The Madhouse of Colonial Williamsburg: An Interview With Shomer Zwelling

         Shomer Zwelling, an American historian who helped direct the reconstruction, is author of Quest For a Cure: The Public Hospital In Williamsburg, Virginia, 1773-1885. He shared his reflections on the history of mental illness and his work on the Hospital.

For most Americans the year 1773 is associated with events leading up to the American Revolution. This was the year of the Boston Tea Party. Few Americans realize that this was also the year when America opened up its first public psychiatric hospital -- in Virginia's colonial capital, just four blocks from the House of Burgesses where George Washington and Thomas Jefferson met. Zachariah Mallory was admitted as its first patient because of his "insane and disordered mind." What do the colonial records tell us about the Hospital's first patients and doctors?

The early hospital records are very spare on these matters, but in some respects they are also remarkably revealing. The staff was small. John Galt was the “keeper” of the hospital and responsible for day-to-day operations.  Tellingly, Galt had previously been the keeper of the Public Gaol in Williamsburg.  His wife Mary was the matron for the woman inmates. John de Sequeyra, an Englishman of Portuguese Jewish descent, trained at the University of Leiden [Netherlands], was the visiting physician.  He was required to examine new patients at the time of admissions and then see them at least once a week. Enslaved African-Americans undoubtedly did some essential work in the hospital and probably built it too.

You refer to the first period in the hospital's history as the "age of restraint." This means literally that restraining devices were used to help restore patients to their "reason." What diagnostic categories and "curative" therapies were used at the time?

By our standards, treatment was crude, aggressive and abusive. Powerful drugs were used to evacuate the bowels, induce constipation or cause vomiting. Other treatments included blistering salves, restraining devices such as manacles and the strait waistcoat or straitjacket, a plunge bath or dunking chair, a small electricity machine to administer shocks, scarificators [scalpel-like devises for bloodletting] and cups for bleeding.  Sometimes obstreperous patients were bound to chairs to quiet them.  Many doctors thought that a certain amount of intimidation would induce patients to reconsider their ways. On the positive side, inmates were fed, clothed and allowed time in the exercise yard -- also known as the “mad yard” -- after it was constructed in 1790.

As for diagnostic categories, they kept it rather simple and succinct in the eighteenth century: mania and melancholia were the only two conditions they recognized.  For the founders of the hospital, those two diagnoses were entirely sufficient.

The hospital admitted only people whom the Court of Directors -- upstanding male Virginians who oversaw the institution and served as the admissions board -- believed could be cured. Amazingly, many eighteenth- century patients were discharged as restored.  Perhaps that’s a testimony to the human spirit even under dire circumstances.     

The revolutionaries and royalists of Virginia who voted for this hospital shared an interest in social reform and institutionalized public charity. Some of them shared the Enlightenment conviction that the human faculty of "reason" could help correct individual and societal ills. But you point out that these leaders also had more ambivalent political motives for institutionalizing mentally unstable subjects or citizens in the era of the American Revolution. Royalists may have hoped to curb dissent by institutionalizing their opponents. Revolutionaries would be concerned that dissenters were truly revolutionary, not just social deviants. You write: "A growing apprehension -- shared by English officials and future revolutionaries alike -- that something was awry in colonial American society together with the hopeful belief that mental illness was a disease that could be cured finally had given birth to North America's first public mental hospital." Can you explain why this hospital was built on the eve of the American Revolution?

To begin with, throughout the eighteenth century, there was a growing confidence that scientific inquiry could solve a whole host of long standing problems.  Prior to that time people who suffered from the ravages associated with severe mental illness were the responsibility of family members, treated by religious orders or placed in a poorhouse.  Increasingly such people were also sent to the public gaol or jail.  In Virginia there were at least four or five persons incarcerated in the Public Gaol in the 1760s. At this same time, though, on both the Continent and in England hospitals for the mentally ill began to spring up.  In Philadelphia, the famed Pennsylvania Hospital, founded by local Quakers in 1751, had a ward exclusively for mentally ill patients. 

