Additional Markers of Insanity

Images of Different Types of Insanity by J.E.D. Esquinol, courtesy Wellcome Images images@wellcome.ac.u

Images of Different Types of Insanity by J.E.D. Esquinol, courtesy Wellcome Images images@wellcome.ac.u

In the April, 1879 issue of the American Journal of Insanity, Dr. Judson Andrews gave some tips for family physicians to use in monitoring the possible development of insanity in their patients (see last post). The physical symptoms were disturbingly commonplace, but Dr. Andrews seemed to hit a bit nearer the mark when he described certain mental signs that might indicate the development of insanity. (In general, he thought these mental symptoms would develop after the physical ones.)

— Emotions might be exaggerated (a little or a lot) or the person might be unable to control expression of the emotion even when he tried.There might not be a cause for laughing or crying in a situation, or the reaction might be out of character for the individual.

An Emotional Patient, Seacliff Lunatic Asylum, New Zealand

An Emotional Patient, Seacliff Lunatic Asylum, New Zealand

— Depression might develop, either as a loss of spirits or a “shading off from the natural cheerfulness of disposition.”

— Patients could experience “forebodings of some indefinite, indefinable evil impending, from which no way of escape lies open.”

–Later, patients would begin to be overly introspective; in reviewing their actions, they would judge themselves far too harshly and negatively.

— Patients could develop difficulty making decisions about simple tasks (like what to wear) and important ones alike; any course they decided upon then yielded to “agonies of doubt” or vacillation.

Other changes might be in personality, dress and personal appearance, and “exaltation or exaggeration.”

Insanity Continued to be a Misunderstood Subject, from a Toronto Newspaper, circa 1915 - 1919

Insanity Continued to be a Misunderstood Subject, from a Toronto Newspaper, circa 1915 – 1919

Unfortunately, many of these symptoms could develop so slowly they would be hard to detect; in other cases they might just be an intensification of the person’s normal personality and also hard to spot. At least, though, concluded Dr. Andrews, insanity had lost its mystery and dread, and “the insane man stands forth simply as a sick man: one, who by reason of cerebral disease, is unable to use his brain.”

This viewpoint was undoubtedly kinder than the fear and judgment insanity had faced in the past.

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Predicting Insanity

An Article from the Trenton Evening New, Nove 7, 1898, Showing a Change in Behavior Leading to an Insanity Diagnosis

An Article from the Trenton Evening New, Nov. 7, 1898, Showing a Change in Behavior Leading to an Insanity Diagnosis

Toward the latter part of the nineteenth century, mental health specialists (alienists) began to alter their approach to diagnosing insanity. Instead of looking at specific behaviors in patients and making a diagnosis from them, doctors thought it made more sense to look at changes in patients’ ordinary behaviors. To paraphrase one expert: Performing a dangerous tightrope stunt would not be considered insanity in a circus performer, but might be in someone who had never done such a thing and suddenly decided to try it.

Of course, neither alienists nor families wanted to wait until someone actually became insane before they intervened. Could there possibly be ways to predict the development of insanity? An article in the April, 1879 issue of the American Journal of Insanity gave some tips for family physicians to use in monitoring the possible development of insanity in their patients. In the words of the article’s author, Dr. Judson Andrews, early indications that might be considered precursors of insanity included:

Front Entrance, New York State Lunatic Asylum Where Dr. Andrews was Assistant Physician

Front Entrance, New York State Lunatic Asylum Where Dr. Andrews was Assistant Physician

— morbid dreams

— impairment of sleep

— a symptom cluster that included loss of appetite and indigestion, with pain, belching, flatulence, heartburn, and offensive breath

— a symptom cluster that included an increased action of the heart, full and strong pulse, a flushed face and slightly elevated temperature of the skin; the appetite might remain the same or even increase, but there would almost always be weight loss

— diseases which might cause the heart to “fail to supply the amount of blood necessary for the nutrition of the brain” or the lungs to “supply the purifying and exhilarating oxygen”

— headache [descriptions of the types of headache people might experience are similar to migraines]

— restlessness in either the extremities or “in the general movement of the whole body”

American Journal of Insanity

American Journal of Insanity

Though it might be alarming to consider any of these physical symptoms an indication of impending insanity, the emotional tips–discussed in my next post–actually could have been red flags.

