When Treatment First Met the Prison

Roosevelt Cornelius had all the excitement of youth in front of him in 1951. Having just spent a year living in California, the twenty-three-year-old decided to return home to Fort Worth, Texas, to see his “people.” After a short visit home, he and two friends set out on a cross-country road trip, intent on making their way back to California. They drove hundreds of miles, passing through the Chihuahuan Desert, isolated towns, and the occasional roadside diner. When the young men pulled into El Paso, which marked roughly the halfway point to California, they parked their car and walked the short bridge over the border into Juarez, Mexico. There they bought five marijuana cigarettes, just enough to get them to the coast. Though the three guys “didn’t have any trouble” bringing the contraband across the border, they met with problems once they crossed back into the United States when they were apprehended by a policeman who arrested them for possession of marijuana. It was Cornelius’s first run-in with the law; it would not be his last.

A couple of years after his first arrest, Cornelius was introduced to heroin. He was at a friend’s house on Evans Street, on the south side of Fort Worth, when four or five “fellows” he was hanging out with offered him his first shot. The rookie watched the experienced guys shoot the drug into their veins and followed suit. After that, Cornelius began using regularly. He purchased heroin from seven or eight dealers in the city who had bought it wholesale from distributors in San Antonio, Houston, and Dallas. Eventually he was spending about twenty-one dollars a day on his habit and turned to shoplifting to cover those expenses. As a result, he acquired not only drug charges but also ones for petty crimes like theft.

Cornelius’s mother was deeply distraught by her son’s behavior. She reached out to their family doctor, and together they contacted the Fort Worth Narcotic Farm. Shortly after, they received an admission application in the mail, which they filled out and returned. Cornelius was invited to show up a week later to interview for a potential placement as a voluntary patient. Before he could sign himself in, though, he was once again arrested on drug charges. He found no sympathy within the legal system. He was, for all intents and purposes, just a junkie, seen as deserving punishment rather than help.

Cornelius’s experience mirrored those of thousands of users during the post–World War II period. On average, drug users during this era were younger than the previous generation; they tended to live in major cities; and heroin became the primary drug of choice. Users were increasingly subject to punitive anti-drug measures and were more likely to accrue state and federal drug charges. Framed as delinquents and troubled criminals, thousands of men and women were impacted by a redoubling of punishment efforts.

Whether users lived in New York, Detroit, Chicago, Kansas City, San Antonio, or Los Angeles, they were all affected by an emerging moral panic. While the number of users was in fact on the rise through the early 1950s, concerns over drug use continued to grow even after those numbers began to decline. Despite the reality that drug-using communities were relatively insular, the fear that drug use and addiction were infiltrating all aspects of society became a political and cultural mainstay. Drugs became an effective way to express fears over a wide range of social ills, and lawmakers, law enforcement officials, the media, and Hollywood helped fuel the belief that the nation’s drug problem was out of control.

Within a Cold War context, officials began to claim that China was sneaking heroin into the nation as part of “a ‘cold war’ weapon” to undermine the moral health of U.S. citizens. Harry J. Anslinger, the longstanding commissioner of the Federal Bureau of Narcotics, played a critical role in cementing the unsubstantiated connection between the “Red Chinese” and the U.S. heroin problem. As Nancy D. Campbell argues in Using Women: Gender, Drug Policy, and Social Justice:

Anslinger painted the purchase of heroin as direct financial support for communist regimes. He painted addicts as communist sympathizers and political subversives—not because of their political beliefs but simply because they bought heroin from communists who sold drugs ‘not only to make money to prosecute the efforts of their Government but also to cause destruction and deterioration among people in the free countries to which this drug is being sent.’

Public hearings recounted the dangers of organized crime, and especially the Italian Mafia, whose reach they claimed knew no bounds. In other cases, drug use became a symptom of the deterioration of racially segregated urban centers, apparently rife with crime and vice. This correlated with concerns over a supposed rise in juvenile delinquency in the postwar years, which public officials and parents feared would threaten the health of the nation’s most vulnerable citizens. In border states, the panic over a seeming drug crisis also dovetailed with fears over undocumented immigrants. As Jill Jones notes in Hep-Cats, Narcs, and Pipe Dreams, by 1951 the problem seemed so serious that President Harry Truman felt the need to weigh in, “declaring the ‘situation’” to be “‘of grave concern to me. Illicit narcotics peddling has recently risen sharply in volume. Moreover, drug addiction has reached serious proportions, particularly among some of the youth of our nation.’”

Anti-drug hysteria pushed many states to mandate minimum sentences and to deny, in the words of Stephen R. Kandall, “narcotics offenders eligibility for probation, and suspended sentences and sometimes parole.” Border states such as Texas, California, and Arizona passed more punitive drug laws by the early 1960s. Kandall notes, for example, that in Texas, anti-drug sentiment had become “so strong” that by 1957 “the state legislature voted unanimously in favor of the death penalty in certain cases involving drug sales to minors.” National legislation played an even greater role. In 1951 Congress passed the Boggs Act, creating the first federal minimum sentences of two years for drug-related convictions. Shortly after, Congress passed the 1956 Narcotic Control Act. Under this act, Campbell writes, “suspension, probation, and parole were expressly forbidden to all but first offenders in the possession, prescription, and registration categories.” It also greatly increased the penalties for drug-related offenses and allowed juries to impose the death penalty on anyone selling heroin to minors under the age of eighteen.

