During the antebellum period America experienced many changes. Americans were becoming aware of their own identity as a nation as well as a responsibility to take care of the citizens of that nation. These altruistic ideas helped to create a moral reform movement that concerned itself with the fact that there were not adequate systems in place to help the less fortunate. Out of this moral reform movement came the proliferation of insane asylums in the United States. During the period from 1825 until 1865 the number of asylums for the treatment and housing of the insane increased almost seven fold, from nine to sixty-two1. One of these asylums was the Milledgeville State Hospital. Established in 1837 by a grant from an unknown northern philanthropist, the asylum at Milledgeville became a typical example of the antebellum asylum. The reform movement in antebellum America was responsible for both the creation of the Milledgeville Asylum and the way that the treatments and diagnoses evolved throughout the period.
After being institutionalized for a short time herself Dorothea Dix became the leader of the movement that sought to create more acceptable conditions for the mentally incapacitated of the nation. She brought the conditions of the average asylum into the public view. The public responded with an outcry for better treatment. By educating people as to the treatment that she was subjected to while in an overcrowded public asylum she became a part of the moral reform movement that was going on in America at the time. Dix's contribution to the creation of many state asylums is invaluable; through education of the public she succeeded in creating the necessary awareness to improve life for the mentally disabled of America.
The concern for an asylum in Georgia was great in the years leading up to the creation of the asylum at Milledgeville. Before it was established there was nowhere in the state for the poor people of Georgia to send their insane after all home treatment had failed. The affluent could send their dependants to other states' asylums, but the expense made this impossible for the less privileged citizens of the state. When a northern philanthropist, whose name is not known, came to Georgia to petition the legislature to assist the mentally ill a bill was introduced to the legislature, which led to the establishment of the Milledgeville State Hospital2. It is pertinent to mention that Milledgeville was the state capital during the antebellum period.
The state was reluctant to give up the money to create a hospital for the insane of the state for several reasons. The first of which being that Georgians had many other needs besides the creation of the asylum. Only property holding white men could vote in the state, so the state legislature was much more concerned with pleasing them than providing the insane paupers of the state with a place to be treated for their various infirmities. A small group of determined citizens saw the bill through the state legislature3. Thus the money was appropriated to create an asylum. The first thing that had to be addressed when creating the asylum was who would be able to make the decisions concerning the location and design of the hospital. A committee was promptly appointed. The trustees decided to have the asylum built near the village of Midway, about two miles from Milledgeville4.
It took several years to complete the asylum. The original budget of twenty thousand dollars was expended rather quickly, by the date of opening, in 1842; forty five thousand dollars had been spent in the construction of the buildings. As was becoming typical of the time the costs were grossly underestimated. The state was more concerned with providing cheap, rather than adequate, care6. A superintendent who answered to a board of trustees headed the asylum. The superintendent was in charge of all the other staff at the hospital. During this time very little was known about mental illness and even less about effective cures for such afflictions. When the first patient was admitted in December of 1842 Dr. David Cooper was the superintendent in charge of the administration of the asylum.
In antebellum America there was little precedent on how to treat the insane. The creation of many asylums also led to a greater interest in the scientific community of how to treat and cure the afflicted. Prior to this period the needy were sent poor houses or prisons when they became too much of a burden on their families. The treatment of the inmates, and especially the mentally disturbed, at these facilities was deplorable. They were "dragged into wretched existence in the jails and poor-houses, in cold and filth, in solitude and chains, abandoned to the tender mercies of their ignorant and irresponsible keepers."7 The conditions afforded to the insane of the period often worsened their mental state.
The superintendents of the newly created asylums made themselves god like authorities on the treatment of the insane. Their ideas and classifications were profound in a time when insanity was still contributed to the devil or demonic possession. This new body of knowledge that was being gathered by the superintendents did not make much difference in the lives of the average American. It seems that insanity, especially in one's own family, was an affliction to be hidden and denied until the victim was beyond the control of those caring for him or her. The first superintendents at Milledgeville had the challenge of treating patients that had often been mistreated for many years. The second leader of the asylum, Thomas Green, believed firmly in the idea that the sooner an insane person was brought under professional care the more likely it would be that he or she would be cured. In a report to the board of trustees he defined one of the chief obstacles of a high recovery rate for his patients was the widely held belief that an afflicted persons could be better treated at home with friends and family rather than removed to an asylum. "After the first three to six months of intellectual derangement, the probabilities of a cure, begin to rapidly diminish; and after the expiration of a year, it is believed by the most reliable authorities, they are not half so great as within the period above stated"8 The great misunderstanding of the causes and cures mental disturbance during this period often led to the mistreatment of the insane by well meaning family and friends. This mistreatment often led to aggravation of their already existing condition and decreased the chances of full recovery depending on the person and the disease.
