well to do, but for stronger reasons, to present to the view of those who look out for relief a landscape marked by no violation of the laws of harmony. For surely no agency contributes more potently to the relief of a mind disturbed than strictly harmonious sensorial impressions.53
The asylum staff, the state of Ohio, and the village of Athens embarked upon the experiment in moral treatment with confidence and hope placed in the curative nature of their methods. Superintendent Holden contrasted the dawning of this new treatment with the methods of the early nineteenth century: “We no longer meet the insane as we would a wild, ferocious animal, with horror and fear, with handcuffs, chains and weapons for defense, but we meet them as we meet other patients[,] with kind words; words of sympathy and comfort, try to gain their confidence, teach them you are their friend, and will do them no injury, and rarely indeed will it be necessary to employ any means of restraint.”54
The experiment was pursued vigorously for nearly twenty years. Superintendents and staff worked hard to acquire clean water, prevent suicides, cope with political reorganization and the resultant constant changing of staff, keep the building and furnishings in good repair, balance the budget, and treat a staggering array of disorders and conditions with, in comparison to today’s array of medications and treatment modalities, what were very limited means. The asylum brought telephone and railroad service to Athens and served as a huge market for its goods and services. Superintendent Richardson hired the first female asylum assistant physician in America, Dr. Agnes Johnson of Zanesville, Ohio,55 to improve the care provided for women, and he also persuaded Ohio’s legislature to fund the first patient dining rooms at any American asylum, so that rather than eating in their wards patients might be served family-style in dining rooms with white tablecloths. Ultimately the experiment ended, a casualty of both overcrowding and medical progress. Richardson, who weathered Ohio’s political spoils system to serve at Athens with national distinction from 1881 to 1890, wrote of his discouragement about politics, overcrowding, and the difficulty of caring for those with chronic severe mental illness as well as the infirm elderly. At the end of the century, new models of psychiatric care rendered asylums essentially custodial rather than curative. Psychiatry was transforming itself from an administrative, moral, and institution-based discipline to a medical specialty based on laboratory research and a new “cottage plan” design for residential treatment.
But the moral treatment pursued at Athens between 1874 and 1893 was the result of the blossoming of an American impulse to provide humane, expert care for those with mental illness. It yielded treatment modalities that flourish today as adjuncts to mental health treatment, now reconceived with new names such as restorative gardening, milieu therapy, art therapy, horticulture therapy, and humanistic psychology. The experiment at Athens, dedicated to moral treatment and founded on hope for curing mental illness, flourished for twenty years as a lively community of thousands of patients, dozens of attendants and workers, a small cadre of physicians, the people of the village of Athens, the families of patients, politicians in Columbus and Washington, social reformers, and a shared landscape of parkland and farms. Superintendent Richardson’s closing words in one of his reports to the trustees reflect his thoughts on the twenty-year experiment in psychiatry:
We have pursued the same general plan of treatment followed during previous years and outlined in former reports. I am well satisfied with the results. I believe, however, that there is still room for improvement in our treatment of insanity, and in the present methods of caring for the insane, and it is our aim to show in some direction every year a growth, and to make constantly honest efforts to improve upon the past, basing our actions always upon the broad grounds of common humanity and genuine sympathy for those in misfortune and helpless dependence. We are in no way circumscribed, but are ready to use any means that may enable us to better care for our responsible charge. . . .
We have done what we could to make the Athens Asylum an institution of which you as well as the people of the State of Ohio need not be ashamed, and the mistakes which we have made have been mistakes in judgment alone.56
TWO
PATIENTS
“Each Admission Represented a Poor, Helpless, Hopeless Sufferer”
On a cold day in the middle of winter, a little girl from Athens County became the Athens Lunatic Asylum’s first patient. Her older brother accompanied her as, likely traveling by horse and wagon, they drove down the earthen road from town, across the Hockhocking River, and then up the great hill to the imposing Victorian structure. Eleven-year-old Alice had spent that Friday morning with her brother in commitment proceedings in the office of Athens County probate judge Leonidas Jewitt. Athens physician Dr. H. M. Lash and her brother provided witness and testimony as to her insanity.1 After arriving at the asylum, they climbed its steps and entered the brick building—with its sixteen-foot ceilings, tile and marble floors, and oak woodwork—walked past the carpeted parlors ornamented with potted palms, and entered the west wing. There she was left by her brother with her clothing and little else.
Alice had a seizure disorder. Known at the time simply as epilepsy, seizure disorders were a great puzzle to American asylum physicians. Generally physicians resisted admitting patients with epilepsy, though by 1877 the Athens Asylum was caring, perhaps reluctantly, for patients with this diagnosis.2 Superintendent Rutter in 1877 wrote to the hospital’s trustees, “The hospital at this time contains forty (40) epileptics, all of whom are, by reason of their unfortunate complication, utterly unfit to be associated with any other class of patients.”3
Effective treatment for epilepsy was not developed until the twentieth century, and nineteenth-century asylum physicians were at a loss in their efforts to care for patients with the disorder. Superintendent Holden of the Athens asylum in 1879 recommended to Ohio’s governor a separate institution for Ohio’s “epileptics,” with the idea of isolating them so as not to disturb other patients. Holden noted: “This class of unfortunate beings should claim the attention of the State, and be provided for in a separate institution. The idea of their being associated with the insane is wrong. The fall, with the piercing cry of the epileptic, is shocking even to the sane person, but to those whose nervous constitutions are shattered, or about gone, it is excruciating and greatly detrimental. . . . [T]he epileptics are often dangerous and homicidal.”4
When Alice arrived on January 16, 1874, her pulse and temperature were noted and a case file opened. The asylum physician who examined her described her as intelligent, kind, and cheerful. Her temperament was noted as “excitable” and her health apparently good. The admitting physician wrote that she “has swallowed pins and cut herself with glass as attempts at suicide. The attacks vary in duration and occur from two days or a week, at times more mild than at others. She appears to have warning of an approaching paroxysm.”5
One can only imagine Alice’s life as a young girl with a seizure disorder among three hundred or more women of all ages with a variety of mental illnesses. The medical notes documenting her progress describe the seizures and her recovery from them.
1/21[/74]: Had one paroxysm. Not very severe, stretched and tossed herself about in bed, jaws firmly closed. She did strike and scratch her nurse and remained partly conscious during the whole paroxysm. Was as well as usual the next morning except a slight soreness in muscles of limb and some headache.
1/27/74: Had slight paroxysm last night similar in form to preceding much shorter in duration and less recovery after. Symptoms are much the same as previous.
1/28/74: Had a mild attack at going to bed 8 pm, no symptoms remaining the following morning.
1/29/74: Had one other mild paroxysm last night, no remaining symptoms this morning.
2/15/74: Has had no attacks since the above date and is doing very
