The Insanity Development

by Geoff Watkinson

Dr. Joseph Spencer DeJarnette, the Superintendent of Western State Lunatic Asylum in Staunton, Virginia from 1905 through 1947, embraced the ideology of eugenics and sterilization wholeheartedly. He was reported to have read, on many occasions, a poem he wrote, “A Plea for a Better Race of Men,” which had been published multiple times. The poem begins: “Oh, why are you men so foolish – / You breeders who breed our men / Let the fools, the weaklings and crazy / Keep breeding and breeding again? / The criminal, deformed, and the misfit, / Dependent, diseased, and the rest- / As we breed the human family / The worst is as good as the best.” DeJarnette’s rhetoric shouldn’t be surprising. It was the American medical community that created a policy of eugenics, validated by the US Supreme Court. In the 1927 case of Buck v. Bell, the Supreme Court upheld a 1924 Virginia law that permitted sterilization of those deemed genetically unfit. Justice Oliver Wendell Holmes wrote in his decision, “It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind…Three generations of imbeciles are enough.”

DeJarnette was well-liked, respected, and often praised by community members; local, state, and federal politicians and judges; as well as his patients. In late 1905, Western State was looking for a replacement to Dr. Blackford, their superintendent who had recently died. The attorney Richard Evelyn Byrd, from Winchester, Virginia, wrote to the hospital board on December 16: “As a citizen of Virginia I am greatly interested in the selection of a successor to Dr. Blackford. I take the liberty of recommending to your favorable consideration Dr. J. S. DeJarnette.” Continuing, he writes about DeJarnette’s qualifications: “I have known Dr. DeJarnette for a number of years and have had a number of opportunities of observing him. I have seen him on the witness stand when testifying as an expert on insanity and I have seen him a number of times with his patients. I consider him one of the foremost alienists in this Country. He is young, vigorous, able and learned. I think that he has positive genius for his particular work.” Byrd ends his letter with a statement validated by many of DeJarnette’s patients themselves: “To me one of [DeJarnette’s] greatest recommendations is the affection which his poor unfortunates have for him.” DeJarnette took over as Superintendent that same year.

Another letter of advocacy, from December 16, 1905, likely from attorney Marshall McCormick of Berryville, Virginia (although the archived letter is unsigned), states that “Dr. DeJarnette is a man of the highest moral character, and of unusual ability, energy, and vigor…Few men in the State had more experience than he in the care and treatment of the insane, a subject which he has made his life work; and I think I can safely say that there is no man in the State who is superior, and few who are equal, to him in peculiar fitness for that service in the matter of temperament and technical knowledge.” He “is robust and wholesome of mind and body; is “of a most kindly and humane disposition, and of an unusually genial and cheerful temperament and manner; all of which, together with his skill and tactfulness in dealing with the insane of whom he has charge, enables him to readily gain and retain their confidence, affection and obedience.” The letter continues, stating that DeJarnette “is an enthusiastic student of his profession,” “a man of much originality of thought and full of initative,” “tactful in the management of his subordinates,” and “a good spirit in his department.”

Under DeJarnette’s supervision, electroshock and insulin treatments were used on patients who suffered from Dementia Praecox, or Schizophrenia. DeJarnette, in his personal papers, notes the characteristics of the illness as disorientation, loss of contact with reality, splitting of the personality. Heredity, DeJarnette writes, “is a decided etiological factor in both dementia praecox and manic-depressive psychosis—but the difference in the inheritance being: in dementia praecox all members of the family are liable to transmit the disease to offspring, while in manic depressive psychosis the individual who is suffering from the disease is the one most liable to transmit it.” DeJarnette notes some of the preeminent symptoms of dementia praecox being shunt-in personality, inordinate laughter, vacant stare into space, delusions of grandeur and perversion of the ego, drooling of the mouth, and impulsiveness.

