Brief History of Eastern State Hospital and the Treatment of Mental Illness in America
The Public Hospital For Persons of Insane and Disordered Minds
The history of Eastern State Hospital begins with a speech Governor Francis Fauquier, Royal Governor of Virginia, gave before the House of Burgesses in 1766 regarding the creation of a public hospital to treat "persons who are so unhappy as to be deprived of their reason." Before the creation of the public hospital, the quality and type of care provided for the mentally ill in the community was varied. According to one historian:
"Until this time the insane in Virginia were usually lumped with other dependent people- beggars, vagrants, the elderly, and the handicapped- and dealt with by local officials in a haphazard and unsystematic fashion. Some were given outright financial support and cared for by their families. Others were, in effect, auctioned off to neighboring families who provided basic needs in exchange for monetary compensation. Still others were housed in poorhouses. In some instances the insane were confined to jails or prison-like structures."1
Fauquier's proposal for a Public Hospital to treat the mentally ill was progressive. The idea that the mentally ill could be cured using scientific knowledge was relatively new, a product of the Age of Reason and the Enlightenment. Fauquier himself was a quintessential enlightenment man, interested in nature, music, science, and philanthropy.
On June 4, 1770, his request for a public hospital was acknowledged when the legislators adopted an act to "Make Provision for the Support and Maintenance of Ideots, Lunaticks, and other Persons of unsound Minds."2 The House of Burgesses appointed a fifteen-man Court of Directors to oversee the future hospital. The first Court of Directors was comprised of highly respected citizens, including such notaries as George Wythe, Thomas Nelson, John Blair, John Randolph, and John Tazewell. It was the Court of Directors' duty to determine whether or not a person was suitable for admission.
The goals of the public hospital were to treat and discharge the curable mentally ill, and confine those who were a danger to themselves or others. Thus, the public hospital did not accept the chronic and harmless mentally ill, for they were not proper candidates for admission. Admittance to the hospital did not rely solely on the Court of Directors. For a person to be considered for admittance, his existence must first have been brought to the attention of a magistrate. Should the magistrate find sufficient reason to believe the person insane, the magistrate would administer to the constable a warrant for the person's detainment. The detainee would then be brought before three local justices for a formal investigation. If the justices agreed to the person's insanity, they would send the person before the Court of Directors with a written testimony of their insanity. Only then would the Court of Directors decide whether the person was eligible for admittance.
In 1771, contractor Benjamin Powell was appointed to began construction on the public hospital. The public hospital was a two-story brick building south of Francis Street. A fire in 1885 destroyed the original 1773 hospital building, which included a central hall leading to the keeper's quarters and the patient cells. A central staircase led to the room in which the court of directors held their meetings, as well as to more patient accommodations. Before he was finished, Powell was also directed to add outdoor "yards for patients to walk and take the Air in" and to "put a fence around the lot."3 The first patient was admitted to the public hospital on October 12th, 1773. The hospital's maximum capacity was 24 patients, a number that was not reached until the early 1800s.
Age of Restraint (~1773-1835)- Living Conditions
The public hospital showed aspects of both jail and infirmary in its design, expressing the increasing fear of social deviants occurring at that time. There were three people originally staffing the public hospital: a keeper, a matron (for female patients), a physician, and a few slaves to care for the daily upkeep of the hospital and its patients. The keeper of the hospital was James Galt, and his wife was the hospital matron. James Galt had previously been the keeper of the Williamsburg Public Gaol, and was responsible for the day-to-day administration of the public hospital. Many members of the Galt family would run the public hospital as keepers and physicians for the next century. John de Sequeyra filled the role of hospital physician. Sequeyra received his medical degree from the University of Leiden in Holland, and had studied under one of the leading medical scientists of the Enlightenment before immigrating to Virginia in 1745. He also had a thriving medical practice in Williamsburg while administering to the patients of the public hospital.
"In traditional conceptions of disease, mind and body were inextricably linked, so that the lay person and doctor alike saw a troubled spirit as particularly vulnerable to mental and physical disease… The origins of mental disorder were now securely located within the individual in the internal imbalance of psychic and physical energies."
In this way, it was believed that those stricken with mental illness had chosen a mindset which had made them vulnerable to the mental illness. Thus, many of the common medical treatments of the time were unpleasant in hopes to dissuade patients from their choice of irrationality. These treatments included restraints, harsh drugs, cold plunge baths (via the ducking chair), bleeding, intimidation, cupping glasses, and blistering salves. In 1793, an electrostatic machine was also added to the treatment list in hopes of shocking patients out of their illness, as well as tranquilizing chairs.
