It ate at Noah Saterstrom. How his old, well-to-do Natchez, Mississippi family, obsessed with its lineage as it was, could have such a conspicuous hole. His great grandfather: Dr. David Lawson Lemmon Smith (1891–1965).

The mention of him stopped Saterstrom’s grandmother Margaret, Dr. Smith’s daughter, dead in her tracks. He was an optimist was all she’d say. A photo of the man spent decades on her desk, but details never escaped her lips.

What was she hiding?

Why?

Even as a boy, Saterstrom (b. 1974), who grew up in Natchez as much as anywhere, could sense there was something “off” about this. A feeling that ripened with age. His curiosity ripened along with it.

In 2017, Saterstrom embarked on a years-long search of state, local, and private archives for information about Dr. D.L. Smith. He’d find a great deal, including why Dr. Smith had been expunged from the family record. That year, while in Jackson, Saterstrom found himself at the Mississippi Department of Archives.

In a leather-bound ledger that hadn’t been opened in who knows how long, Saterstrom found the name he was looking for: “Dr. David Lemmon Smith, Claiborne County.”

The book recorded admissions to the Mississippi Insane Hospital in Jackson, as it was then called.

Cue the dramatic music.

Aided by the state’s librarian, Saterstrom pieced together a remarkably detailed account of his great grandfather’s life prior to institutionalization in 1924. Newspaper clippings. Personal correspondence. Court records.

Revealed is a husband, a father of four, an itinerant optometrist around Mississippi and Louisiana. A man who most definitely lost touch with reality as he progressed into his 30s. Dr. Smith’s letters increasingly displayed classic paranoid personality disorder and schizophrenia. Then there was the accusation of rape by a 15-year-old girl and his near lynching as a result. His languishing in jail. His escape, making it all the way to Washington, D.C. where he received a meeting with President Calvin Coolidge before being apprehended and sent back to Mississippi.

Dr. Smith’s mother, Minnie, pleading with the court for her son to be deemed mentally unfit, which he was, negating the need for a trial and necessitating his admission to the State Hospital for the Insane. He didn’t go willing, but later in life, would pass on opportunities for discharge.

Dr. Smith spent the last 41 years of his life at the state hospital in Jackson and its successor, Whitfield. No one from the family claimed the body when he passed despite being notified, as was customary for wards of the state. Saterstrom isn’t sure where his great grandfather is buried.

This life erased and Saterstrom’s attempts to come to grips with it unfold in epic fashion during “What Became of Dr. Smith” through September 22, 2024, an exhibition at the Mississippi Museum of Art in Jackson centering Saterstrom’s 6-foot-tall, 122-feet-long, 732-square-foot painting of his ancestor’s life composed of 138 2-feet-square canvas panels. Monet’s Orangerie Water Lilies meets Huck Finn. What Became of Dr. Smith envelopes onlookers in characters and vignettes, eerie and mysterious.

A Family History

Saterstrom’s connection to mental illness, sadly, runs deeper than his great grandfather’s writings. He fought it himself. A terrible bout of dissociation in his mid-20s.

According to the Mayo Clinic: “Dissociative disorders are mental health conditions that involve experiencing a loss of connection between thoughts, memories, feelings, surroundings, behavior and identity. These conditions include escape from reality in ways that are not wanted and not healthy. This causes problems in managing everyday life.”

The artist pulled himself out over a course of years through therapy and by making art. He doggedly painted hundreds of family photographs carefully assembled chronologically in albums. Doing so returned his memories to him. A tether to reality.

He’d stare at the pictures for hours and then paint them for hours more. A kind of therapy. A kind of meditation. His mind came back.

Art saves lives.

Oh, by the way, Dr. Smith’s father, Noah Saterstrom’s great-great-grandfather, was institutionalized at the Louisiana State Asylum in 1898.

Like many medical conditions, family history is a leading indicator for mental illness. Resources to learn more and for help are available online.

Asylum Hill Cemetery

As with any great Southern epic, right when you think the story has reached its apex, you realize it’s only begun. So it goes with Dr. Smith and the State Hospital for the Insane which operated from 1855-1935.

A 2012 discovery by a construction worker at the University of Mississippi Medical Center in Jackson unearthed unexpected burials. On what was the last remaining undeveloped area of campus, the State Hospital for the Insane cemetery had been found.

In response, Ralph Didlake, UMMC professor of surgery, vice chancellor for academic affairs and director of the Center for Bioethics and the Medical Humanities, convened the Asylum Hill Research Consortium, a group of scholars and advisors tasked with crafting a long-term solution to the cemetery challenge: assembling an archaeological crew to excavate the area.

