teach others about the latest breakthroughs in mental-health research.

But with the state hospital scheduled to close by July 1, the research unit will soon come to an end. The place is almost empty now, with patients and staff members packing up and moving on shortly after the closure was announced early last year.

The loss of the unit is immeasurable, hospital officials say. To be sure, it is a blow to Camarillo patients. But it is also a blow to patients everywhere who were tough to treat and often written off as lost causes, those who most stood to gain from the marriage of university resources and state hospital needs.

“It’s very, very sad for me to see it close,” said Liberman, who lives in the community of Lake Sherwood, just outside Thousand Oaks.

“They are closing what is generally acknowledged as the premier institution in the world for the developmentally disabled and the mentally ill,” he said. “It reflects a major abdication by society. And it’s going to take some hard lessons before people realize that this retrenchment and lowering of priorities for the mentally ill was a very serious blunder.”

Research Unit Success

Since the 1950s, Camarillo and the state’s other mental hospitals have periodically found themselves tangled in controversy, first for the warehousing of patients, later as they emptied their populations into surrounding communities.

There have been scandals from time to time, cases of patient abuse and neglect common to mental hospitals everywhere across the nation.

But through it all, with little public fanfare, Camarillo’s clinical research unit grew to be one of the most important in the world.

It was at Camarillo, under May’s guidance, where researchers first proved the superiority of the class of drugs known as phenothiazine in battling schizophrenia, conducting studies with hundreds of patients over a span of more than a decade.

By the time Liberman arrived in 1970, however, no serious advances had been made on that work, leaving the door wide open for renewed exploration.

Liberman and his team blended the use of the latest drugs with new social skills training aimed at teaching patients how to control their illnesses and function more independently.

The emphasis was on determining what part of the illness responded best to medication and what was best handled by social therapy, he said. And the goal was to ready as many patients as possible to leave the hospital for a place in the real world.

Although most of the work centered around mental illness, the research branched out over the years to include the treatment of autism and other developmental disabilities.

Liberman remembers one autistic patient in the early 1970s who was moved to Camarillo from a state hospital in Michigan. He was in his mid-20s and could care for basic needs such as eating and getting dressed.

But he was often aggressive, kicking and cursing and spitting at those around him. He would fight with staff members, and when fully enraged would toss furniture around the room. As a result he spent a lot of time secluded and restrained.

Researchers set out to find ways to motivate change.

“We found that 75% of aggressive behavior could be controlled by teaching people how to cope with their illness and exercise self-control,” Liberman said. “Even now most psychiatrists still use reactive methods for controlling behavior. They wait for something to happen, then launch into some kind of seclusion and restraint. We feel there should be a proactive program . . . to preempt that kind of behavior.”

As it turned out, the key in this case was a dollar bill. Realizing that money was extremely important to him, a program was set up that allowed him to earn a dollar a day as long as he behaved. On the flip side, he lost a dime each time he lost his cool and lashed out.

That incentive was combined with a social skills program designed to teach him how to properly communicate his needs, medical and otherwise, to people around him. So instead of demanding help, he learned to ask for it. And instead of growing angry when confronted with problems, he learned to manage his behavior.

As a result, Liberman said, his abusive behavior virtually disappeared in three or four months, and he was discharged to a board and care home where he has lived for more than two decades.

Patient Turnarounds

The story reflects the experience of many of those who spent time on the 11-bed research unit, Liberman said. Patients were handpicked for the ward, depending on the research needs at the time. The vast majority of research patients--perhaps more than 500 over the years--came from other units at Camarillo State and other state hospitals.

About half of those who came to the unit were able to leave the hospital at the end of their treatment, Liberman said. For some, the turnaround was nothing short of miraculous.

Liberman recalls one man who took part in the unit’s most recent study--a three-year review on the efficacy of a new drug called risperidone. That drug so far has yielded promising results in treating schizophrenia while improving the memory and other thinking capabilities of those suffering from the illness.

Haunted by delusions, the man had been in state prison and state hospitals most of his adult life. He saw raw sewage seeping out of shower heads and rarely bathed as a result. He was convinced that magnetic waves were capturing his thoughts, sucking them from his brain. He heard voices cursing him and putting him down.

