Brian Andrew Sharpless, PhD, MA
Washington State University, Pullman, United States
The founding of the hospital
|The Public Hospital of Williamsburg|
Although it is widely known that the first hospital in the United States was the Pennsylvania Hospital (founded in 1751 in Philadelphia), few may realize that the first American hospital devoted exclusively to treating the mentally ill was built in Virginia. The Public Hospital of Williamsburg (also known as Eastern State Hospital or Eastern Lunatic Asylum) was first proposed to the Virginia House of Burgesses by Francis Faquier in 1766 and admitted its first patient on October 12th, 1773.1
The reasoning behind the hospital’s founding rested not only on political and economic grounds (as the mentally ill often had to be transported to other states for treatment), but also on certain changes in public perception. During this pre-Revolutionary War period, editorials and newspaper articles began to document some of the more disastrous consequences of untreated “lunacy.” Several stories in the Virginia Gazette2 detailed the violent and seemingly inscrutable behaviors of the insane. For example, one editor wrote in the wake of a murder committed by a “lunatic” that, “It is really shocking to see the number of miserable people who have lost the use of their reason, that are daily wandering about, for want of a proper house to keep them confined in. If there had been such a place, this poor man would not have met with the above untimely end” (p. 8). Another article noted that a wife described as “long disordered in her senses” murdered her husband with an axe and appeared to be “quite insensible of the horridness of the crime she [had] committed.”(p. 9) As Dain noted in his review, there is (in general) an attitude of sympathy in these articles, rather than recrimination. However, juxtaposed with this sentiment is also recognition of what Foucault would term “the scandal of unreason”3 (p. 81) found in the insane persons’ violations of Enlightenment ideals through their disordered, unseemly, and non-reasonable actions.
The Public Hospital was erected near the College of William and Mary in what we now term Colonial Williamsburg. And although it shut down for five years during the Revolutionary War (and was continually raided for supplies by both sides during the subsequent American Civil War), the original hospital building remained in fairly continuous operation until a large fire occurred on 7 June, 1885.1
During the hospital’s long history, various treatments were implemented.1,2,4 These appear to be fairly synchronous with those applied at other institutions in both North America and Europe. Some of those treatments will likely sound quite strange to modern readers and would appear ineffective at best and dangerous at their worst, but were logically deduced. Dr. John Galt’s writings provide a window into the theories undergirding treatments he provided as hospital superintendent (i.e., 1842-1862) and may serve to cast his antiphlogistic hypotheses for treating insanity into sharper relief. Galt stated that “The indications which we have had in view in most cases, are to depress the excessive nervous excitement, to procure sleep, to keep open the secretions, to support the strength, and to withdraw the patient's mind from his delusions” (p. 488).6 To this effect, Galt and the other physicians at the hospital would prescribe a variety of drugs, physical regimens, environmental modifications, and venesection.6
Regarding drugs, the provision of tonics (e.g., sulphate of quinine) and gentle laxatives was common practice. Purgatives such as castor oil, aloe, and tincture of hellebore were also used, the latter to treat not only insanity but also forms of paralysis (including what would later be known as sleep paralysis7,8). Obviously, the mood stabilizers and antipsychotics we are all familiar with today were not yet available, so opiates such as laudanum were used to induce sleep, lassitude, and behavioral control. Blistering agents and salves were also applied, often to the back of the neck and to the shaved head.6
Physical regimens and modifications to the patients’ environment were also used. Baths of varying temperatures, applications of cold to the head, and exercise (especially military-style exercises) were common. Certain inmates were allowed to work in the hospital grounds and gardens, and leisure activities (e.g., playing musical instruments and games) were encouraged. Dietary modifications were quite prevalent, restrictions in some cases (e.g., avoiding rich foods) and expansions in others (as some patients’ diets were viewed as too temperate).
