Lillian Massie pinches the floppy brim of her hat between her fingers and stares at the camera.

At 24 years old, Lillian is a mother to two children. She’s slim, with wavy hair cropped at the ears and is once again pregnant or has possibly just given birth to a third child. She stands on what appears to be a train platform, a belt cinched above her belly. Sun washes over her face.

It’s 1925, and this is the last known photograph ever taken of her.

For the next nine years until her death, Lillian will be confined at Northern State Hospital, the now-shuttered Washington mental institution folded into a lush valley enclosed by dark mountain peaks an hour’s drive north of Seattle.

The Lost Patients

of Washington’s abandoned
psychiatric hospital
Published July 16, 2023

Carrie Davidson, Lillian’s great-granddaughter, runs her hands over the faded photograph as she sits on a sofa in her Auburn home. She keeps it in a plain wooden box along with pine cones and a broken piece of skylight glass from the crumbling Northern State Hospital campus, where she believes her great-grandmother’s remains could be buried.

Northern State Hospital took in tens of thousands of people like Lillian, most from the Seattle area. Today, there’s scant evidence these patients ever existed. But as the 50-year anniversary of Northern State’s closure approaches this summer, family members and neighbors of the abandoned institution are fighting to recover them.

Davidson has chased after every scrap of information she can about her great-grandmother’s life. She negotiated with Canadian archivists, consulted a lawyer on how to obtain 100-year-old court records and even hired a medium to divine the location of Lillian’s grave.

Shame around her great-grandmother’s story snuffed her out from family history, and Davidson believes it haunted her grandfather for the rest of his life, pushed him to drink. Davidson’s grandfather never knew his institutionalized mother and was adopted shortly after his birth.

Many descendants like Davidson have not been able to find out what happened to their relatives or even where they were buried. Patient records were sealed off. Initials and numbers stand in for names on the hospital cemetery headstones, most now sunk beneath the mud. More than 1,600 patients are believed to be buried on the campus or elsewhere in the valley — close to 900 of them cremated and interred in metal food cans.

The state lost patients in other ways too. Austerity-driven political decisions pushed Northern State patients into group homes and onto the street when the hospital closed in 1973. The legacy of those policies shapes the system today, as people with serious mental illnesses ricochet among Seattle streets, jail and the few remaining state psychiatric beds in Western Washington.

Much of the country is now considering a push for more psychiatric care to get people off the street, such as California’s and New York City’s plans to expand involuntary treatment. Some fed up with the current mental health system look to places like Northern State with nostalgia. Many others see institutions as prisons for people with mental illnesses.

Between the two narratives are missing graves and ghost stories.

<p>The Seattle Times successfully pushed to uncover long-sealed archival records and digitized them for the public. (Washington State Archives)</p>

The Seattle Times successfully pushed to uncover long-sealed archival records and digitized them for the public. (Washington State Archives)

Davidson didn’t even know her great-grandmother’s name until her grandmother’s aging mind revealed it. She scoured genealogy websites and found a death record naming Northern State Hospital in Sedro-Woolley, a small farming town at the base of the Cascade Mountains. She’d never heard of the hospital.

Davidson pleaded with the state for more information and had just about given up looking for her great-grandmother’s Northern State records when she found a Facebook group in the summer of 2020 dedicated to the hospital and its cemetery.

“My great-grandmother was a patient who died at Northern State in 1934,” she wrote to the group. “Is there any way to find out if she’s buried in the cemetery?”

More than a year later, she got a response.

“I have been working on the burial records and uncovering grave markers for about a year now,” the message read. “What information do you have about her? I will see what I can find.”


“Nope, nope, but if that’s the edge of one …”

John Horne sinks a three-foot steel rod into the soft earth of the Northern State Hospital cemetery. A couple of inches down, it makes a sharp cunk, the sound of metal on rock.

He prods again and with a little more pressure, it scrapes past something small. Gravel, not a headstone. Not what Horne is looking for.

He steps a foot away and tries again.


