The Peculiar Institution and the Making of Modern Psychiatry, 1840–1880 by Wendy Gonaver (review)

Founded in Williamsburg in 1773 and renamed in 1841, the Eastern Lunatic Asylum of Virginia was the first public mental health facility in America. Physician John M. Galt II, who served as its superintendent from 1841 until his death by laudanum overdose in 1862, had a unique, albeit racialized vision for the institution and the populations it would serve. The asylum was progressive in the United States for its utilization of environmental-moral therapy, nonrestraint, and outpatient treatment strategies, all of which were novel approaches to psychiatric intervention in the early nineteenth century. Galt also courted controversy for his admission of black patients (both free and enslaved) and use of enslaved staff and caregivers, making it the only institution in the United States “to openly contend with the contradiction of deploying nonviolent curative means within a context of systemic social violence” (6). In that respect, the phrase “the peculiar institution” in the book’s title has a double meaning, referring both to slavery and to the asylum itself.

Delving deeply into the asylum’s archive (housed until recently in a hospital storage closet), the author traces the complex genealogy of this fascinating institution through physician notes, patient records, family and staff correspondence, and a variety of other primary documents to identify how it changed from a racially integrated site of treatment for the mentally ill to a segregated institution for the “defective” within a forty-year period. The monograph is organized around different themes: psychiatry and treatment regimes in the context of racism and slavery, the roles and strategic negotiations of enslaved attendants and patients, the slippery relationships between madness and religious enthusiasm, issues of gender and the psychological trauma of domestic violence, and the impact of the Civil War and Reconstruction on the asylum (as well as broader ideas about mental illness and eugenic defectiveness). Each chapter is rich with poignant details that illuminate the complexities of this institution and the humanity of those who lived with it, breathing life (and agency) into individuals whose stories would otherwise remain unknown. When Galt assumed his role as superintendent at the institution, many of his policies were on the fringe of medical practice and seemed discordant with his personal views on slavery and racial difference. As a result of Galt’s untimely death and Union occupation of the region during the Civil War, the asylum became increasingly obsolete and disorganized. During Reconstruction, the Central Lunatic Asylum was established as a separate institution for African American patients and featured more punitive incarceration (including restraint and eugenic sterilization) for those increasingly seen as “permanently defective” (196).

In many ways, Gonaver’s riveting and thorough analysis of the Eastern Lunatic Asylum defies easy explanation. Although the book’s subject matter is limited to one institution and a discrete time period, the author makes a strong case for situating that place and time at a number of crucial intersections in American medicine, society, and culture. On the surface, the book reinforces historical links between ideas about race and disability, particularly mental illness, which is an increasingly prevalent perspective in recent scholarship. However, Gonaver’s analysis simultaneously combats prevalent biases in Western medical history more broadly, most notably the focus on European and northern American (also white) institutions and physicians in declension narratives of asylum medicine. The author also demonstrates how nineteenth-century constructions of insanity were linked with a staggering variety of other factors, including slavery as both a social category and a labor system; gender, race, and social class in the American South; religiosity and antislavery activism during the Second Great Awakening; sexuality and propriety in the Victorian era; medical eclecticism and professional identities; the social and political upheaval of the Civil War; and Reconstruction policies and the rise of Jim Crow in the late nineteenth century.

Yet, at the same time, the book never loses its close connection to the...