that put me nose to nose with the original campus of Western State Hospital, where, between 1927 and 1964, surgeons sterilized around 1,700 people without their consent.
When I describe the hospital like that, you might conjure up an image of my daily commute that seems ripped from the mind of Shirley Jackson: Western State, not sane, stood by itself against the hills, holding darkness within. But instead, what I came nose to nose with every day was a bustling construction project. The site—an assembly of buildings and land, including a cemetery that contains the remains of as many as 3,000 former patients—was being diligently transformed into a luxury hotel and an upscale property development marketed to retirees and second-home buyers.
In other words, Western State did not stand by itself at all. It was open for business, undergoing renovations that would soon turn it into the newly christened Blackburn Inn and the Villages at Staunton. Its new charm included the meticulous restoration of some of the site’s key architectural structures, but also a branding identity that claimed Western State was the home of an oddly cheerful history: patients who were well-cared-for by benevolent, moral physicians. When you heard the developers’ historical account of the hospital, which had originally been named the Western State Lunatic Asylum, the place felt so sumptuous that you wondered why people in the past didn’t feign insanity just for a chance to visit.
This was not the Western State Hospital that I knew.
A period of what is sometimes called “moral medicine” did indeed briefly exist there, from its opening in 1828 to just after the Civil War. In its earliest and more optimistic configuration, Western State provided respite for white patients who were experiencing acute distress that physicians thought could be relieved by rest, proper nutrition, and a routine of light work. This more humane treatment, the “moral” in moral medicine, was intended to help individuals “regain” their sanity in peaceful environments by setting aside methods such as restraint and corporal punishment that a new generation of physicians felt were unnecessary and brutal. In this period, individuals with more severe, incurable, or chronic conditions, both mental and physical, were cared for by their families ideally, sometimes with assistance from charities, or they were placed by communities or their kin in locally funded almshouses, orphanages, or jails.
But in the late nineteenth and early twentieth centuries, that approach was supplanted by a long era in the history of psychiatric medicine when therapeutic efforts primarily focused on containment and control, not care or cure. More and more, people perceived to have disabilities, along with those who couldn’t care for themselves due to poverty or age, were viewed by society as an expensive and disorderly class prone to criminal behaviors and indigence. Communities began to demand financial relief from the costs associated with helping them survive. By institutionalizing individuals in greater numbers, communities could pass their local financial costs to the state and rid themselves of people who were thought to lead unproductive lives. According to legal scholar Laura Appleman, by 1923 more than 263,000 people were institutionalized nationwide, which meant that “The first modern mass incarceration was not of criminal offenders, but of the disabled.”
Physicians and scientists abandoned their search for moral treatment and instead turned their efforts to prevention by quantifying and categorizing, with ever greater precision, the types and causes of what they considered to be mental incompetence. Their studies, helped by the invention of intelligence testing, produced new taxonomies of weakness, but they overwhelmingly agreed that these afflictions all had a similar root cause: bad breeding.
This was a problem involving both biology and economics. In addition to diagnosing their patients, physicians began enumerating the financial burden and social dangers associated with their survival. Proponents of a rapidly growing movement to study and control human breeding found the pressure point of a unifying message: allowing the “unfit” to reproduce was tantamount to creating a societal debt that could never be repaid. “Every 15 seconds 100 dollars of your money goes to the care of persons with bad heredity: the insane, feebleminded, criminals and other defectives,” read one series of advertisements circulated by the American Eugenics Society in the 1920s. Virginia made eugenic sterilization legal in 1924.
The Western State that I knew was largely a product of this longer historical era. The hospital’s superintendent from 1905 to 1943 was such a vocal leader of Virginia’s eugenics movement that people knew him as Joseph “Sterilization” DeJarnette. He was one of the state’s earliest proponents of population control, calling for marriage restrictions for the “unfit” in 1908. By 1911, he was recommending the sterilization of “all weaklings.” After Virginia passed its Sterilization Act in 1924, and it was affirmed by the Supreme Court in 1927, DeJarnette and the surgeons who worked under him at Western State performed the second-highest number of sterilization procedures in Virginia. Only the Lynchburg Colony, seventy-five miles to the south and designed specifically for feebleminded patients, outpaced it.
Western State remained a segregated hospital reserved for white patients until Virginia was forced to integrate facilities after 1965. Eastern State Hospital in Williamsburg, opened in 1773 as the first public hospital in the United States designed solely for the treatment of mental illness, functioned briefly as an integrated hospital between 1841 and 1870 (with a segregated basement wing for Black patients). After it reverted to a segregated facility for white patients, Eastern State performed 393 sterilizations between 1924 and 1964. In 1869, Virginia opened the Central Lunatic Asylum for Colored Insane in Petersburg, another first of its kind in the United States. It, along with its smaller Petersburg Colony, remained Virginia’s only facilities for Black patients until after integration. Central State performed 1,634 sterilizations, and the Petersburg Colony, which closed in 1955, performed 246. Virginia operated an additional facility for white patients near Marion as the Southwestern Lunatic Asylum, opened in 1887. Around 364 sterilizations were performed there between 1924 and 1964. The Lynchburg Colony, dating to 1910 and where the state confined many but not all white patients labeled feebleminded, performed at least 2,781 sterilization procedures.
Earlier in my life, I lived outside of Nashville among plantations, not hospitals. There my neighbor was enslavement, not eugenics. I am telling you this because when I first moved to Staunton, Western State froze me in a sense of déjà vu; I was again encountering local historical narratives that were dominated by people who were happy, yet forcibly detained, and fine architecture, instead of by trauma and corporeal violence. Enslavement is not eugenics, and yet the two felt familiar, as if all of those modern-day plantation weddings and antebellum architectural distractions had helped lead to a point where this deeply complicated site in Staunton had similarly turned into a valuable asset that was economically inseparable from the modern growth of the community around it.
Were the cheerful stories the developers were telling about Western State intended to achieve some kind of historical balance? Were they meant to help the site and the community move beyond the stigma of eugenics? Or was this more anodyne history just designed to please wealthy property owners and visitors who wanted to stay there? The transformed Western State Hospital boasted new numbers city residents could celebrate: a $21 million investment from developers, $1.2 million in tax credits from the state and federal government, and $595,000 properties for sale. But there were other numbers from its past that now felt unseemly to say out loud: 1,700 lives altered, thousands of graves.
“But the site has good bones,” I heard people in town say, praising Western State’s architectural pedigree and thinking charitably about the transformations and profits still to come. Poet Maggie Smith tells us:
Any decent realtor,
walking you through a real shithole, chirps on
about good bones: This place could be beautiful,
right? You could make this place beautiful.
Well, this is a book about being uncharitable.
