Race, Medicine, and the Origins of American Psychiatry (Review)

In the late eighteenth and early nineteenth centuries, American physicians developed and promoted biological notions of racial difference that have persisted in various forms to the present. Institutions such as medical schools, hospitals, and asylums were critical sites where these ideas were created and disseminated and where institutional prestige lent authority to the racial science that doctors spread in their writings and clinical practices.

Wendy Gonaver’s The Peculiar Institution and the Making of Modern Psychiatry, 1840-1880 focuses on an institution then known as the Eastern Lunatic Asylum of Virginia to connect the scholarship on race and medicine with the literature on the origins of American psychiatry. Gonaver tells the story of the asylum largely through the history of John M. Galt II. One of the many Southern medical graduates of the University of Pennsylvania, Galt returned after graduation to Williamsburg, Virginia, where he became superintendent of the Eastern Lunatic Asylum, previously run by several prior generations of Galt family members. Founded in 1773 as the Public Hospital for Persons of Insane and Disordered Minds, the asylum was the first public institution in the colonies dedicated exclusively to the care of the mentally ill, although Pennsylvania Hospital had previously had a ward that served the same purpose. By the time Galt became superintendent, the Williamsburg asylum was unusual in two major ways: it admitted whites, free people of color, and enslaved people as patients, and the staff included enslaved attendants.

Gonaver argues that previous literature on nineteenth-century psychiatry has not thoroughly considered the role of slavery in shaping psychiatric discourse and the operation of psychiatric institutions themselves. Relying primarily on the asylum’s own archives and the papers of the Galt family, Gonaver shows how Eastern Lunatic Asylum’s demographic characteristics made the asylum unique, while also connecting Galt to a national and sometimes international network of psychiatrists. She argues that many of Galt’s psychiatric ideas were innovative but were not recognized as such among his contemporaries because of his position as superintendent of a Southern institution that used enslaved labor and that accepted both white and Black patients.

Galt was one of the thirteen founders of the Association of Medical Superintendents of American Institutions for the Insane, the precursor to the American Psychiatric Association, but he often clashed with the other members over issues such as mechanical restraint of patients. In particular, he had an extensive professional conflict with fellow Penn alumnus Thomas Story Kirkbride, superintendent of the Pennsylvania Hospital for the Insane and creator of the Kirkbride Plan, a plan for asylum design that became widely used across the nation. Like many other psychiatrists, Galt supported moral treatment, a therapeutic concept that illness could be cured by a healthy environment, routines, and enriching activities, such as reading. In contrast to other superintendents, however, he believed moral treatment necessitated the elimination of mechanical restraint. Yet Gonaver notes that although he was theoretically opposed to mechanical restraint, Galt did sometimes order patients to be force-fed or to be physically restrained for the purpose of forcible shower-baths intended as treatments.