ABOUT THIS BOOK

Fulton State Hospital was not only Missouri’s first state mental asylum but also the first such institution west of the Mississippi. In tracing its founding and evolution over a century and a half, this book sheds light on both a neglected aspect of the state’s history and the development of mental health care in America. It acknowledges the noble aspirations of Fulton State Hospital—as well as its failures, throughout much of its existence, to transform those aspirations into realities.

This institutional history of the hospital traces the debates surrounding its creation (as the State Lunatic Asylum) in a time when mental illness was barely understood. Although the Fulton hospital was initially conceived as a treatment facility, it quickly transformed into a primarily custodial institution. It existed as a self-sufficient establishment until the mid-twentieth century, dependent on patient labor and even producing its own food. But for the most socially disadvantaged and for the severely delusional, life at Fulton was anything but therapeutic.

The book describes not only the lofty goals of professionals dedicated to treating the mentally ill but also an institution once clouded by overcrowding, financial mismanagement, political cronyism, and wrongful confinement. It considers segregation within the hospital, where the first black doctor was hired in 1960 and where racism nevertheless continued to flourish, and it describes how, even after the 1921 Eleemosynary Act, the patronage system continued to plague Fulton for two more decades.

The authors reveal changing attitudes toward new treatments in the mid-twentieth century as psychotherapy and drugs became common, and decisions at Fulton regarding patient care are described within the context of progress in Europe and the eastern United States. The book addresses the complexities facing the physician-superintendents who supervised both medical therapies and administrative matters, depicting ongoing tension between hospital finances and state support and showing the difficulties state institutions faced in a “low tax/low public service” environment.

As Fulton State Hospital enters the twenty-first century, clients have become active in the development of institutional policies—a far cry from the warehousing of patients a hundred years ago. In tracing these seismic shifts in mental health care, this book offers an eye-opening exploration of how one state has sought to care for its citizens.

AUTHOR BIOGRAPHY

Richard L. Lael is Professor of History at Westminster College in Fulton, Missouri, and author of The Yamashita Precedent: War Crimes and Command Responsibility. Barbara Brazos is a Registered Nurse at Mid-Missouri Mental Health Center in Columbia. Margot Ford McMillen is an adjunct instructor in English at Westminster College, whose five other books include Called to Courage: Four Women in Missouri History (University of Missouri Press).

REVIEWS

“Lucid writing is complemented by numerous illustrations of patients, buildings, the city of Fulton, and treatment activities such as occupational therapy. The book includes fascinating descriptions of the hospital’s social learning program and some of the state’s major figures in mental health, leaders who continue to shape mental health policy in Missouri. Anyone interested in either mental illness or the history of Missouri will be intrigued by this book. A joy to read from beginning to end and highly recommended.”—Missouri Historical Review

“Traces the origins and development of the first public psychiatric facility established west of the Mississippi River. The authors are to be commended for following the history of the hospital through the era of deinstitutionalization, a period often treated only as an afterword in asylum narratives. The authors’ extensive use of oral history material is interesting and welcome.”—The Annals of Iowa

“In charting this history, Lael, Brazos, and McMillen examine the enduring shadow of political patronage, evolving psychotherapy and new drugs, and the continuing challenge of overcrowding and chronic underfunding. They also touch upon issues of racial segregation and racism, emerging concerns for patients’ rights, the controversial boundary between criminality and insanity, and intersectional difficulties of class and gender.”—Choice

TABLE OF CONTENTS

Contents
Preface 00
Part I
1. From Idea to Reality, 1844-1850 3
2. Overcoming Obstacles: The First Decade, 1850-1860 00
3. Disaster and Rebirth, 1861-1872 00
4. Administration Gridlock and Recovery, 1869-1897 00
5. "To the Victors Belong the Spoils": Asylum Patronage, 1872-1923 00
6. Search for a Cure: Treatments in Transition, 1905-1940 00
7. Bursting at the Seams: Growing Pains, 1890-1940 00
Part II
8. Three Early Residents 00
9. Dramatic Changes in Treatment 00
10. Missouri's Mental Health Care Comes of Age 00
11. Enlightened Leadership 00
12. New Strategies, New Challenges 00
13. The Challenge of Youth 00
14. Deinstitutionalization 00
15. New Missions as the Century Turns 00
16. An Uncertain Future 00
Fulton State Hospital Administrators 00
Index 00