There were also the tumultuous events preceding and culminating in American independence.  To citizens of the 21st century the outcome might look inevitable -- a cause for celebration -- but in the 1760s and 1770s many people felt uneasy about the uncertain course of events.  They did not know what the future held, but in light of political rumblings and commotion it was cause for grave concern, no matter which side a person aligned with politically.

In this context, shortly after the Stamp Act Crisis with its attendant boycotts and protests, Francis Fauquier -- the popular governor of Virginia, a man of science with a humanitarian bent -- called the attention of the House of Burgesses in 1766 to “a poor unhappy set of People who are deprived of their senses and wander about the Country, terrifying the Rest of their Fellow Creatures.”  Interestingly, most of Fauquier’s address dealt with the widespread turmoil caused by the recent political clashes over taxes and the need for reconciliation between England and her American colonies.  The short section of his address proposing a hospital for the “legal Confinement” of people who “cannot help themselves” -- where physicians would “restore to them their lost Reason” -- seems to have been tacked on to the very end of the communication.  But then again, it was the only other subject Fauquier raised in his address to the Burgesses.  We can only conjecture about his reasons for joining these two subjects in a single address at that specific time: was it happenstance or more meaningful?  The record is silent.  

A few years later, Robert Carter Nicholas, a colonial official who eventually supported the Revolution, claimed that the hospital was constructed because “lunaticks and other unhappy objects of insane minds . . . will multiply too fast in this Country.”  In sum, a growing apprehension that something was awry in American society together with the hopeful belief in scientific inquiry and application carried the day.   

Finally, there were subtle but significant changes that were taking place in family life. For those joined by the bonds of heredity and intimacy, jail apparently was not a welcome option for a severely troubled family member who could not take care of himself, but a hospital might be.

Is it possible, then, to separate political and charitable motives with regard to establishing the hospital, or are they inextricably linked?

That’s a good question, for which there is no simple answer. Within each person who supported the creation of the institution, there was probably a coalition of impulses, thoughts, principles and convictions that came together—for example, charity, compassion, political jockeying, measured optimism, belief in science, fear of the mentally ill, concern for the social order, frustration with an intractable family member.  Because the hospital was the product of a group effort, the underlying motivations are probably even more mixed and complicated.   I don’t think it dilutes history to look at causation and motivation from this perspective.  I think it enriches our understanding of human behavior, whether we’re acting as individuals or as groups. 

In 1776, a free Mulatto woman from Richmond named Charity was admitted. What can Charity's case tell us about race relations at the hospital?

Charity offers an unusual window into hospital life.  We know little about her other than that she was a free Mulatto who was not only admitted to the hospital but also subsequently released from it because she was “restored.”  At the time of discharge, Charity was given a small sum of money to help her make the transition back to community life.  Her story is in many respects unique, but it’s only part of a larger tale.  It may come as a surprise, but from the very beginning free blacks were admitted to the hospital, and although they were not treated as equals neither were they entirely segregated from the larger white population.  

During the mid-1840s, as a result of pressure from slaveholders, the legislature allowed the hospital to admit enslaved African Americans who were suffering from mental illness.  Again the situation was ambiguous.  Enslaved inmates were certainly not treated as well as white patients, but they were not completely separate.  In 1862, there were 40 black patients in the Williamsburg hospital, approximately 13% of the total patient population.  A decade earlier, the record indicates that 45 slaves worked at the facility.

The story changed again during Reconstruction, the period immediately following the Civil War.  In December 1869, Howard’s Grove Hospital near Richmond was designated a mental hospital for African Americans exclusively.  A year later it was renamed Central Lunatic Asylum, and it became Virginia’s state hospital for black mentally ill patients.  After almost 100 years in operations -- in 1967 -- Central State was racially integrated.

It's interesting to speculate on how George Washington or Thomas Jefferson might have weighed in on the Burgesses' debate about building the hospital (although we know Jefferson was exceptionally quiet in public forums). Do we have a voting roster? We know that Jefferson had at least a passing interest in mental illness and was closely affiliated with Dr. Benjamin Rush in Philadelphia, called the "Father of American Psychiatry." Jefferson wrote in later private correspondence that legislators served as "guardian[s] of those… who cannot take care of themselves" -- including "infants, maniacs, gamblers, drunkards." In Jefferson's view, the maniac required "restrictive measures to save him" from "destroying his health, his morals, his family, and his usefulness to society." And Jefferson witnessed the ravages of alcoholic addiction in his own household. After Jefferson's death, his daughter Martha fled from Monticello for Boston with two of her children to escape the violent abuse of her alcoholic husband Thomas Mann Randolph, former governor of Virginia.