“Oh, there we go. There’s one.” Another push with the rod. Cunk.

Occasionally, a visitor to the Northern State Hospital cemetery — an oddly shaped plot dotted by mole hills — will spot a lanky man with a nut and bolt earring digging where the graves ought to be.

Not technically digging, Horne says, because digging up bodies in cemeteries is not allowed without a permit by the state, which has largely ignored the little cemetery.

Rather, he’s simply doing what he calls edging, trimming the grass and brushing away the soil that covers the headstones closest to the surface. For any deeper headstones he finds, Horne has a system of color-coded flags, orange ground paint and an herbicide to mark the grass when the paint gets washed away by rain or flooding.

The muddy 1.8-acre cemetery is more a monument to erasure than remembering. Countless families have made the pilgrimage here over the last half-century, looking for clues about their forgotten relatives. Before Horne started poking around three years ago, the waterlogged cemetery had swallowed nearly all of its headstones under the mud, the identities of patients lost to history.

Today, Horne has uncovered 200 of those headstones and identified 300 more beneath the surface. He matches initials to burial records scavenged from the bottom of a file cabinet on the hospital campus, then uploads the information to FindAGrave.com and Facebook, where more than 1,800 people follow his work. That’s how he met Davidson.

Horne can cite a few reasons why he does this. The first is because of the way his mind works: Horne has attention-deficit hyperactivity disorder, and there’s nothing his brain loves more than fixing something broken or solving a mystery. He can spend entire days, from morning until dusk, working in the cemetery with only cans of energy drinks to keep him going.

Horne sees the possibility of a different world in Northern State’s past, with patients who milked cows from the hospital dairy herd and pickled onions from the institution’s farm. He used to work as a chemical dependency counselor on the Northern State campus, where he admitted patients into a treatment center. There he saw the same people over and over again, cycling through jail, emergency rooms and his office. He watched many die in that shuffle, having found no safe, long-term place to heal.

In some moments, Horne would look out his office window at the crumbling hospital buildings and imagine what they were like in their heyday. Would life be different for his patients if Northern State never closed?

Horne got so burned out that he quit his job last year. But he continues to work on the cemetery, even though the more he does, the less the place makes sense. Most of the headstones aren’t buried in order. The rows don’t line up. And recently, Horne discovered even more headstones and suspected graves outside the cemetery fence, near the parking lot.

He has a theory as to why. Old documents describe the cemetery as a 10-acre plot of the hospital’s best farmland. Now, it’s a two-acre corner near the road. Rumors circulated in Sedro-Woolley for years about people stealing the headstones or mowing them over and piling them up by the fence. One man even found a patient’s headstone propping up the corner of a cabin on his property. A former Northern State campus worker showed Horne a faded Polaroid of headstones piled in a shallow hole.

Based on these discoveries, Horne believes what’s now labeled as the cemetery is actually a small portion of what it once was. The bodies of at least 200 patients, according to Horne, are almost certainly buried beneath the young alder trees north of the property.

Northern State Hospital’s unmarked graves

More than 1,600 Northern State Hospital patients are estimated to be buried or interred in the cemetery or elsewhere in the Skagit Valley.

Grave markers

Most of them do not have grave markers, but the markers that do exist bear only initials and numbers. They're largely out of order and sunk beneath the surface of the soil.

Suspected graves

Suspected graves are identified by softer soil, greener grass or weeds, which indicate disturbed earth. Rows of suspected graves are visible by aerial survey.

Outside the cemetery fence

Cemetery volunteer John Horne recently discovered more grave markers and suspected graves outside the cemetery fence. He also suspects that even more patients were buried north of this plot of land, based on evidence from early property descriptions.

Three of the many buried here

Jennie Kenoyer, mother to Violet and Marshall, was committed to Northern State Hospital and died of what was called “exhaustion” and “dementia” at 32 years old. Her daughter and son, Violet and Marshall, also later became patients at Northern State Hospital and died there at 31 and 34, respectively, both of Huntington’s disease. Their remains were unclaimed and buried in the cemetery.