The first things researchers did was teach him about his illness, assuring him that the voices he heard were real and generated by an unusually sensitive area of his brain.

And they taught him how to interrupt those voices by humming a single note when they started buzzing in his head. It was an earlier research project at Camarillo State that revealed that such “voices,” or auditory hallucinations, could be reduced by about two-thirds by having patients quietly hum to themselves.

Researchers also put him on risperidone, which combined with the other measures helped chase away most of his delusions. Finally, they taught him to care for himself, how to cook meals and clean his room.

After about a year on the unit, he moved into his own place and has been there ever since.

“These were people who were really going to live out their entire lives in what we call the back wards of state hospitals,” Liberman said. “We treated the most severely disabled of the most severely disabled. They are the ones who need the research the most, but who are no longer going to have it available to them.”

Ironically, some of the unit’s most recent research involved reducing the medical profession’s reliance on some of the anti-schizophrenic drugs first tested at Camarillo 40 years ago.

In one study, patients who were unresponsive to even the highest doses of the most powerful drugs--those who only suffered crippling side effects instead--had their medication reduced to see how they would respond.

The results were remarkable. Most became more alert and responsive to their environment, one step closer to their ultimate return to the outside world.

Of course, there were also failures along the way. Researchers studied a drug called fenfluramine about 10 years ago that was touted as a possible breakthrough treatment for autism.

Because autism and schizophrenia are thought by some to be closely related, researchers decided to add the drug to a regimen of medication received by so-called treatment-resistant patients to see if it made them better.

It did not. In fact, most got worse and the research was discontinued. Still, researchers said there were lessons to be learned in that study.

“When we are doing research, a negative finding is as important for the treatment of patients as a positive finding,” said Dr. Michael Green, a Newbury Park resident and UCLA researcher who spent a dozen years at Camarillo. “If a drug pans out, certainly it’s more exciting. But there are costs in using drugs that are not effective. The research contribution is to eliminate those.”

None of the work came cheap. There were 18 staff members for the ward’s 11 patients, by far the highest staff-to-patient ratio at the hospital. It cost about $1 million a year to operate the unit, perhaps two or three times the cost of other units.

Some of those costs were offset by the fact that the program was a joint venture with the UCLA Neurological Institute, which supplied five staff members and other resources. The unit also attracted about $2 million a year in federal and pharmaceutical company grants, which helped ease the financial burden and fueled the research efforts.

But what has become clear over the years is that money and manpower are necessary to do the work and generate the results that have brought the state hospital international acclaim, hospital officials said.

Dr. Barringer Marshall, the unit’s medical director, said he remembers how half a dozen staff members worked with one woman who at times believed she was being beaten and tortured. She would strip naked and wander the halls. And she would attack staff members and disrupt the entire unit.

To change her behavior, staff members developed a program of required relaxation, making her lie down on a mat--no matter where she was--and not move a muscle just as soon as she felt the first inclination to be disruptive. If she refused she would be physically restrained.

In time, she got the message and her behavior improved. But the program was so labor-intensive that few other places could have carried it out.

“For 20 years, we have taken some of the most difficult patients the hospital has and rendered them superb treatment that could be gotten nowhere else in the world,” Marshall said. “I’m really sorry to see the opportunity to continue to do that go down the drain.”

Opposing Sentiments

That sentiment, however, is not universally embraced.

Some mental-health advocates argue there is no shortage of research centers nationwide, and that there will be little or no impact when Camarillo’s shuts down.

Furthermore, they argue that because the unit is simply transferring to the Veterans Affairs Hospital in West Los Angeles there will still be plenty of opportunity for researchers to continue their work.

Steven J. Taylor, coordinator of disability studies and director of the Center on Human Policy at Syracuse University, said it made sense to have research programs in state hospitals when they were providing the bulk of the care for the mentally ill and retarded.

But just as that care has shifted over the years away from institutions and toward community care programs, research efforts must shift as well.

“They can celebrate the work and the history and the past, but times have changed and it’s time to move on,” Taylor said. “I think the bottom line is you don’t keep people in institutions just to make it convenient for research.”

