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The First Dedicated Psychiatric Hospital

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The First Dedicated Psychiatric Hospital

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This hospital was made to care for orphans, abandoned children, and the mentally ill. It was established as part of the Hospital Provincial de Valencia, also known as the "Hospital General," which served as a major healthcare institution in the city. (2) The Hospital de Inocentes played a crucial role in providing care for vulnerable individuals who were often neglected by society. This included children who had been orphaned or abandoned, as well as adults who were deemed incapable of caring for themselves due to mental illness or intellectual disabilities.(1) In terms of care, it was decently custodial however similar to a jail in the sense of routine.

Source (2): https://pubmed.ncbi.nlm.nih.gov/18286394/

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On the morning of Feb. 24, 1409, while Friar Jofré (1350-1417) was heading to the Cathedral of Valencia to preach the sermon on the first Sunday of Lent, he saw a crowd mistreating and making fun of a mentally ill man. Outraged, he spoke in his sermon about the need for an institution for the mentally ill ( 1, 2). Ten merchants offered to provide the necessary funds to carry out Friar Jofré's request, and on March 15, 1410, the building of a hospital, Spital Dels Folls, Orats, e Ignocents (Hospital of the Lunatics, Insane, and Innocents), began ( 2).

Friar Jofré rescued Christian captives as a Mercedarian friar in North Africa. In his missions he may have heard about hospitals for the mentally ill that already existed in the Arab world ( 3). He may also have met Christians admitted to such hospitals suffering from pellagra ( 2). Although some hospitals in England and Germany admitted mentally ill patients, this hospital was the first one built only for that purpose ( 4). The Spanish humanistic tradition regarding the mentally ill spread throughout Iberia and then to the Hispanic Americas ( 5, 6). Philippe Pinel would later praise the occupational therapy used for treatment in this institution ( 7). For over six centuries, the Spital Dels Folls, Orats, e Ignocents of Valencia has been a beacon institution for the treatment of mental illness.

References

1 Ramajo Alista F : 1998 Vida y Obra del Padre Juan Gilabert Jofré. Valencia, Spain, Diputación de Valencia, Google Scholar

2 Tropé H : Del Hospital de los Inocentes (1409-1512) a la Casa de los Locos del Hospital General (1512-1699), in El Manicomio de Valencia del Siglo XV al XX. Edited by Livianos L. Madrid, Paradox, 2006, pp 15-117 Google Scholar

3 Ackernecht EH : A Short History of Medicine. Montreal, Maxwell Macmillan, 1970 Google Scholar

4 Rumbaut RD : The first psychiatry hospital of the western world. 1972; 128:1305-1309 , Link Am J Psychiatry Google Scholar

5 López-Ibor JL : La fundación en Valencia del primer hospital psiquiátrico del mundo. 2008; 36:1-9 , Medline Actas Esp Psiquiatr Google Scholar

6 Delgado Roig J : Fundaciones Psiquiátricas en Sevilla y Nuevo Mundo. Madrid, Paz Montalvo, 1945 Google Scholar

7 Pinel P : Traité médico-philosophique sur l'aliénation mentale, ou la Manie (an IX). Paris, Richard, Caille & Ravier, 1801 Google Scholar

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The Foundation of the First Western Mental Asylum

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On the morning of Feb. 24, 1409, while Friar Jofré (1350-1417) was heading to the Cathedral of Valencia to preach the sermon on the first Sunday of Lent, he saw a crowd mistreating and making fun of a mentally ill man.

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Bethlem Royal Hospital: Founded in 1676, Bethlem Royal Hospital, also known as Bedlam, is one of the oldest mental health institutions in the world. While it became notorious for its harsh treatments, it also played a significant role in the early understanding and treatment of mental illness. Those who became patients were usually the poor and usually believed to be dangerous.(1) In the time the hospital was around it was relocated a total of 3 times,(2) and it defined the original state of mental health treatment: one which was terrible and relied on theology more so than science.(2)

Source(2): https://museumofthemind.org.uk/projects/european-journeys/asylums/bethlem-royal-hospital

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The origins of Bethlem Hospital

In the 13th century, Simon FitzMary rose from modest origins to become the Sheriff of London - twice. He was said to have had a veneration for the Virgin Mary and the Star of Bethlehem, which developed during his time in the crusades. When he became a wealthy political figure, FitzMary donated a piece of land in the Bishopsgate ward of the City of London to the Bishop of Bethlehem for the creation of a charitable hospital.