 

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A Medicine Show

Goodnight Is Credited With Inventing the Chuck Wagon

Goodnight Is Credited With Inventing the Chuck Wagon circa 1866

Medical care on the frontier came in a variety of forms. Doctors could provide care (see last post), but people also relied on their own herbal concoctions and traditional Native cures. Charles Goodnight (who with his partner established the first cattle ranch in the Texas panhandle) believed firmly in the power of buffalo fat. He and his wife made buffalo soap that Goodnight felt would cure almost anything: “I am satisfied it will relieve rheumatism. Try it for tuberculosis. I do believe it will work.”

Medicine shows provided more fun, though, and were always popular when they reached town. These shows might be only one-wagon affairs, or they might contain several wagons and a tent. Even the one-wagon show could cram in plenty of supplies and bottled “cures.”

A Small Medicine Wagon

A Small Medicine Wagon

The wagons were usually brightly painted and splashed with the name of the particular show, but it was mainly up to the pitchman to move products. This person might be a doctor, clergyman, or learned professor–or at least call himself one–and usually enhanced his character by dressing in a fancy long-tailed coat and tall silk hat. The voice was everything, and most pitchmen could whip a crowd into a passion for the alcohol-laden line of remedies they peddled.

Medicine Show Wagon

Medicine Show Wagon

Medicine shows were also shows, often featuring a female who might dance, sing, or play an instrument. A man might do magic tricks like eat fire, trade dialogue with the pitchman in a comedy routine of sorts, or show off with tricks like rope spinning. Early showmen often attacked the competency of the local doctor(s) in order to secure their own business; doctors countered by trying to get the shows run out of town. Later, the two entities learned to co-exist. Doctors quietly allowed the show to run its course, then sold the same (leftover) stock that had so impressed the locals.

 

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Rough and Ready Medicine

Office of Doctors Charles Hathaway and Ross Bazell, 1902, in Winslow, Arizona, courtesy Old Trail Museum

Office of Doctors Charles Hathaway and Ross Bazell, 1902, in Winslow, Arizona, courtesy Old Trail Museum

Medicine in the eastern United States was often hit-or-miss in the early 1800s, but those who pushed to the edge of the constantly changing western frontier were even more apt to suffer at the hands of physicians.

Frontier physicians often took on a variety of jobs: treating horses, pulling teeth, and concocting medicines, in addition to more traditional medical tasks like setting bones and performing simple surgeries. Many physicians were self-taught and consulted a medical manual or two for anything complicated. They relied heavily on substances like morphine; calomel, a compound containing mercury (which the World Health Organization has declared unsafe at any level); and tartar emetic, a toxic laxative containing the carcinogenic, antimony.

Dr. H. M. Greene at Right, in a LaCrosse, Washington Saloon and Pharmacy, courtesy Oregon Health and Science University

Dr. H. M. Greene at Right, in a LaCrosse, Washington Saloon and Pharmacy, courtesy Oregon Health and Science University

Because they typically had few credentials, doctors in the West tried to impress patients with seemingly exclusive or “inside” evidence of their expertise. Doctors’ offices frequently displayed medical instruments and splints; jars of leeches; body parts bottled in alcohol; and beakers, flasks, and perhaps tubing that implied scientific experimentation or the ability to make mysterious concoctions.

Distilling Devices Known as Alembics Impressed Patients

Distilling Devices Known as Alembics Impressed Patients

The local populations would be impressed, but they were equally impressed by Native American remedies and tonics touted in traveling medicine shows. The medical profession itself did not have any kind of a monopoly on public trust or faith.

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Food for Thought

Farm With Hospital Buildings on Western North Carolina Insane Asylum, circa 1886

Farm With Hospital Buildings at Western North Carolina Insane Asylum, circa 1886

A man suffering from acute melancholia and admitted to Stockton State Mental Asylum (likely in the late 1890s or early 1900s) mentioned  that his first noon dinner (lunch) consisted of soup, beans, and potatoes. His 6:00 p.m. supper was only tea and bread. This meager menu was a far cry from the original intentions of asylum founders, who strove to provide nourishing meals to patients as part of their treatment programs.

Weston Insane Asylum Farm, circa 1892, courtesy West Virginia and Regional History Collection

Weston Insane Asylum Farm, circa 1892, courtesy West Virginia and Regional History Collection

Farms were usually incorporated into asylum grounds, both to provide fresh produce for patients and staff, and to provide useful “occupational therapy” for able-bodies patients. Superintendents proudly reported the pounds of produce they had raised, as in Dr. Harvey Black’s report for Southwestern Lunatic Asylum (Virginia) at the end of fiscal year 1887. He noted that their gardens had produced 400 bushels of turnips valued at 25 cents/bushel, 12,000 heads of cabbage at 5 cents each, and 62 dozen squash at 15 cents/dozen. Altogether, the gardens produced nearly $2,000 worth of goods for the asylum’s kitchen.

