In the past decade, the wealthy seaside enclave of Malibu has been dubbed the “Rehab Riviera” and the “Lourdes of Luxury Rehab.” People from all over the world come to the city’s rehabs, often because of the free publicity generated by famous patients like Lindsay Lohan, Robert Downey Jr., and Charlie Sheen. These luxe facilities have many opponents in the mainstream rehab community, who view their exorbitant fees, lack of medical staff, and coddling of patients as unethical and ineffective. Opponents also include many residents and government officials, who claim parts of Malibu are being turned into a giant “medical subdivision.” In 2013, there were 35 rehab centers in Malibu, a city of about 13,000 residents. They say the rehabs are gobbling up land, affecting land values, and scaring locals.
To our Celebrity Rehab-jaded ears, this may seem like a thoroughly modern discussion about thoroughly modern institutions. But it is, in fact, part of a larger conversation that has shaped Southern California since the 1870s, when people sick in mind or body began streaming into the area, convinced the sunshine and temperate climate would cure them of their ills. This role as a second chance haven greatly influenced SoCal’s architecture, its city planning, and its sense of self.
“Invalids come here by the hundreds, and in every case, where they are not past all hope, they speedily find that precious boon which they have sought in vain in every other clime.” So said one of the numerous brochures, books, and pamphlets that circulated throughout America in the late 19th century.
Real estate developers, railroad companies, and civic boosters, flush with thousands of acres of cheap, available land, promoted Southern California’s Mediterranean climate to East Coast and Midwestern residents sick of brutal winters and sweltering summers. It was claimed the climate could cure tuberculosis, chronic pneumonia, cirrhosis, and jaundice. “The overworked and over worried class, will find here a most soothing climate to regain their lost energy or restore the nervous system to its normal equilibrium,” one promotion read.
Cities like Pasadena, Altadena, Monrovia, and Santa Barbara were marketed as health resorts in their earliest days. Invalids filled hotels and boarding houses during the winter months, displacing more able-bodied customers and finding the heating systems totally inadequate.
By 1883, the Los Angeles Herald was calling for large, evergreen-lined streets with no dust or mud holes, so that the city’s numerous invalids could take beneficial outdoor strolls. One wag claimed that all anyone talked about in SoCal was their health, with questions like “How do you feel today?” and “Do you cough much now?” filling the citrus-tinged air. Another joked, “When I left home I had but one lung and it was almost gone… I have been two weeks in Pasadena, have three lungs, can roar like a descending avalanche [and] ate three mules for breakfast.”
The greatest number of ill people coming to Southern California had the respiratory disease tuberculosis (also called consumption), which in its active form was incurable and often fatal. By the late 1800s, sanitariums began cropping up all over the Southland to deal with this influx of TB patients.
TB sufferers would come to stay at LA’s Barlow Sanitarium, Crescenta Valley’s Utley's Sanitarium, Pasadena’s Las Encinas, Altadena’s La Vina, Sylmar’s Olive View, and the lush Sierra Madre Villa. They were often housed in Craftsman-style bungalows or large outdoor tents.
According to historian John E. Baur, the sanitarium boom helped shape the penchant for large windows, glassed-in sleeping porches, and airy parlors in California architecture. SoCal’s plethora of sanitariums was considered such a selling point that one developer planned to donate land for a neighborhood sanitarium to increase his surrounding property’s value.
The “treatment plans” at these TB sanitariums often amounted to little more than extended periods of TLC, according to Dr. Drew Pinsky, noted addiction specialist, radio and television personality, and former head of the Las Encinas Hospital rehabilitation program. “People would come to just sit on the porch and get the fresh air and the heat and get away from the cold in the wintertime,” he says.
One patient at Barlow recalled that “all the beds, with patients squinting in the sun, were rolled out… onto a long screened porch fronting a wide, tree-lined road called Chavez Ravine, otherwise known as Lovers Lane. Here at least we could watch the cars go by and whistle at the new nurses who made the mistake of taking the front path to the dormitory.”
Over the years, some of these sanitariums, including Barlow and Las Encinas, would become respected hospitals and virtual little villages with working farms, water tanks, libraries, and stores. While Barlow stayed focused on patients with respiratory illnesses, some like Las Encinas would branch out into other medical areas, including mental health.
By the 1910s and 1920s, private mental health sanitariums were cropping up all over Southern California. Often housed on large abandoned estates built by early settlers, they were catchall institutions whose (usually not medical) staff did not differentiate between illnesses and addictions. “There was great confusion about what was psychiatric, what was neurological, what was medical, what was psychological,” Dr. Drew says. “So all kinds of different phenomenon, often medical, but with various kinds of neurological or psychiatric manifestations were all together.”
One of the earliest of these institutions was Banksia Place in Hollywood. Opened in 1910, it followed the cottage-garden model of earlier TB sanitariums. Run by Fredrick Kimball, the former superintendent of Patton State Mental Hospital, it offered the “nervous” a chance to “get away from it all.”
The Crescenta Valley, long a popular spot for TB sanitariums, soon had so many upscale, private mental health sanitariums that it became known as “the place where the nuts are.” Hillcrest Sanitarium in Sunland, “where health is the air,” played host to troubled star Clara Bow while she was recuperating “from the effects of a strenuous career.”
Mount Lukens (later Dunsmore Sanitarium) featured low stone walls, which may have been built by the patients for therapeutic reasons. There was the notorious Kimball’s Sanitarium, run by Fredrick Kimball’s son Merritt, which was located in an old Victorian house on Foothill Boulevard. Celebrities, including Frances Farmer and Bela Lugosi, spent time there. Historian Mike Lawler described what the estate's grounds entailed:
There was a big barn to the east and behind the house were several small cottages with Murphy beds, presumably for patients who could be trusted. The main event however was the building to the west that had the padded cells … It [was] a cement blockhouse, long and low. On one end was an open shower area. A very wide hallway ran the length, with padded cells on each side, featuring leather manacles.
