The land beneath the hospital once belonged to Cayetano Juarez, part of the Rancho Tulucay granted under Mexican rule. In 1872, Juarez sold the property to the State of California, and three years later, on November 15, 1875, the Napa Insane Asylum opened its doors. The facility was built to ease overcrowding at the Stockton Asylum, California's first state mental hospital, and it sprawled across 192 acres stretching from the Napa River to what is now Skyline Park. At its center stood an ornate brick building the staff called "the Castle" -- an imposing structure that served as the institution's architectural heart. The grounds operated as a self-sustaining world: dairy and poultry ranches, vegetable gardens, and fruit orchards fed the residents. By the early 1890s, the patient population had swelled past 1,300, more than double the facility's intended capacity. Relief came only in 1893, when the Mendocino State Hospital opened and absorbed some of Napa's overflow.

Napa State Hospital was among the California institutions that operated sterilization programs, part of a eugenics movement that the state embraced more aggressively than any other. Between 1909 and 1979, California sterilized approximately 20,000 people in state institutions -- a program that later drew the explicit admiration of Nazi Germany's architects of racial hygiene. The patients buried in the hospital's fields represent another kind of erasure. These were people whose illnesses, poverty, or social marginalization placed them beyond the reach of family or community. They died in institutional care and were interred without ceremony. About 1,400 more patients from the Sonoma Regional Center share a similar fate. The Castle itself, the grand brick edifice that once defined the hospital's silhouette, was demolished after World War II. What had been built to project permanence and authority became rubble, leaving the campus with the utilitarian architecture that remains today.

The hospital's patient rolls read like a shadow history of American life. Carleton Watkins, the pioneering photographer whose images of Yosemite helped persuade Congress to protect the valley, spent his final years at Napa after his daughter committed him. Sara Kathryn Arledge, an avant-garde artist and filmmaker, was forcibly committed by her husband in 1956. Eddie Machen, a top-ranked heavyweight boxer who had fought the likes of Sonny Liston, was admitted in 1962 after threatening suicide. Edward J. Livernash, a journalist accused of murder, later won election to Congress. Each name carries a story of talent or ambition derailed by illness, circumstance, or the cruelty of those closest to them. The institution also housed those society feared most: Earle Nelson, a serial killer who escaped from Napa multiple times before his killing spree, and Richard Allen Davis, who faked a suicide attempt in 1976 to engineer an escape.

In 1978, an event occurred at Napa State Hospital that would become legendary in punk rock history. The Cramps, a garage punk band from New York, played a free concert for the patients. The performance was filmed, and the footage -- patients dancing, swaying, and responding to the raw, distorted music with uninhibited joy -- became one of punk's most celebrated documents. The band played on a makeshift stage in a recreation room, surrounded by institutional walls and fluorescent lighting. There was no barrier between performers and audience. The concert captured something rarely seen in depictions of psychiatric hospitals: people experiencing uncomplicated pleasure. For those few minutes, the institution's rigid hierarchies dissolved, and the patients were simply an audience at a rock show, reacting as any audience might -- with energy, confusion, delight, and abandon.

Today, Napa State Hospital occupies 138 acres and remains one of California's five state psychiatric hospitals. It holds both civil and forensic patients -- people committed through the criminal justice system alongside those placed through civil proceedings. During the 2016-2017 fiscal year, the hospital employed 2,338 people, making it one of the largest employers in a region better known for its wineries and restaurants. The campus sits along California State Route 221, the Napa-Vallejo Highway, unremarkable from the road. Drivers pass it on their way to wine tastings and Michelin-starred dinners, most never knowing what lies behind the fences. The field where thousands of patients rest remains largely unmarked, a quiet reproach to the valley's curated beauty. Napa State Hospital endures because the problems it was built to address -- severe mental illness, criminal insanity, society's discomfort with minds that work differently -- have never been solved, only managed.