Lesson Plan: Overview

Too Large to be a Lunatic Asylum: South Carolina’s Mental Health

Grade Level: 8th

Robert Mills Drawings for the South Carolina Lunatic Asylum, ca. 1822

Academic Standards

No academic standards available for this lesson plan.

Literacy Elements

A. Distinguish between past, present, and future time
B.
Establish chronological order in constructing one’s own historical narratives
D. Create and interpret data on time lines
J. Demonstrate responsible citizenship within the school community and the local and national communities
L. Interpret calendars, time lines, maps, charts, tables, graphs, flow charts, diagrams, photographs, paintings, cartoons, architectural drawings, documents, letters, censuses, and other artifacts

Historical Background Notes

At the outbreak of the Civil War, Judge James Petigru – a Unionist – said, “South Carolina is too small to be a nation and too large to be a lunatic asylum.” This witty joke makes a reference to South Carolina’s real lunatic asylum, one of the first state-sponsored asylums in the country. The issue of mental healthcare and funding has been documented as early as colonial times and continues to the present.  Today, one in every five South Carolinians suffers from a mental illness.  Everyone knows a close friend or someone in their family that has a mental illness.  Throughout the history of South Carolina, three questions have plagued and continue to plague the care of the mentally ill: Who should care for the mentally ill?   What should be the treatment?  and How will it be funded?   Looking at the history of mental health in South Carolina can provide answers to issues that the government still faces today.

In 1828, the South Carolina Lunatic Asylum admitted its first patient – a young woman from Barnwell County.  This state hospital was only the third mental health facility built in the United States and South Carolina was only the second state to provide funds for the care of people with mental illnesses.  Yet, South Carolina textbooks honor this progressive attitude with just one sentence: “In South Carolina, the state built an asylum in 1828 in Columbia” (Horne & Klein 2000, 265). The State Lunatic Asylum was not South Carolina’s first experience with the mentally ill.

In 1694, the Lords Proprietors established that the mentally ill in Carolina should be cared for by public expense by local governments.  In many cases, those with mental illnesses were jailed, physically abused, chained down, or left wandering.  The more fortunate ones were cared for and kept locked away by their families.  Churches and charities also became involved.  In 1762, the Fellowship Society of Charleston established a hospital for the mentally ill (Craft 2003).  In 1810, Colonel Samuel Farrow and Major William Crafts petitioned the South Carolina legislature to fund a lunatic asylum.  According to legend, Farrow had been moved at the sight of a mentally ill woman wandering the roads in his Up Country district (Craft 2003).  However, it wasn’t until 1821, that the state government assumed responsibility for the state’s mentally ill and agreed to fund the asylum.  The South Carolina State Legislature approved $30,000 to build the asylum and a school for the deaf and dumb. Farrow, who was from Spartanburg, and Crafts, who was from Charleston, had worked tirelessly to pass this legislation.  South Carolina was proud of its new asylum and advertised for patients in Tennessee, Georgia and North Carolina (McCandless 1996, 73).  This was twenty years before Dix’s groundbreaking efforts in the care for the mentally ill.

The Antebellum years saw many important social reforms in the United States and in South Carolina.  Among those reforms were prison reforms, both for the mentally ill and for children.  Dorothea Dix was an early advocate for those with mental illnesses.  In the 19th century, many people with mental illnesses were considered criminals and kept in prisons with convicted criminals.  Dix successfully convinced Massachusetts lawmakers in 1843, to care for the mentally ill, not warehouse them. Her appeal was summed up with, “I come to present the strong claims of suffering humanity. I come to place before the Legislature of Massachusetts the condition of the miserable, the desolate, the outcast. I come as the advocate of helpless, forgotten, insane men and women; of beings sunk to a condition from which the unconcerned world would start with real horror.”  She was eventually responsible for the creation of 32 mental health facilities in the United States, including South Carolina.

Robert Mills was chosen as the architect for the asylum and work began in 1822.  The hospital, finished in 1828, was an innovative building – It was fireproof, had central heating and rooftop gardens.  Its most impressive fact, though, was that it was only the third asylum in the nation built only for the mentally ill.  All patients were required to pay for their care, with paupers being cared for at the expense of their home district.  Despite the building’s impressive features, it quickly became inadequate because of the increase of poor patients.  This became doubly difficult as patients had to be separated by gender and race.

The primary treatment for the mentally ill in the antebellum years was “moral treatment.”  Doctors and reformers, such as Benjamin Rush, believed that kindness and no physical punishment would cure the mind.  Patients also engaged in activities such as gardening, handicraft, and games (“Changing Minds, Opening Doors” 1995, 8).  Patients with severe illnesses often underwent bleeding or “heroic medicines.”  These medicines, such as mercury, usually caused more harm than good.  There is evidence that the Asylum began to get overcrowded in the 1840s and 1850s.  This problem coupled with decreased funding limited treatment available to the patients (McCandless 1996, 64).  Dorothea Dix visited the facility several times and is credited with convincing the South Carolina State Legislature to vote for more funding in 1860 (McCandless 1996, 139).  Other funding sources were local governments and the patients themselves.  South Carolina was progressive in the area of mental illness not only because of the asylum, but also because it actively sought methods to treat the mentally ill, not just ways to warehouse them. 