Jennie E. Kenoyer: born 11/24/1889,
died 03/10/1921. Natural burial.
Grave marker 299 J.K. (location unknown)

Violet Kenoyer: born 5/7/1904,
died 12/8/1935.
Natural burial. Grave marker 660 V.K.

Marshall J. Kenoyer:
(also known as Russell Kenoyer)
born 1/26/1908,
died 8/8/1942. Natural burial.
Grave marker 700 M.K.

Unclaimed remains

Patients’ ashes were also buried in Northern State Hospital cemetery, between graves and in unknown locations. In 1983, a local funeral parlor discovered 200 food cans labeled with Northern State Hospital patient identification numbers. These cans were then buried at another cemetery.

Horne has described his findings to the state’s Department of Archaeology and Historic Preservation. He’s sent old property descriptions, cemetery documents and work orders. He’s tried to convince the Sedro-Woolley mayor that a plaque at the cemetery undercounts the dead.

So far, state officials haven’t been sympathetic to what would be a time-consuming and expensive task of locating the forgotten graves with ground-penetrating radar.

But Horne’s biggest obstacle to solving the mystery of the cemetery isn’t public officials. It’s the cemetery itself.

It’s fall and before long, the ground will freeze and Horne must pause his work. By spring, the cemetery thaws and soaks up rainwater like a sponge, gulping the headstones back down beneath the mud. Each year, some of Horne’s work is erased, and he has to start over.

Nobody deserves to be forgotten like that, Horne says, continuing to probe the earth.


In some ways, Northern State Hospital began like many American ideas: as a business plan.

In 1909, the businessmen of Sedro-Woolley saw an opportunity. At Fort Steilacoom, 120 miles south, the facility that would later become Western State Hospital was overcrowded with a growing number of people taken in from local almshouses.

Washington needed a new institution. Sedro-Woolley needed jobs.

The businessmen persuaded Washington state officials to build a farm powered by patients for Fort Steilacoom in their town. That farm became a hospital. Patients from the Fort Steilacoom institution were brought to clear the land, and John Charles Olmsted — son of New York’s famed Central Park architect — was hired to design the property.

It was a striking Spanish Colonial Revival design, with terra-cotta roof tiles that wouldn’t look out of place on a Tuscan villa. The campus faced southeast toward the mountains, so patients could see them. The hospital’s first superintendent remarked that Northern State was “destined to become one of the most beautiful and profitable places the state will ever have.”

The first half of the 19th century had been an optimistic time for what was called the “moral treatment” of people with mental illnesses. At the turn of the 20th century, Northern State would attempt to cure patients through occupational therapy — work that gave patients a sense of purpose — and sustain itself with a prize dairy herd and patient fees paid by families. Healed patients would return to their communities as productive members of society.

Quickly, officials realized the financial boon they envisioned was out of reach.

Cities and counties desperate to offload the costs of care for the vulnerable sent people with epilepsy, dementia and alcoholism. Wards became overcrowded. Hospital superintendents pleaded with the state to fund a separate tuberculosis ward.

Doctors began trying new cures, according to records in the state archives. Northern State attempted various treatments in the ‘30s based on the idea that mental illness had bacterial origins, as syphilis had ravaged patients’ brains. Doctors began removing thyroids, appendixes and tonsils, hoping to eliminate the sources of their patient's mental illness.

Doctors at Northern State and throughout the country deliberately infected patients with malaria, thinking the fever would wipe out madness. Patients were subjected to hourslong baths in hot water and comas induced by insulin injections.

In the 1910s and ’20s, the institution started aggressively deporting patients without U.S. citizenship to try to save money.

Eugenics became the next attempt to cut costs. Between 1935 and 1940, Northern State conducted at least 100 sterilizations on patients, according to biennial reports. Records newly uncovered by The Seattle Times show all sterilization paperwork read the same: Each patient had the potential to produce “offspring who, because of inheritance of inferior or anti-social traits, will probably become a social menace or ward of the state.”