“(UMMC) is a very important institution for the health of Mississippians, so they need the land,” Jennifer Mack, lead bioarchaeologist for the Asylum Hill Project at the University of Mississippi Medical Center, told Forbes.com. “There were a lot of conversations with the administration and bioethicists and anthropologists, heavy discussions about weighing the needs of the living and respect for the deceased, and it was finally determined that as long as (excavation) was done respectfully, and in consultation with known direct descendants, it would make sense to remove people from the cemetery.”

The Asylum Hill Project is undertaking the work of exhuming the bodies and researching who these people were. Asylum for the institution that once stood there, hill for the prominence it occupies.

In late 2022, exhumations of individuals began and will likely continue through the end of the decade. As of July 19, 2024, 486 bodies had been removed. Remote sensing indicates there’s somewhere between 4,000 and 7,000 graves within the 12-acre cemetery.

At one point, all the graves were clearly marked with wooden markers that deteriorated over time. Some families funded stone monuments for their relatives buried there.

“Each of these wooden markers was painted with the name of the deceased, the date of death, and then the county the person came from,” Mack explained. “Letters to the family (were written) saying the grave is carefully marked and if you ever want to come lay flowers on the grave, we can show you.”

Excavations thus far have revealed graves laid out in neat, orderly rows. All deceased were buried clothed in at least a pine box. No mass graves have been found.

Children were found, a fact Saterstrom didn’t realize prior to the completion of his painting. Upon learning this, he added one to a panel depicting the Asylum Hill cemetery. Look for her when inspecting the artwork. She’s about eight-and-a-half, nine years old.

How does a cemetery containing thousands of graves become forgotten? It was never forgotten, per se, but its scale was. When the Asylum Hill facility closed in 1935, Mississippi and the country were in the depths of the Depression. Then came World War II. People move on. They get old. Memories fade.

Vegetation grows fast in this part of the world; without regular upkeep, the gravesite would have been covered over entirely in a year. Nothing happened on the site for decades until all the old state hospital buildings were eventually demolished and UMMC opened in 1955. The cemetery site was unused for nearly 80 years.

Who’s Buried On Asylum Hill?

The state of Mississippi began keeping official death records in November of 1912. From that time until Asylum Hill’s closing, presumably, everyone who died there will have a death certificate filed with the state giving the place of burial. Researchers have created a database of around 4,300 individuals who were buried in the cemetery during that period; for the 57 years the cemetery was in use prior to the official death records, accounts are spotty.

Extant patient records, admission records, discharge books, newspaper accounts, court records, census records, and family histories are being used to help identify individuals. Anything predating the Civil War was destroyed in the war.

“One goal of the bioarcheological part of the project that really aligns with what Noah was doing in his painting is trying to humanize the experience, help people who haven’t thought of it to see that these are individuals, and individuals are suffering with mental illness today,” Mack said. “They had whole lives before they were institutionalized, and within the institution. As with people who are at Whitfield today, they have lives in an institution, they form friendships and relationships, have activities; your life doesn’t end just because you’re ‘locked up.’ It wasn’t just a nameless, faceless mass of people in the asylum. Descendants want us to be able to identify their ancestors. They’re hoping that through bioarcheological analysis and DNA, we’re going to be able to say, ‘Okay, this set of human remains is your great-great-grandmother.’”

Contradicting Stereotypes

Approximately 30,000 people were treated at the Mississippi Insane Hospital in Jackson over its 80-year existence. Many of those people were admitted multiple times making an accurate number of patients hard to come by. The site also housed a nursing home and drug treatment center

The care shown with burials indicates the facility was not the nightmare factory of “insane asylums” from horror movies and ghost stories.

“The popular media makes everyone think, ‘Oh, it’s a dungeon and people are forced in this.’ It’s important to remember that it was a hard decision for families to send a loved one here, not just because–even at the time–people probably viewed it as not a great place to end up, but just because it’s hard to let go of your loved one,” Mack said. “We have stories from one family in particular who would say every time we went to see her, she was further and further away. As much as families would want to bring their loved one home, people with severe mental illness just couldn’t reach a point where they could be discharged. It’s never easy to send someone you love away, but if you can’t care for that person at home (what choice do you have)?”

The state hospital was staffed by medical professionals, doctors and nurses. Remember, too, when it opened, Mississippi was a wealthy state thanks to “King Cotton.” The facility was actually a source of pride.

“This was a great philanthropic venture and it was intended to improve the lives of Mississippians,” Mack continued. “Part of the impetus was that there were people rotting away in jails, under no charge, just because there was no other place to put them and (citizens) thought that was wrong.”

Dr. Smith was jailed with mental illness, residing between the courts and medical care. In a tragic echo of the past, incarceration is increasingly being used across America as a “solution” for a rampant mental illness problem.

“People look at the old asylum and think, ‘Oh, they probably did terrible things there,’ but I would caution them to think about how well are we doing today with the same issues,” Mack said.