Bulletin of the History of Medicine

The history of insanity has been a fertile area of research in recent years, and some of the best work deals with the United States. But little attention, even in works national in scope, has been paid to the psychiatric history of the American South. In general, the region has been ignored or treated as a psychiatric backwater in comparison to the Northeast and Midwest. Peter McCandless’s Moonlight, Magnolias, and Madness is a notable step in rescuing the South from this relative neglect.

McCandless explores the perception of insanity in South Carolina and the treatment of the mentally ill, both within the community and in the asylum. He also places insanity in the broader political, economic, cultural, and social context of the state. And because of the persistent debate over southern distinctiveness and the issue of race, he examines how the psychiatric experience of South Carolina, a state generally representative of the southern experience, paralleled or diverged from that of the nation at large. McCandless argues that “in many respects the fate of the insane in South Carolina was not unusual” (p. 321). While slavery in the Old South and poverty and racialism in the defeated region aggravated their condition, the experience of the insane outside institutions was not that unlike that of the noninstitutionalized insane in the rest of the nation, and in Europe. Those sent to the South Carolina Lunatic Asylum (the [End Page 537] South Carolina State Hospital after 1895) between its opening in 1828 and World War I, however, shared a more complicated experience. Like similar institutions in the United States and Europe, this one began as a small establishment characterized by therapeutic optimism and became a mammoth custodial warehouse. What set the South Carolina Lunatic Asylum apart from other institutions was the marked deterioration in conditions from the antebellum to the postbellum eras.

The radical transformation of postwar South Carolina society was accompanied by a dramatic increase in the number of patients in the asylum, overcrowding, and a decline in services because of the admission of formerly excluded blacks and paupers. The state’s worsening economic fortunes led to a paucity of support. Finally, there were the enervating effects of the politicization of the asylum resulting from the repeated political revolutions that rocked the state and the lingering racial animosities growing out of defeat in the Civil War and its aftermath. Inexorably, and perhaps to a greater degree than in other custodial care institutions of the era, there was a dangerous decline in the patients’ environment. The scandalous conditions at the state hospital were not addressed until the Progressive Era. But even after improvements were made, white patients benefited more from them than blacks.

This is a highly commendable study. Impressively researched and clearly written, it sheds important light on the history of mental illness in the South. It is also a fine example of psychiatric history at its best. Moonlight, Magnolias, and Madness is an important contribution to southern, social, and medical history.