In 1247 the Priory of St Mary of Bethlehem was founded, devoted to healing sick paupers. The small establishment became known as Bethlehem Hospital. Londoners later abbreviated this to 'Bethlem' and often pronounced it 'Bedlam'.

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From Bethlehem to Bedlam - England's First Mental Institution | Historic England

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The origins of the 'Bethlem', England's first hospital for the mentally ill.

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In France, originally La Salpetrière was used as a gunpowder factory, however, it was turned into an asylum that operated more like a prison, mainly for females. (1). It had no promises of any treatment and or recovery and it was most common for patients to simply pass away from lack of nourishment, suicide, etc.(1). After the revolution began in France the people of the hospital were brutally murdered and nothing changed until many years after the revolution.

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At first it was the fate of the female beggars but more and more, other women began to be labeled and taken. Prostitutes, crazies, orphans, libertines, protestants, cripples, cretins, Jews, criminals, alcoholics, moribunds, witches, melancolics, the blind, girls born of adultery, lesbians, epileptics, thieves, sorcerers, seniles, idiots, depraved, intriguing minds, erotomaniacs, spoiled girls with suicidal tendencies, bohemians, fatties ...

This creative and seemingly endless list showcases a collection of some of the charges, symptoms or assigned behaviors used to ostracize a woman from society. Parisian women of the 1700s could be labeled any one of those things, true or false, branded hysterical, and regardless of her social status could be sent away into the dingy halls of the asylum forever.

Centuries ago, before becoming one of the largest hospital complexes in Europe, La Salpetrière had a less altruistic use as a gunpowder factory. Under Louis XIV, it was turned into an asylum that operated more like a prison, where female outcasts could be shut away from existence. With no promises of recovery or freedom, the unfortunate "patients" usually finished out their natural lives there, "for their own good."

This era was defined by Michel Foucault as the "Grand Confinement," when battalions rummaged every night through the darkest streets and dead ends of the capital to arrest the poor, the immoral or the incurable ones. Isolation and repression being considered an effective way to purge debauchery, the prostitutes were gathered at La Force, an imposing prison with a special building just for the ladies. The women were held in "La Petite Force," and their punishment for trying to survive was decided. Some of them would be selected to be deported to Louisiana, Quebec or the Caribbean colonies; others would end up in La Salpetrière.

During the September Massacres of 1792, a frenzied mob invaded the Salpetriere, with the intention of freeing the imprisoned prostitutes. Anger, fear and mob mentality took hold and after the working women were freed, the women that were truly ill were dragged into the streets and brutally murdered, staining the revolution with ugliness.

Starting at Place Camatte Zaydoff, go through Rue des Archers and you'll see the long, monotone housing constructions that once housed the battalions. Not far from there in Rue des Petites Loges (Quartier Charcot) you'll come across a series of three one-floored buildings. Established in 1680 to solve La Force's overpopulation issue, these small houses used to form the so-called "Quartier des Folles," the district that housed around 600 hysterical women being kept in miniscule cells. Each day, following a highly popular hygiene regimen, the women were chained outdoors to the semicircular benches seated on the floor, allowing them the smallest breath of fresh air.

Tormenting society's delicate sensibilities by their mere presence in the heart of Paris, the disheveled pariahs in their white gowns were anonymous ghosts. These pitifully forgotten remained in their rat hole until their savior, Doctor Pinel, set them free, in a manner of speaking, with his revolutionary ideas of moral therapy and humane mental health care.

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Discover The Pitié-Salpêtrière Hospital in Paris, France: Pitié-Salpêtrière was the dumping grounds for women who received the dreaded diagnosis of "hysterical.".

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Founded by William Tuke, York Retreat was established as an alternative to the harsh and often brutal conditions found in traditional asylums of the time.(2) It emphasized humane treatment known as the Inner light, moral therapy, and the importance of a peaceful and supportive environment for the recovery of individuals with mental illness.(1) It to this day serves as a model for the moral treatment movement in mental health care. Its principles and practices laid the groundwork for more humane and compassionate approaches to the treatment of mental illness.

