by Gilbert King
Institutionalized mental health care in America originated in Philadelphia in 1753, when Benjamin Franklin and Dr. Thomas Bond sought to assist the growing number of “lunaticks” living on the city’s streets. Their philanthropic efforts in time encouraged Pennsylvania Hospital to admit “deranged” patients, although they were relegated to cells in the hospital’s dark basement, where they endured appalling negligence. Many of them were also restrained with “hand irons, leg locks, and mad-shirts,” or straitjackets. They soon became curiosities for the people of Philadelphia, who’d come to the hospital to gawk at the strange, afflicted creatures in their locked cells. The hospital installed a special hatch door to ensure safe viewing, for which it charged a four-pence fee.
The treatments for mentally ill patients varied in method but not in their cruelty. Bloodletting, restraint in sensory-deprivation boxes, and subjection to “twirling wheels” or stinging sprays of water were common up to the end of the eighteenth century, when institutions like Pennsylvania Hospital adopted more humane treatments. Restraints fell out of favor, and physicians began to place an emphasis on dignity in the treatment of patients, whose curiosities, doctors now believed, could be cured. By the middle of the nineteenth century, Pennsylvania Hospital was offering swimming pools, libraries, and “occupational therapy suites” to aid in the treatment of the mentally ill. Such care was expensive, however, and thus available only to those from wealthy families.
As America became a more populous, industrialized nation in the latter part of the century, smaller, private facilities for the mentally ill began to disappear and state-run “insane asylums” started sprouting up on the outskirts of large cities. Medical staffs at these larger facilities were not only insufficient for their populations but also frequently untrained and incompetent. As individual professional attention to patients declined, neglect and abuse began to rise. Admissions protocols were vague and lacking in rigor. Although the field of psychiatry had by then become a medical specialty, cause for commitment remained highly subjective and did not always require a professional diagnosis of mental illness. In many cases, family members of the prospective patient were able to convince administrators of the need for institutionalization.
Florida’s newly founded Asylum for the Indigent Insane proved to be no exception in its unexacting policies and practices. Because the determination of a person’s insanity was often, as Chattahoochee historian Sally J. Ling notes, “based upon the observation of unusual social behavior,” virtually any individual could be shipped off to Chattahoochee “by neighbors and/or authorities that identified [him/her] as socially abnormal or simply undesirable”—a designation that might include the senile, alcoholics, epileptics, homosexuals, and the mentally retarded. Patients committed to Chattahoochee with medical diagnoses like cigarette addiction, pregnancy, abnormal menstruation, and excessive masturbation strained the asylum’s barely functional staff and contributed to the eventually massive overcrowding at the facility. Restraints at the asylum were “rigidly imposed,” and “brutal force”—a carryover from the institution’s recent incarnation as a prison—was meted out by attendants, often arbitrarily, as a means of establishing authority. In 1885, black males were segregated from the asylum population; at the facility that housed them, in the first year of its operation, a quarter of the forty-four black residents died, allegedly because of poor ventilation.
When, in 1896, “insanity” pleas were legitimized as a criminal defense and in many cases were employed, as Ling points out, “to deceive the jury during the commitment process,” criminals with issues having nothing to do with mental illness might find themselves languishing at Chattahoochee rather than serving hard time in labor camps. Even young boys facing minor criminal charges were sent to Chattahoochee. In one case, an eight-year-old was committed, as Superintendent J. W. Trammell noted, because he was “dumb and unable to defend himself in court.” By the end of the century, more than six hundred patients were resident at the facility, which had been renamed Florida State Hospital.
In the mid-1930s, the Department of Corrections established a prison facility for the criminally insane on the grounds of Chattahoochee. A subsequent investigation uncovered scandalous conditions: a lack of basic sanitary measures, a lack of privacy in shower and toilet areas, a lack of proper nutrients in the prison diet. The physician-to-patient ratio was “clearly ridiculous,” and the shortage of attendants reduced treatment largely to restraint, for the most part by cuffs and chains. Among the outrages that the investigation turned up was the instance of a toddler who was living with his mother among “intensely violent and disturbed patients” in the white female department.
