Eastern State Hospital, founded in 1773 in Williamsburg, Virginia, has the unique distinction of being the first hospital built in America specifically for the confinement and treatment of the mentally ill.
Before the construction of this facility, individuals who suffered mental illness were not diagnosed by a physician knowledgeable in such conditions but judged by a jury of 12 citizens to be a “criminal,” “lunatic,” or “idiot.”
Those classified as “lunatics” were locked away in a brick building called the Public Gaol (pronounced “jail”) in Williamsburg. This first-of-its-kind facility was built to change all that.
The Publick Hospital for Persons of Insane and Disordered Minds
The Court of Williamsburg appointed a man named James Galt as the keeper of the hospital and Dr. John D. Sequeyra as the visiting physician.
When the doors opened on what was then called “The Publick Hospital for Persons of Insane and Disordered Minds” on October 12, 1773, two patients, Zachariah Mallory and Catherine Harvey, were evaluated and deemed insane, becoming the asylum’s first residents. That number grew to 36 by the end of the first year.
During that first year, few referred to the facility by its official name, most preferring what it was: the “Mad House” or “Bedlam.”
By 1784 the facility was filled, compelling the Court of Directors to petition the Governor of Virginia to allot more funds to expand the building to accommodate the growing number of “lunatics” still roaming the city.
Four years later, funds were finally provided, not to expand the building to accommodate the growing number of patients but to repair the already deteriorating structure.
Treating the Inner Battle Between Good and Evil
With even the earliest concepts of psychiatry still decades away, doctors based theories of mental illness in the late 18th Century on superstition and beliefs dating back hundreds—even thousands of years.
Physicians believed that deviant, antisocial behavior reflected the inner battle between good and evil inside the individual’s soul. They believed that forces outside the body and beyond the environment controlled human behavior, thinking, and emotions—and the insane were helpless to do anything about it.
Though some physicians claimed to be able to distinguish the influence of a demon from a spirit, a spirit from a divinity, most believed that little could be done once an outside force had taken control of an individual’s soul.
The best one could hope for war was to persuade that force to leave of its own accord. And though doctors used many treatments to accomplish this (essentially, various forms of torture), most patients spent most of their time in the hospital chained to the wall of their cells. Some were allowed to roam free, strapped into straitjackets.
Changing Times, Changing Perspective
By the start of the 19th Century, the public clamor for patient reform brought a change in perspective and treatment to The Publick Hospital.
Rather than keep patients locked away from society, French physician Phillippe Pinel promoted the idea that a large percentage of the mentally ill could be cured with proper treatment—beginning with removing chains and restraints, except in the most violent cases.
And though the majority of patients soon saw freedom from their shackles and chains, “treatments” commonly used on the insane during this time included ice water baths, forced-feeding of rotten food (to induce purging), physical abuse (to scare out the invading entity), use of a dunking stool, bloodletting, blistering, and the bizarre practice of bathing patients in whiskey. Unskilled attendants administered most treatments under the presiding doctor’s supervision.
In the end, patients who resisted this abusive treatment were placed back in chains or straitjacketed until ready to submit.
Early Impact of The Publick Hospital
Despite the seemingly counter-productive treatment patients received at The Publick Hospital, of the 355 patients admitted from 1798 to 1824, 135 were deemed “cured” and released back into society.
Their return to sanity is attributed to William Galt (the second of three Galts to hold the position of keeper of the hospital), who observed that patients admitted in the early stages of illness were far more likely to benefit from the facility’s treatment regime (as harsh as it was) than those who were not.
To this end, W. Galt promoted the idea that insanity should not be equated with crime; that individuals displaying erratic behavior should not be indiscriminately tossed into prison but first brought to the hospital for evaluation.
But even with his warning, numerous individuals who were eventually deemed insane and admitted to the hospital had already spent a year or more in jail and had endured such abuse from prison guards that any attempt to treat them was met with rage.
In 1833 the Court of Directors saw that stricter laws were passed requiring sheriffs to inform the hospital when they’d jailed someone suspected of insanity. But even with these laws, some 50 “lunatics” remained jailed in 1841 due to the hospital’s lack of available beds.
That same year, The Publick Hospital again asked for funds to expand the buildings–which they received. The state allotted funds to employ eight male and six female slaves to help Galt apply his “moral” treatment methods on a larger scale, help with patients’ day-to-day needs and see to menial labor and general upkeep of the building.
Though a cure was unavailable from 1825 to about 1835, syphilis cases rose dramatically across much of America, making it medically deemed a “disease,” general paresis.
This was significant to The Publick Hospital (as well as other hospitals and insane asylums around the country) in that the disease presented itself as psychosis with similar symptoms as insanity: paranoia, delusions, and hallucinations.