At Milledgeville, as well as many hospitals throughout the nation, patients were classified by the amount of control the exerted over themselves rather than the actual symptoms of their psychosis. The close systematic study of the insane that began in earnest within the antebellum asylums was one of the driving forces in creating an actual system of classification for the mentally disturbed. The previous terms that defined any person worthy of commitment to an asylum were idiot, lunatic, and epileptic. An idiot was loosely defined as someone lacking the mental capabilities to be socially responsible. A person was usually born an idiot, though the term was also used to describe foreign- born people who did not assimilate to American culture during this time period. The terms used to describe these people in more recent years are usually mentally handicapped or retarded. A lunatic seems to be anyone who once conformed to the values of society, but for reasons of their own became either oblivious to the norms of society or simply chosen to ignore them. An epileptic was a person prone to violent fits and seizures. These fits could be a product of psychological or physical trauma. These terms were to become antiquated in later years, but the system was slow to change.
As diagnoses got more specific they began to be based largely on the testimony of involved family members. These diagnoses were usually very obvious descriptions of the person's behavior. The most common include "melancholia on withdrawal, depression, or threats of suicide; mania on extreme mental or physical excitement; and dementia on evidence of temporary or permanent intellectual debility."9 These diagnoses were not used to decide a cure for the patients as evidenced by the case histories written by the first superintendent of the asylum. The medication and treatment provided to each patient had much more to do with keeping them physically under control and relaxed than actually changing their mental state as we think of today. However, the attempt to create an organized system by which patients could be classified was a very progressive step in the field of psychology.
Insanity was still largely defined as social nonconformity on the part of the afflicted. The reasons for some of the patients' assent to the asylum clearly show that there were many different motives for either committing oneself or being committed to Milledgeville. The asylum was not only for paupers; it served many people from different walks of life. "For many families, lunatic asylums where places of last, not first, resort. They institutionalized their loved ones only after months of home care."10 However, sometimes motives of interested relatives played a part getting an eccentric, yet rich, family member into the hospital. It was not hard to prove to a court that a person had defied social norms in some way and therefore be worthy of a ticket to Milledgeville. Many times these patients were released within the year, their diagnosis being "not insane."11 Some women came to Milledgeville to escape abusive husbands. There was really no other way for these women to adequately protect themselves from abusive relationships during this period due to the fact that they had very few rights.
Social conformity was very much a part of antebellum American society. It was the beginning of the Victorian Era in Europe. America was gaining a place in world society. Americans were beginning to think of themselves as a nation equal to that of any in the world. The moral reform movement that took place during this period was dedicated to creating adequate public assistance for the poor or disabled of the nation. The movement for more acceptable accommodations for the underprivileged people of the North came before Georgia's creation of the Milledgeville Asylum. The treatments that the doctors at Milledgeville used were often copied from the more prominent hospitals in the north, specifically the work of Amariah Brigham, the superintendent of the New York State Asylum at Utica.
One of the most time honored treatments for the insane, or any group of committed persons during this period, was the idea that labor could be a valuable tool in the recovery or reformation of the inmates. A garden existed at the Milledgeville Asylum. All the patients who were able worked in the garden to grow food that helped defray the costs of the Asylum to the state. The people working in the gardens of the Asylum were able to spend time outside as well as gain some sense of normalcy in the work. Those whose illness was too profound, or for whom the risk of escape was too great, to work in the garden were subject to other treatments.
Many of the patients that were committed to the Milledgeville State Hospital in the early days escaped. The patient histories frequently describe patients as "escaped, apparently cured."12 In fact the most common ways of exiting the hospital seem to be death by maniacal exhaustion and escape. During this period the kind of law enforcement that exists today was not in place. Unless an escaped patient caused trouble or committed a crime he or she was often assumed cured without the intervention of local law enforcement. This treatment of escapees is exemplary of the way that the general public regarded insanity during this time period. If the escaped person began to adhere to social norms, or at least appear to, he or she was seen as cured.