On January 17, 1938, insulin treatments, which were experimental, began with “chronic cases averaging from eight to fifteen years duration and with a hopeless prognosis.” The procedure went as follows: 40 units of insulin are given to the patient “at 7:00 a.m. intramuscularly, no breakfast, and…increase[d] 10 units daily until coma is produced – some cases requiring as much as 645 units to produce a comatose condition, but the average number of units given was 200.” This particular treatment was administered to 48 male patients. DeJarnette continues: “[We] usually had two physicians in attendance and an attendant for each patient to avoid accident from sudden collapse, struggling and choking from saliva. The 16% of the cases that had convulsions had better results from the treatment. They were allowed to remain in the coma from two to three hours, and were then brought out by intravenous injections of 50 C.C of 33/3% glucose (Lilly) which usually aroused them in two to eight minutes sufficiently to drink 2 pints of milk each containing eight ounces of sugar well dissolved. In less than 10 minutes they were fairly awake.” To visualize the procedure, consider the scene in A Beautiful Mind when Russell Crowe’s character, John Nash, is injected with insulin and then violently convulses as he wakes from a coma.

A physician was kept on the ward day and night, as well as trained attendants. Of the 48 treated with insulin, DeJarnette recorded that 23 were “apparently cured,” six were “improved sufficiently to go home,” three “greatly improved,” and 16 were “still under treatment.” DeJarnette notes that “between the treatments the patients were encouraged to play games, read, walk and live a normal life.” Treatment continued until February 27, 1939 when the hospital “had one death from a non-reversible case.”

Staunton, Virginia is 150 miles southwest of Washington, D.C. The grounds of Western State Hospital, formerly Western State Lunatic Asylum, sprawl over 80 acres and include dozens of buildings constructed throughout the nineteenth and twentieth centuries. Many of the hospital’s earliest buildings—administrative and dormitory—have been converted to The Villages: luxury condominiums selling for between 300 and 800 thousand dollars, industrial offices, a luxury hotel and spa, and a brew pub. The effort has been funded through a public-private partnership.

I drove out to Staunton from Norfolk, Virginia—three hours east on the coast—to explore the transformation and talk to John Beghtol, the Community Services Director for Western State Hospital, about the nearly 200 years of operating history of the hospital and the influence of DeJarnette.

The DeJarnette Sanatorium, named after the Superintendent, is one of the buildings not currently being restored. It’s set back on an overgrown hill across Richmond Road from the hospital’s operating campus that was constructed just after the Second World War. DeJarnette has clay-colored bricks with white wooden shutters covering coffin-shaped windows. Four Romanesque columns stand on the crumbling cobblestone stoop where two four-story annexes converge. No Trespassing signs and wire fencing encircle the property.

The DeJarnette State Sanatorium opened on May 30, 1932, just months before Hitler was appointed Chancellor in Germany. On March 29, 1934 Virginia legislation gave complete control of the building to Dr. DeJarnette and Western State’s hospital board. It was a special unit intended for voluntary patients who paid their own way.

DeJarnette scribbled a poem in the margins of a 1937-1938 bulletin from The Washington School of Psychiatry that begins: “Time is not duration only / But we know it never ceases / To grow old and always older / As the minutes succeed each other.” Obsessed with time, DeJarnette wrote dozens of poems about it over the course of decades. Two more poems appear fifteen years later, scribbled on a letter from his brother dated March 14, 1953 (the underlining is his): “Now is always passing is my rhyme / Whatever you say whatever you do / Now is the center of time.” His poems are written by hand on the back of reports and scrap paper. Some are typewritten. He wrote poems that defined music, contemplated God, and advocated hope. He had patients write creatively—poems, memoirs, essays. He held onto many of them, as a parent holds onto their child’s art.

Metrazol, a circulatory and respiratory stimulant, was used in early 1938 at the same time as the initial insulin treatments, and then again in June 1939. In 1934, it was discovered that metrazol caused convulsions when given in high doses and thus began being used as a treatment. “The metrazol cases,” DeJarnette writes, “were of longer duration than the insulin cases. Because of the concomitant dangers and difficulties the insulin treatments were discontinued and we used metrazol which is safer and quite as satisfactory.” DeJarnette was attempting to discover—as he saw it—more effective treatments. Metrazol treatment wasn’t discontinued until 1982, when the FDA revoked its approval due to proven ineffectiveness and horrific side effects. England had stopped its use in 1939.

