Past treatment of the mentally handicapped
The American antebellum
period saw a reform movement that brought about change in many aspects
of everyday life. One such aspect is the treatment of the mentally disabled.
In the past, ignorance, superstition, religious fanaticism, and prejudice
had blocked the path of progress in the understanding of various mental
disorders." Insanity was believed to have been caused by divine influence
and therefore to be considered as sacred, or to have been caused by demons
and for that reason to be treated by exorcism, punishment, and the most
refined methods of cruelty." Some of the cruelest parts of human history
are the suffering of those inflicted wiht mental illness. 1
The mentally ill have been subject to just about every strange, cruel, or heartless treatment conceivable. Many of the methods used may seem absolutely ridiculous to us, but the medical practices of the time were very crude and religion was the law. The list of methods used includes the use of holy water, sanctified ointments, the breath or spittle of priests, the touching of relics, visits to holy places, exorcisms, obscene and vile epithets, filthy and rank smelling drinks and drugs, pictures of the devil that were spit upon and sprinkled with foul compounds, dungeons and chains, the ringing of bells, witch towers, burning at the stake, trials, condemnation to death, hanging, excommunication, prayers, blood-letting, and being shocked into a pool of water and tossed up and down until the patient recovered or the last hope of recovery was gone. There is even one account on record where an exorcism ended in an agreement signed by five devils to the effect that the victim would not be further molested. 2
There were a few bright spots though, marked by the care of a few compassionate individuals. Around 460 B.C., Hippocrates stated a relationship between brain disorders and mental illness. In the fifth century A.D., Caelius Aurelianus, a Greek physician, was noted for his humane methods and treatments. These methods include the best possible conditions of light and temperature, quiet relief from distraction and excitement, not antagonizing the patients, and very limited use of physical restraint. Also, he was one of the first to convey the use of occupational therapy. Aurelianus denounced the use of improper feeding, bleeding, chains, and over use of drugs.
Many hospitals for mental disease began to pop up throughout history. One in Jerusalem was established in 491 A.D. The House of Grace surfaced, in Bagdhad, during the twelfth century, and the Saint Mary of Bethlehem institution was founded in 1547. The first such hospital in the United States was established by the Society of Friends in 1751. These facilities seldolmy separated the mentally ill from criminals, though. The first hospital designed exclusively for the mentally handicapped opened in Williamsburg, Virginia in 1773. These institutions were often called "lunatic asylums" or "insane asylums" and still is some cases were mistreating the mentally ill.
Even into the eighteenth century, doctors were still naive to the causes of insanity. Many mentally ill persons were being sent to poorhouses and even prison when their families could not longer handle the burden. Still, most every ordinary American believed that insanity was God's will. Most every doctor of the antebellum era agreed that insanity was rooted in the brain. It was believed that an autopsy of the brain would reveal lesions and apparent physical damage in every insane person. One top asylum medical superintendent of the time emphatically supported this idea. 3 This view did not lead to intensive experiments and studies though, for medical superintendents did not allow this kind of research on their asylums. Instead, they shifted their attentions to the social causes of insanity.
Medical practitioners insisted that insanity was curable and came up wiht many more outrageous and far-fetched causes. A New York Physician in 1845 laid claim that the causes of insanity in his patients were among ill health, religious anxiety, loss of property, excessive study, blows to the head, political excitement, and even going into cold water. A practitioner in Tennessee presented disappointed love, pecuniary embarrassment, and the present state of the country as the possible causes of insanity. Other good ones include masturbation, fear of poverty, the ridicule of shopmates, and suppressed menstruation. 4 In most of these cases, the causes of insanity listed are of a social, not physical variety.
The stressful life of modern America was bound to produce insanity. Blame was placed on most aspects of everyday life including politics, religion, business, the strict educational practices of the time, and even family. Insanity was thought of a price paid for civilization. Barely anybody in the United States of America refuted the correlation between insanity and civilization. The aspiration of economic advancement and its ensuing fear of failure was believed to drive many Americans insane. The responsibility of being a voting citizen in a republic was also thought to endanger mental health. A medical superintendent of the antebellum era cited that public agitation is never at rest around a citizen in a republic, and he is constantly questioning public policy. 5 Manifestations as to the the cause of insanity remained well into the twentieth century, but the treatment of the inflicted gradually improved in many of the asylums across the nation. The mentally ill were still being mistreated by their family and peers, for the word had not yet reached all of the common folk.