While there is no documented proof that The Publick Hospital used the one proven cure for syphilis (injecting the patient with blood from someone carrying malaria), many such facilities across the country quietly did—meaning some were likely cured inadvertently by this unsanctioned procedure.
Time For a Change: The Eastern Lunatic Asylum
To better reflect the true design and objective of The Publick Hospital for Persons of Insane and Disordered Minds, in 1841, the Court of Directors renamed the facility “The Eastern Lunatic Asylum” (a name it would carry until 1894).
With this name change came a restructuring of administration, making the 22-year-old Dr. John Minson Galt, II (no apparent relative to keepers’ Galt) the Medical Superintendent of the facility.
Unlike his predecessor, Dr. Galt came with considerable credentials regarding mental illness, having studied every treatise on insanity available and had himself written many academic papers on the subject–as well as a book titled, Treatment of Insanity, which he would publish in 1846.
Revolutionary Treatments
From the onset of his tenure, Dr. Galt’s approach to treating patients was revolutionary. He kept methodical, detailed files categorizing each patient by many criteria: Possible Cause of Insanity (domestic troubles, religious feelings, fright, use of opium, anxiety of mind . . .), Occupation (farmers, tailors, teachers, sailors, peddlers . . . ), as well as Religion, Age, Marital Status, and Length of Time in an Asylum.
Galt believed that effective patient care was grounded in knowing how one patient differed from another and then tailoring treatment accordingly. As a result, he was one of the first physicians in the country to see the short- and long-term value of taking patient histories.
Galt’s approach to treatment hinged on first establishing calm and tranquility in a patient. Only in a tranquil state of mind could a patient fully open themselves to a cure. He knew that further traumatizing a patient by forcing treatment would only delay or prevent a cure.
Those having difficulty achieving calm were typically placed in a room without furniture or kept under the influence of tranquilizing drugs until they did.
Only when these measures failed, and patients remained unable to self-control were they placed in restraints. Once openness to treatment was demonstrated, individual therapy based on their case history and responsiveness would begin.
Among the many options Galt employed were a variety of recreational activities, game playing/interaction, moderate labor (to provide a sense of self-worth), a wholesome, well-balanced diet, tonics, ample liberty (as earned), access to books (including Bibles, travel, biography, and history books), and any other treatments prescribed by conventional medicine. As a result, Galt was light-years ahead of other physicians around the country attending mental-health facilities.
Expansion and Innovations
Due to Galt’s impressive success record, additional funds were provided to build two new wings (added to the main building) and make major improvements.
A carpenter shop, shoemaker’s shop, leather goods shop, broom-making department, and a serving room for employees were added.
For the patients, bookcases and an assortment of books were purchased–constituting the beginnings of a patient library (which Galt believed was essential to returning patients to good mental health). For the new wings, he designated a sitting room and work room, complete with a sofa and piano.
In 1852, four acres of land were purchased to accommodate further expansion of the facility and the installation of gardens and decorative landscaping.
The following year, Galt advocated for a female guard to tend female patients, and by 1858 had stoves, steam, and fireplace heat installed throughout the buildings. Before this, buildings were unheated.
In his annual report to the Court of Directors in 1861, Galt wrote, “Insanity is no longer a mysterious affliction . . . it’s a disease of the brain just as mumps are of the parotid gland.” Little could he have imagined that all his efforts and hard work would be for nothing.
The Civil War and Aftermath
On May 6, 1862, Union troops occupied Williamsburg (which physically straddled the Mason-Dixon line), capturing the asylum and replacing Dr. Galt with a Union physician.
In the days preceding the occupation, asylum employees fled to avoid capture—leaving 252 patients confined to their rooms with minimal supplies and no caretakers–save Dr. Galt himself.
Records for the next 20 years are sketchy, but what is known is that the war years brought an indefinite number of new patients to the facility and that mental healthcare took a major plunge as prevailing theories of the North viewed treatment of the mentally ill as a waste of time and effort.
On June 7, 1885, a year after being renamed “Eastern State Hospital,” the facility burned to the ground. Though rebuilt multiple times, it never returned to the productive therapeutic state of care established under Dr. John Minson Galt, II.
The original site is now a popular tourist destination.
References
American Journal of Psychiatry, “The History of the Founding of the Eastern State Hospital of Virginia,” https://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.110.9.644?journalCode=ajp
“A History of the Eastern State Hospital of Virginia Under the Galt Family (1773-1862),” https://scholarworks.wm.edu/cgi/viewcontent.cgi?article=3916&context=etd
Durand, Mark, The Essentials of Abnormal Psychology, Thomas Wadsworth, 2006.
“The Treatment of Insanity,” The Treatment of Insanity – Worcester Historical Museum Library and Archives