During the Civil War, the hospital was converted to a Union Officer POW camp and later sheltered the citizens of Columbia after the city burned in 1865.  The Reconstruction years were the leanest for the Asylum.   With the abolition of slavery, the population of the Asylum increased.  The funding and space problems increased because patients had to be segregated by race and by gender.  In many cases, the superintendents of the Asylum used their own money to provide for their patients (McCandless 1996, 224).  With the overcrowding, there was almost no treatment.  The Asylum was relegated to the task of warehousing the mentally ill. By 1900, the mortality rate was 14 percent (McCandless 1996, 283).   The overcrowding was temporarily relieved when a separate facility was created for the African-American patients in 1913.

In the 1920s, the treatment of the mentally ill began to move towards outpatient care instead of institutional care.  The first outpatient center was created in Columbia in 1923. Within the next few years, traveling clinics were founded to service the Up Country and Low Country.  In the 1930s, the Mental Health Association was founded to be an advocate for the mentally ill and their families. The 1940s and 1950s saw the introduction of new medical treatments.  Shock therapy, “miracle drugs” (tranquilizers), and even lobotomies were used in institutions throughout the country. Government support and spending increased in the 1960s. The federal government’s Medicaid paid for the care of impoverished mentally ill patients.  The South Carolina Community Mental Health Services Act (1961) and the Federal Community Health Centers Act (1963) provided more funds for local mental health care.  In 1964, the South Carolina Department of Mental Health was founded and in 1967, the Columbia Area Mental Health Center was created.  This was the first mental health care complex built in the South (Craft 2003).  In the 1970s and 1980s, patients rights became a more political issue along with the increase of mental health advocate groups.

Today, there is a much advanced knowledge of mental illnesses.  Severe patient are treated in state or private institutions with medication and therapy.  Most patients are treated at outpatient centers, but live with their families or on their own with the true help of medicine.  Many are successful at work or school.  Government care and funding is as much an issue today as it was in 1840.  In South Carolina, there are 5 inpatient facilities and 17 community health centers.  Over 14,000 patients are treated as inpatients and over 90,000 patients are treated as outpatients.  Our communities and South Carolina have not yet discovered how best to fund the care for the mentally ill.  Lack of funding and space puts many impoverished patients out on the streets, in jails, and in the homeless shelters.

Materials

   
  Primary Sources
  Bates, W.T.C., letter to R. J. Moody, 25 February 1822.  Moody Family Papers.  Manuscripts Division, South Caroliniana Library, University of South Carolina, Columbia, South Carolina.
   
  Crafts, William.  Oration on the occasion of laying the corner stone of the Lunatic Asylum, at Columbia, S.C., July, 1822Charleston, S.C., 1822. Published Materials Division, South Caroliniana Library, University of South Carolina, Columbia, South Carolina.
   
  Mills, Robert.  Architectural Drawings for the South Carolina Lunatic Asylum. ca., 1822.  MB 17, Folder 10.  South Carolina Department of Archives and History, Columbia, South Carolina.
   
  Moody, Jane, letter to Richard J. Moody, 7 August 1822.  Moody Family Papers.  Manuscripts Division, South Caroliniana Library, University of South Carolina, Columbia, South Carolina.
   
  Townes, Henry, letter to Rachael Townes, 6 May 1835.  Townes Family Papers.  Manuscripts Division, South Caroliniana Library, University of South Carolina, Columbia, South Carolina.
   
  Mental Health Community Participants
   
  Secondary Sources
  ____. “Changing Minds, Opening Doors.” South Carolina State Museum, 1995.
   
  Craft, Susan.  “History of the South Carolina Department of Mental Health.”    South Carolina Department of Mental Health. Accessed 17 October 2003.
   
  Horne, Paul, and Patricia Klein.  South Carolina: The History of an American State.  Columbia, SC: R.L. Bryan Co, 2000.
   
  McCandless, Peter.  Moonlight, Magnolias and Madness:  Insanity in South Carolina from the Colonial Period to the Progressive Era. Chapel Hill: University of North Carolina Press, 1996.
   
  Tools
  PowerPoint with Computer or Overhead Projector (optional)
Note: This is a large file.
   
  Mental Health Student Packet
   
  Panel Presentation by Mental Health Community Participants

Lesson Plans

Too Large to be a Lunatic Asylum: South Carolina’s Mental Health examines the change overtime of Mental Health care in South Carolina.  This complex topic brings history out of the textbook and into the community. Each lesson takes one to four class periods.
 
