Mental Health in Colonial America

Insanity in colonial America was not pretty: emotional torment, social isolation, physical pain—and these were just the treatments! In the late 1700s facilities and treatments were often crude and barbaric; however, this doesn’t mean that those who applied them were fueled by cruelty. There were often dedicated and intelligent individuals behind the torturers’ masks. How can this be? Prevailing thoughts on the etiology of mental illness and political forces played large roles in how patients were treated. An excellent example of this is the story of North America’s first public mental health hospital: the Public Hospital for Persons of Insane and Disordered Minds in Williamsburg, Va.

Prior to the opening of the mental health hospital in 1773, the prevailing goal was to minimize the trouble caused to the community by the mentally ill. The quietly insane were simply left to their own devices in the countryside. Those who committed crimes, caused a nuisance or posed a potential threat of either, though, were subject to imprisonment in the local jail.

Virginia’s Acting-Royal Governor and Chief Administrative Officer Francis Fauquier (1758-1768) struggled with the legality of imprisoning the innocent, as well as the lack of treatment for them. Publicly run hospitals specifically for the insane had been in practice for a century in France and England. Fauquier proposed a similar idea to be implemented on American soil.

Photo (above): A scene from Bethlehem Royal Hospital—known as “Bedlam.” Bethlehem was around from 1247-1997 and was the world’s oldest institution for caring with people with mental disorders.

The hospital was born of unruly times. In 1766, pre-Revolutionary-War America experienced growing anti-British grumblings and political unrest. Just one year prior, a 1765 British Stamp Tax had been imposed on the colonies. Mass riots and pillage ensued. Eventually the tax was repealed. Fauquier gave a speech calling for citizens’ gratitude and obedience to the British Parliament for this concession.

He also proposed the mental health hospital in this speech. Given the juxtaposition, it has been suggested that the governor was likening the violent protests against the Stamp Tax to unreasoned acts of the mentally ill. He described the insane as “persons who are so unhappy as to be deprived of their reason,” a phrase that could equally describe unruly dissenters. Taking this further, one might wonder if Fauquier hoped these protesters would be similarly contained.

What qualified as mental illness? A list of “supposed or assumed causes of insanity” for the hospital’s 754 patients in 1879 identifies 46 such causes. Many, such as excessive study, seduction, matrimony, or the fall of the confederacy, are unlikely to make the modern DSM. But some are familiar (e.g., loss of property, disappointment in love, intemperance, excessive fatigue, and ill health).

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