A case file during Dr. Cooper's administration in the early 1840s describes the treatment afforded to a male patient:
23 year old farmer; deranged for six months; hostile; violent; hallucinated visually; raved, ranted, and cursed; was chained to the floor in the basement, put in a strait jacket and puked several times a day. We succeeded in tranquilizing him and weakening his phrenzy. After a few days of nauseants, cold baths, cathartics and digitalis, he informed us that he had found religion the night before. While the sentinel was not watching he escaped. He has assumed his social duties at home and continues in good physical health and proper exercise of his mental faculties.13
This case is typical of the Cooper administration of the Asylum. As is obvious those that were sent to the Asylum for help were often treated harshly. It was Cooper's belief that maniacal people must be dealt with harshly in order to weaken them and, therefore, force them to be reasonable. Cooper's theory sharply contrasted with the treatments that patients received under the administration of Thomas Green.
Dr. Green had more humanitarian concerns. His theories on curing the insane were to be kind to those that had been abused in the past. He vowed not to abuse any of his patients, as had been the common practice prior to this period. He did not allow anyone to be chained unless they posed direct danger to themselves. He was a great promoter of talking to the people under his care as a means of finding out what was wrong and how to treat them. It makes sense because in order to cure a person of any disorder, especially psychological, you first have to discover the cause. Only then can you begin to find a solution to the problem. Many patients that were handled in this manner described the violent abuse they had undergone in the past. Being treated as a human being helped many of Dr. Green's charges to regain perspective and assume their civic duties once again.
Dr. Green's theories on the treatment of the insane in his care were very typical of the new attitudes emerging in the field that was to become psychology. Before the moral reform movement there were very few people who studied human behavior to any extent. The new ways in which doctors began to treat their patients was cutting edge for the time. The insane began to be viewed as people who had the ability to recover rather than a burden that should be locked away in a basement. Positive reinforcement under the Green administration helped to increase the recovery rates of the patients in the care of the Asylum. Many patients benefited from the more humanitarian treatment offered by Dr. Green and his staff.
The general opinion of the public toward insane asylums and their occupants largely remained the same despite discoveries in modern science. It was still generally seen as disgraceful to put a family member in an Asylum. People generally preferred to keep their loved ones out of asylums because it was looked upon in most communities as shirking ones duties to take care of his or her family in time of need. Only when a person could no longer be dealt with at home was commitment an honorable option for the family. It is for this reason that many people who would probably have benefited from psychiatric treatment soon after the initial onslaught of their disease were unable to attain it. Often the care provided by family members and friends was not adequate. It only served to worsen the situation of the afflicted person. The treatment that a person received within the first few months of their disease was critical to their recovery. Victims of abuse and mistreatment often had a much longer road to recovery than those that received formal care relatively early.
The conditions for afflicted persons changed dramatically due to an influx of public activism during the antebellum period. The Milledgeville Asylum is a result of the concern of the Georgia public to have a place to care for the less fortunate of their state. The superintendents of the asylum had varying viewpoints on how to treat their patients, but must be understood that these views were based on the knowledge that was available to them during their tenure at the asylum. Many new ideas came out of the medical community as a result of the reform movement. Creating more asylums gave doctors more opportunity to observe their patients and experiment with new ways of curing them. The study of the insane that is done during this time is the predecessor of modern psychology.
Milledgeville State Hospital is Georgia's contribution to the scientific as well as the local community. It was a great help to those who could not afford to go elsewhere. Many families in Georgia were relieved to send their maniacal relatives and friends away to Milledgeville to be dealt with rather than have the daily burden of caring for them. The opportunity to study people and experiment with the newest techniques of treatment is one of the privileges the doctors at Milledgeville enjoyed. The evolution of the treatments, care and classifications of the patients at Milledgeville is exemplary of a national trend. The doctors followed the trends of the medical community and began the first real movement towards a true and effective form of psychology.
Footnotes
1.Stephan Knadler, "Hawthorne's Geneaology of Madness: The House of Seven Gables and Disciplinary Individualism," American Quarterly 47, no. 2 (June 1995) [database online] JSTOR.
2.Peter Cranford, But for the Grace of God Milledgeville: The Inside Story of the World's Largest Insane Asylum (Augusta: Grand Pyramid Press, 1981), 3
3.Cranford, 4
4.Cranford, 10
5.Thomas Green, Report of the Trustees' Superintendent and Resident Physician of the Lunatic Asylum of the State of Georgia for the years 1854-1855 (Milledgeville: Boughton, Nisbet, and Barney, 1855)
6."American Hospitals for the Insane," North American Review 79 no. 164 (July 1854), in Cornell University Making of America.
7."American Hopitals for the Insane," 73.
8.Green, 10
9.Ellen Dwyer, Homes for the Mad: Life Inside Two Nineteenth Century Asylums (London: Rutgers University Press, 1987)
10.Dwyer, 3
11.Green, 6
12.Cranford, 11
13.Cranford, 14