As the postwar heroin market grew, and as anti-drug legislation went into effect, the patient populations at Fort Worth Narcotic Farm and Lexington Narcotic Farm—the only two federally funded narcotics addiction treatment centers in the entire nation—ballooned. Patients were admitted both under their own free will (as in the opening story of Roosevelt Cornelius) and by the Bureau of Prisons (BOP). Lexington operated at full capacity throughout the 1950s, with an patient population of about 1,200 at any given time. At Fort Worth, structural changes made during the war continued to shape the population, and during the 1950s it averaged about half patients being treated for addiction and half psychiatric patients. In total, between November 1939 and December 1964, 35,622 people were admitted to Fort Worth; of those, 15,187 were treated for addiction.

Patients admitted to Fort Worth during the postwar years were subject to a formalized structure: the administration considered controlled, orderly, and consistent daily routines essential to the therapy program. From a treatment perspective, patients who developed healthy, productive lifestyles within the institution’s walls could emulate those patterns once they were released. Remove them from the jazz clubs, dance halls, and border towns in which they had acquired their habits, and you could instill in them a sense of normalcy and personal responsibility. Yet the day-to-day experiences of patients highlight an inherent tension in this model: patients were supposed to learn to be self-sufficient, good citizens by following structures, mandates, and orders that were beyond their control.

Physically segregating patients was one important element of institutional control. Patients were separated according to their carceral status. A 1953 pamphlet about the facility explained, “All the volunteer patients stayed on [ward] 4A1, which was the ground floor.” Though this sometimes also included low-risk incarcerated patients, no volunteer patients were allowed on wards 4A2 and 4A3, which were exclusively for incarcerated patients and subject to additional security provisions by the Bureau of Prisons.

Most wards included dormitory quarters made up of two- and four-bed units, a television room, a dayroom, a latrine, and a garbage room at the end of the hall. Lights turned on at 6:25 a.m. each morning, at which point patients were required to prepare their units for inspection. Each ward had to meet a ten-point checklist detailing the proper order for beds, floors, clothes, lockers, linens, walls, wastebaskets, and window screens. Any item from other parts of the institution (such as the canteen, kitchen, or doctors’ quarters) was considered contraband and caused the ward to fail inspection. Meals were served at 7:00 a.m., 11:45 a.m., and 5:30 p.m., and each week wards alternated the order they were allowed into the dining room. Any patient late for meal call had to wait until other patients finished before they were allowed into the dining hall. Ward lights were turned off at 10:15 p.m. each night. At “count time,” which occurred at 4:00 a.m. and 10:00 p.m., patients were required to return to their beds and remain there until the security count was completed.

On a typical day, patients spent between six and eight hours working in occupational therapy, or, as administrator Richard Lindblad later recalled, “two hours working and then the rest of the day in different educational classes or occupational therapy classes.” The vocational therapy supervisor, who oversaw vocational counseling and aptitude testing, gave each new patient their work assignments. Patients had to report to their designated work supervisor, who was responsible for instructing them in their duties. Any patient who failed to show up within ten minutes of their reporting time was referred to the Security Office. If a patient refused to work, the work superior called the Chief Security Office and completed an Adverse Behavior Report. Ultimately the patient’s assigned physician instructed the work superior on disciplinary actions to be taken. Patients could request a change in jobs, but they normally had to wait at least sixty days and demonstrate to the vocational therapy supervisor that they had a legitimate reason for requesting a transfer. This way, the administration hoped, it could impart a sense of occupational stability on a population whose previous work experiences were considered unstable and unproductive.

But the administration’s claim that Fort Worth represented a self-contained community that mirrored many elements of the outside world quickly gave way to the realities of a manufactured carceral setting. No matter how many modernization projects or recreational opportunities the staff created, coercion and control were required to get patients to adhere to the program. Staff used a two-pronged approach to achieve this. On the one hand, they developed a system of incentives and rewards ranging from providing small daily comforts to greatly expanded privileges. According to ward manuals, to reduce contraband and “stimulate ward cleanliness,” if wards in 4A received an excellent rating they were allowed to leave their television on until midnight on weekdays. Wards that “earned [an] excellent rating 4 weeks in a row” were allowed to keep their TV on until the show they were watching ended—even past midnight. If patients behaved, and if approved by the unit supervisor, each ward was permitted one birdcage or one fishbowl to hold pets. Patients could hang three framed pictures to remind them of their life outside the farm (excluding images of “nudes or scantily clad” models). They also received four packs of cigarettes every other week and could purchase additional packs as well as personal, hygiene, and food products from the canteen.