Then there are those who have harder feelings against the research unit. Dr. Judith Vukov, a psychiatrist from Glendale, sued Camarillo State Hospital in 1994, alleging the facility contributed to the death of her daughter.

Jennifer Abigayle McIntyre, 25, spent 2 1/2 years at the state hospital, including the last days of her life on the research unit, Vukov said. Hospital officials say McIntyre was never a research patient, but was living on the unit while being evaluated to see if she could participate in the risperidone study.

The lawsuit alleged that staff members at Camarillo--who released McIntyre on a pass shortly before her death to go shopping with her mother--failed to treat her mental and physical ailments. The lawsuit also named Ventura’s Community Memorial Hospital and the Buenaventura Medical Clinic, alleging that collectively their faulty treatment led to McIntyre’s death from an aspirin overdose while on leave with her mother.

The lawsuit against all defendants was eventually resolved.

Still, Vukov said she blames the hospital, in part, for her daughter’s death.

“People aren’t guinea pigs, you just can’t offer them research. You have to offer them other things too, to make them better,” she said. “I’m glad it’s closing down. I see no value in their research. When this happened, I can tell you I lost my faith in psychiatric research.”

Liberman is quick to point out that neither the hospital nor the research program were found culpable for McIntyre’s death. Moreover, in terms of research, he said it’s hard to argue with the results achieved at Camarillo over the years.

Thousands of workers all over the globe have been trained to use the treatment techniques developed on Unit 45. Education programs, which can teach entire families how to better cope with mental illness, have also been widely replicated.

Training programs to teach independent living skills--such as teaching patients how to manage their own medication--have been translated into a dozen languages, put on videotapes and distributed worldwide.

“A lot of the revolving door syndrome that you see is because clients are sent out into the world but aren’t taught the skills they need to function on their own,” Liberman said. “We find that teaching them how to do this makes a tremendous difference. These methods are powerful, they are widely accepted and we are credited with bringing them about.”

The future of those efforts, however, remains in doubt. The unit actually closed last year, on Halloween, with the bulk of the research team boxing up its belongings and transferring to the VA Hospital in Los Angeles.

Marshall, the unit’s medical director, was a state employee and has been transferred to another unit where he serves as a staff psychiatrist. Now 65, he said he will probably retire when the hospital closes rather than move away from his Camarillo home.

Researchers gather about once a week at the unit--a sun-bleached building right off the main entrance to the hospital campus--to review the volumes of data collected during the risperidone study.

This is a place in transition. Its narrow corridors, floors worn smooth by years of foot travel, are empty most of the time. Labs and offices, once home to some of the world’s most important research, now are used for storage. Boxes are stacked high and scattered throughout the building.

Outside, weeds have taken control of the courtyard where patients used to gather for picnics or volleyball. Two wings of the building are sealed off completely, so that not even the researchers can get in.

Liberman has not packed up. One wall is still lined with framed certificates and diplomas, attesting that he graduated from medical school at Johns Hopkins and received medical training from the Harvard School of Medicine.

In his office is a framed cartoon that shows Charlie Brown, of Peanuts fame, talking to Lucy at her makeshift psychiatry booth: “Good grief,” Charlie Brown says, “you mean psychiatrists have problems too.”

Indeed they do. Liberman worries whether the forces will ever again come together to create another research unit as effective as the one at Camarillo. And if that does not happen, he worries what that will mean to those patients who stood to benefit the most from continued research.

“There will be a proportionate share of these individuals who will not be able to succeed when they leave here,” said Liberman, who was among the most active lobbyists in the fight to spare the hospital from closure.

“These people are going to be lined up in our emergency rooms, they’re going to wind up in our jails,” he added. “It means there’s going to be much more vagrancy. And it means there’s going to be an extraordinary increase in the burden on families. It means we’re going back to the 19th century, before we had state hospitals.”

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About This Series

“A Community Says Goodbye: The Closing of Camarillo State Hospital,” is an occasional series chronicling the final days of one of the most famous institutions in Ventura County. This installment focuses on the hospital’s clinical research unit, which won worldwide acclaim for its breakthroughs in treating mental illness and other disorders.