Daily life in the public hospital during this period was often monotonous and grim. The patient cells were prison-like with barred windows, batten board doors, and restraining chains fixed to the walls. The furnishings for a cell consisted of a straw-filled bed on the floor, a blanket, and a chamber pot. In 1790, fences were built at each end of the hospital to provide exercise yards for both male and female patients. Occasionally, patients were allowed to take in fresh air in the barren exercise yards attached to the hospital. In 1799, two cells were dug under to first floor for patients arriving to the hospital "in a state of raving frenzy." Between 1773 and 1779, of the 42 patients admitted, 10 were released as restored and 5 were released to the care of their families- a 20-25% cure rate.
In 1800 conditions improved slightly when shelters and benches were provided for the exercise yard. However, as the number of chronic patients increased through the 1820s and 30s, the number of people restored to health declined. More improvements came in 1835 after a special committee, assigned by the Virginia House of Delegates to observe the hospital, wrote a critical report of the hospital's management in regards to daily activities provided for the patients with the following observations:
"The patient's day, according to the report, began at dawn when cells were unlocked. Inmates were cleaned in the morning and then escorted to sitting rooms. Patients spent their daylight hours either in these public rooms or in the privacy of their own cells. Although some of the women residents helped make undergarments, bedding sheets, and clothing, idleness generally marked the day."2
This critique of the hospital led to changes in the activities provided by the hospital, as well as the way in which it was run. The greatest changes occurred in 1841, when John Minson Galt II became superintendent of the public hospital.
Eastern Lunatic Asylum- John Minson Galt II
In 1841, the name of the public hospital was changed from The Public Hospital For Persons of Insane and Disordered Minds to Eastern Lunatic Asylum, carrying with it the connotations of a sanctuary for the mentally ill. Also in that year, a third story was added onto the main building. The gaol-like positions of superintendent and matron were replaced with the position of superintendent. The superintendent was a resident, full-time doctor and head administrator to the hospital. The superintendent in 1841 was John Minson Galt II, who made sweeping changes in the management and care of patients. At his death in May of 1862, the hospital housed between 200 and 300 patients in its 7 buildings.
In the 1850s, Superintendent Galt suggested a day-patient approach similar to the town of Geel (present-day Germany), where patients went into town and interacted with the community during the day and returned to the hospital at night to sleep. The Court of Directors rejected this proposal. The idea was a century ahead of its time and re-emerged as deinstitutionalization in the 1900s. However, Dr. Galt did carry out an experiment with deinstitutionalization in Williamsburg that lasted for a decade. Convalescing patients who behaved well and had good self-control (approximately half of the 280 patients at the time), had the freedom of the town at all times during the day. The townspeople were also encouraged to visit and socialize with patients still confined to the hospital grounds. Many of these changes were a part of a new era called "moral management," brought about due to a change in social perception of mental illness.
Moral Management Era (~1836-1862)- Living Conditions
This change in the treatment and care of patients was merely one of a group of reforms sweeping antebellum America, including anti-slavery, temperence, and religious reform movements. Moral Management, a practice developed first in Europe, "emphasized kindness, firm but gentle encouragement to self-control, work therapy, and leisure activity." A concern for human dignity and kindness had arisen, as well as an air of patriarchal benevolence, in part due to the work of Dorothea Dix to improve the living conditions of the mentally ill throughout the country, and partly as a result of firsthand experience with patient's needs and conditions. During this period, life for the patient became more comfortable.
John Galt II strove to gain the "self-respect, confidence, esteem and love" of the patients under his care, believing a stronger doctor-patient rapport was essential to the treatment process. The staff was also encouraged to converse with the patients and many organized activities were planned. There was an increase in cures during this time and chronic patients were more comfortable and manageable. The moral management movement came a little late to Williamsburg. However, by adopting moral management treatments the asylum attracted Southern patients whose wealthy families would normally have sent them to Philadelphia for care. Galt hoped that attracting paying customers to the facility would balance out the expense of housing the chronically ill and elderly frequently sent to Williamsburg by another state hospital. Though physical restraint never fully disappeared from American institutions (European superintendents posited that Americans were desensitized to violence and forcible restraint by slavery), it was considered a last resort during Dr. Galt's superintendence. Although he was not an abolitionist, Galt also made the (at the time) radical proposal to desegregate the asylum. He succeeded with desegregation for a decade, despite disapproval from other superintendents around the country.
