History of Mental Health in the US

RJ Davis

Proposal: Controversies in Virginia’s Central State Hospital

Arguably, Central State Hospital in Petersburg Virginia never had its heyday in the picture of modern equality-based perceptions of successful mental health practices. Opening in 1862 as Howard’s Grove Hospital for Confederate soldiers, the grounds were repurposed in 1869 and renamed the Central Lunatic Asylum for Colored Insane, exclusively for black male Virginians. In the late 1800’s, women were admitted for the first time, and in 1967, the state owned hospital was forcibly desegregated. 

Controversy was intertwined with Central State from its 1862 inception. Over the course of its history, 1,000 were sterilized between 1924 and 1974 and its reputation was marked by civil rights violations, overcrowding, staff shortages, excessive use of restraint, mistreatment and inadequate facilities. Today, Central State Hospital is winding down operations and downsizing its facilities. A new building has been broken ground on adjacent to the original property, presumably to be under a different name, but the legacy and calamities of Central State itself remain minimally studied in comparison to larger, and more influential hospitals such as Western and Eastern State.

The proposed project would delve into the understudied controversial events such as segregation, eugenics and excessive restraint that span the length of Central State Hospitals’ 160 year history. The presentation for the proposed project would be delivered with an in-depth and factual 10-15 minute documentary to serve as a comprehensive study of Central State’s tumultuous existence, and analyze the conditions that allowed for its continuous decline. This analysis would be achieved with a comprehensive summation of Central State’s annual reports and records, as well as news articles, and court cases. Eugenics has been studied extensively in Virginia’s history, but little scholarship exists in terms of the direct causation of Central State’s controversial lifespan, this project seeks to fill that gap. 

Primary Sources

1872-73 Annual Report of the Central State Hospital. Richmond, VA: R.F. Walker, 1873. 

The 1872-73 annual report of Central State Hospital is one of the oldest annual reports available in the 19th century history of Central State. The report largely is centered around the growing needs of the fairly recently founded Central State Hospital, with emphasis on the need for additional construction, and particular attention to the inadmissible who were deferred to prisons rather than being placed into mental health treatment. In the 1872-73 annual report, a need for a freestanding ward for the criminally insane is also discussed, though this development appears unfounded, as the hospital would only get a building dedicated specifically to the criminally insane in the 1940s. The initial 1872-73 document provides important background information to the accumulating factors that would lead to later controversies within the institution, by detailing exactly what the state wanted, versus what the hospital needed. 

1883-84 Annual Report of the Central State Hospital. Richmond, VA: Rush U. Derr, 1884. 

The 1883-1884 annual report opens with general frustration towards the state for providing inadequate funding for the much-needed and previously discussed constructions and subsequent removals of buildings on Central State’s grounds. While frustration is palpable in this annual report, a Kirkbride style building was constructed around 1890 to suit the needs of an expanding Central State Hospital. Of note, in the 1883-4 report, approximately 40% of patients taken in during these years were discharged, or deemed cured. However, also discussed is the increasing admission of “incurable” terminal patients, which lowered overall admissions of those who could be cured and discharged. The 1883, 4 annual report therefore serves as an early warning of overcrowding conditions, and the contained information would be used to illustrate how controversies built quickly at Central State as the result. 

1886-87 Annual Report of the Central State Hospital. Richmond, VA: A.R. Micou, 1887. 

The 1886, 87 annual report discusses the previous funding granted by the state of Virginia, and how the funding was used to construct new buildings. However, also noted is that these measures did not accompany ongoing needs of the physical plant to maintain and compensate for the increase of over 100 beds and hundreds of square feet of construction. Though oftentimes, the annual reports of Central State are mainly positive, the 1886-87 report lists more grievances than positives. At the time of its publishing, the hospital was operating 35 patients over the capacity of 400. The 1886-7 report represents the tumultuous nature of the pre-eugenics era at Central State, and delivers a consistent picture of a rapidly overcrowding institution in dire need of expansion. 