A request to sterilize a 15-year-old Seattle girl stated she was “somewhat backwards in school” and became “careless in appearance and posture” after psychosis. Her father asked doctors to remove her appendix while they removed her fallopian tubes.

Rumors of mistreatment lingered through the decades. One allegation claimed fetal and infant remains from impregnated patients and staff were buried in a creek bed on the campus, according to an anonymous letter received in 2018 by a Sedro-Woolley city council member.

The city supervisor forwarded the letter to the state's Department of Archeology and Historic Preservation to see if there was anything to it. The state said it couldn't find records of what the letter-writer described.


A fat, gray envelope arrived at Davidson’s door from a Canadian court.

Nine months earlier, Davidson had learned from a cousin that something may have happened to Lillian in Alberta, Canada. She spent hours interviewing the cousin with an old tape recorder at a Marysville Burger King, where her relative shared that, as a teen, Lillian had been involved with a man who went to jail.

Davidson searched through Alberta’s online court system until she found a hit. An archivist identified a record that named Lillian as the victim of a crime.

When the gray envelope arrived, 52 pages described how Lillian, then 15, was raped — or “seduced” in the parlance of the early 1900s — by a 23-year-old who told her he would marry her.

Lillian testified before an Albertan court that she did not want to sleep with the man and told him to stop.

As Davidson read the case records, she realized two things: Her great-grandmother had been raped, and her great-grandfather was the rapist.

After her great-grandfather was released from jail, he and Lillian married, moved to Washington and had two daughters.

Davidson still doesn’t know why her great-grandmother married her rapist. She doesn’t even know how the two met again after his release from jail. Family lore has it that they reconnected on a bus.

But over the last three years of researching Lillian, Davidson now knows what happened next. The same cousin who told Davidson about her great-grandfather’s jail time also told her he gave syphilis to his wife, though he claimed in divorce records she cheated. When Lillian’s mind deteriorated in an era before treatment, he had her committed to Northern State Hospital. Doctors there diagnosed her with psychosis.

Shame, silence and — three generations later — rage. Davidson’s voice quavers with it when she talks about this unhealed hurt, her family inheritance.

“He destroyed her,” Davidson says. “She had no voice.”


Horne returns to the cemetery in the spring.

The ground has thawed, and he’s anxious that the rain and mud have erased his headstone marks. Some are still visible, but others have turned into mud pits for Pacific tree frogs.

Outside the cemetery fence line, Horne sees someone has left dried flowers on one of his newly discovered graves. Inside the cemetery, there are bundles of baby’s breath tied with silver ribbon on the uncovered headstones.

Horne wants Northern State’s history to be preserved, in part to show how much the state used to invest in treating people with mental illnesses. But also “as a memory of what shouldn’t be repeated.”

Records show Northern State doctors started lobotomizing patients in the late 1940s and performed 21 lobotomies in 1949 and 1950.

One of those lobotomy patients, Phil Deiro, wrote to an attorney pleading to be let out. He was released in 1971 and landed at a Harbor Island boarding house while experiencing seizures. After he died, Deiro’s friends and caseworkers emblazoned his name on a bronze leaf on the sidewalk outside Seattle’s Downtown Emergency Services Center, a homelessness services agency.

By the 1960s, antipsychotic medications were changing attitudes toward the treatment of mental illness. Doctors and psychiatrists at Northern State advocated for shorter stays, believing patients would never recover in institutional settings and should be cared for in their communities.

Progress, however, faced backlash. Lawmakers launched an investigation into Northern State and other state institutions because of an open-door policy allowing patients to move around the campus freely. They questioned the institution’s leadership about escapes and pregnancies.

State hospitals fought the investigation, but history was not on their side. Public sentiment had turned against institutions as costs rose. Short-term stays proved more expensive than confining patients for longer periods.