Source 2: http://www.historyofyork.org.uk/timeline/georgian/the-retreat

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The York Retreat

H. Brown, The Friends' Retreat, near York. Undated, Print. Collection 850, Quaker and Special Collections, Haverford College, Haverford, PA.

Quakers founded the York Retreat, a mental institution in York, England, after a negative experience in the existing network of asylums. In 1790, a Quaker named Hannah Mills was placed in the York Asylum, a non-Quaker institution. Her family, who lived far away, asked Quakers in York to visit her, but they were not allowed to do so. Shortly afterwards, she died under mysterious circumstances. This incident galvanized York Quakers to form their own asylum. The founders argued that a Quaker asylum would respect the connections between groups of Quakers and therefore allow visits from Quakers who were not family members. An institution founded specifically by and for Quakers would have the added benefit of protecting the Quaker patients from the corrupting influences of the world's people. They also reasoned that a familiar, Quaker environment would be conducive to a cure. The staff in the asylum would work to cherish the Inner Light in patients in order to try to cure them. An early history of the Retreat articulated this model of treatment, noting that they "treat... the patient as much in the manner of a rational being as the state of his mind will possibly allow" (Account of the Retreat 56). Thus, the York Retreat was founded in 1796 on the principles of kindness and equality, even for those who were insane. The York Retreat served as a model for the Friends' Asylum and many other asylums.

Moral Treatment

Although the Retreat and the Asylum were founded specifically to treat Quaker patients with Quaker methods, they did not operate in a vacuum. Other mental institutions in Europe and the United States were also experimenting with less violent treatment of the insane at the time. These asylums called their methods moral treatment, and resolved to use as little restraint as possible and help the patients regain control over their minds. The most famous reformer in Europe was Philippe Pinel, who worked in the Salpêtrière and the Bicêtre in France. Pinel coined the term moral treatment.

American Asylums and Moral Treatment

S. Sloan, Pennsylvania Hospital for the Insane, Department for Males. Undated, Print. Collection 850, Quaker and Special Collections, Haverford College, Haverford, PA.

In America, the Friends' Asylum was the first private asylum to be founded and run on the system of moral treatment. Several public hospitals, like the New York Hospital and the Pennsylvania Hospital, which served insane patients as well as others, began to try to implement moral treatment for their patients as well. These hospitals struggled to incorporate moral treatment into the systems they already had. Later, both hospitals opened separate buildings for their insane patients, which allowed them to complete their transitions to moral treatment because the new buildings were designed accordingly. Quakers were involved in the administration of both the Pennsylvania Hospital and the New York Hospital, although neither hospital was affiliated with the Society of Friends. In Connecticut, Dr. Eli Todd founded a private hospital, the Hartford Retreat, based on the example of the York Retreat. The Hartford Retreat was not Quaker at all. As can be seen from these other asylums, moral treatment was not necessarily a Quaker method. However, moral treatment at the York Retreat and the Friends' Asylum did take on a distinctly Quaker flavor.

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Quakers founded the York Retreat, a mental institution in York, England, after a negative experience in the existing network of asylums. In 1790, a Quaker named Hannah Mills was placed in the York Asylum, a non-Quaker institution. Her family, who lived far away, asked Quakers in York to visit her, but they were not allowed to do so.

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Being one of the USA's first public mental hospitals, it provided crucial care and support to individuals with mental illness during a time when religion was typically an overrule to mental health. While treatment methods of the era were different from those of the modern day, the establishment marked a significant step forward in recognizing the need for specialized care for those with psychiatric disorders. To this day this hospital is still utilized with about 400 beds with varying treatment forms outside of just the brain (2)

Source (2): https://www.dshs.wa.gov/bha/division-state-hospitals/eastern-state-hospital-overview

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Eastern State Hospital has the honor of being the first public facility in the United States constructed solely for the care and treatment of the mentally ill. In the summer of 1770, Colonial legislators met in Williamsburg, the capital of the Virginia colony, and passed a bill authorizing the construction of a hospital for this purpose. The building was erected on an eight-acre site near the College of William and Mary, and the first patients were admitted on October 12, 1773.