On the other end of the spectrum, staff relied on coercive policies designed to control unruly patients. Along with ward segregation, the control of patients’ movement across the grounds was a critical aspect of the security program. Except for “trusty” patients, all patients were required to carry passes when moving about. Since all wards shared the same dining hall, mealtime required a heightened security presence. Guards accompanied each ward to meals, and patients had to “walk in pairs of two abreast, on righthand side of white line” in the tunnels connecting each building. This was done to help prevent them from fraternizing with patients from other wards. Patients were barred from “entering dining hall ahead of assigned ward, straggling, coming in late, loitering in mess hall after completion of meal, cutting line, and obtaining unauthorized food from kitchen, [or] bringing food out of dining hall to wards.” When the bell rang, it was time for that ward to leave the dining hall, and they had to leave before any other ward was allowed to enter. Under no circumstances could patients in the population ward meet with patients from the withdrawal ward in the tunnels. In these cases, regulations required that “if a 4A side ward meets this [withdrawal] ward, it must go back to the nearest grille and get behind it” until they passed through the tunnel.

Like other federal prisons, patients had to adhere to an institutional dress code. Any patients found wearing apparel that was manufactured in the garment shop, laundry, furniture factory, or other sites on the grounds would have it confiscated and be subject to an Adverse Behavior Report. Entire wards could also be punished for violating manual rules. As one ward manual detailed, if the ward had been loud or was acting out, the ward aide, at his discretion, could turn off the TV, radios, or record players, and order lights out early. Staff also limited patients’ communication with people on the “outside.” Patients were rarely allowed to make or receive phone calls, so letter-writing was their primary form of communication. Though administrators believed that access to mail was important for patients’ morale, they also feared it would be an avenue for sneaking in contraband or connecting with people from their using circles back home. As a result, all mail was censored by the Security Mail Unit. Patients could receive as many letters as were sent to them, but they could only send two outgoing letters per week. Any attempt to include drugs, weapons, or other contraband was a felony and punishable by imprisonment of not more than ten years. Patients could not correspond with any former patients, and foreign-language mail was permitted only if it was mailed from a foreign country.

Daily routines and structures reveal a treatment program in conflict with itself. On the one hand, patients were supposed to learn to be responsible, self-sufficient citizens who could hold down a job, had a wide range of recreational and personal interests, and were in good physical health. Yet at the same time, they had to learn to follow strict routines and had little control over their own schedules. That the farm required both incentives and punishments to maintain order speaks to the fact that patients often had difficulty adjusting to the institutional setting. Looming over the campus layout, modern programming, and expanded recreational opportunities were clear carceral structures modeled on BOP policies.

If on the surface the narcotic farms seemed to be a stark contrast to a carceral approach toward addiction, the postwar years put that misconception to rest. At a time when the nation was enacting increasingly punitive solutions to the nation’s drug problem, now largely visible among a younger, urban population of heroin users, the narcotic farms became more firmly embedded in the criminal justice model. For voluntary and incarcerated patients alike, the isolated nature of the facilities and their carceral features seemed to reinforce a sense of alienation rather than a desire to reintegrate into “normal” society.

Within this carceral setting, many patients felt their time at the institution reinforced rather than challenged their status as addicts—as social pariahs unfit for life in the wider community. Those who could usually left early, seeking to return to life beyond the walls of the institution. Patients who remained were largely mandated there by the state for increasingly longer periods of time and became enmeshed in the “prison culture.”

What would have happened had Roosevelt Cornelius signed himself into the Fort Worth Narcotic Farm, as his mother had so hoped? It is possible he would have found a reprieve from his fast-paced lifestyle in the Fort Worth underworld. His time at the farm may have given him some distance from which he could reevaluate his social groups and using community in the city. He may have learned a skill that would translate into a “productive” job, and it may have given him the tools to repair his relationships with his mother and other loved ones who had been affected by his addiction. The records indicate, though, that it is likely his experience at the institution would have gone in another direction.

We will never know the impact the farm could have had on Cornelius’s life, since his arrest derailed his treatment plans. The young Texan ended up, as far as we know, at one of the other thousands of jails and prisons that incarcerated drug offenders in the punitive postwar years. By the early 1960s, some medical specialists, researchers, and lawmakers began to openly question if there had ever really been a difference.

Excerpt adapted from Rehab on the Range: A History of Addiction and Incarceration in the American West by Holly M. Karibo, © 2024, published with permission from the University of Texas Press.

_{Image: Forth Worth Star-Telegram photograph from 1938 showing one of the wards in the then new Forth Worth Narcotic Farm. The original caption reads, “One of the hospital wards at the new $4.5 million U.S. Public Health Service Hospital.” Original image part of the Fort Worth Star-Telegram Collection of the University of Texas at Arlington Libraries. Used under a Creative Commons license (CC BY-NC 4.0).}

Contributors

Holly M. Karibo Holly M. Karibo is an associate professor of history at Oklahoma State University and author of Rehab on the Range: A History of Addiction and Incarceration in the American West.

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