In 1923, a nurse named Agnes Richards, fed up with the cold sterile mental hospitals she had worked in, opened perhaps the most famous mental health sanitarium in the LA area. Rockhaven Sanitarium for Women was essentially a lovely little village featuring Craftsman cottages with names like “the Rose,” ivy-covered stone walls, fountains, garden trails, and grottoes.
Geared toward women suffering from “overwork and exhaustion,” Rockhaven promised potential patients and their families that “the tranquil beauty of the gardens, and the opportunity for quiet seclusion—all help to hasten the patient's early recovery.” The women (including Marilyn Monroe’s mother Gladys) participated in soothing activities such as playing the piano, reading in the library, or arts and crafts.
But not everyone was a supporter. Prefiguring the current controversies in Malibu, many residents and real estate agents in the Crescenta Valley area became fed up with the number of patients in their community. In 1928, residents blocked the application of a new sanitarium that wanted to open across from Kimball’s. That same year, mass meetings were called to fight Richard’s planned expansion of Rockhaven.
Some people claimed that the presence of sanitariums devalued property, while others simply claimed to be scared of the patients. Real estate agents and residents called for a ban on all sanitariums in the area, even forming a group called the La Crescenta Protective Association. Richards fought back with lawyers and slander suits, and by the early ’30s, the uproar over sanitariums had died down.
Some therapies, including electroshock, psychoanalysis, occupational, and hydro therapy, and even lobotomies, were employed in sanitariums during the 1930s through 1950s. But what these places mainly offered was rest and relaxation.
For alcoholics, they were a place to dry out. This was true even at places like the respected Las Encinas. “It was a place you came, and you contemplated the garden, and you walked around in the fresh air and you had a cabin and the nurses would bring your breakfast in and the doctor would come visit you in your room,” Dr. Drew says. “WC Fields used to go there all the time. He was there essentially getting treatment for his alcoholism.”
This trend continued for decades. “I can’t name to you all the movie stars and television stars I saw come through Las Encinas, because even when I was there in the ’80s and ’90s, there were still vestiges of here’s where you go to get the TLC and no one will tell anybody,” he says.
The birth of the “modern” rehab as we know it was many decades in the making. Alcoholics Anonymous was founded in 1935. In 1955, alcoholism was declared a disease by the American Medical Association. During the ’50s and ’60s, doctors were increasingly beginning to sort out different mental disorders and diseases. As they did, they began to formulate different treatment plans for various maladies.
Most of the early alcohol and drug treatment centers were run out of hospitals. In 1978, First Lady Betty Ford entered the Long Beach Naval Hospital to get treatment for an addiction to alcohol and pills. In 1982, she helped found the Betty Ford Center in Rancho Mirage, three hours east of Los Angeles. “Most of the treatment at that time was hospital based,” she explained. “I realized we wanted a recovery hospital that would be less institutionalized and more of a relaxed setting in these mountains with their serenity and the beauty of them where people would be able to reach a spiritual feeling about their recovery.”
There was soon an explosion of 12-step-based rehabs all over Southern California. Places like Las Encinas and Cri-Help developed highly regarded in-patient drug and alcohol programs. Celebrities like Elizabeth Taylor publicly discussed their treatment at rehab facilities. Ordinary people began seeing 30-day rehab stints as a viable option to cure their addiction. They were aided by a system that worked in their favor. “Insurance in the 1980s paid for everything,” Dr. Drew says. “People could spend 28 days and really get comprehensive, full service, full psychiatry, full psychological services and insurance paid for it. It was Shangri-La.”
There are many different theories about the best architectural and design concepts for rehab. Dr. Drew believes the ideal rehab has the design ethos of a Big Sur cabin. “To me, the best thing is a centralized unit with a nursing station that can see everybody, and a peripheral unit with bungalows, with at least two people in each room, because addicts by themselves are never good,” he says. “And not too nice. It should not be a hotel.”
Not everyone agrees with moderate architectural approaches like this, used by long-running treatment centers like Betty Ford, Las Encinas, and Cri Help. The rehabilitation world of Southern California was turned on its head in 1988, when Richard Rogg founded Promises West LA. He later opened a second location in Malibu. This “personalized” treatment facility introduced a controversial new style of extravagant rehab: the "Malibu Model."
Over the past 20 years, dozens of these high-priced, spa-like rehabs, including Passages, Seasons, and Renaissance, have opened on estates all along the Malibu Coast. Richard Taite founded Cliffside Malibu in 2005. After turning his “elegant Connecticut farmhouse” with ocean views into a rehab center, he worked with a designer to model Cliffside after his favorite hotel, the San Ysidro Ranch in Montecito.
Taite believes providing patients with luxury services and products, like high thread count sheets, helps with their recovery. “I know that when I'm in a place that is comfortable and convenient and elegant I'm in a better headspace.” A recovering addict himself, he insists touches like roomy interiors (patients don't need to be on top of each other in early sobriety) and TVs in every bedroom (he fell asleep to Sports Center when he was getting sober) are personalized perks that make rehab a better experience.
Today, rehabilitation centers are big business in California. Recovery.org, a popular addiction resource site, puts the number of rehabs in the state at more than 1,400. They range from nonprofit, community-based rehabs to places like Passages, which cost more than $65,000 a month. The recovery industry, including sober living facilities for those newly out of rehab, shows no sign of slowing down in sunny Southern California. The more things change, the more they stay the same.