The Hospital provided treatment during the turbulent crises of both the Revolutionary War and the War Between the States. By the mid-1930s, Eastern State Hospital had expanded significantly from its early beginnings. Because of the embellishment of Colonial Williamsburg by the Rockefeller family, there was a need to relocate the Hospital from its downtown site to more spacious surroundings. Dunbar Farms, which was located approximately three miles to the west, was chosen as the new site. This move was accomplished on a gradual basis and completed in 1970.
Topics in ESH history: The Civil War at Eastern State Hospital
The Civil War devastated Eastern State, destroying the advanced therapeutic community Dr. Galt had nourished. The Hospital found itself on one side, then another, of the battle lines. One of the displays is a fragment from one of Dr. Galt's journals. The January 4, 1862 entry reads, "Mr. Miller said he had conversed with Mr. Saunders about the expected attack on the asylum," and then trails off mysteriously unfinished. It is the most recent writing of Dr. Galt held in the Library's collection. Robert Saunders was a member of the Court of Directors, and his April 5, 1862 note to Hospital Steward William Douglas illustrates the innumerable small ways in which the war disrupted lives. The Hospital was finally captured May 6, 1862, and Dr. Galt died soon after, on May 17 or 18. He had probably suffered from depression for many years, and either accidentally or purposely overdosed on laudanum, which he liberally dispensed to his patients as a neuroletic substitute.
The Superintendency of Dr. John Galt, 1841- 1862
In 1841 the Hospital, called Eastern Lunatic Asylum and housing 125 "inmates," came under the supervison of Dr. John Galt, an incontrovertibly brilliant physician who brought the full flower of Moral Management treatment to Williamsburg. As Dr. Galt put it, three successive revolutions in psychiatry occured in Williamsburg. The "First Revolution" was the Hospital's founding as a publicly supported facility exclusively for the care of the mentally ill. The "Second Revolution" was the introduction of Moral Management therapy. This taught, as Dr. Galt said, that the mentally ill "differ from us in degree, but not in kind" and are entitled to human dignity. Dr. Galt introduced therapeutic activities and talk therapy. He was probably alone among contemporary asylum superintendants to advocate that the psychiatric hospital undertake in-house research and claimed to treat African-American patients on an equal footing with whites. Dr. Galt used restraint very sparingly (one year restraining none) and sought a calming medication to replace restraint. He dispensed opium liberally to patients in a foreshadowing of our twentieth century neuroleptics.The "Third Revolution in Psychiatry" became clear in 1857, when Dr. Galt was the first to advocate deinstitutionalization and community-based mental health care. He wrote, "A large number of insane, instead of rusting out their lives in the confines of some vast asylum, should be placed... in the neighboring community... were any other class of persons than the insane collected together in such large numbers as is the case in some asylums, we are satisfied that the greatest disorder would be likely to ensue." Dr. Galt's was a lone voice, over a century ahead of its time-there were no echoes of agreement beyond his office, and the Hospital's Court of Directors three times prevented his accomplishing these plans. His disappointment and consequent depression probably contributed to his suicide five years later.

Thus, it was that at Eastern State Hospital all the components of the modern psychiatric hospital may have first been put into practice-human dignity for the mentally ill, therapeutic activities, talk therapy, calming medication, in-house research, deinstitutionalization, and community-based mental health care.

Symptoms of a Dysfunctional Age: The Nineteenth Century in America was characterized by a lack of civil rights for the majority of the people. There was slavery for African-Americans and oppression of women and children, as well as tremendous stigma against the mentally ill. The list of servants is actually a list of slaves owned by Eastern State Hospital around 1850. There were as many as 45 slaves working at the asylum, and they appear to have taken a large share in the work to be done. Dr. Galt trained them, as well as white "officers" (nursing aides, currently termed Human Services Care Workers), to provide talk therapy for the patients, although Dorothea Dix disapproved. Eastern State had been an integrated hospital since its beginning in 1773, and in 1846 Dr. Galt successfully submitted a bill to admit slaves as patients.

