Today we welcome the first of two guest posts from Wendy Gonaver, author of The Peculiar Institution and the Making of Modern Psychiatry, 1840–1880, just published this month by UNC Press.
Though the origins of asylums can be traced to Europe, the systematic segregation of the mentally ill into specialized institutions occurred in the Unites States only after 1800, just as the struggle to end slavery took hold. In this book, Wendy Gonaver examines the relationship between these two historical developments, showing how slavery and ideas about race shaped early mental health treatment in the United States, especially in the South. She reveals these connections through the histories of two asylums in Virginia: the Eastern Lunatic Asylum in Williamsburg, the first in the nation; and the Central Lunatic Asylum in Petersburg, the first created specifically for African Americans. Eastern Lunatic Asylum was the only institution to accept both slaves and free blacks as patients and to employ slaves as attendants.
The Peculiar Institution and the Making of Modern Psychiatry, 1840–1880 is available in both print and ebook editions.
Jailing People with Mental Illness, Part 1
Prisons have become the primary providers of psychiatric treatment for many Americans much as they were in the 1840s when the Association of Medical Superintendents of American Institutions for the Insane, the organization that eventually became the American Psychiatric Association, was founded. Then as now, prisons were not designed to provide mental health care. A 2015 Human Rights Watch report documents the consequences of this incongruity: delusional prisoners unable to follow strict rules and commands are subjected to excessive force with alarming frequency. A particularly brutal case in point that made national headlines in 2012 was that of Darren Rainey, a 50-year-old schizophrenic man who died at Florida’s Dade Correctional Institution after being locked in a scalding shower for over an hour by guards who were angry that he had defecated on his cell floor. Rainey did not have access to the temperature controls. Witnesses later testified that he begged to be let out before collapsing.
The abuse of mentally disabled prisoners is a familiar story that was first popularized by reformer Dorothea Dix in 1842. Disgusted by the widespread use of restraints, incidents of sexual assault, and the practice of convict leasing, Dix goaded legislators to fix the faulty policies that had produced this humanitarian crisis. State and federal governments responded by building asylums. By the end of the 1850s, there were 29 public asylums in operation throughout the country. In theory if not always in practice, these institutions offered a gentler approach to managing mental illness. Asylum Superintendents sought to minimize the use of restraints, relying instead on positive inducements to encourage temperate behavior and the calming influence of a carefully conceived environment.
So why didn’t the proliferation of asylums in the nineteenth century solve the problem of mentally ill people being held and mistreated in prisons? Explanations for the current crisis commonly cite gradual disillusionment with the curative potential promised by early asylum boosters, followed by equally unrealistic expectations beginning in the 1950s that drugs like chlorpromazine would make costly residential institutions redundant. Missing from this account, however, is the role of race in the advent and demise of American asylums.
The growth of asylums and the struggle to end slavery occurred simultaneously. Ideas about blackness and insanity were often intertwined in public discourse. Supporters of slavery believed it was a civilizing institution that benefited slaves just as asylums inculcated self-control in “lunatics.” Critics of asylums argued that patients were deprived of personal liberty just as slaves were denied freedom. These rhetorical debates paid little attention, however, to the actual experiences of enslaved people. Although some of the first patients at public institutions in the South were black, the admission of black patients was quickly discontinued at every place except for one. The Eastern Lunatic Asylum of Williamsburg, Virginia was the only institution to accept slaves and free blacks as patients and to employ slaves as attendants.
Free black patients who ended up at Eastern Lunatic Asylum were typically first arrested for disturbing the peace or acts of violence. Local knowledge determined whether the trouble that led to an arrest was viewed as a symptom of mental derangement. Once admitted, free black patients were maintained by the state for fraction of the per capita annual allowance paid to support indigent white patients. If considered stable, free black patients worked on the wards or for local families to supplement the cost of their care and engage in purposeful activity. Enslaved patients were committed by wealthy owners who were unwilling to handle the challenges presented by someone who was either senile or, perhaps, mentally ill. Diagnosis for all patients was, of course, highly subjective. Slave owners and asylum administrators overlooked the most obvious explanation for erratic behavior: the trauma of violence and family separation that was a fundamental feature of slavery.
Despite serious shortcomings, for many black patients the asylum was nevertheless the best option from among limited choices. For example, a free black woman who had spent six years chained by the leg in jail prior to her admission to the asylum lived the remainder of her life working as a nurse for convalescent patients. She was never again subjected to mechanical restraint. This woman’s experience exemplifies the advantages of asylums that advocates like Dorothea Dix championed, yet Dix did not approve of the Eastern Lunatic Asylum’s management. For Dix and the majority of superintendents with whom she collaborated, the presence of black patients and enslaved attendants at Williamsburg marked it as a provincial, backward institution. Their objections stemmed from racism rather than concern about the exploitative nature of slavery. The long-term ramifications of this racism reverberate today, and will be further explored in Part 2 of this blog post.
Wendy Gonaver is archives assistant at the Frank Mt. Pleasant Library of Special Collections and Archives at Chapman University.