Eastern State Hospital

Eastern State Hospital, located in Williamsburg, Virginia was the first public facility in the United States constructed solely for the care and treatment of the mentally ill, and remains in operation today.

Establishment
The Public Hospital for Persons of Insane and Disordered Minds, as the facility was first known, was established by act of the Virginia colonial legislature on June 4, 1770. The act, which intended to “Make Provision for the Support and Maintenance of Ideots, Lunaticks, and other Persons of unsound Minds,” authorized the House of Burgesses to appoint a fifteen-man Court Of Directors to oversee the future hospital’s operations and admissions. In 1771, the Court, comprised of such Williamsburg dignitaries as George Wythe, Thomas Nelson, Jr., John Blair, and John Randolph, authorized contractor Benjamin Powell to construct a two-story building on Francis Street near the College of William and Mary capable of housing twenty-four patients. Powell engaged noted Philadelphia architect Robert Smith, best known for his design of Carptenters' Hall, to draw up the plans for the hospital. The design of the grounds included "yards for patients to walk and take the Air in" as well as provisions for a fence to be built to keep the patients out of the nearby town.

Early years
At the time of the first admittance to the hospital on October 12, 1773, the facility was meant only to treat and discharge the curable mentally ill and to confine those who were a threat to themselves and others. Thus, the public hospital did not accept the chronic and harmless mentally ill, for they were not proper candidates for admission. There were three people originally staffing the hospital: a keeper, a matron (for female patients), a physician, and a few slaves to care for the daily upkeep of the hospital and its patients. The keeper of the hospital was James Galt, and his wife was the hospital matron. James Galt had previously been the keeper of the Williamsburg Public Gaol, and was responsible for the day-to-day administration of the public hospital. Dr. John de Sequeyra, a Jew of Portuguese descent born in London in 1712, and a 1739 graduate of the University of Leiden in Holland and prosperous local doctor who practiced medicine in Williamsburg from 1745 until his death in 1795, filled the role of hospital physician.

At this time, treatment for psychiatric disorders primarily consisted of restraint and application of discomfort, as many believed the irrational behavior exhibited by the mentally ill to be a conscious choice that the patients were to be dissuaded from. At the public hospital, a variety of restraining devices and drugs accomplished the first goal while such treatments as cold plunge baths (via the ducking chair), bloodletting, intimidation, cupping glasses,  blistering salves, and, beginning in 1793, an electrostatic machine, attempted to bring about the latter. Though rates of release were relatively high (20-25%) in the hospital’s first years, the rising number of chronic patients in the 1820’s and 1830’s, as well as reports of monotony and inhumane treatment prompted the Virginia House of Delegates to release a critical report of the hospital management in 1835.

John Galt and Moral Management
In 1841, the hospital was renamed the Eastern Lunatic Asylum and newly-appointed superintendent John Minson Galt II initiated a series of reforms which came to have great effect on the history of mental treatment. In the 1850s, Galt suggested a day-patient approach similar to the town of Geel (present-day Germany), where patients went into town and interacted with the community during the day and returned to the hospital at night to sleep. The Court of Directors rejected this full implementation of this proposal. The idea was a century ahead of its time and was to re-emerge as deinstitutionalization theory in the 1900s. However, Dr. Galt did carry out an experiment with deinstitutionalization in Williamsburg that lasted for a decade. Convalescing patients who behaved well and had good self-control (approximately half of the 280 patients at the time), had the freedom of the town at all times during the day. The townspeople were also encouraged to visit and socialize with patients still confined to the hospital grounds as a form of talk therapy that had not previously existed in American mental treatment. Many of these changes reflected the new idea of "moral management," a self-directed form of rehabilitation advocated by reformers such as Dorothea Dix which brought about a change in social perception and treatment of mental illness. Galt strove to allow patients a greater degree of comfort and dignity than previously provided and to improve their relations with the staff. Under his guidance, the rooms at the Eastern Asylum were made to resemble apartments rather than jail cells, activities, lectures, and a library were introduced to provide social and leisure opportunities, and sedating drugs steadily replaced more physical forms of restraint in use at the hospital.

Williamsburg, which struggled following the move of Virginia's capital to Richmond in 1780, was often said to be the place where "five hundred lazy live off five hundred crazy" due to the economic importance of the hospital in the 19th century.

Civil War and Decline
On May 6, 1862, Union troops captured the asylum, which in the same month was struck by the death of Superintendent Galt. In the following decades, the increasingly crowded hospital saw a regression in methodology as science was increasingly viewed as an ineffective means of dealing with mental illness. During this era of custodial care, the goal became not to cure patients, but to provide a comfortable environment for them, separate from society. On June 7, 1885, the original 1773 hospital burned to the ground due to a fire that had started in the building’s newly-added electrical wiring, an unfortunate consequence of the great expansion of facilities at this time.

Restoration
By 1935 Eastern State Hospital housed some 2000 patients with no more land for expansion. The restoration of Colonial Williamsburg and the Williamsburg Inn surrounded the facility with a thriving tourist trade. It is said that, on one of his frequent strolls through the restored town he helped finance, philanthropist John D. Rockefeller Jr. happened to pass by Eastern State and introduce himself to an inmate out for a walk around the grounds. Upon hearing Rockefeller’s name, the inmate is said to have replied “Oh sure – and I’m Napoleon Bonaparte.” The hospital’s location and space issues made a move become necessary. Between 1937 and 1968, all of Eastern State’s patients were moved to a new facility on the outskirts of Williamsburg, Virginia, where it continues to operate today.

In 1985, the original hospital was rebuilt on its excavated foundations by the Colonial Williamsburg Foundation and now operates as a museum.