The founding of Georgia's insane asylum
In 1834 Georgia had no such facility to care for
its "insane." Then Georgia Governor Wilson Lumpkin petitioned the state
house and senate to care for its "idiots", "lunatics", and "insane." A
commission of lunacy was appointed, but the ignorance of the times slowed
a bill to set up an asylum. President Andrew Jackson's conservative views
reigned throughout the South, and there was still a lot of confusion
to the nature of mental illness. But on December 28, 1837 Georgia legislature
passed an act creating a state lunatic, idiot, and epileptic asylum.
The institution prided itself in being the first such facility in the world to care for idiots, lunatics, and epileptics all together. An idiot usually described a person born with mental retardation or downs syndrome. Ultimately the lacked the mental capacity to care for themselves. A lunatic was a person that at one time conformed into society, but at some point in time lost all reason. Lunatics were known to hear voices, talk to God, have violent outbursts, and to hallucinate. An epileptic had fits and seizures.
A group of people toured other asylums across the nation to search for an architectural model. Hospitals in Worchester and Charlestown, Massachusetts. Forty acres of land were purchased on a hill two miles south of Milledgeville. This plot of land was bought because of its close proximity to the capitol, and being in the central part of the state. The property was purchased for only $4,000. 7 The trustees were given an original budget of $20,000 that was used up rather quickly. Construction slowly began on what soon would be the largest facility of its kind in the world.
The first twenty years
The State Lunatic Asylum at Milledgeville opened
its doors November 1, 1842. On December fifteenth, the Milledgeville newspaper
reported that a "sad profession" came to Milledgeville from Macon. It was
to be the first patient. His name was Tilman B. and he was brought in restraints
by his wife and men kin folk. The thirty year old white male was violent
and destructive. He would eventually die six months later of "maniacal
The counties were to pay for its pauper patients, those who could not pay for themselves, and financially sound friends and family paid for their dependants. Patients from other states were accepted until 1877. 9
Three Milledgeville physicians were appointed as trustees. The head physician at the hospital was paid only $200 per year at the time, so the three doctors alternated by the month. The original staff was composed of a steward, his wife, who also served as the matron, and a few slaves that served as attendants. Soon Dr. David Cooper, one of the original trustees, was appointed as superintendent. At this time the hospital consisted of just one building, four stories high, and one hundred by thirty feet. Construction slowed on an identical building that is parallel to the first. Men comprised the first and second floors, while women took the third and fourth. The women were supervised by the matron who was there day and night. The kitchen was in the basement, and it served all of the floors with dumb waiters.The slave attendants were also quartered in the basement.
Dr. Cooper served as superintendent for three more years before the hospital was placed in the hands of Dr. Thomas Green, the son of an Irish exile. He found the patients in bad shape. Green criticized Dr. Cooper for taking in only the worst patients saying: "Only those who were a burden at home, and for whose recovery there was no hope, were sent to the asylum, which being regarded as a madhouse, inspired the people with terror." 10 Dr. Green was a kind man with great energy and enterprise. Green did not agree with the harsh measures Cooper used on the patients. Cooper thought that the insane must be treated harshly in order to force them to be reasonable. It was his entrepreneurial ability that kept state appropriations pouring in each year. Dr. Green headed the asylum from 1847 to 1879. He is, for the most part, responsible for the growth of the institution into what it is today.
The second building opened its doors in 1847. Female patients were placed in the new building allowing for the separation of the sexes. Dr. Green advocated to separate the patients into twelve classes based on their conditions. Then he lobbied for a separate building for the epileptics, saying it is quite distressing for an insane person to witness an epileptic seizure. Dr. Green also discontinued the use of slave attendants, and hired white attendants. He also increased the annual budget to $12,000 promising to raise the recovery rate from 25% to 50%.
The patients were usually in pretty bad shape when they were brought to the asylum. They were often beaten brutally, kept in jail, and their clothes were rarely changed. Some battered wives checked in also to escape their abusive husbands. The punishment they recieved most often made their conditions worse. When these patients checked into the hospital, the first thing that Dr. Green did was to release them onto the grounds. The patients were exuberant to be freed from their chains and rarely caused trouble. Of the 200 or so patients that he did this to, only twelve had to be detained.
After working with the insane for five years Dr. Green came to this conclusion about insanity. “Insanity often comes on slowly and imperceptibly; the workings of disease are hidden from our view and the real cause lies behind the apparent one. In this way intemperance, religious feeling, the solitary vice…are the supposed causes, when in fact, they are only the effect of the first impulses of the disease.” “It is doubtless true…that one cause does not come alone. Ill health, the derangement of a man’s affairs, misfortunes of one kind or another…often come in clusters, and their combined influence, disturbs that condition of the brain and nervous system upon which the integrity of the mind depends.” 11 It is evident Dr. Green was well ahead of his time when he issued this statement, unlike many other practitioners across the nation jump on the next idea and claim it to be the cause of insanity. He believed that the sooner a patient was brought to the asylum, the higher his or her chances for recovery were.