Federal officials saw states struggling. John F. Kennedy, whose sister was lobotomized then institutionalized, signed the Community Mental Health Act of 1963. The law intended to replace institutions with smaller mental health centers embedded in communities and save states money.

Psychiatrists at state hospitals and some health care workers warned shutting down the institutions would leave people with mental illnesses stranded. The state had nowhere near enough community resources to treat people and reported that five counties had practically nonexistent services, according to a 1968 superintendents staff meeting and a legislative hearing.

Sedro-Woolley residents also fought the imminent closure of Northern State Hospital, one of the area’s biggest employers.

“Half of the town works up there, and the other half used to work here,” one local banker told state lawmakers in 1968. Sedro-Woolley high school students took buses to the state capitol to deliver a cake to Gov. Dan Evans that read, “Have a heart.”

Their protests failed. State and federal governments never fully funded community clinics, and by 1978, Washington ranked 45th out of 50 states for lowest mental health care spending. Seattle Times stories and editorials tracked down “lost persons” from former institutions to group homes and the street.

Most Northern State buildings fell into disrepair. This winter, Skagit County demolished a barn on the campus that was on the verge of collapse, leaving only a cement foundation.

Horne knows time will likely continue to destroy evidence of the people who once worked and lived there. So he picks up the steel rod and keeps probing the cemetery, the impassive mountains behind him still topped with snow.


A breakthrough in Davidson’s quest has her driving in her red Chevy Impala to the state archives in Olympia.

The Washington attorney general has issued new guidance that unseals the archives’ Northern State Hospital’s records on its patients 50 years after their deaths — a result of The Seattle Times’ reporting.

Beside her is a thick binder of research about her great-grandmother. She’s nervous.

She’s prepared for the possibility she finds nothing.

Davidson is buzzed into the reading room where an archivist steers her to three cardboard boxes of records — admissions, paroles, deaths.

Before she even sits down, Davidson asks, “Can we go to January 1925?”

The woman flips to the year and shows Davidson the page. Her hand flies to her mouth.

“Oh my god, there she is.”

Lillian Hansen, it reads as her married name. Inmate number 29-4264. County of origin: Skagit. Occupation: housekeeping.

Behind her glasses, Davidson’s bright green eyes fill with tears.

“She’s real,” she whispers.

Gingerly, Davidson opens an enormous red leather tome the size of a small coffee table.

She finds the last nine years of her great-grandmother’s life spelled out in one handwritten line. Her diagnosis: psychosis with mental deficiency. Her death: pulmonary tuberculosis. Cremated.

Another record notes Lillian received hydrotherapy, or “pretty much being straitjacketed and put in the bathtub,” Davidson says.

The first time Davidson visited Northern State Hospital, she marveled at its beauty, the mountains, the broken terra-cotta tiles. If her great-grandmother really was losing her mind from syphilis, maybe she found peace.

On a later visit, Davidson met Horne, who handed her a piece of glass from a female ward. Davidson peered through broken windows into rooms the size of closets. Locked inside, Lillian probably couldn’t see the mountains.

In the archives, running her hand over the yellowed pages of the red leather book, Davidson asks herself why some records are kept and others thrown away. She imagines Lillian standing in front of the person who wrote the book’s first entry about her. Her great-grandmother is 24 years old, pregnant, confused.

These records don't tell Davidson where Lillian’s ashes are. But they reveal the one time she was allowed out: in 1925 from May 27 to June 14.

Davidson’s grandfather was born on June 9. Lillian had five days with her only son before she was sent back to the institution in the valley, the one she could never leave.

Sydney Brownstone: 206-464-3225 or sbrownstone@seattletimes.com; on Twitter: @sydbrownstone.


Reporter: Sydney Brownstone

Editor: Laura Greanias

Graphics: Fiona Martin

Videography: Lauren Frohne

Photography: Karen Ducey

Photo editors: Colin Diltz, Angela Gottschalk

Design and development: Frank Mina

Project coordinator: Kaleigh Carroll

Audience engagement: Taylor Blatchford, Qina Liu

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