Cases from the Asylum Archive
Eli Hill (1832-1877)
Robert C. Allen
Reliving the War
We started with the first African American patient noted in the admissions ledger: “Isaac (African)”. There was so little information about him—not even his last name. He was 45 years old, married, and from Wake County—the county of the state capital and of the asylum itself. He was among the first thirteen African Americans to be admitted between April 1865 and August 1868. They are listed by their first names with the notation “African” in parentheses: Isaac, Priscilla, Anthony, Harriett, William, Haywood. Hannah, Dennis, Harris, Sylvia, Louisiana, and Sally. One other name is illegible. Isaac appears twice, but is most likely the same person admitted for a month in the spring of 1865, then readmitted in August 1866. He died from “exhaustion” in May of 1868. We can infer that they were all recently emancipated slaves.
There are supposed causes listed for only two of these patients. Lousiana was admitted in May 1866 having suffered from an unspecified fever for a year. She died in the asylum in January 1867. The supposed cause for Isaac’s first admission to the asylum was “the War.” Our database showed that Isaac was one of 22 individuals with this designation between Feb. 13, 1862 and April 1865, but, of course, the first (and only) African American. Fifteen other patients were admitted with “the War” as their supposed cause between May 1865 and April 1868. None of these was African American. A sixteenth (white) patient was admitted in March 1891 with the notation “injured during war by bomb.”
Violating our own principles, we could not help but see a possible connection with what we’ve known since the 1970s as Post-Traumatic Stress Disorder. PTSD was codified as a psychiatric disorder in DSM-III (1980) to account for symptoms experienced by Viet Nam War veterans sometimes years after the precipitating trauma. Today it also associated with the psychiatric effects of sexual assault, child abuse, and domestic violence—among other forms of trauma. Certainly the admission ledgers were pointing to a causal connection between military trauma and a psychiatric disorder severe enough to require treatment in the state’s only public asylum. In all but three cases, the “form” or diagnosis of the condition was listed as mania.
However, it is important to note that soldiers involved in conflict were not the only people to be traumatized by this and other wars. For example, in April 1866 Hannah P. Finley was brought to the asylum from her home in Sandy Ridge, Union County, North Carolina. Her supposed cause was listed at “the War” and the form of her insanity as mania. Hannah was 27 years old, single, and had been suffering for a year prior to her admission. She remained in the asylum for nine years, being released as “improved” in 1875. We can find only one immediate family member who saw action in the war: her brother, Robert, whose regiment was involved in some 150 actions between 1861 and 1865. Robert was wounded and hospitalized twice. He survived the war, returning to his farm in Union County (Hannah lived with him), dying in 1901.
We can only imagine what Hannah’s experience of the war might have been. Both parents were dead. There is no indication that her one brother returned home from the time he enlisted in 1861 until his demobilization in 1865. We know of only one other sibling: her sister Sarah (born 1832). Would the two sisters have managed the farm by themselves during the war? Union County itself was not immune from military violence: it was the scene of a notable skirmish (Wilson’s Store) in March 1865, and in the path of Sherman’s troops as they moved into North Carolina from South Carolina. What fears, losses, grief, and trauma would they have endured?
What did “the War” mean to Isaac? To the other African Americans who were inmates at the asylum? The Civil War would have affected every African American person in the South, before and after Emancipation. In his Sick for Freedom, Historian Jim Downs provides insight into the plight of African Americans in the South at the moment Isaac was admitted in April of 1865. He was one of millions of former slaves trying to make lives for themselves and their families in a war- and disease-ravaged region. No longer property, they were not yet citizens–that would not be settled until the passage of the fourteenth and fifteenth amendments to the Constitution in 1868 and 1870. Isaac was released from the asylum after only a month. Being from Wake County, he might have become part of a labor gang or found work on a nearby farm. African American women were more profoundly displaced from the Antebellum workforce. Many wandered from town to town looking for shelter and temporary work. They also were particularly susceptible to exposure, violence, and overlapping epidemics—typhoid, dysentery, yellow fever.
As noted above, the Freedmen’s Bureau was established in 1865 to address the many problems confronting some one million former slaves. The medical division of the bureau employed one hundred doctors and staff to set up and operate forty hospitals and “almshouses.” But the goal of the medical division as for the bureau as a whole was not to establish persistent institutions but to transfer responsibility for indigent former slaves to newly constituted state and local governments.
Bureau doctors recognized the plight of former slaves suffering from mental illness, but were ill-equipped and to deal with their problems directly. They had no experience treating the mentally ill and so did not establish dedicated wards in bureau hospitals. Rather, bureau officials had to negotiate with local and state asylums to admit African Americans. Overriding local lunacy commissions, the bureau created “certificates of insanity” authorizing the transfer of former slaves from bureau hospitals to local asylum. Here they faced the resistance of embittered white officials as well as the long-standing policy of most asylum superintendents across the country to deny treatment to African Americans, regardless of status.
Downs notes that by 1866 the supposed cause for admission of many African Americans and whites was “the war,” and superintendents feared that their asylums would be overwhelmed. He also argues that even slaves who sought out help were reluctant to relinquish newly-won liberty to white doctors. At the 1866 meeting of the AMSAII Edward Fisher expresses his and his colleagues’ resistance to having African American patients foisted on them. What, he asks, should be done with them? Should they be “thrown into your excited wards of whites?” Based on his experience, this was untenable: whites, he said, were angry over the end of slavery and had attacked African Americans placed in his care.
It is unknown at this point how many African Africans at Dix were admitted through the intervention of the Freedmen’s Bureau, but it is no coincidence that nearly a majority (21 out of 47) were admitted before 1869, by which time the bureau had largely ceased its medical work in the South. We await the further transcription and digitization of bureau records to shed light on how some of those admitted between 1865 and 1868 might have come to the attention of the bureau. Some records of the Freedmen’s Bureau North Carolina Field Office have been digitized and are accessible through Ancestry.com. Not yet searchable by name, these include records of former slaves examined and treated at makeshift medical stations at the end of the war. Many of the diseases and conditions from which they suffered might have had psychiatric, or perceived psychiatric expressions: epilepsy, syphilis, apoplexy, neuralgia, and senility. Others were characterized as “idiots” or “imbeciles.” One man examined at the Raleigh station, Ben Thompson, was diagnosed specifically with insanity in June 1867, but there is no record of his being treated at Dix.
Proceed to next chapter.