1889 Annual Report of the Central State Hospital. Richmond, VA: J.H. O’Bannon, 1889.

The 1889 annual report marks a higher death toll, and lower discharge rate than notated in the last annual report. No disease was reported, however no autopsies or pathological reports were performed for those who died, representing an unusually high 7:3 intake/death ratio. By 1889, the hospital had 600 beds and was once again, rapidly nearing capacity. However, the ongoing problem of admitting overflow patients into local prisons appeared to be increasing in the 1889 report, with well over 100 patients being deferred to prisons when there wasn’t space for them at Central State. The 1889 annual report would be utilized by this project to contextualize the perpetual overcrowding issue, and bring attention to the unusual patterns in mortality rate at Central State during this period. 

1892 Annual Report of the Central State Hospital. Richmond, VA: J.H. O’Bannon, 1892. 

The 1892 Annual Report of Central State is one of the most detailed 19th century reports publicly available. Unfortunately, many prior annual reports appear to be either unavailable, or available only in print. In contrast to several scholarly works on Central State Hospital, the 1892 report immediately disproves several facts about Central State, particularly regarding the chronology of the admission and housing of females. As record keeping at Central State appears far from stellar, much of the information in the 1892 annual report serves as the sole factual source for any material deemed not suitable for scholarly material in the past. 

1901 Annual Report of the Central State Hospital. Richmond, VA: J.H. O’Bannon, 1901.

The 1901 Annual Report of Central State Hospital follows a fairly similar format as the 1915 and 1910 documents as far as overall content and the aggregation of statistics goes. However, the 1901 document is fairly unique as it includes a ten-page superintendent’s report to accompany the statistical information for the hospital. Nearly every other Annual Report from Central State either omits this segment of the document, or isn’t particularly detailed. It remains unclear if this is an unintentional practice or contingent on the superintendent at the time of the documents publishing. As such documents are submitted to governmental bodies in Richmond, a positive summation of the hospital’s activities are preferred in such correspondence. In contrast to the 1915 Annual Report which states physical restraint was fully forbidden by the late 1800s, the 1901 document contradicts this statement, admitting that approximately five patients were actively restrained. As discrepancies can be found between annual reports of varying superintendents and years, this information can be used to discuss the seemingly persistent disorganization that potentially led to the controversial aspects regarding restraint of the institution. 

1910 Annual Report of the Central State Hospital. Richmond, VA: Davis Bottom, 1910.

The 1910 Annual Report of Central State notably claims to mark a palpable improvement over the state of the institution in 1910. However, the report also documents the annually increasing number of patients in their care, often projected at a net increase of around eighty a year, with the projected mortality rate not exceeding 5% of intake. The 1910 annual report specifically mentions the lack of patients being sent to jail in other parts of Virginia, however it remains unclear whether this policy was newly introduced or not, as the 1901 report mentions deferring several “criminally insane” patients to jails in other parts of Virginia. The 1910 report can be used to discuss deferment of prisoners, and prisoner classifications as determinative factors to their housing location. 

1915 Annual Report of the Central State Hospital. Richmond, VA: Davis Bottom, 1915. 

The 1915 Annual Report of Central State Hospital is notably more detailed than other 1910’s-era documents produced by the institution. Unlike the 1919 year annual report, the 1915 document contains specific statistics about the cause of admission for many of Central State’s patients. Additionally, emphasis is placed on diversion, farming and community adjustment programs that were being developed during this transition time in Central State’s History. As the 1915 document is much richer in detail, facts can be gathered about Central State’s chronology, such as the 1895 full ban on restraint and the introduction of a cottage-based housing system. In particular, the 1915 report can be used to better contextualize Central State’s chronology and to provide emphasis on Central State’s attempts to prescribe a form of moral treatment. 

1919 Annual Report of the Central State Hospital. Richmond, VA: Davis Bottom, 1920. 

The 1919 Annual Report of Central State Hospital in Petersburg is a highly-detailed document about the demographics of Central State Hospital for the 1919 fiscal year. Morality and recoveries over the 1919 year, in comparison to the historical rates of the hospital are recorded, as well as any expenditures the hospital encountered over the 1919 year. The 1919 document notably is a pre-eugenics record, with no mention towards the practice itself. Additionally, the increase of female patients and their admission are recorded in this document. By providing detailed admissions statistics, mortality and admissions rates can be compared to other institutions and used as a metric for a better understanding of conditions within the institution. By this point, Central State was overcrowded. Of note is that the 1919 Annual Report appears to be fairly incomplete when compared to other reports of Central State, and omits details such as cause of admission. 