The quotes from Jefferson are intriguing.  They are absolutely in keeping with my view of the era’s attitude toward the mentally ill, especially among the Virginia elite, whether revolutionary or loyalist.  That phrase -- “restrictive measures to save him” -- is laden with meaning, and pithily captures the thinking of that period with regard to mentally ill persons. To my knowledge there is no record of the vote in the House of Burgesses.  

You divide the history of the Hospital into three periods. Can you talk about these three periods and how they reflect changing attitudes about mental illness and "curative" therapies? From what you know, were patients "cured"?

As I indicated before, treatment in the early years was coarse and coercive by our standards, notwithstanding good intentions and an abiding faith in science.  It’s hard to believe that this kind of treatment was a step ahead of what took place previously, but it probably was. In Quest for a Cure, I refer to the early medical regimen in the hospital as “treatments of desperation,” but nevertheless approximately 22% of the patients from 1773 to 1790 were released as cured.  Another 9% were discharged to the care of family or friends.  Approximately 26% died in the facility, but it’s important to keep in mind that we do not know their condition at the time of admission.  For contemporaries, however, the great surprise was that almost 40% of the patients remained confined.  In 1834, the hospital population consisted of 59 patients: seventeen or 29% had been inmates for over ten years.  That was the unintended consequence.  Hospital administrators had no plan of creating a long-term care facility, but that’s exactly what they seem to have done -- inadvertently -- from the very beginning.

Winds of reform began to sweep through the world of mental health care in the early decades of the nineteenth century, in the form of the "moral management" movement, but change came slowly to the Williamsburg hospital. Dr. John Minson Galt II was appointed superintendent of the newly named Eastern State Asylum in 1841, and he instituted the relatively benevolent "moral management" regimen in Williamsburg. Galt minimized the use of restraints, administered opium copiously, established a patient library, began a reading program for illiterate inmates, arranged evening social gatherings, introduced a wide array of organized daytime activities and scheduled carriage rides about town for female patients.  His overall goal was to treat patients humanely and then release them back to the community, but he was more successful in the former than the latter. Galt wanted to tear down the wall separating the hospital from the community.  In creating that goal, he was way ahead of his time and roundly criticized by his professional peers and the local Williamsburg citizenry.  Still, he plugged ahead and remained fully engaged in his work until the very end of his life. While the hospital was undoubtedly a far more kindly place during the Galt years—from 1841 to 1862—the number of long-term patients continued to grow.  That fact troubled him deeply.

After the Civil War, there were still attempts at reform, but something had been lost in the way of confidence and optimism among the staff and leadership.  "Custodial care" reigned and the Hospital became an institution where patients were admitted with very little hope for recovery or chance of release.  Another dark chapter in the treatment of the mentally ill had begun. 

What happened to the Hospital after the fire in 1885?

After the conflagration, the Commonwealth of Virginia constructed several new buildings on the hospital grounds.  Other than that, custodial care continued to rule the day.  With the coming of Colonial Williamsburg to town in the 1930s, hospital administrators and town officials slowly began shifting the entire hospital campus and its population to the outskirts.  Among other considerations, City Fathers and Colonial Williamsburg Foundation executives didn't want to frighten or disturb tourists on vacation. I'm told that especially at night in the old days before modern medications, things could get rather noisy within the confines of the hospital, and the Williamsburg Lodge with its upscale clientele was relatively close by. I believe the move was finally completed in the early 1960s.  After that, the old hospital structures -- vacant and unsightly -- were completely razed. 

In the latter part of the 1960s and throughout the 1970s, the site of North America’s first public hospital for the care and treatment of the mentally ill was a pleasant field with only an occasional archeologist rummaging around.  All the time, though, the ideas that Galt first proposed in 1857 were germinating and then finally coming of age within American society and the mental health care community, especially during the second half of the twentieth century.  Then in the 1980s -- while residents of state asylums were being released to the community and halfway houses -- the old building reappeared again on its original site, not as a hospital but as a museum.

