Evolution of a Missouri Asylum: Fulton State Hospital, 1851–2006 (review)

Richard L. Lael, Barbara Brazos, and Margot Ford McMillen have written an informative book on the 155-year-old history of Missouri’s first lunatic asylum. Besides serving as a history of how Missouri has dealt with the issue of mental health and illness, this book also sheds light on the asylum movement that was developing throughout the country during the mid- to late-nineteenth century in the U.S. Missouri had only been a state for twenty-three years when Governor Meredith Marmaduke decided to address the issue in 1844. Governor Marmaduke realized that jails, which were the primary place to house the mentally ill at the time, were meant “to house criminals, not to provide an atmosphere where insane patients could be treated effectively” (5). Completed in 1851, the State Lunatic Asylum, as it was called then, was the first of its kind built west of the Mississippi River.

The book is divided into two parts. In the first section, Lael skillfully pieces together the asylum’s history from its inception to World War II using a wide variety of traditional sources, a major accomplishment since many of the state’s official documents were destroyed in a fire when the Missouri State Capitol burned to the ground on February 5, 1911. According to what Lael found, politics, funding, and overcrowding were continuing problems for the asylum from the very beginning.

The second part of the book, written by Brazos and McMillen, incorporates oral histories, among other sources, covering the hospital’s history from World War II to 2006. By using oral histories, the authors are able to move beyond the official record and learn about the hospital’s history by interviewing the employees who worked there and helped care for and treat patients. In this case, the use of oral histories has allowed the authors to work around patient records that would have provided details into patient care and treatment over time but are permanently sealed due to patient privacy laws.

The oral history interviews, which they conducted with a variety of hospital employees, including former superintendents of the hospital, provide valuable information that the official records cannot. The authors’ use of oral histories to try and present the reader with a more personal side to the hospital’s history should be commended for their efforts. However, the reader might have been better served had the authors provided more disclosure regarding their methodology on how people were selected, how the interviews were conducted, and the relationship, if any, between the interviewees and interviewer, as well as to what extent the interviews were edited. Since all of the recordings reside in the authors’ private collection, readers are unable to answer these questions, and therefore must discern what they can from the citations, which need some attention.

Several of the interviews may have been group interviews with former employees, as several of the citations suggest. For example, one citation: “Unidentified Fulton State Hospital worker speaking at meeting with authors at Kingdom of Callaway Historical Society, January 6, 1999, tape recording in authors’ collection. The group agreed . . .” (167). This citation also brings up the issue of using “unidentified” interviewees, which are used several times throughout this section. Unidentified interviewees are problematic in this instance because the reader does not know whether the person being cited was known to the authors but just might not be identifiable on the recording, or whether the person was at the group meeting but simply was not known to the authors. This section also uses several “anonymous” sources, which is anathema to some oral historians. But considering the delicate subject matter and the use of current and/or former employees as interviewees, a case can be made that keeping them anonymous was justifiable in order to gain an inside perspective on the hospital. It would be nice to know whether the “unidentified” and “anonymous” sources cited were...