Caring for the Mentally Ill

public hospital

Williamsburg’s Public Hospital was the first facility for the treatment of the mentally ill in British North America.

Learn more: The Public Hospital


Lloyd Dobyns: Hi! Welcome to Colonial Williamsburg: Past & Present on This is “Behind the Scenes” where you meet the people who work here. That’s my job. I’m Lloyd Dobyns, and mostly I ask questions. This time, I'm asking Jan Gilliam, and at Colonial Williamsburg, she's the manager of exhibit planning, and is an expert on the first hospital for the insane in the colonies.

Jan Gilliam: That's correct, in British North America.

Lloyd: I've always been curious – who had the idea, and why did they do it?

Jan: Governor Francis Fauquier actually did when he was a governor in residence here in Virginia. He had the idea that we needed to take care of these people who kind of fell between the cracks. The jail was actually used to house some of those that were considered insane, but that was the only place to put them. He didn't feel that that was quite the right place for these people, so he went to the House of Burgesses and asked that they pass a law to have a public hospital built. He did this in 1766, and it took until 1770 for the House of Burgesses to agree, but they did. 

Lloyd: Why does that sound typical?

Jan: (Laughs.) But between 1770 and 1773, Benjamin Powell was hired as the contractor, and he built the public hospital. It opened in October of 1773.

Lloyd: Was that a popular decision that the governor made, to open this public hospital to get people who are not quite right some, I don't know if we could say help, but at least they had a place to go?

Jan: It was a new idea, and it was the age of enlightenment, and this kind of fit in with that idea of a new way of doing things, and trying to take care of these people who had really not been cared for before. Although it took a while to get passed, it did finally do so. Although the hospital was never full, some people were committed to the hospital. They would only take the dangerous or those that could be cured, because they felt this is something where you could cure people of insanity.

Lloyd: What did they think could be cured? I have had people tell me that insanity is not curable.

Jan: We know that today, but they did not. At the time, they felt insanity was caused by an imbalance in the body, and if you could balance that back out, if the humors could be balanced, perhaps you could cure them and they would become normal again.

Lloyd: What was the treatment?

Jan: In the beginning, in the 1770s when they first opened the hospital, we were sort of in the age of restraint. It was a cell, probably not a lot different than the cells in the jail, but they were specifically set aside for the insane, in a separate building. There were manacles to keep them in place, their cells might only have a bed of straw. They were cared for, they got meals, but a lot of times, they were left alone. They were treated with some drugs, or they did bleeding, because the bleeding helped relieve the humors. They felt if you let out some of them, the body would reacclimate, and perhaps that might help. So, those were their treatments.

Lloyd: I don't think that would cure me.

Jan: No, it would not, I don't think so.

Lloyd: There was a fire, once. I've read that someplace.

Jan: Yes, that was almost 100 years after the opening, in 1885. The public hospital building that we have reconstructed today, that one burned in the 1880s, so the building we see now was up for about 100 years, and then it burned, and we reconstructed it about 100 years after that, opening in '85.

Lloyd: How many patients were there at any given time?

Jan: When it first opened, there were 24 cells, and only one person per cell. They didn't want these people interacting, because they felt they sort of might feed off each other, so they were isolated. On an average, they only had about maybe 10 to 15 at a time. There really was never capacity. As it progresses into the 19th century, at one point, there's as many as 450 people. By that point, we're talking five, six, seven buildings on the property, all sorts of different complexes.

Lloyd: Still individual cells?

Jan: By that point, you've gotten to more common areas, and they begin to call the cells "apartments," and there's actually a bed, and there's some amenities that you would consider more home-like. They took the bars off the windows, and some other things that made it what they were hoping would be a more domestic setting for these people.

Lloyd:  At what point, if any, is it more a warehousing thing than it is a treatment thing, even if the treatment is sort of minimal?

Jan: Right. It went through different stages through this 100-year period. Since it was a new field, the treatment of the insane was constantly changing and developing. At some points, as I said, when it first opened, they felt they could cure the insane within a couple years. So they wouldn't take long-term patients at all. That was not the facility. After a while, they realized that maybe that isn't working, and they're only releasing two or three people a year, if that. They realize that it's long-term care now, not just come in, treat, and release. This is something where these people need to be taken care of for a long period of time.