Dr. Galt claimed to treat patients equally "without regard to race." In fact, he published no records as to the racial breakdown of the patient population. The mentally ill were another group suffering oppression at this time. Chaining and other forms of long-term restraint were common at Eastern Lunatic Asylum until the late 1830s, when Moral Management thinking introduced the ideals of human dignity and least restraint. In some years, Dr. Galt used no restraints at all. However, patients that escape were sometimes cruelly treated by the surrounding community. The letter dated September 4, 1843 is a bill for the castration of an Eastern State patient who was captured near Lynchburg, Virginia. Dr. Galt's reaction (he was then 23) is not known, but he did not send payment.
Letter from Dr. Francis Stribling, Western Lunatic Asylum, to Dr. Galt
This routine piece of correspondence between two founding members of the American Psychiatric Association has many relatives. Frequently Dr. Stribling (whose Staunton, Virginia asylum was founded in 1828) refused transfer patients from Williamsburg, and, perhaps almost as frequently, Dr. Galt returned the favor. It is not known what was the race of the "man" Dr. Galt wished to transfer. If Dr. Stribling knew him to be African-American, that would have been sufficient reason for the refusal, as the Western Lunatic Asylum was not desegregated until 1968.
Eastern State Hospital 1853 and 1935 - Assorted Documents
The first of two routine documents from the 1850s is a leave slip submitted by Somersett Moore in 1855. Seven years later Moore, whose position was perhaps similar to a charge aide's, was the only non-African-American employee who returned to the Hospital when it was captured by Union troops in May 1862. All other white employees ran away and locked up the 252 patients, leaving them to starve. Mr. Moore saved their lives by giving the Hospital keys to the Northerners. The second document is a letter of Galt's to the Court of Directors which independently administered the then Eastern Lunatic Asylum, in which he expressed apparently chauvinistic opinions concerning the ability of a woman to be an officer (human services care worker).

The April 17, 1935 letter copy from the Virginia Governor's office shows the convergence of the interests of Eastern State Hospital and Colonial Willliamsburg regarding the relocation of the Hospital to its present site at Dunbar. ESH's "emergency" was overcrowding - over 2000 patients lived downtown and there was no more room for more buildings. Colonial Williamsburg viewed the patients as "noisy" and destructive of the atmosphere of the restored area and the Williamsburg Inn where well-to-do tourists stayed. The first patient care buildings were constructed and inhabited at Dunbar in 1937.
Fragment from Notes for "The Farm of St. Anne"
These preliminary notes, probably from 1854, outline some of Dr. Galt's principal thoughts for this important essay which was published in the American Journal of Insanity in 1855. "I am satisfied that the insane, generally, are susceptible of much more extended liberty than they are now allowed," he wrote in the essay. Earlier, in 1847, he wrote that it was "fully as important an indication after a while to separate a maniac from the associations of the hospital as of those at home."

Dr. Galt drew inspiration from the experimental farm of St. Anne at the French asylum of Bicetre, and the Belgian village Gheel. He envisioned the mentally ill living in supervised group homes, boarding with community members, or living independently and working where possible. Some of these independent living arrangements should be relatively close to the asylum to ensure the availability of care. In particular Dr. Galt wished to remove from the asylum harmless chronic patients.

This proposal stirred some controversy among members of the American Psychiatric Association. Matters were not helped when Galt reflected upon other American asylums and found them to be prison-like, nor did his characterization of his fellow asylum superintendents "tinkering with gas pipes and studying architecture." Thomas Kirkbride in particular felt himself a target, writing that Galt had "little idea of the restraint really necessary for recent cases and that [visitors to Eastern State] know why so much liberty is permitted between townspeople and the patients, which certainly is not seen in any other institution in the country." Kirkbride's sharp remark refers to Dr. Galt's ten-year experiment with deinstitutionalization in Williamsburg. From 1841 until 1852, half of the Hospital's 280 patients had the freedom of the town at all times, and the townspeople were encouraged to visit and socialize with the patients still confined to the grounds. Considerable enlightenment must be ascribed to the locals. How many towns today would support this experiment?
Letter from Dr. Kirkbride, Pennsylvania Hospital for the Insane, to Dr. Galt
This routine correspondence, dated September 22, 1852, shows that Dr. Galt and Dr. Kirkbride (both founding members of the American Psychiatric Association) were on good terms when not disputing issues of deinstitutionalization. Kirkbride is requesting specifications so that he may commission for Galt a zinc dial set for the latitude of Williamsburg.