Drewry, William Francis. Feigned Insanity. Petersburg, VA: n.p., 1896. 

William Francis Drewry, the longtime superintendent of Central State presented Feigned Insanity at some point in the late 19th century, or early 20th century. The fourteen page booklet was a summation of three cases of individuals institutionalized at Central State hospital and information regarding the legal proceedings that would have deemed such individuals insane. Of note is the corroboration that oftentimes these black Virginians were institutionalized for nothing other than exhibiting behavior that was considered undesirable, such as “drapetomania.” While not particularly long in length, Feigned Insanity provides a look at three unique cases from early on in Drewry’s career at Central State and the lackluster factors that could result in institutionalization. 

Hurd, Henry M. (Henry Mills), William Francis Drewry, Richard Dewey, Charles Winfield Pilgrim, G. Alder (George Alder) Blumer, and T. J. W. (Thomas Joseph Workman) Burgess. The Institutional Care of the Insane in the United States and Canada. Baltimore, Md: The Johns Hopkins Press, 1916.

The Institutional Care of the Insane is a book published by several American medical superintendents in the early 1900s. William Francis Drewry, one of the authors, served as the superintendent of Central State Hospital for over twenty years. Their book was published with the intent of summarizing every public mental institution open at the time of its publishing in 1916, and to detail any particularly interesting or unique elements of each institution. This book can be used to provide a means of comparison between Central State, and other hospitals with consideration to overcrowding, beliefs on eugenics and other major factors.

Survey of Hospital Facilities in Virginia. Report of the Department of Hospital Survey and Construction, Virginia State Health Department. Richmond: Division of Purchasing  and Printing, 1947.

The 1947 Survey of Hospital Facilities in Virginia discusses the ongoing needs of Virginia hospitals, including mental institutions. The report calls for the need of a new construction for the housing of the criminally insane, tuberculosis patients and for the facility to increase its amount of beds to around 4,500. Of note is that overcrowding at Central State was in deep swing, and this would continue until approximately the 1980s. The 1947 survey provides detailed insight into the state’s goals for Central State, but also context to the facilities future, which in later years would center itself around the treatment of those deemed “criminally insane.”

U.S. Department of Justice, Civil Rights Division. “Central State Hospital Findings Letter.” Letter to Governor Mark Warner, Richmond, VA. June 30, 1997. 

This 1997 letter from the CRIPA to Mark Warner, the Virginia governor at the time, discusses a four-part list of grievances regarding Central State Hospital. The inadequacies discussed in this document are fairly severe in nature and tend to negatively exceed the same topics as discussed in previous annual reports. For example, restraint is a major grievance in the CRIPA report, with restraint being used very frequently during the 90’s for issues as small as talking back to staff members. The report contains records of hours spent in restraint, a metric also included in early 20th century reports. The CRIPA report serves as an important piece of comparison to annual reports of the early 1900s, which largely claim to strongly limit the use of restraint, amongst other topics inconsistent between the two. 

U.S. Department of Justice, Civil Rights Division. “Virginia Central State Hospital Settlement.” N.D.

This settlement, also sponsored by CRIPA, immediately follows their report from 1997 that discusses abuse and mistreatment allegations from the 1990s at Central State. The document also includes follow up standards that needed to be met by Central State, and deadlines for these dates. Legal correspondence for the implementation of any medical standards is also mentioned. This settlement can be utilized to better understand the standarde enforced by the state of Virginia, and how their comprehensive plan to implement them theoretically would function. 

Secondary Sources

James, Arthur Wilson. Virginia’s Social Awakening; the Contribution of Dr. Mastin and the Board of Charities and Corrections. Richmond, Va: Garrett and Massie, incorporated, 1939.

Wilson’s Social Awakening covers a social history of Virginia’s social awakening at the turn of the century. In particular, social reform in the 1900’s in Virginia is attributed in part to William Francis Drewry of Central State Hospital. The book discusses the perceptions of public welfare in Virginia, and how Drewry sought to improve the situation overall. While Drewry doesn’t seem particularly effective in the long run, Wilson frames Drewry’s intentions as being geared towards social reform and progress, whether implemented at Central State or not. Wilson’s book draws upon primary material from the early 1900s, though published after Drewry’s death in 1934. The primary use of Wilson’s book is for the context of intentions, versus actual implemented practices as reflected in Central State Hospital annual reports.