Restraint was used in response to extreme cases of behavioral disorder or dangerousness. When presenting the vignette of a self-injurious female patient, Galt noted that, “If she attempts to injure her person, moderate coercion with the straight jacket [will be] necessary. Your deportment [is] to be tender, but, at the same time, resolute and firm; proper authority should be exercised over her, and she should be kept in awe of you”(p. 485).6 Benjamin Rush’s tranquilizing chair and other means of patient confinement were liberally used.1
Galt also used bleeding, a medical practice in common continuous application since at least ancient Greece and clearly betraying lingering humoral assumptions. It typically involved drawing some eight to sixteen ounces at various intervals, ranging from three to sixty individual drawings depending on the particular disorder being treated.6
Who were the patients that received these multifarious treatments? In reviewing the available data from 1868-1879,9 the patients appear to have run the gamut of socio-economic classes and professions. Most common were the unemployed (20.95%), farmers (20.29%), and housewives (17.11%). Though more men (54.77%) were confined in the hospital than women, the sexes were represented fairly equivalently. Interestingly, “idiots” were not admitted to the hospital after 1830, but the cause for this shift in admissions was not entirely apparent in the records. A clue may be found in Galt’s subsequent writings, as he was of the opinion that “idiots” should not be permitted to come within the view of the “incurably insane” or “convalescents.” Galt noted that, “The indiscriminate mixture of all cannot fail to be an endless source of riot, and of serious disappointment” (pp. 111-112).6
The putative “causes” of insanity documented at the hospital were quite heterogeneous, ranging from biologically-based hypotheses (e.g. paresis, menstrual disturbances) to social (e.g. the fall of the confederacy) and psychological (e.g. excessive study, business affairs) ones. The most frequently documented etiologies were hereditary (13.13%), ill health (6.76%), masturbation (5.57%, exclusively found in men), and intemperance (3.32%). For many patients, however, the cause was unknown (35.94%). Interestingly, the peak age of admission fell within the twenty to twenty-five year range, which also corresponds to the well-known sensitive periods for the development of psychosis and bipolar disorders.
Although the hospital a) weathered a devastating 1885 fire, b) survived the vicissitudes of the Revolutionary and Civil Wars, and c) lacked what we would now consider to be standard medical record-keeping and outcome tracking, outcome data are nonetheless available. Outcomes from three time spans can be found in Table 1. However, as is apparent, the description of outcomes is quite vague (e.g. What was the precise definition of “recovered” used during this time? What was the relative effectiveness of confinement compared to venesection?). These limited data indicate that hospital outcomes improved over time, but whether this was due to increasingly effective interventions, changes in definitions of improvement, or variations in patient problems is unknown. Data also imply that a number of deaths occurred as well, but reasons for these (i.e., how many deaths resulted from treatments?) are similarly obscure.
Table 1. Admissions and Outcomes at the Public Hospital of Williamsburg, Virginia
|Years||N of Patients Admitted||% “Restored” or “Recovered"||% that Died|
In closing, the Public Hospital of Williamsburg was the first dedicated asylum built in the American colonies. The treatments used reflected the theories of the times, and data indicate that at least some of the patients were helped. The hospital’s doctors practiced during times of intense social upheaval and when modern psychiatric treatment was in its infancy. Although the hospital remains in operation today, services are now conducted in a new location on the outskirts of Williamsburg, instead of the restored main building.
- Zwelling SS. Quest for a cure: The Public Hospital in Williamsburg, Virginia, 1773-1885. Williamsburg, VA: The Colonial Williamsburg Foundation; 1985.
- Dain N. Disordered minds: The first century of Eastern State Hospital in Williamsburg, Virginia 1766-1866. Williamsburg, VA: The Colonial Williamsburg Foundation; 1971.
- Foucault M. Madness and civilization: A history of insanity in the age of reason. NY: Vintage Books; 1988.
- Jones GL. The history of the founding of the Eastern State Hospital of Virginia. American Journal of Psychiatry. 1954;110:644-650.
- Cushman P. Constructing the self, constructing America: A cultural history of psychotherapy. Boston,MA: Da Capo Press; 1996.
- Galt JM. The treatment of insanity. New York, NY: Harper & Brothers; 1846.
- Sharpless BA, Doghramji K. Sleep paralysis: Historical, psychological, and medical perspectives. New York, NY: Oxford University Press; 2015.
- Sharpless BA. Changing conceptions of the Nightmare in medicine. Hektoen International: A Journal of Medical Humanities (Moments in History Section). 2014.
- Thompson PM. Annual report of the Eastern Lunatic Asylum of Virginia for the fiscal year ending september 30, 1879. 1879.
Brian A. Sharpless, PhD, MA, is assistant professor of psychology and director of the Psychology Clinic at Washington State University (WSU). He received his Ph.D. in clinical psychology and M.A. in philosophy from the Pennsylvania State University and completed his pre-doctoral internship at Pennsylvania Hospital. After graduation, he finished a post-doctoral clinical fellowship (Pennsylvania Hospital) and post-doctoral research fellowship (Center for Psychotherapy Research) at the University of Pennsylvania. Prior to his position at WSU, he was on faculty at the Pennsylvania State University. Current research interests include anxiety, unusual and rare psychological disorders, psychoanalytic therapy, and the history and philosophy of clinical psychology.