In its early days, the facility was a resort-style asylum. It had terraced gardens where patients could plant flowers and take walks, roof walks to provide mountain views, and many architectural details to create an atmosphere that would aid in the healing process. However, by the mid 19th Century, this utopian model of care had vanished, replaced by overcrowding in the facility and the warehousing of patients. Techniques such as "ankle and wrist restraints, physical coercion, and straitjackets" were used. After the passage of the Eugenical Sterilization Act of 1924 in Virginia, patients were forcibly sterilized at Western State until the law authorizing the practice was repealed in the 1970s. Later, electroshock therapy and lobotomies were practiced at the facility. Joseph DeJarnette, a noted eugenicist, was director of the hospital from 1905 to 1943.