The Patients' Library is the oldest library of its kind in a public psychiatric hospital. The purchase authorization from the Court of Directors places the Library's founding date exactly-August 31, 1843. Dr. Galt was one of the earliest to write about what we now call bibliotherapy. In a lecture (later published) entitled "On Reading, Recreation, and Amusements for the Insane," which was presented at the American Psychiatric Association's 1848 meeting, Dr. Galt noted the therapeutic value of reading in the treatment of mental illness. As "The Bibliography of Insanity" illustrates, he also advocated the establishment of medical libraries at psychiatric hospitals. Eastern State's medical library was housed in Dr. Galt's home during his superintendency, and fragments survive at Colonial Williamsburg's Foundation Library. Both of Dr. Galt's libraries continue to this day.
18th Century vs. 19th Century
The letter of August 11, 1793 describes a visit to Bethlehem psychiatric hospital in London, the namesake for our word "bedlam." Although it seems to be by the hand of Dr. John Galt II, it must be a copy as it precedes his birth by a quarter century. Although there were harsh medical measures like bleeding (and the ever-present restraints), there was little effective treatment. The role of the psychiatric hospital as public entertainment should also be noted-the writer expressed disappointment in being unable to view Margaret Nicholson, who had been admitted there after attempting to assassinate King George III, and who had enhanced her notoriety with a ghost-written best-seller.

The 1793 letter's remark about the relative lack of restraint and presence of only a few recreational activities at Bethlehem shows the influence of a new way of looking at mental illness, Moral Management, which began about this time. Moral Management arose from the same intellectual conditions as the French Revolution's "liberty, equality and fraternity." The mentally ill were, as Dr. Galt wrote, different from us "... only in degree, not in kind" and were to be treated with dignity, kindness, socialization, talk therapy, therapeutic activities, and the least possible restraint. Much experimentation went on in search of effective medication, and a staff-patient ratio of 1:1 was recommended, although Dr. Galt achieved a ratio of only 1:2. The Circular of 1846 was distributed by Dr. Galt to advertise for out-of-state paying patients, and summarized the Moral Management treatment modalities that Eastern State provided. Note Dr. Galt's promise that paying patients would be assured separation from patients of lower socioeconomic backgrounds. Also some attendants were hired specifically to provide talk therapy.
Screening Form, After 1852
This form, first printed by Dr. Galt in 1852, was used in particular by local community and healthcare officials to provide information for an initial assessment. It would have been forwarded to Williamsburg where the final determination for admission was made. Many criteria, such as danger to self or others and family history of mental illness, are still used by the Hospital today.

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Eastern State Hospital has the honor of being the first public facility in the United States constructed solely for the care and treatment of the mentally ill. In the summer of 1770, Colonial legislators met in Williamsburg, the capital of the Virginia colony, and passed a bill authorizing the construction of a hospital for this purpose.

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My docent is a man by the name of William Tuke, his work at the York Retreat contributed significantly to the reform of mental health care in England and beyond. His approach emphasized the importance of treating individuals with mental illness with compassion and understanding, rather than subjecting them to neglect and mistreatment. (1) The York Retreat was established with a core commitment to treating individuals with mental illness with kindness, respect, and dignity, diverging sharply from the harsh and often cruel practices common in contemporary institutions. (2) His influence in the world of mental health is something that made me belive that he is the most appropriate character to consider my docent.

Source (2): https://pubmed.ncbi.nlm.nih.gov/24944052/

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McLean Hospital, nestled in Belmont, Massachusetts. Built in 1811, McLean, provides the best support possible for people facing mental health challenges. They cover inpatient care, outpatient therapy, or a safe residential program. They specialize in helping with all sorts of mental health issues, from depression and anxiety to bipolar disorder, schizophrenia, and struggles with substance use.(1) Something different about McLean is that they always push the boundaries of what's possible. They're constantly researching and developing new treatments, ensuring they're offering the most effective help.(1) But beyond all the science and expertise, their heart really sets McLean apart. This is super important to this museum because it shows the evolution of care and understanding of mental health and psychology, neuroscience over the years!

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Founded in 1811, McLean Hospital is a leader in psychiatric care, research, and education and is the largest psychiatric teaching hospital of Harvard Medical School.

Our staff, faculty, volunteers, and supporters are dedicated to improving the lives of individuals and families affected by mental illness. We are here to help you.

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For over 200 years, McLean has been dedicated to putting people first in mental health treatment, research, training, and education.