Tennessee Lunatic Asylum

The movement for an asylum in Tennessee arose in the context of the nationwide reforming furor associated with the Second Great Awakening. The asylum movement in America built its ideological arguments upon the theories of a group of European physicians including Phillipe Pinel of France, Daniel Hawke Tuke of England, and Vincenzo Chiarugi of Italy. These thinkers advocated a system known as “Moral Treatment.” The heart of this system consisted of the theory that insanity often arose in the context of a disordered environment. Treatment involved removing the patients from harmful surroundings and immersing them in a carefully controlled milieu in which they could develop the habits and modes of thought conducive to health.

The Tennessee General Assembly established the asylum in 1832, and it opened its doors to patients in 1840. The physicians and staff of the institution quickly attempted to apply the principles of moral treatment in combination with somatic therapies such as venesection and purging commonly used during the era. In 1845 a book titled A Secret Worth Knowing, purportedly written by an asylum patient named Green Grimes, appeared praising the asylum’s success. The book was followed the next year by a sequel, Lily of the West.

Despite Grimes’s praise, however, the institution quickly faced a set of interlocking, intractable problems. The legislature had been quite generous with its appropriations, at least as measured by the total size of the state budget. For most years during the antebellum era, asylum appropriations far exceeded those for the state penitentiary, the other public institution founded during this era of reform, and in fact the asylum budget often surpassed that of the entire executive payroll. But the money was never enough. Despite the fact that the staff of the asylum emphasized the crucial role of prompt treatment (within a year of the onset of symptoms) in curing mental disease, families and local governments unburdened themselves of relatives or citizens with long-standing problems. The asylum also found itself overwhelmed with pauper cases, which required state financial assistance. The latter problem was compounded by an early underestimation of the costs of caring for paupers in the asylum. Actual costs per patient for pauper care amounted to more than twice the original estimate. Finally, the assumptions of antebellum medical science may well have worked against the asylum. The institution treated persons with a wide variety of illnesses including alcoholism, depressive disorders, mania, seizure disorders, and frank psychosis. While some of these conditions might have responded to an environment structured according to the ideas of moral treatment, others did not. Indeed, many of these conditions only found effective treatment with the development of modern drug therapies, and many others still cannot be treated effectively.

The asylum lurched along, chronically over budget (sometimes by as much as 200 percent) and understaffed. Its original quarters, at the corner of the present Twelfth Avenue South and Division Street in Nashville, proved woefully inadequate. A visit by Dorothea Dix, the itinerant champion of asylum and penitentiary reform, combined with the pleas of asylum staff, prompted the legislature to approve the construction of another facility. This building, located on Murfreesboro Pike to the southeast of Nashville, remained the home of the asylum from 1851 to 1995. During that period it underwent several changes of name, becoming first the Tennessee Hospital for the Insane, then, upon incorporation with the developing system of state mental hospitals, Central Hospital for the Insane, and finally Middle Tennessee Mental Health Institute. Its institutional history, however, stretches back unbroken to the first lunatic asylum founded by the legislature in 1837.

By 1865 even the superintendent of the asylum flatly admitted that the asylum could not hope, under existing conditions, to strive for the goals of moral treatment. Instead, the institution had become a custodial facility, harboring the chronically and irredeemably ill. Yet the institution’s continued existence, albeit with a long checkered history, into the present day attests to the power and nobility of the original vision.