Abstract
In the years of visceral sociopolitical antagonism not unlike today’s, Southerners before the Civil War placed slavery within a divine order while Northerners believed the opposite, that slavery offended the fundamentals of Christianity. Each asserted their moral authority over the uncommitted. Yet in 1844, John Minson Galt, a young doctor and medical superintendent in Virginia, would write: “In the Eastern Asylum, no particular strictness is observed in isolating the white from the coloured patients; nor under th[is] arrangement…is there the slightest difficulty in management originating from the presence of the two races in the same asylum” (p. 30).
White Southerners of the 1840s used the term “peculiar institution” as a patronizing euphemism for slavery. For this book's title, however, the same term is complex: on a macro level, it conveys the intraprofessional upheaval wrought by Dr. Galt’s belief in a racially integrated mental institution, and on a microlevel, it emphasizes the enigmatic qualities of psychiatric symptomatology. The Eastern Lunatic Asylum (ELA) of Virginia was the first, and for many years the only, asylum in the United States to admit enslaved (and later free) black patients along with white patients. There Galt also advanced the use of “moral therapy,” crediting the “persuasive power of kind treatment and the disciplinary power of healthful habits to overcome erratic behavior without force” (p. 181). He abolished mechanical restraints and corporal punishment as treatments for mental illness, and promoted the twin ideals of a peaceful therapeutic institution paired with community-based outpatient care. In an apparent contradiction though, he supported slavery as an economic instrument (the ELA survived on the labor of slaves) while advocating for increasing patient freedom and mobility regardless of race. But this was the plantation milieu where black skin signified dangerous primitivity. Galt’s facility was repeatedly defunded by the State of Virginia, and his vision of mental health care cost him the respect of his peers; he died by suicide at age 42.
John Galt was neither an abolitionist nor a feminist, and certainly not a collectivist, yet his innovations in mental health care enticed progressives like Dorothea Dix to visit his institution. To explain his psychiatric and institutional approach with the depth it deserves, the author draws on her scholarly experience of organizing the ELA’s own archives, Galt’s correspondence and publications, the Galt family papers and a wide range of pre–Civil War and post–Civil War documentation including medical treatises. The richness of primary source data is a strength but oddly also a limitation as Gonaver develops the ELA story over six chapters. The first two chapters are biographical and descriptive, focusing on Galt’s program of reform and his increasingly uneasy leadership roles in professional psychiatry as one of the founders of the Association of Medical Superintendents of American Institutions for the Insane, the forerunner of the American Psychiatric Association. Much of this unease stemmed from Galt’s insistence that white and black patients alike were competently looked after by slaves, some paid and some not, while their powerful off-site owners (to whom the slaves’ earnings were sent) also ran the state government. In line with this stratification, as described in Chapter 3, this white ownership class held to the moral authority of their own Christianity but nonetheless saw fervent religiosity as a likely symptom of mental illness when exhibited or expressed by those individuals without property or civic standing, especially women and black people. Galt was wary of patients’ religious “excitement,” and he pathologized patients’ articulations about race, gender, and social class. “A prominent delusion [among African American patients was] to imagine themselves white” he said (p. 94). Moral therapy, he believed, would help patients sublimate expressions of spiritualism and also overt (female) sexuality. But just as the ideal of individual freedom was quashed by the deep capitalism of slavery, so the environmentalism of moral therapy was constrained by overdetermined patriarchal power: Disregarding the experience and effects of systematic violence against women, the ELA administrators were persuaded that reproductive and sexual organs caused insanity.
In the book’s two final chapters which trace the ELA’s history during reconstruction, racial integration held throughout the 1860s. After Galt’s death and in the wake of the Civil War, however, the facility declined. Galt’s opponents had all the black patients transferred to the segregated Central Lunatic Asylum (CLA) because, they said, the “Colored Insane [are] a class now rapidly increasing” (p. 177). The CLA, characterised as a “carceral institution” by the author (p. 193), modeled the “new” asylum, discarded moral treatment and regarded black patients as animal-like prisoners, irrational, vulgar, and manic.
Wendy Gonaver has successfully anchored “the making of modern psychiatry,” at least psychiatry in the United States, in the history of slavery. Body exploitation and sexism do merit further interrogation, and Michel Foucault’s theoretical constructs and methodology, though perhaps contrary to the author’s rigorous empiricism, would have enhanced the narrative. But the history of the first integrated asylum in the United States is important and the research is profoundly exciting. For the good of us all, the book deserves a readership well beyond academia.