Bolivar State Hospital

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Bolivar State Hospital
Established 1885
Opened 1889
Current Status Active
Building Style Kirkbride Plan
Architect(s) Harry P. MacDonald/Adolphus Heiman
Location Bolivar, TN
Architecture Style Gothic Revival
Peak Patient Population 2,300 in 1961
Alternate Names
  • Western Hospital For the Insane
  • Western State Mental Hospital
  • Western Mental Health Institute


Opened to receive patients on November 22, 1889, the then denoted "West Tennessee Hospital for the Insane" was designed by architect Harry P. MacDonald of Louisville, Kentucky, and Memphis, Tennessee. The MacDonald firm was responsible for many fine, large public buildings in the South, such as the Sevier County Courthouse in Sevierville, Tennessee (1896). The institution was intended not only to meet the mental health needs of the Western Section of the State, but also to complete Tennessee's first efforts at implementing a social policy initiated before the Civil War. Tennessee initiated its public policy regarding the institutionalization of the mentally-ill in the 1840s. The "lunatic asylum" in Nashville soon proved inadequate and architect Adolphus Heiman produced a Gothic Revival design following the advice of Thomas S. Kirkbride.

By 1892, 319 patients were living in the mental hospital. Entertainment, work, diet, and discipline were still considered the main types of therapy. In 1900 the hospital was overcrowded with 594 patients. It was continually being modernized and around 1910 a new wing was built. When weather allowed, the unfinished wing was used as sleeping quarters for several patients. Other additions to the facility were constructed in the 1920s. These included a tubercular hospital or ward and a congregate dining room. In 1927 the two story brick Doctors' Apartment Building was constructed, while an adjacent frame cottage was built by the family of a former patient. These structures emphasize the growth of professional medical staff as well as changes in therapies in treating the mentally ill.

Therapy in the 1920s and 1930s "tended to be highly eclectic." This was true at Western as well, under the administration of Dr. Edwin W. Cocke. "He was author of the 1919 Tennessee State Law which dealt with the legal aspects of psychiatric patients' treatment, and he was co-producer of the first diathermy to produce artificial fever in the treatment of syphilis of the brain and allied diseases." These new treatments included fever therapy, prefrontal lobotomy, metrazol and insulin shock, while occupational therapy was also still relied upon. Dr.Cocke was likewise a pioneer in the use of the then novel insulin shock therapy devised by Viennese physician Manfred Sakel. Sakel had observed mental changes in diabetic drug addicts who were treated with insulin. "The injection of a sufficiently large dose of insulin drastically lowered the sugar content of the blood and ... induced a hypoglycemic state. In this state of 'shock,' the patient went into a deep coma which could be relieved by. ..sugar. After the process was over the patient's mental condition appeared to improve." Dr. Sakel's visits to the United States in the 1930s helped popularize this therapy, although it was abandoned by most American mental institutions in the 1950s. Along with insulin shock therapy, metrazol therapy swept across the country from 1937 to 1940.

The institution's patient population grew from a few hundred in the 1890s to over 2,000 in the 1960s as patients remained hospitalized for decades. Many were crowded into large dormitories and had little privacy. With a limited number of doctors and attendants and a large patient population, many were simply "warehoused." Patients at Western received the treatments available in their period of institutionalization. These treatments ranged from hydrotherapy and insulin shock therapy to lobotomies and electric shock therapy. With the severe staff limitations, however, patients were fortunate to receive ten minutes per week with a psychiatrist.

The system for securing financing for patient care limited the operating budget. In Tennessee, there were three classes of patients: the state-pay patients, the county-pay patients, and the private-pay patients. State agencies agreed to pay for one patient out of a population of one thousand. Once this portion of the payment had been satisfied, the county was responsible for additional costs. The county payments consistently lagged behind, and superintendents had to engage in deficit spending to keep the hospital operating. The two most influential superintendents, Dr. Edwin Cocke and Dr. Edwin Levy, often faced political pressure from state officials, but both managed to make some improvements in the care offered at Western.

In modern times, "deinstitutionalization" produced a marked decrease in the patient population as mental health experts called for treatment of the mentally ill in local mental health clinics. Although there have been indications that this treatment has not been successful, it continues to the present time, and the indigent mentally ill continue to pose a major problem for society.

Images of Bolivar State Hospital[edit]

Main Image Gallery: Bolivar State Hospital


There are two cemetery sites; the earlier one on the west side of the hospital grounds and the more recent one .22 miles north on Stevens Road, which runs off of Hwy 64 about 1/2 mile east of the hospital. These cemeteries contain hundreds of interments of patients whose remains were not claimed by family members. The graves were originally marked with small white numbered markers, most of which are now missing or damaged and unreadable. A few of the graves are marked with larger tombstones, placed there by family members.


Grains of Sand : A History of Western Mental Health Institute - 1886-1986