More hopefully, the 1930s also brought new methods of treatment to the state hospital. Insulin shock therapy, whereby intravenous delivery of the drug induced a coma, was introduced to relieve psychotic episodes among schizophrenics, as was Metrazol shock therapy, in which the drug was administered in large doses, but often with negative effects. The convulsions produced by Metrazol were in some cases—42 percent of the subjects in one study—so violent that patients sustained spine fractures during treatment. Thousands of patients at Chattahoochee underwent drug therapies daily, until the advent of electroconvulsive therapy (ECT).
Originally administered to relieve severe depression, ECT soon came to be viewed as a cure for any number of mental disorders. Through electrodes placed on the temples of the patient, who’d been strapped to a gurney, electric current was transmitted to the brain, where it triggered a grand mal seizure. The convulsions lasted for only about twenty seconds, but patients usually received a series of ECT treatments over roughly a two-week period. Memory impairment was the most common side effect of the therapy. In 1951–1952 alone, Florida State Hospital at Chattahoochee recorded nearly six thousand ECT treatments. By the 1950s, the hospital had joined a trend common to institutions across the country, in utilizing electroshock therapy not only for patients suffering from depression but also as a means of controlling behavioral problems, largely to the benefit of overtaxed hospital staff. By the mid-1950s, the abuses of ECT had become a cause for alarm.
There was, however, no treatment for mental patients more infamous than the lobotomy. The first prefrontal lobotomy in the United States was performed in 1936, in Washington, D.C., by the neurosurgeon James W. Watts, who had been engaged by the American psychiatrist Walter Freeman to operate on a female patient suffering from insomnia, anxiety, and depression and, like the majority of patients committed to asylums, facing institutionalization for life. The physicians deemed their first lobotomy a success. After performing another sixty-four procedures together, in 1941 they notoriously failed when they performed a lobotomy on Rosemary Kennedy, the “apparently retarded” daughter of the statesman Joseph Kennedy (and sister of John F. Kennedy and Robert Kennedy), who had been experiencing frequent and violent mood changes. Watts’s diagnosis of “agitated depression” led him and Freeman to conclude, with some persuasion from Joseph Kennedy himself, that the twenty-three-year-old Rosemary would benefit from a prefrontal lobotomy. It was undertaken at George Washington University Hospital. Into an inch-long incision at the top of the mildly sedated patient’s skull, Watts inserted a “butter knife”–like instrument, which, at Freeman’s direction, he first rotated and then moved up and down before he began “slicing through the brain tissue.” The procedure did not, as promised, render Rose “happy and content.” In fact, it left her lethargic, partially paralyzed, incontinent, unable to communicate, and incapable of dressing herself.
Dr. James Lyerly Sr., the only neurosurgeon practicing in the state of Florida in the late 1930s, had for the most part been performing operations on hematomas and benign brain tumors in Jacksonville. The emerging field of psychosurgery, however, captured his professional interest, and an opening on the medical staff at Florida State Hospital at Chattahoochee enabled him to exercise that interest. Initially, Lyerly performed his lobotomies—slightly modified versions of Fr
eeman and Watts’s prefrontal techniques—on middle-aged patients who were suffering from severe depression and had attempted suicide. Before long, though, Lyerly was also scheduling children at Chattahoochee for his innovative surgery, among them an agitated, “feeble-minded” twelve-year-old girl who had become “a disturbance to the other children in the institution.”