Lesson One:  Picturing the Lunatic Asylum: A Brief History of Mental Health in South Carolina
 
Lesson Two: Laying a Foundation: William Crafts Cornerstone Laying Speech, 1822
 
Lesson Three: Letters from a Patient:  The Moody and Townes Letters
 
Lesson Four: Panel Discussion: Mental Health and Government Today

Teacher Reflections

Picturing the Lunatic Asylum: A Brief History of Mental Health in South Carolina

From the beginning I realized that this would be a difficult unit for middle school students.  I decided to go ahead with it, because I thought it was important to expose them to issues that affect society, government and even our history.  …Some of these students are not in a developmental stage to be able to distinguish change over time.  That was very evident in their final essays.  …

The initial activity was important in getting their attention for the entire unit.  …  They are split up into groups and given a photograph of something related to the State Lunatic Asylum.  …This activity went very well and provided a great start to the lesson.  The only thing I would change is to add more photos.

I employed three stages in teaching them the history of mental health in South Carolina.  On the first day, I presented chronological notes with a PowerPoint presentation.  …  In the future, I would print out outline slides so that students could focus more on listening rather than copying notes.

The second stage of this process and lesson was the guest speaker.  Fritz Hamer, Curator of History at the SC State Museum graciously accepted my invitation to speak to my students.  Using slides from the Museums’ exhibits he lectured and answered questions about the history of mental health in South Carolina.  …Although some of my students thrived with this presentation, I saw many of my students struggling to stay involved.  They were used to either seeing PowerPoint notes or an outline for the notes.  They had difficulty taking notes from a guest speaker.  This could be remedied by asking the speaker to provide an outline or by providing more experiences to the students.  …

The third stage required my students to actively organize this information.  …  I decided that a timeline would be the easiest way for them to organize their notes.   However, this was going to be a special timeline – a triplicate timeline.  I wanted them to create a timeline with three parts:  Type of Treatment, Government Involvement, and Source of Funding.  I provided the examples of the 1700s and for today (2004).  Students were assigned to independently create their timelines and submit them with their final essays.

Many of the timelines had inadequate amount of information.  I had provided the examples for the 1700s and today – most students simply added some information for the 1800s and 1900s (Timeline 2 and Timeline3).   One student did a good attempt to assimilate the information (Timeline 1) but she left gaps in her timeline.  The largest gap was between 1822 and 1930.  Another student did something rather unique by making two separate timelines:  one for treatment and one for funding.  He neglected the timeline for government role; still he had a lot of information.   I would like to see him take one more step and put all on the same timeline.  I think that the students did well considering the level of understanding required for this assignment.  In the future, I will guide them more on the timeline being careful not to just impose more facts on them.  …

Panel Discussion: Mental Health and Government Today

…One of my overall objectives was for my students to understand how things change over time and to connect contemporary issues to the past.  After listening to community officials speak about this issue, the students were assigned to write an editorial that included everything that had learned from the history to the role and responsibility of government.  I think this is a great lesson, but I ran into many obstacles trying to implement it.

Surprisingly, getting volunteers for the panel discussion was not difficult.  Both elected officials and government employees were willing to participate.  Originally I was able to get a director from the SC Department of Mental Health, a director from the Mental Health Association – SC, a Richland County Councilwoman, a director of a homeless shelter and a state legislator.  As we moved closer to the date, the state legislator pulled out due to appointments and I was not able to replace him at late notice. 

My students were hesitant to ask questions and I could tell that few were actually prepared with questions.  However, the students who did ask questions did a wonderful job.  Their questions showed thought and that they had listened to the speakers. The students were mostly drawn to Mrs. Constance Shepard, the mental health advocate.  She really connected to the students and put everything at a level they could understand.  I found many of her quotes in the final paper they were assigned to write.  … I can only assume the discussion would have gone more smoothly with preparation.

…One student did an excellent job of incorporating the history into an editorial on the current status of mental health (Editorial 1).  She ended with a fantastic thought:  “We should address mental health with the same urgency as physical health.”  Another student focused more on the panel discussion (Editorial 2) but his editorial showed that he understood that funding and stigma were two major issues facing mental health in South Carolina. 

Although well written, some students didn’t quite grasp budget difficulties and the government.  Some essays urged the government to do more for mental health regardless of other issues (Editorial 3 and Editorial 4).  Both students failed to mention that funding is a difficult issue.  One student, however, did an excellent job of connecting the issues of prisons and hospitals (Editorial 4).  I had hoped that this lesson would explain those difficult decisions to the students and most importantly highlight the importance of active citizenship.

… My students have a stronger idea of citizenship after participating in a panel discussion and then writing an editorial on the issue of mental health.  In the future, I will definitely replicate this idea, although probably with a different issue. 

Student Assessment

1. Student assessment is based upon an evaluation of the accuracy and completeness of student notes and the timeline assignment.
   
2. Student assessment is based upon the degree of participation in class discussions and by an evaluation of the students’ understanding of the documents analyzed in class as demonstrated in a written response.
   
3. Student performance is based upon group participation and the evaluation of a written assignment asking students to respond to the items examined in class.
   
4. Assessment is partially based upon student participation in the panel discussion.  Furthermore, student understanding of the topic may be evaluated by critiquing their written editorials for comprehension and knowledge.

Examples of Students Work

  Student Editorial
  Student Timelines

Credit

Jeremy Shumpert
Summerville High School, South Carolina