In 1931, Charles F. Williams, superintendent of the South Carolina State Hospital, urged the state legislature to allocate funding for a “criminal insane” building. This was certainly not the first such request. Williams added, “Year in and year out this matter has been called to your attention and it is earnestly hoped that provision will be made for the care of these patients.”[1] Hospital superintendents started asking for a secure building in the late 1890s, but the hospital was not able to build high security facilities until the early 1950s. The funding and construction of the Maximum Detention Buildings became a half-century ordeal, representative of the underfunding and overcrowding that plagued the state hospital for most of its existence.
Already severely overcrowded, the state hospital desperately needed secure wards for its large population of high risk patients.[2] Before 1920, there were two categories of high risk patients. The first group consisted of regular patients at the hospital who posed a significant threat to themselves or others. The second group consisted of defendants in criminal cases whom a judge declared incompetent to stand trial. These patients were supposed to stay at the hospital only until they met the legal requirements for competency. In practice, these patients often languished in the hospital indefinitely, a problem that continued until a Supreme Court ruling in the 1970s.[3]
After 1920, the courts started sending defendants to the hospital for thirty days of observation and evaluation. A revision in South Carolina state law allowed judges to shift the determination of mental competency to state psychiatrists. After the observation period, doctors either released them as competent to stand trial or, declaring them incompetent, admitted them as patients.[4] Thus, the hospital now had an even larger number of forensic patients, in addition to regular patients who were violent or otherwise threatening.
Without specialized facilities, the staff resorted to various mechanical restraints, such as straitjackets, to secure patients. In his study of the South Carolina State Hospital, historian Peter McCandless found that turn-of-the-century conditions for all patients “approached the horrific.”[5] During this period, the use of restraints was the highest since the early years of the hospital and exceeded that at institutions in other states.[6] In his 1897 report, superintendent James W. Babcock objected to the state penitentiary sending prisoners to the hospital when they required psychiatric care. Citing a recent example in North Carolina, Babcock urged the construction of a psychiatric ward at the state penitentiary.[7]
In subsequent years, the Board of Regents echoed Babcock’s concern and requested separate wards for the “more violent” patients.[8] The influx of temporary forensic patients after 1920 only exacerbated the problem. Year after year, the superintendent and the regents reiterated the need for secure facilities. They also reminded the governor and legislators of the hospital’s legal obligation to assist the courts. Forensic patients were flight risks, and the lack of security permitted several successful escapes.[9] In the 1930s, the courts allowed particularly dangerous individuals to remain at the penitentiary, and doctors traveled there to provide services. However, this was not an ideal situation for the doctors who needed to observe these patients for extended periods of time.[10]
In 1942, with some funding available for new construction, the state hospital commissioned plans for a “criminal insane” building. A Columbia architectural firm, Lafaye, Lafaye & Fair, drew up the plans. The hospital used the Lafaye firm for all of its building projects. Unfortunately, the War Production Board rejected the building application. It would require too much material considered critical to the war effort.[11]
At the end of the war, architect Robert S. Lafaye recommended that the project continue as soon as possible. The hospital still had the 1942 plans, but those needed major revisions. Based on input from the hospital and the U.S. Public Health Service, the architects completely redesigned the buildings in 1948. Even though wartime restrictions were gone, chronic funding shortages were not, and the project stayed on the drawing board.[12]
In 1949, the McPherson Company of Greenville completed an architectural and engineering inspection of the Bull Street and State Park campuses. The report was a searing indictment of the hospital’s overcrowded, outdated, and unsafe facilities. At this point, high risk patients were isolated from other patients, but their ward buildings were unsecured and in disrepair. Male patients lived in the Taylor Building, while female patients lived in the Talley and Thompson Buildings. All three received poor assessments, but conditions at the Taylor building were deplorable. In fact, Taylor became a symbol of the disgraceful condition of hospital facilities. The structural integrity of the building was compromised, with a crack extending from the foundation to the third floor.[13]