Death was ever present at many asylums across the nation. Many early patients died of such diagnoses as maniacal exhaustion. At present time there are over 30,000 bodies buried at the cemetery of the Central State Hospital in Milledgeville (formerly the Georgia Lunatic Asylum). That makes it perhaps the largest cemetery in the world solely for the mentally disabled. A lot of the deaths can be contributed to the very poor conditions of the patients when they were brought in, but many died from disease and natural causes. A large amount of cases of dysentery and typhoid reaped through the hospital in 1854, causing many deaths. 12
Life Inside the Asylum 1859
In his report by the trustees to Governor Joseph E. Brown in 1859,
Dr. Green Claimed if there is a better conducted institution of this kind,
or one costing as little to the people, we should be glad to become acquainted
with it. For the year 1859 there were three hundred and eight patients
receiving care in the facility. Thirty-two of those patients were discharged,
twenty-one died and, one eloped. The total number of residents living on
the grounds, including laborers and attendants, was three hundred and thirty
The average daily cost to maintain the patients was eleven and one half cents per day. In total $14,433 was spent on food and substance for the year. Wages paid to all workers totaled $10,000 on the year, and the institution received a total of $13,664 from its paying patients. Dr. Green was on a salary of $1,800 per annum, and $15,000 per year was needed for the pauper patients. Bedding and clothing cost the hospital $5,551, while improvements and repairs totaled $3,077. Only $787 was spent on medical supplies. The institution cut down on costs by making some of its own materials. Female attendants and patients together made 3.627 pieces of clothing, 1250 lbs. of lard and 10,000 lbs. of soft soap. 14
Patients were fed rather well during their stay, at least a lot better than they ate bacon, salt fish, corn cheese, poultry and eggs, fruits, molasses, tea coffee, rice, fodder, and the hospital made its own bread. A garden on the grounds of the asylum produced many vegetables, and poultry, eggs, and milk were produced on grounds.
Patients were still being brought to the asylum in very bad condition. Dr. Green describes a few cases in annual report. One patient was brought in who was confined in a log hut for three years without clothing or bedding. There were only two holes in the hut, one to slide food through, and one in the corner of the floor for bodily matters. The individual that brought him said that the stench coming from the hut was unbearable. A female patient brought in by her father was confined to a pallet with chains around each appendage, and even her neck. In the hospital she was free to wander the yard and hallways and was not subjected to any form of confinement whatsoever. A gentleman was brought in that was chained and handcuffed nude in a jail for several months, and was furious and dangerous. He entered the hospital and his chains were removed. Later that day when talking with Dr. Green, he said that he never would have been so bad if they had not treated him so. 15
Through reform movement of the antebellum period did bring about change in the treatment of the mentally disabled. After hundreds of years of cruel and unusual punishment the mentally ill were finally receiving humane treatment in many asylums around the world. Even though many mentally ill persons were still being mistreated by their family and peers, breakthroughs for the humane treatment of the mentally handicapped were becoming omnipresent. By the year 1865 there were sixty-two facilities for the housing of the insane across the nation. The days of chains and dungeons are no longer common thanks to the likes of practitioners like Dr. Thomas Green. The people of Georgia have him to thank for helping to build what would become the largest facility for the care of the mentally ill in the world. Dr. Green was a great advocate for the mentally ill, by substituting comfort, kindness, respect, and gentleness for cells, chains, dungeons, filth, and wretchedness.
1. Edwards, A.S. Outline of Abnormal Psychology. Division of
publications, The Univesity of Georgia, 1934. 1
2. Edwards, 1
3. Rothman, David J. Discovery of the Asylum; Social Order and Disorder and
4. Rothman, 111
5. Rothman, 111
6. Rothman, 117
7. Cranford, Peter G. But for the Grace of God: The Inside Story of the World’s Largest Insane Asylum Great Pyramid Press Augusta, Ga. 1981 4
8. Cranford, 4
9. Cranford, 6
10. Powell, T.O.M.D. Psychiatry in the Southern States. American Medical-Psychological Association Baltimore, MD 1897. 37
11. Powell, 36
12. Cranford, 25
13. Green, Thomas Report by the Trustees of the State Lunatic Asylum at Milledgeville for the Year 1859. 22
14. Green, 23
15 Green, 9
Central State Hospital