In the aftermath of World War II, with the return of thousands of traumatized servicemen, the population at United States mental institutions swelled. Approximately 271,000 admissions were recorded in 1946, nearly tripling the number of patients just three years before. Estimates indicated that half of the hospital beds in the country were occupied by the mentally ill and that the patient population in the nation’s mental institutions had reached more than 600,000. The postwar increase in psychiatric patients, Dr. Freeman recognized, demanded a lobotomy technique more efficient than the time-consuming procedure of drilling into a patient’s skull. He thus devised the “ice pick” lobotomy, in which a narrow metal pick was inserted beneath the upper eyelid and into the patient’s orbital cavity until the tip reached the bony case. The pick (which was indeed taken from the doctor’s kitchen) was then tapped with a hammer until it punctured the brain, at which point the surgeon twisted the pick “back and forth like a windshield wiper” to sever neural fibers. The surgery took only minutes to complete, “without surgical gloves or sterile draping,” and Freeman dispensed with the need for a local or general anesthetic by immobilizing his patients with electroconvulsive shocks. Traveling in his “lobotomobile,” he performed thousands of transorbital lobotomies in assembly-line fashion at state institutions across the nation.
By the mid-1950s, Dr. Lyerly, along with his partner and son, Dr. James Lyerly Jr., was driving to Chattahoochee once a month to perform two lobotomies a day. The father-and-son team was reported to have conducted more than a hundred lobotomies at Florida State Hospital, most of them, they said, with “fantastic results.” Their procedures, which were designed to pacify disruptive patients by blunting their emotional distress and anxiety, became a “significant part” of treatment at Chattahoochee throughout the decade. Although the hospital reported non-prefrontal lobotomies as “other neurosurgical procedures” and categorized them as “elective surgery,” they were without doubt occurring on a frequent and consistent basis at Chattahoochee, just as they were at mental institutions across the country. In effect, transorbital lobotomies mutilated a patient’s brain and “permanently altered the emotional lives of tens of thousands of men, women, and children.”
Another factor that drastically affected the hospital’s population in the postwar decade was the Florida legislature’s passage of the 1951 Child Molester Act. The act mandated that any person convicted of rape, sexual assault, or lewd and lascivious behavior against victims under the age of twelve had to be examined by two licensed psychiatrists, who were obliged to provide the court with psychiatric reports of their findings prior to sentencing. As a result, many convicted criminals who would previously have been dispatched to Florida State Prison at Raiford were sentenced instead to terms at Chattahoochee. One year after the Child Molester Act became law, the patient population at Chattahoochee had increased to 6,223, with only twelve physicians on staff, most of them untrained in psychiatry. The low salaries offered to doctors and the hospital’s remote location in Florida’s Panhandle made positions at Chattahoochee “unattractive to men with families.”
While doctors at Chattahoochee continued to prescribe ECT, insulin shock therapy, and lobotomies in their treatment of mentally ill patients well into the 1950s, the decade would see the introduction of a therapy that psychiatrists would newly claim produced “miraculous results.” Two French physicians—Henri Laborit, a surgeon, and Pierre Deniker, a psychiatrist—had been experimenting with chlorpromazine, a drug used largely as an anti-nausea medication in the United States, when they discovered that, in stronger doses, chlorpromazine worked to sedative effect on some of their “most agitated and uncontrollable patients.” It induced “disinterest without loss of consciousness,” and for long periods of time the patients would sit motionless—“often pale and with eyelids lowered,” Laborit observed. That effect earned the drug—known more commonly by its trade name, Thorazine—its epithet as a “chemical lobotomy,” and it quickly gained prevalence as the therapy of choice in state institutions across the country. Difficult patients became docile and could be “moved around like puppets.” Thorazine did not remedy patients’ disorders, but, rather, it moderated their behavior, and did it with such efficiency that the drug was dispensed indiscriminately. A patient in the white male department at Chattahoochee disclosed that the care of the wards’ thirteen hundred white men was the responsibility of a single physician—the “pill-doctor,” as he was called—who was “licensed by the state as an obstetrician.” According to the patient, the “pill-doctor” dispensed antipsychotic medications to patients who sometimes had not been seen by a doctor for years. For doctors and attendants at Florida State Hospital, which was teeming with violent psychopaths, rapists, and murderers, Thorazine was a godsend.
