by Abigail Coy, MD, psychiatry intern, Mayo Clinic College of Medicine
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.
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 Eventually the tax was repealed.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).
It seems the more things change, the more they stay the same: In those predisposed to depression, mania, or psychosis, psychosocial stressors often precipitated acute psychiatric decompensation. In addition, physiological factors such as substance abuse, insomnia, and delirium often played a large role as well.
The treatments of the time seem like torture today. During the hospital’s first 60 years prevailing treatments included solitary confinement, conditioned fear of doctors, powerful but minimally effective drugs, bleeding, shackles, and plunge baths. It was thought that the patients had chosen a life of insanity and needed to decide to change their ways.
Eventually, thought changed. In 1790s post-revolution France, the beginnings of the “moral management” movement took place. This was based on the idea that mental illness was rooted in emotions and that harsh treatment simply confirmed the patients’ fears, thus being ineffective and detrimental.
By the 1840s, these ideas finally spread to Williamsburg. John Minson Galt II took over the hospital in 1841 and dedicated himself to maximizing the use of respect and kindness in shaping the behavior of the mentally ill. He instituted treatments such as good nutrition and sleep, socialization, and recreational therapy. The hospital census swelled, stretching resources thin. As the Civil War brewed, support shifted to the war effort, and the hospital was forced to release many patients into the countryside.
Thus, things had come full circle. Due to the political upheaval, mental healthcare had returned to pre-Revolutionary War conditions. Despite continued interest in the “moral management” methods of treatment, the political times could not provide the support.
As is so common today, the struggle between idealism and practicality was clearly reflected in the patients’ treatments and lives. Though the pendulum did swing back, bringing better treatment for the mentally ill, we continue to seek this fine balance. TH
Zwelling SS. Quest for a cure: The public hospital in Williamsburg, Virginia, 1773-1885. Williamsburg, Va; Colonial Williamsburg Foundation: 1986.
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