Cases from the Asylum Archive
Eli Hill (1832-1877)
Robert C. Allen
This gave me an epiphany — a grand vision of the future of social reading. I imagined a stack of transparent, margin-size plastic strips containing all of my notes from “Infinite Jest.” These, I thought, could be passed out to my friends, who would paste them into their own copies of the book and then, in turn, give me their marginalia strips, which I would paste into my copy, and we’d all have a big virtual orgy of never-ending literary communion. It was a hopelessly clunky idea: a vision right out of a Library Science seminar circa 1949. It occurred to me later, however, that this embarrassingly analog fantasy should actually be possible, fairly simply, right now, with digital technology — that this sort of hypercharged marginalia might be one area where the e-book can actually improve on the tree-book.
Recovering Forgotten Lives
Since fall term 2018, graduate students in a CHW-linked research seminar have been the first scholars in the world to explore and analyze the admissions ledgers and other historical patient records from this period of the history of mental health treatment in North Carolina—a period during which modern psychiatry emerges in the U.S. A key expression of their discoveries has been the case study: recovering the personal, medical, family, and social biography of individuals who were treated at Dix during this period.
At one level the patient case study is an act of archival liberation: it seizes upon the moment an otherwise invisible individual is transformed from citizen to inmate and makes this into a historical event. In doing so, it transports the individual from the margins of history to the center of scholarly attention and gives that person a historical identity outside the pages of the ledger and beyond the walls of the archive.
At another level, case studies such as these test the limits and possibilities of leveraging archival and digital history in recovering the shreds of public records that might form a makeshift quilt of moments in the life of a person who lived more than a century ago: a census enumeration, marriage license, death certificate, draft card. Case studies done within the context of an interdisciplinary, trans-domain graduate seminar require that participating scholars and practitioners in training work together to quickly become competent digital genealogists and family historians. Researching case studies is a process of unfolding bits and pieces of historical evidence into patterns, of proposing connections among seemingly disparate people, places, and events. As Carolyn Steedman puts it in Dust: the Archive and Cultural History, this kind of historical inquiry is about recreating a social world from a nutmeg grater.
Creating case studies that can inform our understanding of the asylum and its role in defining the causes of and treatments for insanity—indeed, the very meaning of the term—requires steeping oneself both in the discourses and practices of the past and contemporary analyses of them in a burgeoning scholarly literature approaching them from a variety of perspectives: the history of medicine and psychiatry, medical anthropology, medical humanities, gender, race, sexuality, region, disability, among them.
Crafting case studies is always about storytelling, about narrating a life the contours of which we can barely make out. In doing so we are aware that the story we tell is from our perspective. It is a story as much about us as about the person we construct as the story’s central character. Thus the most useful case study is a self-reflexive meta-narrative that raises more questions than it answers, a story that refuses to reduce its subject to the expression of a psychiatric category. It acknowledges the central paradox of the archive: the more it reveals, the more it refuses to yield.
The case study approach interrupts the triumphalist march through history from ignorance to knowledge, simplicity to complexity, backward-looking to progressive. This would seem to be a particularly important in a field like psychiatry, which has shifted paradigms of etiology and treatment a number of times since Dix Hospital opened in 1856. In Hysteria to Hormones, her study of the historical relationship between women’s bodies and “insanity,” Amy Koerber enlists philosopher of science Michel Serres to help us rethink our notion of scientific progress. We tend to think of time as a continuous line punctuated by discoveries and invention, making error and false beliefs bumps in the road that are consigned to “back in the day. . . “ and quickly forgotten. He suggests changing the spatial metaphor to conceive of what we know today as being at the imagined center of the epistemological universe. “Just as in space we situate ourselves at the center, at the navel of things in the universe, so for a time, through progress, we never cease to be at the summit, on the cutting edge, at the state-of-the-art development. It follows that we are always right, for the simple, banal, and naïve reason that we are living in the present moment.” (Koerber, p. 103).
In Hidden Valley Road: Inside the Mind of an American Family (2020), journalist Robert Kolker examines the case of the Galvin family. Of twelve children born between 1945 and 1965, six would be diagnosed as schizophrenic. This period was dominated by a theory that schizophrenia was associated with a failure of mothering, a catastrophic breakdown of family nurture. Kolker notes that the theory of the “schizophrenogenic mother” was itself a pendulum swing away from what by mid-century seemed the crude and unverifiable biologism of the early 20th century. The six brothers were also treated with a variety of antipsychotic drugs, whose long-term and potentially fatal side effects were not understood. He interviews scientists who have spent careers trying to confirm the biological and hereditary basis for schizophrenia. At the end of the book he advances a “new” theory: the “vulnerability hypothesis” suggests that certain hereditary factors could make some people particularly susceptible to environmental triggers. Schizophrenia can be understood as an information-processing disorder with both nature and nurture components. (Jennifer Szalai, “A Family Consumed by Schizophrenia,” New York Times, April 1, 2020, p. C5.)
The vulnerability hypothesis chimes, however distantly, with the theoretical framework for insanity developed by asylum superintendents in the mid-1800s and reflected in the questions that would have been asked of/about any new patient. An “attack” of insanity was thought to be the co-incidence of two factors: a psychological or constitutional debility, vulnerability, or fragility, and a precipitating event, trauma, or condition. The two combined to produce the “form” of insanity from which the patient was suffering: dementia, mania, or melancholia. The “trigger,” as we might call it today, might be anything from a blow to the head to childbirth—we have hundreds of different supposed causes listed in the admissions ledgers.
The first psychiatrists struggled to identify why some people had robust psychic resources while others succumbed to mental illnesses from which they might not recover for years or even decades. They generally agreed that insanity was a brain disease, some suggesting that different forms of insanity were caused by lesions in particular areas of the brain. That early psychiatrists were eager to prove a hereditary basis for insanity is also manifest in the records—from the 1850s into the 1920s. G. E. Wyche, patient number 310, was admitted on August 23, 1859, his supposed cause listed as “hereditary disposition.” He was the first of 875 patients for whom “hereditary” or “heredity” is noted. General case book record forms contained fields for both insane ancestor and insane relative. Admissions ledgers and genealogical resources have enabled us to begin to build family trees for multi-generational and intra-generational groups of biologically related patients.
The scientists Kolker interviewed might resist the creation of continuities between their sophisticated genetic tracking and the casual labelling of “heredity” as a supposed cause by a long-forgotten (and unnoted) intake clerk more than a century ago. Certainly there have been advances in our understanding of and treatment for mental illnesses such as schizophrenia. But asylum records and case studies suggest the possibility that the history of science, medicine, and psychiatry are recursive rather than linear, a never-ending dynamic of forgetting and remembering. (Koerber, p. 103).
Over the past two years, seminar participants have used case studies to connect women suffering with “puerperal insanity” in the 19th century with women in 2019 who might benefit from the first drug ever specifically designed to treat postpartum depression and psychosis. They have traced continuous multi-generational family presences at Dix over its first century of its operation and challenged 19th century understandings of the demography of suicide. They have connected madness with nutrition through the etiology of pellagra, connecting mill workers in early 20th century North Carolina with 21st century refugees in Syria and recovered the story of the family that became, quite literally, the poster family for the eugenics movement in North Carolina in the early 1920s.
Proceed to next chapter