Scholars have long characterized nineteenth-century American asylums as places of control and coercion, as institutions where doctors, nurses, and administrators surveilled, experimented on, and otherwise abused patients, particularly women, recent immigrants, and people of color. Scholarship has focused predominantly on the asylum staff and bureaucratic processes within the state that were relevant to asylum development and administration. Significantly less work has been done that focuses on these places as sites of resistance and patient agency, despite a longstanding call by historians to see the doctor-patient relationship ‘from the bottom up,’ or from the perspective of patients (Porter 1985).
The purpose of my work has been to rethink patient experiences, previously interpreted as simply a constellation of symptoms of the perceived mental illness that led to their asylum enrollment. In particular, this study focuses on multiple forms of patient resistance at the South Carolina Lunatic Asylum (SCLA), which operated under that name from 1821 to 1895. I argue that resistance occurred at the SCLA and was carried out through a variety of means. Although physicians and asylum staff generally interpreted such behaviors as symptoms of the patients’ mental illness, I argue that such acts of noncompliance represented patients’ efforts to regain autonomy and agency. Thus, I build on the work of scholars such as Nancy Tomes who in her work on the Pennsylvania Hospital for the Insane describes what she calls the ‘noncompliant patient’ who behaved in disruptive ways prior to and during institutionalization as either a conscious or unconscious response to treatment (Tomes 1984, 235-236).
Complaints from patients indicated how they felt about the asylum, its staff, and its policies towards them; however, most complaints were recorded by asylum staff, making patient motivations and concerns harder to recover. Doctor Daniel H. Trezevant, a physician at the SCLA, acknowledged in 1835 that he often received complaints from patients about their unsatisfactory treatment (Anonymous 1845, 220). Trezevant found that patients were particularly dissatisfied with not being able to leave the institution to visit friends and family or their home. He also noted that patients complained about the “savage conduct” of attendants, whom he called “keepers.” Mary P. Allston, who was one of the wealthier patients, wrote to her relatives in 1850, begging for release as her “poor weak shattered Nerves are truly harassed and tortured by being confined in a Madhouse or perfect Bedlam! [She] would now rather suffer the most excruciating death than be confined here” (McCandless 1996, 103). These instances of lodged complaints against the SCLA are examples of patients trying to regain lost autonomy under the stringent rules and control of the asylum.
Patients also resisted by escaping the SCLA, either for short periods of time or permanently. In the 1830s, escapes from the institution were common with both completed and attempted escapes reaching up to four times a week (McCandless 1996, 103). For some patients, escapes were not permanent but reflected a desire to regulate their own time and leave the asylum as they saw fit. They returned home to see family and friends or engage in temporary amusements, only to return to the asylum afterwards. Patients who attempted to leave or successfully escaped the SCLA resisted the physical control imposed by the asylum and demanded that they be able to see their friends and family when they chose.
Violence was yet another method used by patients to avoid treatment and challenge the control of asylum staff. Attendants were frequently the recipients of patient violence. In one case in August 1859, Marion Wooten, who was generally described as good-natured and a model patient, acted aggressively towards a staff member. Other patients used violence alongside verbal threats. In the 1830s, multiple SCLA patients complained about their treatment and the quality of their food; when their concerns were not met, they organized a riot. Patients may also have used violence to resist because this was how they believed they could best communicate with asylum staff. Attendants used physical force to get patients to participate in treatment, activities, and mealtime. Violence, then, became a shared language that both patient and attendant responded to and spoke as they jockeyed for power within the institution.
Although patient resistance was often aggressive and explicit, it could also be subtle and subdued. Some patients refused to speak or limited their interactions with staff members as a means of resistance. SCLA staff often described patients as willfully remaining silent unless spoken to by an attendant. Erving Goffman in his book, Stigma, provides a possible explanation for this behavior. Goffman argues that patients may not be inclined to speak with staff in mental institutions because of perceived judgment from them. He describes ways that patients then navigate their interactions with staff, combining “stiffness, dignity, and coolness in a particular mixture that conveys insufficient insolence to call forth immediate punishment and yet express that one is entirely one’s own man” (Goffman 1961, 318). Arguably, this can be taken a step further to also suggest that patients may have been selective when speaking with staff as a resistance method, as seen with SCLA patient James Green. Green was admitted in July 1866 after the death of his brother during the Civil War. He was documented as speaking to himself and laughing alone quite frequently. However, when communicating with asylum staff, Green was described as “apparently indifferent, he always answers sensibly, but his countenance never changes” (South Carolina State Hospital, 1866). Selective communication with staff members was one small way that patients could control themselves and their engagement with the institution.
Still other patients resisted by destroying property, primarily their clothing. U. D. Jones, whose insanity was believed to have stemmed from being wounded in the 1864 Battle of Florida, as well as Conrad Sahlman, admitted to the SCLA in the 1860s for derangement, were both recorded as tearing their garments, which led to their physical restraint (South Carolina State Hospital, 1866, 1859). In addition, James Kirk, who was admitted for mania during the same time period, destroyed any possessions he was able to acquire, whether that be clothing or other items. Total institutions, such as asylums, maintained a full level of control over inmates that did not afford people with many opportunities to resist or exert agency. As such, while some forms of resistance, such as the tearing of clothing, may appear trivial on the surface, these options were likely the only ways that patients had to obtain or display any control.
While the South Carolina Lunatic Asylum staff interpreted patients’ aggressive or challenging behaviors as symptoms of their mental illness, I reify them here as expressions of resistance and assertions for agency. This reorientation works to reclaim the power and autonomy of asylum patients despite their oppressive surroundings.
Note: In this essay, I utilize modern language about mental illness, rather than the contemporary “lunacy” that asylum staff and patients would have likely used. The term “lunacy” has a loaded history, often used in the oppression of those with mental illnesses and disabilities, as well as LGBTQ+ people and people of color. To avoid propagating this term, I have elected to use “mental illness” when appropriate.
References
Anonymous. 1845. “LUNATIC ASYLUM IN SOUTH CAROLINA,” The Boston Medical and Surgical Journal (1828-1851) 33, no. 11 (October 15): 220.
Goffman, Erving. 1961. Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. Garden City, NY: Anchor Books.
McCandless, Peter. 1996. Moonlight, Magnolias, and Madness: Insanity in South Carolina from the Colonial Period to the Progressive Era. Chapel Hill, NC: University of North Carolina Press.
Porter, Roy. 1985. “The Patient’s View: Doing Medical History from Below.” Theory and Society 14, no. 2 (March): 175-198.
South Carolina State Hospital, Patient Treatment Records, Collection 190000/.S 190019, South Carolina Department of Archives and History, Columbia, SC.
Tomes, Nancy. 1984. A Generous Confidence: Thomas Story Kirkbride and the Art of Asylum-Keeping, 1840-1883. Cambridge: Cambridge University Press.
Chayyim Holtkamp (she/her or they/them) is a recent graduate of the College of Charleston and the Citadel, receiving her M.A. in History. She received a B.S. in both Psychology and History from Appalachian State University. She focuses her research on disability and the history of psychology. She is particularly interested in Holocaust studies, with an emphasis on Nazi medical experiments. She is a current graduate student at the Citadel where she is working on her M.Ed. in Higher Education Leadership with a graduate certificate in Student Affairs. She plans on continuing her education to receive a Ph.D. in History, focusing on the Holocaust, after she completes her second master’s degree.
