OVERWHELMED: Brains of autistic patients, operation of Arizona State Hospital are both a mystery

In part two of the special report OVERWHELMED, The Show reports on the complexities for people diagnosed with both autism and serious mental illness, and what effect those complexities have inside the Arizona State Hospital when it’s charged with providing care to a patient with a dual diagnosis.

If you've lived in metropolitan Phoenix for any amount of time, chances are pretty good that you've driven past the Arizona State Hospital and never knew it. Located on 90 acres at the northeast corner of 24th and Van Buren streets, the hospital complex is wrapped in chain link fencing, lined with razor wire and trimmed in hot pink bougainvilla.

Last year, the bushes were cut way back and now it's possible to see orange clad patients exercising on the dead winter grass. There are mysterious, gorgeous old buildings that may or may not be occupied today.

A newer administrative building with a big “no trespassing sign” hundreds of yards in front of the entrance keeps the place shrouded in secrecy, and employees leaving at shift change look away from observers standing on the trash covered public sidewalk.

If you have heard of the state hospital, it's probably in regard to Winnie Ruth Judd, the infamous trunk murderess who was a patient at Ashe between 1933 and 1971.

INTERVIEWER: You escaped from the Arizona State Hospital seven times.

WINNIE RUTH JUDD: Yes, but I hadn't escaped then. I waited 7 years before I did.

INTERVIEWER: OK, but you left the hospital seven times.

That's Judd in a 1969 documentary produced by KTAR.

On the southwest corner of the ash grounds, a small structure is being built to someday provide transitional housing for a few dozen patients. On the far northeast end, there's a long, unkempt lot packed with graves of long ago ash patients, including children.

The hospital opened on this spot in 1887. The 1912 annual report includes a long list of diagnoses that landed people at what was then called the State Asylum for the Insane, including alcoholism, sexual perversion and melancholia, as well as the feeble-minded, now referred to as intellectually disabled.

By the 1940s, the place was packed with hundreds of patients, including many World War II veterans, and the population topped 2,000. In 1970, the Arizona Legislature voted to discharge anyone who was not deemed a danger to themselves or others, and patients streamed onto Van Buren Street without much more than a few dollars and the clothes on their backs.

Like the inner workings of the Arizona State Hospital, specifics of just how our brains work can be hard to come by.

Blair Braden is a researcher at Arizona State University specializing in autism and aging.

“We understand the behaviors associated with autism, but we don't understand the biology that's contributing to them. We really don't know that much from a research perspective,” Braden said.

“I would say the things that we do know, broadly speaking, is that most cases of autism are caused by a variety of genetic differences that are really hard to pinpoint in any one individual,” Braden said.

Today, ASH houses fewer than 400 patients, including Matt Solan.

“Well, if I could sum it up in one word, I would use the word torture,” Solan said.

About half are in the forensic unit for residents with severe mental illness who have been found guilty of a crime and ordered by a judge to get treatment. The rest are civil commitments, those who are considered a danger to the community but haven't been charged with any crime.

When you think of autism, you likely recall that diagnosis rates among children began to climb in the mid-1990s and continue to soar. But unless you have a family member or are otherwise close to such a person, you probably don't think or know much about what happens to an individual with autism when they reach adulthood.

Some kids eventually appear to outgrow their symptoms, depending on their level of need - remember, autism is a spectrum - and the kind of therapy they receive in younger years.

Applied behavior analysis, or ABA, is a very intense program that trains children to behave more “normally,” and in recent years has fallen out of favor with many people in the autism community. This in part explains the sensitivity many have toward the idea of therapy for adults with autism.

And then there's the reality of how adults with autism are received by society.

Cynthia Macluskie is director of advocacy for the Autism Society of Greater Phoenix.

“I think that when you're small and cute and young and easily directed, that's where some people like to stay,” Macluskie said. “And the older that you get and the more needs you might have, the more opinions you might have, makes it maybe more difficult to work with and treat.”

But the number of adults with autism is going up as kids on the spectrum age and adult diagnoses increase. It's tough to know how many of those people have a dual diagnosis.

But the problem is significant enough that in 2022, the federal government created the Link Center, housed under the Administration for Community Living and designed to help people with dual diagnoses of intellectual and developmental disabilities and mental health conditions.

Jennifer Johnson, a member of the Administration for Community Living executive team, says the work is just beginning.

“There's a lot of challenges in terms of really, not only, you know, the challenges in terms of us not having national data on this population to know exactly how many there are and so their co-occurring conditions and their general health status,” Johnson said, “but also, it's hampered by the fact that it can be very hard to get a differential diagnosis of somebody with a … Is it their intellectual disability? Is it a mental health disability? Sort of truly understanding, you know, the, the differences between the two.”

The national data isn't there, and the local numbers at ASH have not been made available. But it is known that serious mental illness like schizophrenia or bipolar disorder occurs more often in people with autism than it does in the general population.

Researchers are just beginning to ask why.

“A lot of genes contribute to autism risk, and then things that people experience in their environment that we don't have a good handle on either,” Braden said.

While researchers grapple with the hows and whys, many people impacted by autism and serious mental illness are just trying to make it through the day.

“It was way quieter and less overstimulating in jail than it is at ASH, which I found nuts,” Solan said.