Now She Is Choked

This chapter examines the chaotic lives of women committed to the asylum, and reveals how the principles of moral therapy were often undermined by the violence experienced by these patients, especially enslaved women. Domestic violence and poverty often precipitated problematic behavior and crimes like infanticide, yet asylum administrators increasingly chose to focus on female reproductive and sexual organs instead of the trauma that destabilized so many women. The asylum also promoted a racialized vision of healthy womanhood and motherhood that ignored the trauma of abuse, fostered dependency in white women, and disproportionately characterized black women as promiscuous imbeciles. This somatic emphasis on pregnancy, parturition, and puerperal fever as productive of insanity was at odds with the environmentalism of asylum medicine, but complemented the paternalism of asylum superintendents.

No Peculiar Strictness Is Observed

This chapter examines the life and writings of Superintendent John M Galt, and argues that the experience of heading an asylum in the United States South and the example of slaves hiring out prompted institutional innovation. Galt was the only American Superintendent to publicly endorse total non-restraint, reject racial segregation, and promote the cottage system of outpatient care. By showing that slavery provided the impetus for cost-saving initiatives that also maximized patients’ rights, this chapter connects the history of psychiatry with recent scholarship on slavery and modernity. Shunned by his peers in the Association of Medical Superintendents of American Institutions for the Insane, Galt tried to establish a transnational network with superintendents in Brazil and Russia, two societies that were also shaped by systems of coercive labor.

Conclusion

The conclusion opens with discussion of Edgar Allen Poe’s “The System of Dr. Tarr and Prof. Feather,” a satire of moral treatment. Poe was a distant cousin of Superintendent John M. Galt, and he might have based his fictional institution on the Eastern Lunatic Asylum, particularly his depiction of the attendants as African apes. This story provides an opportunity to review the ideals and shortcomings of moral therapy, and to connect the history of psychiatry to analysis of race. It is asserted that racial antipathy undermined humane asylum care and stalled implementation of successful outpatient care models. Instead, moral medicine gave way to moral hygiene and eugenics as asylum and prison moved closer together. The conclusion ends with a brief discussion of psychiatrist Franz Fanon, who drew upon his professional experiences to outline a different asylum nightmare than that envisioned by Poe.

Servants, Obey Your Masters

One of the key cultural functions of nineteenth-century asylums was reframing mental suffering or “insanity” as medical illness—a secular experience—while also promoting the values of mainstream Protestantism, which, in the South, included the preservation of slavery. This process of cognitive reframing posed particular challenges for enslaved and white patients who adhered to marginal beliefs. Engaging in voodoo, believing oneself “tricked,” and espousing abolitionism were characterized as superstition or fanaticism by administrators who attempted to suppress these ideas and practices. Distinguishing between religion that promoted social conformity and that which fomented dissension was perceived as especially important at a time in which denominational schisms over slavery divided the nation’s churches and permeated political discourse.

So Different

This chapter looks at the transformation of asylum care that was initiated by the Civil War. At the Eastern Lunatic Asylum, the biggest change came after the suicide of Superintendent John M. Galt during Union occupation of Eastern Virginia. Ultimately, Galt’s death created opportunities for his professional rivals in the Association of Medical Superintendents of American Institutions for the Insane to end his experiments with outpatient care and to insist upon the creation of segregated institutions for black and white patients. In the interim, the asylum was run by a series of Union doctors and civilians with the aid of former staff, including enslaved attendants. Operating during wartime was especially difficult for enslaved staff because their legal status was in limbo, and they were liable to seizure by raiding Confederates. Wartime shortages further compounded these challenges.

Introduction

The introduction surveys nineteenth-century asylums. Two features are emphasized: 1) the transatlantic appeal of moral treatment and its demise in the United States after the Civil War; and 2) the refusal of most asylums to admit black patients. Advocates of moral treatment eschewed corporal punishment and sought to minimize reliance on mechanical restraint, depending instead on positive psychological inducements to inculcate temperate behavior. Most superintendents worried that the presence of black patients on the wards would denote pauper disgrace to the white public. Because the Eastern Lunatic Asylum in Virginia did accept slaves and free black patients, its records offers unique insight into the relationship between race and early psychiatry. These records are more nuanced than the proslavery publications of Samuel Cartwright. Although the inherent violence of slavery made impossible the creation of a therapeutic environment free of coercion, it is argued that the asylum simultaneously promoted patients’ rights and a medical model of suffering that was detrimental to African Americans.

Not a Human Being

The two decades after the Civil War saw the creation of a handful of insane asylums for African Americans in the South. The first of these institutions was the Central Lunatic Asylum of Virginia, to which all African American patients at the Eastern Lunatic Asylum were transferred at the end of the war. The quality of care at asylums generally deteriorated in this period due to overcrowding and underfunding, but this chapter argues that asylums for African Americans were at the opprobrious vanguard. Focusing on conditions at Central Lunatic Asylum reveals that moral means were immediately abandoned in favor of mechanical restraint and hard labor because white superintendents asserted that newly freedmen and women lacked a moral conscience and refined sensibilities. Using dehumanizing language, they characterized patients as sexually profligate and viewed African American religious culture as inferior.

As the Eagle to the Sparrow

This chapter discusses the lives of the enslaved men and women who worked at the Eastern Lunatic Asylum, particularly their interactions with patients and administrators. Enslaved attendants were tasked with arduous labor; enslaved women were assigned the most menial jobs. They were also entrusted with significant authority; some were even authorized to seize and forcibly medicate patients when moral methods failed. Dorothea Dix and other asylum reformers criticized the asylum for its reliance on slave labor because they didn’t believe slaves were capable of providing moral treatment. Despite the challenges of institutional caregiving, enslaved attendants used their influence to assert their capacity for moral judgment. The actions of asylum slaves suggest that an ethic empathic equality rooted in Afro-Christianity was central to their conception of care.