In all three buildings, the lack of proper safeguards allowed patients to vandalize electrical equipment, leaving live wiring exposed. National guidelines called for a centralized locking system that allowed doors to lock and unlock with a master key from one location. The hospital had no such system in place, but rather, an assortment of keys corresponding to various locks. In case of fire or other emergency, staff could not evacuate the building in a safe and timely manner. At the State Park campus, high risk patients lived in two unnamed buildings, known only as No. 6 and No. 7, in similar states of disrepair.[14]
The McPherson report provided detailed and systematic descriptions, yet the message was nothing new. As administrators said year after year, the hospital needed major repairs and new construction immediately. In 1951, Governor James F. Byrnes appointed a nine-member committee to conduct an independent investigation of hospital conditions. In his 1952 State of the State address, Byrnes labeled the hospital “Problem No. 1” for South Carolina. This concern even trumped the governor’s other priority for the state: maintaining school segregation at any cost.[15] Byrnes called for an emergency appropriation of five million dollars for the state hospital. He named maximum security buildings as a top priority. The next day, Byrnes led a delegation of over one hundred legislators on a tour of the hospital. The General Assembly approved the requested amount plus additional funds, coming to a total of eleven million dollars.[16]
The hospital now undertook the “greatest period of sustained construction” in its 125-year history.[17] In 1953, construction began on four “Maximum Detention Buildings” with a total capacity of 608 beds. During the planning process, administrators had toured facilities in other states to see the latest in secure design. In January 1954, state officials and members of the general public attended an open house at the new buildings. State mental health commissioners called them “magnificent” and a “credit to the institution.”[18]
The four dormitories were one-story brick buildings on the eastern edge of the campus. Their Modern architectural style was similar to that of countless public buildings in postwar America. They included medium security open wards with central nurse stations, high security private rooms, treatment rooms, occupational therapy rooms, and barber or beauty shops. In addition to an indoor recreation room, each building had two enclosed courtyards and exterior recreation areas surrounded by a 13-foot security fence. In October 1954, the patients moved into their new dormitories.[19] That same month, Maryland officials toured one of the buildings as part of their planning for new facilities.[20]
The two buildings for female patients were named for the first two female physicians at Bull Street: Sarah C. Allan (1895-1907) and Eleanora B. Saunders (1907-1914). The two buildings for male patients were named for Thomas Cooper, member of the Board of Regents (1828-1829) and president of South Carolina College (1821-1834), and William C. Preston, member of the Board of Regents (1828-1831), president of South Carolina College (1845-1851), and U.S. senator (1833-1842).[21]
Contractors completed two additional buildings at State Park in 1955. Both followed the same design as Saunders and Cooper, having longer rear wings with space for more private rooms. With a total of 304 beds, these dormitories began receiving patients in July 1955.[22] The Davis Building was home to female patients. Its namesake was Dr. James Davis, the first physician at the hospital (1828-1835) and a member of the Board of Commissioners which purchased land for the South Carolina Lunatic Asylum in 1821. The Shand Building, home to male patients, was named for the Reverend Peter J. Shand, member of the Board of Regents (1842-1857) and rector of Columbia’s Trinity Episcopal Cathedral for half a century.[23]
The hospital had lobbied for these specialized buildings for over fifty years, but within twenty years, the dormitories were no longer solely used for their original purpose. With deinstitutionalization and the decreasing inpatient population, the hospital converted many of the wards to regular use. In the 1970s, the state hospital underwent a major reorganization. Administrators created units based on patients’ home regions or specialized needs. The geographical units developed close relationships with providers in each region, hoping to facilitate patients’ transition from the hospital to community care. Allan and Saunders hosted Unit IV, serving patients from the Pee Dee region. Unit IV staff remodeled the wards to give them a more open and welcoming feel. Saunders even had a patient garden in back. The number of inpatient secure wards gradually decreased.[24]
Over time, Cooper became the primary facility for forensic services at the state hospital. Although the hospital was not involved in the case, the 1975 Supreme Court ruling in O’Connor v. Donaldson greatly impacted its handling of forensic evaluations. The court case had involved a man involuntarily committed through the civil courts but left untreated in a criminal ward at the institution. The justices ruled that involuntary commitment for nonviolent patients was a violation of their constitutional rights.
