A Hospital for the “Distracted”

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A Hospital for the “Distracted”

Beliefs and Attitudes. Mental illness was even less well understood than the physical sort in the eighteenth century. The medieval notion that insanity, or “distraction,” was inflicted by God on account of the victim’s or someone else’s sins, died hard, especially when medical science offered little byway of explanation or cure. In the first century of English settlement the mentally ill were either humored or ignored if deemed harmless or shunned, restrained, or imprisoned if feared violent. Little attempt was made to understand the cause of the victim’s condition (God’s will could not be questioned), and even less effort was given to therapy. The stigma that mental illness carried with it meant that harsh discipline and corporal punishment were legitimate means to at least enforce obedience.

Problem of Treatment. Enlightenment-era thinking demanded a more rational explanation for insanity than an angry and capricious God. Doctors postulated that insanity was a disease, perhaps an imbalance of the body’s “humors” that affected the brain, and therefore capable of a cure. Unfortunately the sort of humoral therapies with which doctors were familiar—bleedings, blisterings, and purges—were no more likely to cure the insane than to cure a cold. As often as not, doctors took on insane patients to experiment with a new remedy, or with variations on an old one. But there was no institution in America dedicated to the treatment of the mentally ill; unless the subject was homeless or considered a threat to the community, the care of the distracted person was entirely the responsibility of his or her family.

Asylum. In 1766 Gov. Francis Fauquier of Virginia proposed to change this. He proposed that public money be used for a building to house “these miserable Objects, who cannot help themselves.” Fauquier probably had in mind something like London’s famous Bethlehem (pronounced “Bedlam”) Hospital, which had long been used to incarcerate some of England’s insane. If so he presumably intended a more benign institution than the notoriously filthy, overcrowded prison that Bedlam had become. The House of Burgesses enacted the legislation and voted for the funds in 1770. The Public Hospital, as it was to be known, was to be situated in Williamsburg, Virginia’s capital, and so was intended to be an architectural showpiece, a symbol of the Enlightenment in the colony. The building committee turned to Philadelphia’s Robert Smith, who had designed that city’s famous Carpenter’s Hall and Walnut Street Jail. The result, completed in 1773, was a long, handsome, two-storied brick building with hipped roof and cupola.

Step Forward. Perhaps the inmates of the new hospital appreciated the architecture, but their fate was still fairly grim by modern standards. Medical science was no closer to curing mental illness in 1773 than it had ever been, and inmates, prisoners in all but name, were still subject to restraints and discipline. Nevertheless, the intention of the Public Hospital was not simply to shut away social misfits but to encourage doctors to study the puzzling disorders of the mind and to provide care for patients who might one day be cured. The Public Hospital represented a giant leap in perspective on the nature of mental illness and of a society’s obligation to treat it.