By Anna Smith

“The Asylum, Actualized: Utilizing Public Records and Digital Humanities Tools to Illuminate the History of Mental Health Treatment in America,” presented at the Society of North Carolina Archivists (SNCA) 2019 Conference, described a current project of UNC-Chapel Hill’s Community Histories Workshop (CHW). The speakers walked the audience through the development of the Dix Hospital Admissions Database and discussed the ethical and scholarly implications of its content. The CHW was represented by Director Robert Allen, Project Manager Sarah Almond, and Undergraduate Research Fellow Dani Callahan.

Robert Allen began the session with a brief history of CHW, which was established in 2016 and collaborates with communities to digitally present the public history of a place, weaving in the multi-layered stories of all those who have interacted with that place. Allen explained the background of the Dix Hospital Admissions Database. Working with the Dorothea Dix Park Conservancy Legacy Committee and the City of Raleigh, the CHW was tasked with, as Allen phrased it, conducting “historical due diligence” of the park’s site. The project focused on the Dorothea Dix Hospital, which served as North Carolina’s first and principal insane asylum from 1856 to 2012. Research into the material history of this site began in the summer of 2017 and led to the State Archives of North Carolina, where CHW staff discovered the admissions log for Dix Hospital. The admissions log chronologically listed the hospital’s patients from its opening in 1856, with over 7,300 entries.

Sarah Almond spoke to the digital structure and components of the project. On one side of the Dix Hospital project is the admissions ledger, which has been digitized and transcribed to create the database, presenting its quantitative data in a way that is now searchable that the handwritten, chronologically arranged ledger is not. The CHW utilizes Prospect for this database, which is a data visualization plugin for WordPress, developed by UNC’s Digital Innovation Lab. For the data visualization component of the project, the CHW has highlighted patients’ listed professions at intake to be viewed as a percentage, the gender breakdown of patients, and length of stay by diagnosis.

Other tools that have been used for this project are OneDrive for digital storage, Google Sheets for metadata, and Ancestry.com and Newspapers.com to verify personal information in case studies. The admissions ledger was photographed by CHW team members. To create the database’s metadata, the admissions log was transcribed verbatim to a spreadsheet. All the same fields of the admissions log were copied to the spreadsheet with the addition of a few columns used to verify first and last names and occupations of patients. The second half of the project extends the quantitative information of the admissions log to case studies of individuals, providing the qualitative, personal narrative of this data.

Dani Callahan explained the workflow of the ledger’s transcription and case studies. The transcription was split up among supervised undergraduate workers who worked in a shared spreadsheet in Google Sheets to avoid redundancy. Working this way also provided the ability for side-by-side comparison of the transcribed metadata spreadsheet and an image of the intake ledger. In this way, Callahan was also able to check the accuracy and integrity of the undergraduates’ transcription work and simultaneously research the patients for case studies. Researching the patients individually involved verifying the intake log’s personal information, gathering further details, if available, by using primary sources to track an individual’s life before and after their time at Dix Hospital. Callahan gave an example of how this research has opened up questions in the data that can’t necessarily be answered: An entry in the ledger says a certain patient left the hospital in July 1860, but primary sources list his family as claiming he was living at home in June 1860. Was the family trying to avoid the stigma of a relative spending time in an asylum, or is one simply recorded incorrectly?

The session turned to a discussion of ethical concerns around this information and its availability in the digital environment. The CHW team members clarified that the entries currently included in the database are from 1856 to 1917, which are not covered by HIPAA and are, therefore, public records. At the same time, they are extremely aware that the data is sensitive. Using Prospect means that they can redact any data easily and quickly, if any concerns arise. They also noted the database is not scrapable. Names of patients are not made available to the public in both the database and case studies.

The ethical considerations of the genealogical research of patients that can be traced to the present were also addressed. An audience member asked whether they are contacting living relatives in these cases. Currently, the CHW is letting people come to them. This continues to be an ongoing conversation with their advisory board. The CHW team includes members of the archival and medical fields in these discussions for a broad view of the ethical concerns with this data.  

Looking at the professional and ethical responsibilities and implications of this project, Allen says they are considering how the information should be used, by whom should it be used, and for what purpose. Working with department heads of interest, including American Studies and Psychology, the CHW is exploring how to push this information into scholarly areas of study to expand its usage and what can be learned from it. They are working to include the project in future curricula of psychology coursework. Allen, also a professor of American Studies at UNC-Chapel Hill, is currently teaching a graduate level seminar with SILS and History students which centers around furthering the research of this project. Students are continuing the case studies of patients grouped by diagnosis and reason for admission–i.e., disappointed love, disappointed ambition, disinheritance, epilepsy, exposure to sun, “gestation,” “The [Civil] War,” masturbation, melancholia, and “religious excitement.”

Anna Smith is a Special Collections Librarian at Charleston Library Society.

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