In South Carolina, forensic patients not competent to stand trial apparently remained in secure wards. Now, the hospital had to either release individuals for trial or commit them for treatment in regular wards. They only stayed in maximum security if they demonstrated a clear danger to themselves or others. In that event, the hospital had to notify the state Attorney General’s office. Doctors could also transfer particularly dangerous patients to the Stoney Building at Central Correctional Institution in Columbia, but only on a case-by-case basis.[25]
Beginning in 1981, outpatient evaluations in county facilities greatly reduced the number of forensic admissions in Columbia.[26]In the mid-1980s, the Forensic Services unit became part of the William S. Hall Psychiatric Institute and operated completely out of the newly upgraded Cooper Building. However, the physical move was short-lived. During the 1990s, the Maximum Detention Buildings joined the accelerated downsizing of the hospital, and all four facilities closed by 1997.[27]
In 1955, The State Magazine published a piece on improved hospital conditions. The headline proclaimed, “No Snake Pit Now.” The first photo was of a Maximum Detention Building.[28] The reputation of state mental institutions had reached its nadir in the mid-twentieth century.[29] The recently-opened dormitories were a major part of the hospital’s image rehabilitation. Personal recollections by former employees, however, temper that assessment. Michael Byrd has spent his career in public health and worked for years at the state hospital. He remembers witnessing numerous problems in the 1970s, including overmedication and ill-trained attendants. On an orientation tour in a Maximum Detention Building, Byrd vividly remembers the guide showing callous disregard for the patients.[30]
Unfortunately, reconciling these competing narratives will have to wait for more sources to become available. Despite plentiful architectural and administrative information, the full story of these buildings remains largely obscured. Staff notes and patient records from this period are still sealed because of privacy restrictions. Hopefully, in years to come, researchers will access these documents and shed more light on the realities of life inside the Maximum Detention Buildings.
[1] Annual Report of the South Carolina State Hospital for the Year Ending September 30, 1931, Box 2, Series 190002, State Dept. of Mental Health Agency History Record, South Carolina Department of Archives and History, Columbia, SC. Subsequent citations from the DMH records will give the title, box location, group/series number, and repository name.
[2] Note on terminology: Contemporary sources used various names to describe these patients, including “disturbed,” “excited,” and “violent.” In some cases, “criminally insane” referred to forensic patients only. In other instances, it referred to all patients deemed too much of a threat for regular wards. For the sake of clarity, the general term “high risk” will refer to all types of patients requiring extra security. “Forensic patients” will refer to individuals committed through the criminal courts or admitted temporarily for competency evaluations.
[3] J. B. O’Connor v. Kenneth Donaldson, 422 U.S. 563 (1975). See below for further discussion of case and impact on hospital procedures.
[4] Annual Report of the South Carolina State Hospital for the Year 1922, Box 2, S190002, SCDAH; S.C. Code Ann. § 13-53-3375 (1912); S.C. Code Ann. § 13-56-28 (1922).
[5] Peter McCandless, Moonlight, Magnolias, and Madness: Insanity in South Carolina from the Colonial Period to the Progressive Era (Chapel Hill: University of North Carolina Press, 1996), 270; 294-296.
[6] Ibid., 279-280.
[7] Annual Report of the South Carolina State Hospital for the Insane for the Year…, 1897 and 1898, Box 1, S190002, SCDAH.
[8] Annual Report of the South Carolina State Hospital for the Insane for the Year 1902, Box 1, S190002, SCDAH.
[9] Annual Report of the South Carolina State Hospital for the Year…, 1923, 1924, 1925, and 1926, Box 2, S190002, SCDAH.