DeJarnette added equipment for electro-shock therapy in 1942, which he used on 865 patients suffering from “dementia praecox and manic-depressive phycosis, especially the agitated form.” He writes that the hospital had “marked success,” describing the procedure as follows: “The patient is placed on the table without a pillow and no mechanical restraints. Six attendants are required for each treatment to steady the patient during the seizure – to hold the arms to the sides, the legs together on the table, the head on the table, hand on [the] chin to prevent dislocation of [the] lower jaw and to place [a] mouth-piece between the teeth.” Groups of from 12 to 20 patients were treated three times per week and DeJarnette preferred “to treat no patient over 70 years of age.”

Once the patient was on the table, the treatment began “with a shock of 2/10 of a second duration and 80 volts and [then volts were] increase[d] to 145 – 140. If this fails to produce a convulsion we raise the duration to 3/10 of a second and cut volts to 118 and then increase voltage gradually to 135-140 or until a convulsion. When we reach a voltage of 135-140 and [there is] no convulsion we raise the duration to 4/10 of a second and drop volts to 118 and again gradually raise volts until a convulsion is produced…The average convulsion lasts 45 seconds and follows the shock sometimes by 15 seconds – one case 4 ½ minutes after the shock…In giving the treatments frequently a tolerance is formed for duration and volts and after a rest period we make a new start as in the beginning – shock of 2/10 of a second duration and 80 volts.” The electro-narcosis, DeJarnette notes, “which we encourage lasts from 5 minutes to 1 ½ hours and most patients feel better immediately after the shock, but a great many dread the shock after a few treatments. We have been able to see improvement after 2 treatments, but sometimes not until the patient has had 25.”

A photograph of DeJarnette in late middle age—around the time these procedures took place—depicts a well-built man, bald except for some fuzz on the back of his head. He wears circular glasses pressed closely against dark, analytical eyes. His eyebrows are bushy, growing thicker as they retreat away from his nose. His lips are long and thin, naturally angled downward in the corners, like short pieces of linguini that haven’t quite been cooked in the middle.

Justice Henry W. Holt, of the Supreme Court of Appeals of Virginia, wrote to DeJarnette a week before Christmas in 1936: “In these days of grace it has grown to be a custom to wait until men are dead before telling them of their good deeds. I think we might give some expression to our appreciation that it may reach them when alive, and so I take advantage of this Christmas season to tell you how much I think the Commonwealth owes to its valued servant.” Holt continues: “The services which you have given the State for so long have been invaluable, and while it is said that there is some one to take the place of each of us, yet in your case I doubt it. It is my deliberate judgment when I state for the past generation the State has had no more valued services, and I trust indeed that you may be spared for many years to continue to do good as you have done.” DeJarnette would be spared for nearly another decade until he would be strongly advised to leave his post as superintendent. His services may have been valued, but his role in advocating for eugenics and sterilization would alter his status within the medical profession. Holt signed his letter “Cordially your friend.”

In 1916 the hospital was fined, and thus DeJarnette was fined, for having women work more than ten hours a day, which was a violation of a 1908 Supreme Court ruling that limited the hours women could be forced to work. “There’s a report,” says John Beghtol, 74, who was, at the time of writing, Western State Hospital’s current Director of Community Services, “where DeJarnette is bragging to Richmond that he built one of those buildings down there with patient labor. There’s no record that he paid anything.” Insulin, metrazol, and electroshock were only the beginning.

In the first few decades of the twentieth century, California had a law that if you were of reproductive age, you could not be discharged from the hospital unless you were sexually sterilized. DeJarnette wanted that in Virginia, but he couldn’t get it right away. When DeJarnette’s efforts failed to convince the Virginia Assembly to bring the sterilization law to the committee level, he wrote, “When they [the Virginia Assembly] voted against it, I really felt they ought to have been sterilized as unfit.”

The July 1, 1933 Western State Report of Board of Directors, a letter addressed “To HisExcellency, John Garland Pollard, Governor of Virginia,” states the following: “Sterilization, we think, is our greatest work and we sterilized during the year 105 patients. This is the greatest economical measure we have as it prevents the reproduction of the unfit by the unfit and enables us to turn back into the world, under supervision, these patients without any danger of reproduction or bringing into the world extra burdens for the state in the form of criminals and dependents.” The report claimed it was the busiest year the hospital ever had. John Beghtol claimed that “DeJarnette was hooking up a depressed patient to a manic patient, transfusing their blood. I mean the Nazis were doing that stuff. Dr. Mengle in Germany, in the concentration camp, was doing it.”