Patient comfort became an important concern, and in 1845 the furnishings of the patient rooms became similar to those of an apartment. These furnishings were modest, but rooms now had plastered walls with painted trim. The batten board doors were replaced with panel doors, wire mesh replaced the bars above the room door, and exterior rather than interior window bars were used. A 10 ft wall was also built around the hospital, allowing convalescent patients to traverse the hospital grounds. John Minson Galt II brought individual attention to his patients, and preferred medication (usually opiates, such as laudanum) to the restraints and more drastic treatments previously used. Galt created a carpentry shop on the grounds, a patient's library, a game room, and a shoemaking shop. For his female patients, Galt provided rooms for sewing, spinning, and weaving. Dr. Galt also provided evening lectures, social gatherings, and concerts; carriage rides about the town were scheduled for female patients. The patient library was the oldest of its kind in a public psychiatric hospital.
Civil War- A Time of Changes
Many changes to Eastern State Asylum occurred at this time. The asylum, as well as the surrounding area, was captured by Union troops on May 6th of 1862. John Minson Galt II, superintendent for 21 years, also died that month. With the capture of the city, all but one of the white attendants had fled. The 252 patients had been left, locked in their apartments to starve. The remaining attendant, Sommersett Moore, handed the keys to the hospital to the Union army and saved the lives of the patients.
A great many changes occurred during the next 23 years, to both the administration of the hospital, and to the size of its population. Superintendents did not always have the full support of their staff or the Court of Directors, and the hospital did not always receive adequate financial support. In 1876, fire destroyed one of the asylum buildings. One superintendent, Dr. Harvey Black, was inspired by Dr. Galt's manuscripts to try and deinstitutionalize some of the 400+ patients at the hospital in the late 1880s. He was fired by the court of Directors and replaced by Dr. Richard Wise, whose goal was to find space within Eastern State Asylum for as many "unfortunates" as possible. Under his supervision, the population of the hospital rose from 323 to 447 patients. At this time, there were 10 buildings on the Eastern State Asylum property. A few of the therapeutic activities introduce by Galt still continued, but for the most part the hospital became a long-term care facility for the chronically ill.
Custodial Care Era- (1862-1885)
After the Civil War, there was an increasing lack of confidence in the ability of science to cure mental illness. Though mental illness was believed to be hereditary or of physical nature, the problem of its cure defied scientific solution. The hospital became crowded with the chronically mentally ill, and the number of patients successfully cured declined. Admission to the hospital was on a first-come, first-serve basis, regardless of chances for successful treatment. During the era of custodial care, the goal became not to cure mental illness, but to provide a comfortable environment for the mentally ill, separate from society. Recreational activities such as dances, steamboat excursions, and tea parties were offered to patients, as well as magic lanterns, a stereopticon viewer, and checkerboards. The use of restraints, in the forms of straightjackets and Utica cribs (mesh boxes to confine the violent and unruly), were also reintroduced during this time.
On June 7th in 1885 on a Sunday evening, a fire destroyed the original 1773 hospital building. The nearest fire engine at the time was in Richmond, some 50 miles away. Students from the nearby College of William and Mary came to the assistance of the hospital staff to help put out the fire. By the time the fire was out, five other buildings in the asylum complex had burned down. The fire left two patients missing (presumed dead) and 224 other patients displaced. Electrical wiring for lighting, one of the improvements made to Eastern State Asylum during the superintendence of James D. Moncure, was suspected of sparking the blaze.
Eastern State Hospital (1894-Present)
In 1894 the hospital was renamed from Eastern Lunatic Asylum to Eastern State Hospital. By 1935 Eastern State Hospital housed some 2000 patients with no more land for expansion. The restoration of Colonial Williamsburg and the Williamsburg Inn surrounded the facility with a thriving tourist trade. A proposal was made to move the hospital to Dunbar Farms, located west of the city on Ironbound Road. The first care buildings at Dunbar were constructed and inhabited in 1937. The Dunbar Farm land is where Eastern State Hospital stands to this day.
Treatment of patients also changed during this time, as effective psychiatric drugs for the treatment of mental illness became available after World War II. The idea of community-based care, a version of which was proposed by Dr. Galt a century prior, was carried out in the 1960s under the name of deinstitutionalization. To learn more about the current treatments available at Eastern State Hospital, click here or return to the homepage to browse.
When the move from Francis Street to Dunbar Farms was completed in 1960, the old asylum complex was razed. In 1972 the original public hospital building was excavated. The debris from the 1885 fire had merely been shoveled into the remaining foundations, and various small items such as glass were recovered. In 1979, Colonial Williamsburg received approval to reconstruct the old hospital building, which was opened to the public in June of 1985. Today, the reconstructed building houses a public hospital exhibit, staff offices, and serves as an entrance to the DeWitt Wallace Decorative Arts Museum.
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