Lloyd: Let me switch gears, here. When people tour that facility, what are their comments?

Jan: It's interesting to watch them, because the building was reconstructed on its original site, in its original configuration, but when they go in, it's very modern when they first come in. Our exhibit area is off to one side, and when they open the door, they begin to hear, actually, these patients arguing, because we have audio in there from an 18th-century person confined to the cell. They can go in and they can see the 1773 cell, and then they turn around and they can see the 1845 apartment. They get a sense of the differences. We have a lot of graphics from the 18th and 19th century that show insane people. I think it's interesting that people – they're not sure what to expect with it. I think most people are somewhat horrified by the tranquilizer chair that we have, and the Utica crib where someone was confined, and all of these different things that look a little scary.

Lloyd: And probably are.

Jan: Yes they are.

Lloyd: Going back, I think in my youth, Olivia De Havilland was in a movie called "The Snake Pit," do you remember that, have you ever seen it?

Jan: I don't think so.

Lloyd: OK, it was about insane asylums, and how bad they were in the 1940s. Do older people, like me, ever look in the cell and say, "Gee, that's not as bad as it might be?"

Jan: I think there is some, because it does look pretty neat and clean, and you see the graphics like, from Bedlam prison in England, which was long before the 18th century. The images you see there are horrifying. There are people in the hallways, and these scary-looking people, and there seems to be no care, and it's very dirty, and it's messy. There's always that reputation of them not getting proper care, so yeah, it's scary.

Lloyd: And if you ever wondered where the word "bedlam" came from, now you know, it was the insane asylum in London. When I discovered that, I thought it must have been really bad, and I guess it was.

Jan: Yes, the images are very bad.

Lloyd: Did the governor get the idea from Great Britain, or was he just a nice guy who wanted to try and do something?

Jan: He got it from England, I'm sure. It's, as I said, the age of enlightenment, and he was one of those who was very much of his age, and learned, and wanting to know more, and learning more about the world around you, which included the people around you. A movement to really learn about the body and what it takes, and why certain people are different than other people. He was very much a part of his time period. Many gentlemen, this was a study they made as a hobby, we might say. Discovering things, it was an age of discovery, in not just land terms, but in terms of what was around you, and your body.

Lloyd: I guess it's got to be, as you say, they are trying to learn things, but it seems to me that that would be kind of advanced learning.

Jan: It was, for gentlemen of the time, there was the Royal Society in London, which William Byrd and some other Virginians belonged to, and it was about discovery and learning. Medical guides were published that weren't just for the doctors, other people might have them in their homes and in their libraries. They were interested in anything to do with that.

Lloyd: So actually, while I think it's kind of interesting and unique and insightful of him, he probably was just doing what everybody of his day did.

Jan: That's right, if he was interested in what was sort of happening at the time, in his sort of part of society, that's what was happening.

Lloyd: When they became apartments rather than cells, and you had 500 or 600 people confined in five or six buildings, does anyone know how many people were ever served by this facility, whether it was 28 cells or 800 apartments? Do we have any records of it?

Jan: You mean long term, over time? The yearly capacity rate varied a lot from the beginning when there were just 24 cells. Over the years, it kind of averaged about 200 a year. Then you have your peaks, like after the Civil War, they got a lot, and they started to talk about the fact that they were war patients, but they were considered insane. So, you get a larger number of people.

Lloyd: I wonder if, in the Civil War, they had Post Traumatic Stress Disorder, is that what it's now called?

Jan: That's what it's now called, and I have a feeling that's probably what these people who were being confined as war patients probably were, because there were very many of them. Again, the treatment of the insane was still sort of unclear at the time, and they would not have recognized it.

Lloyd:  That, I didn't know. So what we consider a modern disorder was probably present in 1865 and after.

Jan: I think so. It seems like they make a point of saying that the patient list went up after the Civil War, specifically with war patients, men.

Lloyd: I don't know why I thought it was new, but it's certainly not.

Jan: I think we always find there's some reason in the past that it might have been.

Lloyd : That’s Colonial Williamsburg: Past & Present this time. Check often, we’ll post more for you to download and hear.

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