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

Wendy Gonaver’s book might not exist but for her persistence in identifying and cataloging 15 cubic feet of archival material she found in a storage closet of the patient library of what was once the Eastern Lunatic Asylum. Her painstaking work over two years with these materials not only made them accessible to future generations of scholars (they are now available at the University of Virginia), but also resulted in a rich manuscript that makes a strong case for the role of race and the American South in the development of psychiatry.

Operated by iconoclast John Minson Galt II from 1842 to 1862, the asylum was the first of its kind in the United States and one of a kind as well, as it was the only to treat a racially mixed patient population under the same roof. Although many asylums initially experimented with this approach, all except Galt dropped the idea within a few years. Galt was no abolitionist; in fact, he believed that slavery provided a sort of moral protection against insanity through hard work. He also realized that accepting Black patients was of practical economic benefit as well. Galt was unusual in that he publicly denounced the use of restraints, whilst using hydrotherapy and experimenting with electric shock as a form of treatment. While he was a founding member of the Association of Medical Superintendents of American Institutions for the Insane (AMSAII), the precursor of the American Psychiatric Association, he soon found himself an outcast as a result of both his ideas and his trying personality.

Gonaver’s work, which provides a thick description of the Eastern Lunatic Asylum in the vein of the works of Nancy Tomes and Ellen Dwyer, argues that the South played a critical role in the history of American psychiatry. Certainly, John Galt played a critical role in debating issues such as racial integration and the potential placement of patients in the community as a part of their treatment. But more broadly, Gonaver argues that “slavery and ideas about race were fundamental to early psychiatry” (p.4).

The Eastern Lunatic Asylum, Gonaver shows, has much to tell us about psychiatry in nineteenth-century America (p.4). In this unusual institution, enslaved persons were both paid attendants and patients. This created a complex racial hierarchy in which enslaved attendants had a certain amount of power over white patients while they simultaneously were often forced to do backbreaking or filthy work, lacked political capital when they complained about larger institutional issues, and were vulnerable to sexual assault. Gonaver effectively illustrates the work needed to cook, clean, and care for a complex group of often unruly patients and alerts readers to moments when the racial power hierarchy must have been especially strained, such as during the act of bathing white patients. Yet it is also important to remember that enslaved people often performed these intimate tasks for the families who owned them, and that in many ways these acts reinforced existing power relationships.

While it remains somewhat unclear why his colleagues in the AMSAII were opposed to treating patients of more than one race under the same roof–they failed to provide a clear rationale for their strong position–one wonders where Black Americans deemed insane were sent in other areas of the country. Because Galt was such an exception and his institution an outlier in this respect, Gonaver’s argument that race played a central role in the development of American psychiatry is somewhat weakened. More comparative work might have further strengthened this bold assertion.

Gonaver is at her strongest when exploring the role of religion and gender in the Eastern Lunatic Asylum. She beautifully uses case studies to demonstrate how excessive religiosity was interpreted as insanity, and argues that this was particularly damaging to Black patients at a time when more Black Americans than ever were joining traditional churches...