Today we welcome a second guest post from Wendy Gonaver, author of The Peculiar Institution and the Making of Modern Psychiatry, 1840–1880, just published this month by UNC Press. You can read the first installment here.
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 2
Dorothea Dix marveled at the liberties extended to patients at the Eastern Lunatic Asylum, but was shocked by the authority entrusted to enslaved attendants. These attendants were the gatekeepers and guardians of the room keys; they grew, prepared, and delivered the food; they initiated and took patients on excursions; they bathed and shaved patients who were willing but unable to attend to personal hygiene. Most controversially, enslaved attendants were authorized to seize unruly patients—black and white—and subject them to restraint, showers, and isolation, as well as forcibly administer medication and food on the doctor’s orders. It was not the injustice of uncompensated labor to which Dix objected; she didn’t earn a wage for her advocacy work and recommended that Superintendent John M. Galt employ nuns. Her concern stemmed from her belief that African Americans lacked the ability to provide exemplary moral care.
As someone who looked favorably upon the Dred Scott decision in which the Supreme Court ruled that African Americans, whether free on enslaved, were not and could never be U.S. citizens, the close contact between black and white Virginians offended Dix. She was not alone in this regard. Prominent northern superintendents also disapproved of the anomalous governance of the Williamsburg asylum. They disparaged the institution at professional meetings, in the pages of the American Journal of Insanity, and in private letters to one another and to politicians responsible for funding asylum construction. Superintendent Galt countered these criticisms with assurances that the enslaved staff was trustworthy. He also insisted that asylums were ethically obligated to accept all needy patients without regard to race or social class.
Galt complicated his effort to persuade colleagues of the merits of racially mixed institutions by simultaneously publishing essays decrying the alleged abuse of the South by the North over the issue of slavery. Whatever their opinions about slavery, northern superintendents perceived that the presence of black patients on the wards would denote pauper disgrace to their white clientele.
The gap between Galt and his colleagues became an unbridgeable chasm, however, only after he began to experiment with outpatient care. Partly inspired by his experience with slaves hiring out, Galt recommended that patients live with and work alongside host families or reside semi-autonomously in cottages where they could attend to their own cooking and cleaning. These radical approaches undermined the professional identity of asylum doctors and were swiftly condemned.
Galt’s professional isolation turned to despair during the Civil War. He died in 1862 of an opiate overdose in the midst of Union occupation of Williamsburg. The war years saw deprivation and high administrative turnover. Working conditions were especially stressful for enslaved attendants. Confederate soldiers raided the asylum’s food supply and impressed several attendants into service with the Confederate Medical Department in Richmond. The chaos also yielded opportunities for Galt’s rivals to exercise their influence and change institutional policies. In January of 1870, the Eastern Lunatic Asylum transferred all African American patients to a former Confederate hospital near Richmond. Newly elected African American members of Virginia’s General Assembly protested the removal of patients to a segregated facility, but to no avail. The hospital was renamed Central Lunatic Asylum that same year.
Central Lunatic Asylum bore little resemblance to the institutions lauded by Dix et al. Conditions were extremely rough. The only ostensibly therapeutic treatment on offer was farm labor. Water was supplied by a single pump and carried in buckets to the buildings. Patients could bathe and change clothes just twice a week, with four patients sharing a tub. Patients were frequently shackled to walls. After a white matron disclosed to African American politicians instances of abuse that she had witnessed, she was fired and the members of the Richmond City Council were prohibited from making inspections. A white man supervised the women’s ward alone thereafter.
White doctors evinced a pessimistic attitude towards the patients. In its first year of operation, the superintendent at Central Lunatic Asylum labeled the overwhelming majority of patients as incurable. Consequently, the patient population grew at an astonishing rate. The majority of patients were committed involuntarily and, in some cases, for no justifiable reason. A few men, for example, were admitted for “loafing.” It is unclear why these men were sent to the asylum instead of jail for violating racist vagrancy laws, but the two institutions were clearly viewed by authorities as somewhat interchangeable. Notably, incarceration in either institution rendered men ineligible to vote.
Several all-black institutions were created in other states in subsequent years. The quality of care generally declined in the late nineteenth and early twentieth centuries, but facilities for African Americans were especially terrible. For many patients, deinstitutionalization was a welcome change. Yet the failure to fully fund community care models in the wake of hospital closures and, most importantly, the criminalization of social problems that led to mass incarceration of African Americans at a rate rivaling the 1880s have created a new humanitarian crisis. Is the treatment available at Dade Correctional Institution or Rikers Island the best solution?
Bipartisan support for the Comprehensive Justice and Mental Health Act inspires some cautious optimism. This law authorizes the Department of Justice to give grants to programs that train first responders to better recognize mental illness and improve coordination among agencies working to reduce the number of mentally ill people in prison. The Black Lives Matter movement has also raised awareness about this issue. Whether the emphasis on crisis response within the criminal justice system will generate deeper investment in community mental health for all Americans remains to be seen.
Wendy Gonaver is archives assistant at the Frank Mt. Pleasant Library of Special Collections and Archives at Chapman University.