In 1957, in response to the situation at Chattahoochee, with its overcrowded wards and inadequate care, the state established the Division of Mental Health, which opened two new mental hospitals to relieve some of the population stress at Florida State Hospital. Nevertheless, admissions at Florida State continued to rise, in large part because violent criminals who’d pleaded insanity almost invariably ended up at Chattahoochee, an institution much reputed for its function as a high-security prison for the mentally ill. More than a third of its approximately seven thousand patients in 1957 had been charged or convicted of a crime, but they were not separated from the general population. Nor was there any “segregation as to type of mental illness, age, health, or charge.” As a result, the “feeble elderly were housed among teen-agers, psychopaths and criminals, ranging from forgers to rapists and even murderers.”
It wasn’t only the criminals that patients at Chattahoochee had to worry about. Overtaxed attendants—who themselves were sometimes jumped, beaten, and even killed by the hardened criminals—would commonly lash out at docile patients, young and old alike, often without provocation or at the slightest infractions of hospital rules. Patient abuse was rampant. The attendants favored choking and beating, and they’d enter the cause of patients’ broken arms as “fall in shower” on their internal reports. “At Chattahoochee, each of us stood alone,” wrote one patient who kept a diary of his stay there, “helpless to save ourselves or a friend. There were times when the horrors crowded me to the edge and all I could see was blood on a man spread-eagled on a bed; blood on a ninety-eight-pounder in a straitjacket; blood on an old man’s ear. And a naked woman in a cage.”
Perhaps the most famous patient at Chattahoochee at the time Jesse arrived was Ruby McCollum, a black woman from Live Oak, Florida, who in August 1952 had shot a white physician and state senator, Dr. C. Leroy Adams. She was tried and found guilty by a jury of white men (some of whom were patients of Dr. Adams’s) and sentenced to death in the electric chair at Raiford. Zora Neale Hurston, while living in Florida, covered the trial for the Pittsburgh Courier and brought national attention to the case by reporting what the trial judge (who had been a pallbearer at Dr. Adams’s funeral) had kept out of the proceedings. McCollum, whom the judge had placed under a gag order, had also been prevented from testifying at her trial as to the details of what she had written in notes and letters: that Dr. Adams had repeatedly forced her into sex over the years, and that she had given birth to a daughter by him and was pregnant with another child of his when she went to his office and shot him four times. Hurston’s coverage of the trial managed to expose another ugly truth of white supremacy in the Jim Crow era—the lingering existence of “paramour rights,” another unwritten law of the antebellum South, which entitled a white man to take a black woman, married or not, as his concubine and force her to bear his children.
> In 1954, the Florida Supreme Court had overturned McCollum’s guilty verdict on a technicality, thus forcing a retrial. This time, however, McCollum entered a plea of insanity, and after a psychiatric evaluation, she had been declared mentally incompetent to stand trial and was committed to the infamous “Florida madhouse” along the Panhandle.
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AZALEAS WERE IN FULL BLOOM at Chattahoochee when Jesse Daniels stepped out of Evvie Griffin’s Plymouth. Live oaks shaded the neatly trimmed lawn that abutted the redbrick pathway up to the freshly painted white administration building with grand porches on both of its two stories. The deputy left Jesse with two male attendants in white uniforms. They escorted him back inside.
Since Jesse had undergone a psychological evaluation and a dental exam a few weeks before, he bypassed the records room and proceeded to admittance, where he was weighed and measured. His height was recorded as five feet, nine inches, his weight as 133 pounds, and his vital signs as normal, except for a significantly higher blood pressure than that recorded during his February evaluation—the staff attributed the spike to anxiety. His blood was tested, and he was vaccinated for smallpox and typhus. Now patient A-27378, Jesse was given a bath, deloused, and issued institutional clothing. Attendants, meanwhile, inventoried the items on his person at the time of admittance:
1 Pocket watch with leather string
1 Billfold [money, if any, not indicated]
5 Pictures
1 S.S. Card
1 Registration Card
1 Xray Card
1 G.P. Card
1 shirt
1 Tee shirt
1 pr. Socks
1 pr. Pants W/Belt
1 pr. Shorts
1 cap
1 Holy Bible
1 Tube Cement