What spurred the Colonial Williamsburg Foundation to finally reconstruct the building?

When the project was first conceived, the idea was to rebuild the exterior of the Public Hospital and place the Foundation’s decorative arts collection on exhibit within that shell.  Soon planners, architects and administrators realized that the reconstructed hospital would be far too small a building for the vast collection, and then one thing led to another.  Eventually Colonial Williamsburg decided to head-on address the issue of treatment of the mentally ill during the eighteenth and nineteenth centuries at this site. To some, I’m sure, an exhibit on the treatment of the mentally ill in a reconstructed hospital setting seemed like a leap of faith at best and perhaps more aptly a quixotic jump into an abyss.  There was no outright opposition insofar as I knew, but there were lots of skeptical smiles. Fortunately, wiser heads prevailed, and Colonial Williamsburg took an educational chance.
Remember, this was well before the Holocaust museum in Washington, DC, before we knew there was an audience for this kind of very sobering exhibit. Really, when you think about it, it was quite a bold and courageous move, especially because the presentations are direct and forthright, not in the least sugarcoated.

How does the Public Hospital help us to understand our own attitudes toward mental illness and help inform public policy on behalf of the mentally ill? Where are we in our "quest for a cure," or multiple cures for the myriad facets of mental illness?

The public's continued interest in the Public Hospital story is testimony to the relevance of the subject. The exhibits continue to speak to us, to challenge us. I find it gratifying that the exhibit and Quest For A Cure still stir interest and spark the imagination.   In constructive ways, I believe the exhibits in the reconstructed hospital disturb us and raise questions about these very complex issues in our own day.

In some ways I think the efforts and the struggles that we see in the contemporary world of mental health care are unexpectedly similar to what occurred during the first half of the nineteenth century.   In other ways, of course, they’re profoundly different.  Still, this story of time past resonates with us today.  Consider these simple facts when comparing today with yesterday.  Approximately a century and a half ago, Dr. Galt’s work was restricted to the asylum, as he himself was the first to woefully acknowledge.  Fifty years later, in the early twentieth century, only a few European medical doctors -- Freud and Jung foremost among them --engaged in the innovative work of outpatient treatment for troubled clients.  Fast-forward another five decades to the 1950s, and the psychiatrist’s consulting room was confined to the doctor, the patient and a host of ghosts from the client’s haunted past, but increasingly ordinary Americans were starting to seek mental health care treatment.  Today, insurance companies, pharmaceuticals, state licensing boards, university graduate school programs, the court system, state penitentiaries, halfway houses and rehab centers are all an integral part of the mental health care system in addition to families, patients, social workers, psychologists, case managers, yoga instructors, art therapists, neuroscientists, meditation teachers, self-help recovery groups and life coaches.  At times the outpatient therapist’s office can seem very crowded indeed.  Meanwhile the hospitals are relatively empty and the prisons crowded. 

For some of the parties in the mental health care system -- perhaps the pharmaceuticals being the foremost example -- the quest for a cure is still a compelling aim and ambition.  For others, however, management of a life-long condition is the primary goal.  Think, for example, of AA -- a marvelous innovation -- with its disease model and twelve-step recovery program.

Clearly, there is no unified theory of mental health care treatment today, but increasingly, cognitive-behavioral therapy -- in tandem with medication -- has become the coin of the realm. These modalities together have been effective in addressing a whole host of formerly intransigent problems. But I doubt that many therapists would call this combination a “cure.”  Maybe a way station would be a more apt description.   

My own hunch is that the people who created the mental hospital in Williamsburg during the early 1770s or the staff members who worked there diligently in the mid-1850s would be stunned by the length and breath of the current Diagnostic and Statistical Manual of Mental Disorders, commonly known among psychotherapists as the DSM.  Our forebears would also probably be astounded by our modern-day delivery systems and our myriad treatment options, but I think they would find contemporary outpatient clients -- both the hopeful and the despairing -- who go to the mental health clinics in America today strangely familiar.  In that sense, we’re still in the early phases of a very old story.