[10] Annual Report of the South Carolina State Hospital for the Year Ending June 30…, 1936, 1937, and 1939, Box 2, S190002, SCDAH.
[11] Annual Report of the South Carolina State Hospital for the Year Ending June 30, 1942, Box 2, S190002, SCDAH.
[12] Annual Report of the South Carolina State Hospital for the Year Ending June 30, 1945, Box 2, S190002, SCDAH; Robert S. Lafaye to L. W. Shelley, May 25, 1949, Box 1, S190012, SCDAH; Robert S. Lafaye to T. F. Stevenson, June 17, 1949, Box 1, S190012, DMH Record.
[13] McPherson Company, Report for South Carolina State Hospital (1949): 15-16; 58-66, Box 2, S190012, SCDAH; “‘Disgrace’ Doomed: Bid to Raze State Hospital Edifice Approved,” Columbia Record, May 7, 1955.
[14] McPherson report 25; 39-40; 142-148.
[15] This was during the same time that the ongoing Briggs v. Elliott case was challenging school segregation. Originally filed in 1950 in Clarendon County, S.C., the lawsuit was part of the collection of cases that led to the 1954 Brown v. Board of Education decision.
[16] “Byrnes Sees State Hospital, Segregation as Top Issues,” The State, January 9, 1952; “Governor Leads Legislators on Hospital Inspection,” The State, January 9, 1952; Annual Report for the Year Ending June 30, 1954, Box 2, Series 190002, SCDAH.
[17] Annual Report for the Year Ending June 30, 1954, Box 2, Series 190002, SCDAH.
[18] Annual Report for the Year Ending June 30, 1953, Box 2, Series 190002, SCDAH; “New State Hospital Buildings to Give Patients Modern Accommodations,” The State, January 29, 1954.
[19] “New State Hospital Buildings to Give Patients Modern Accommodations,” The State, January 29, 1954; Annual Report for the Year Ending June 30, 1955, Box 2, Series 190002, SCDAH.
[20] Maryland Group Inspects Hospital Division Here,” Columbia Record, October 15, 1954. Clipping included in scrapbook assembled by Inez Nolan Fripp, Box 1, S190008, SCDAH.
[21] “Modern Ward Buildings Named at State Hospital,” The State, October 27, 1954.
[22] Sheet 5, Commission No. A-153-AA, Lafaye Associates Records, 1902-1981, South Caroliniana Library, Columbia, SC; “Report of the South Carolina Mental Health Commission,” Annual Report for the Year Ending June 30, 1955, Box 2, Series 190002, DMH Record; “State Park Hospital Sets Open House,” The State, July 4, 1955.
[23] “Modern Ward Buildings Named at State Hospital,” The State, October 27, 1954.
[24] South Carolina Department of Mental Health, Annual Report…, 1973-74, 1974-75, 1975-76, and 1976-77, Box 3, S190002, SCDAH.
[25] South Carolina Department of Mental Health, Annual Report 1974-75, Box 3, S190002, SCDAH; J. B. O’Connor v. Kenneth Donaldson, 422 U.S. 563 (1975); National Register of Historic Places, South Carolina Penitentiary (Central Correctional Institution), Columbia, Richland County, South Carolina. National Register #20051208. Retrieved from http://www.nationalregister.sc.gov/richland/S10817740107/.
[26] South Carolina Department of Mental Health, Annual Report…, 1985-86 and 1986-87, Box 3, S190002, SCDAH.
[27] Mike Mefford, interview by Kim Campbell, Columbia, SC, March 26, 2014.
[28] “No ‘Snake Pit’ Now,” The State, October 2, 1955. Clipping included in scrapbook assembled by Inez Nolan Fripp, Box 1, S190008, SCDAH.
[29] Mary de Young, Madness: An American History of Mental Illness and Its Treatment (Jefferson, NC: McFarland, 2010), 111-116.
[30] Michael Byrd, conversation with University of South Carolina students, April 10, 2014.