Catte, Elizabeth. Pure America: Eugenics and the Making of Modern Virginia. Cleveland, OH: Belt Publishing, 2021.

Catte’s book covers the history of eugenics in the state of Virginia, primarily centered around the five mental institutions in Virginia that actively practiced eugenics. Central State Hospital notably performed far fewer sterilizations than its counterpart Western State Hospital. Catte emphasizes that oftentimes black Virginians at Central State were sterilized for mere feeblemindedness and other minor issues. Catte’s Pure America draws upon otherwise inaccessible primary source material to reach these conclusions, and her book can be used in conjunction with  Central State records to draw conclusions about Central States eugenics program.

Dorr, Gregory Michael. Segregation’s Science: Eugenics and Society in Virginia. Charlottesville: University of Virginia Press, 2008.

Dorr’s Segregation’s Science provides a detailed history of eugenics in the picture of society in the state of Virginia. Dorr analyzes eugenics between different racial, socioeconomic and gender based groups and the motivating factors between them. The intermingling of race and eugenic practice is crucial to Dorr’s work, as Central State Hospital wasn’t desegregated until the beginning of the end of the eugenics movement. Not only does Dorr’s book provide context, but it attempts to understand the root cause of the eugenics movement, and it can be applied to how the movement impacted Central State. 

Dorr, Gregory Michael. “Defective or Disabled?: Race, Medicine, and Eugenics in Progressive Era Virginia and Alabama.” The Journal of the Gilded Age and Progressive Era 5, no. 4 (2006).

Dorr’s 2006 article “Defective or Disabled” discusses the formation of eugenics during Virginia’s progressive era (1896-1913). Dorr discusses the intermingling of the field of eugenics with that of the overall scheme of public health, using records from various Virginia hospitals to prove this point. While eugenics was not the defining characteristic of Central State Hospital, particularly in comparison with Western State Hospital in Staunton, Dorr’s work can provide context to the popularity of the field of eugenics following the progressive era. 

“Feeblemindedness is Problem Before State.” Richmond , Virginia, January 27, 1914. Chronicling America. 

The 1914 article “Feeblemindedness is Problem Before State” discusses W.F. Drewry, the 1914  superintendent of Central State Hospital, and his beliefs regarding the concepts of both “feeblemindedness’ ‘ and the state of mental healthcare as a whole. While eugenic sterilization was not permitted until Virginia law allowed it in 1924, W.F. Drewry discusses his strong beliefs that “feeblemindedness” is hereditary, and the only way to prevent it is by impeding the ability of the afflicted to reproduce. The candid view of publicly held beliefs stands particularly true as evidenced in Drewry’s accounts from this article. Yet another example of which includes his belief that black women who had more children, increased the potential of mental disorders, amongst other improbable and culturally unacceptable beliefs by today’s standards. Drewry’s early admission to believing in the practice of eugenic sterilization allows the project to gain an extrinsic approach to Drewry’s personal beliefs, versus those in practice at Central State. 

Norris, Caroline. “A History of Madness: Four Venerable Virginia Lunatic Asylums.” The Virginia Magazine of History and Biography 125, no. 2 (2017): 138–82.

Carolina Norris’s journal article discusses the four primary mental institutions in Virginia, and their contributions to mental healthcare in Virginia. The overall picture of Norris’s article finds overcrowding as a consistent theme within the Virginia institutions and expansions not necessarily meeting future needs. Dr. William Drewry, the long term superintendent of Central State is also brought into the picture by Norris, particularly due to his detailed annual reports, and forbidding of restraint between 1906-1924. The journal article provided by Norris serves as a comparative piece, to benchmark Central State versus the other three major mental institutions in Virginia. 

Document: https://docs.google.com/document/d/1CmPnj2cjCgqOUp0Kd4ghhkjekwMwUTzhpA_Jx-q3P3M/edit?usp=sharing

I chose this image from memebase as it is interesting when considering anxiety in women in this period. While reading and researching for my topic, I have read how many times women’s anxiety or depression during this period could stem from the role she was playing in society. I thought this meme was kind of subtly directed at the “anxious housewife” and what she was responsible for.

“1950s – 1950s.” Memebase. Accessed September 13, 2023. https://memebase.cheezburger.com/tag/1950s.