A single sentence paragraph of the 1933 report states, “Chancellor Adolph Hitler has recommended a national law for Germany to sterilize her unfit, showing that the idea is becoming more or less universal.” The following year, DeJarnette commented in the Richmond Times-Dispatch: “The Germans are beating us at our own game.”

Eugenics—the improvement of the human race through selective breeding—had become a global science. Only twenty years earlier, in 1913, a report sent to the Governor of Virginia by the hospital directors claimed the following (which is only part of the actual list) were causes of “insanity,” and thus potential cause for sterilization: masturbation; menopause; grief; isolation; imbecility; poverty; immoral life; paralysis and gangrene; heredity and financial trouble; overstudy; death of a neighbor; fear of persecution; abnormal brain from birth, blow on the head and a wandering life; neurotic condition; love of money and loss of friends; excessive use of drugs, especially cocaine; money, cigarettes and whisky; epilepsy; fright; disappointment in love; sunstroke and malaria; and religion.

Behind the new marketing office at The Villages Condominiums, up on a big hill with scattered oak trees, is the second Western State Hospital cemetery—a place where nearly 3000 patients, and maybe some staff members, were buried between 1848 and 2001. Many of these individuals were unclaimed, even in death, by loved ones, or simply called Western State home.

The state of Virginia, in Richmond, without telling John Beghtol or Western State Hospital, sold the cemetery to the City of Staunton. The city let the hospital maintain the cemetery for years and never told them they owned it. Then when the developer got it, Beghtol’s crew was maintaining the grounds one day when they found a hunting blind built in the middle. So they started tearing it down. A crewmember for the developer came over and asked what they were doing.

“We’re tearing this down,” a man from Beghtol’s crew said.

“You can’t do that. You don’t own this. We own it.”

And then Beghtol and his staff looked for the deed—the transfer deed—and found that the City knew they owned, let the hospital maintain it, sold it to the developer, and the developer let the hospital maintain it. “They lied to us,” Beghtol said. “We asked the Attorney General to reverse it. No luck. So we have nothing to do with the old cemetery. We’ve been shut out.” Relatives called Beghtol, asking for help. He told them that he’d tried, but that it was time for them to get legal counsel and go to Richmond. It was a “bad scene.”

A few years earlier, an ABC film crew had come and spoken with Beghtol about a documentary being produced on cemeteries. On a bright fall morning, around 10:30, Beghtol took the crew to the cemetery. The sun streamed down through the big oak trees. It was striking, eerie. When Beghtol looked at the two guys in the crew, they looked as if they’d seen a ghost.

“Are you okay?” Beghtol asked them.

“Yeah,” one said, “But you know what hits us? There are no names on those stones. And those blank stones represent their lives.”

Early on, the hospital painted identification on the markers, but it washed off over the years. And then came confidentiality. Names weren’t legally permitted on grave markers. And so the graveyard was left, as Beghtol says, “with blank shadows.” Each patient who died was given a uniform concrete marker—like the uniform rooms they lived within—and a “dignified burial.” Records naming the deceased still exist, but no map of corresponding patient numbers has been found. An occasional grave is marked, however, with named stones provided by loved ones.

I told Beghtol how that reminded me of the phrase “naked existence” from Viktor Frankl’s Man’s Search for Meaning. He looked to his office window, nodded, and said, “Yeah. They make them soulless.” It was unclear whom he meant by “they.” Maybe he meant the hospital. Maybe he meant the City. Maybe he meant the developer. Maybe he meant all of us.

GEOFF WATKINSON is the founding editor of Green Briar Review, an online literary magazine. He teaches writing at Old Dominion University, works as a technical writer, and has contributed to Guernica, The Virginian Pilot, Moon City Review, Switchback and Bluestem, among others. He’s working on a short book of personal essays, and a biography about Joseph DeJarnette, from which this piece is an excerpt. He’d love some representation on the projects. Find him at or on Twitter: @GeoffWatkinson.