Piggery at Athens Asylum

Piggery at Athens Asylum

Since the asylum had treated only 162 patients that year, the amount of food grown (Black mentions 16 different crops) probably allowed for a reasonably healthy diet–perhaps better than some patients were able to get at home. Though working on a farm sounds distasteful today, some patients undoubtedly enjoyed it: they got outside, the work was meaningful, and they could both see, share, and enjoy the fruits of their labor.

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Healthy Minds and Bodies

Oregon State Insane Asylum, circa 1900

Oregon State Insane Asylum, circa 1900

Factors in the way alienists (early experts in mental health) treated the insane arose from the medical field’s understanding of the mind. In certain ways, physicians (and alienists) were surprisingly ahead of their time, since they believed that the mind profoundly affected the body. However, they often over-emphasized this aspect of the mind-body connection to arrive at simplistic or sometimes surprising conclusions.

In her 1906 book, The Perfect Woman, Mary R. Melendy discusses this mind-body connection during pregnancy. ” . . . we met with a youth who had finely molded limbs and a symmetrical form throughout,” she says. Melendy stated that the mother did not have this same symmetry or beauty and then continued, “The boy is doubtless indebted for his fine form to the presence of a beautiful French lithograph in his mother’s sleeping apartment, and which is presented for her contemplation the faultless form of a naked child.” Melendy likewise attributed the presence of so many beautiful Italian girls to the prevalence of Madonna images throughout the country.

Melendy's Book on Womanhood

Melendy’s Book on Womanhood

Gibson Girls Were Considered Ideal Images for Womanhood in the 1800s

Gibson Girls Were Considered Ideal Images for Womanhood in the 1890s

This belief that the mind could affect the body so profoundly was one reason alienists felt it was important to take patients from their homes–where their mental illness originated–and shelter them in asylums. There, new habitats and calming scenery could lead disturbed minds toward a new perspective. Recreational activities, mild distractions, and (and at least in the early days of asylums) quality time with a sympathetic asylum physician, were ways to divert a patient’s thoughts from “wrong” views and toward a more beneficial outlook.

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Hiawatha Insane Asylum Honoring Ceremony for 2017

The Keepers of the Canton Native Asylum Story and local historians are hosting the annual Honoring Ceremony at the Asylum cemetery on July 29, 2017. The address is:

2400 E. 5th St.; Canton, SD 57013. Please note that the cemetery is located on the grounds of the Hiawatha Golf Club. The following will be of particular interest:

2:00 p.m.: The Sacred Horse Society will ride through Canton to the Asylum cemetery (address above)

3:00 p.m.: Gathering at the Asylum cemetery site for the Honoring

A potluck will follow, so attendees should bring food to share. This moving, respectful event will be held rain or shine. For further information or with questions, contact:

Ross Lothrop, Chair, Keepers of the Story at 605-261-6717 or

Anne Dilenschneider, Secretary, Keepers of the Story 605-906-5404

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And the Living Wasn’t Easy

Lewis Hines Photo of Oyster Shuckers in Port Royal, South Carolina, early 1900s, courtesy Library of Congress

Lewis Hines Photo of Oyster Shuckers in Port Royal, South Carolina, early 1900s, courtesy Library of Congress

When reformers first began to champion the use of insane asylums in the 1830s, these institutions really did tend to operate as the havens they were meant to be. Life was harsh everywhere for most people: there were few protections for workers, public aid for the weak or disabled scarcely existed, and bodily comfort might mean no more than a slice of bread and a straw-filled sack to sleep on.

It was an age when a professor at the Paris Faculty of Medicine could safely state: “The abolishment of pain in surgery is a chimera. It is absurd to go on seeking it . . . Knife and pain are two words in surgery that must forever be associated in the consciousness of the patient.”

When surgeons scoffed at the idea of easing pain for (presumably) paying patients, what comfort could lunatics–who supposedly did not feel pain, cold, or hunger–expect? When Dorothea Dix began her crusade to provide compassionate care to the insane, she wrote graphically about the filth and misery she found in jails and outbuildings where the mentally ill were held as prisoners. Once asylums were established, however, these patients could expect decent food, clean bedding, warmth and ventilation, and human attention.

Reformer Dorothea Dix

Reformer Dorothea Dix

Newspaper Article from April 14, 1940

Newspaper Article from April 14, 1940

Conditions deteriorated quickly as families filled asylums with relatives they either did not want or could not handle. Some asylums became little better than the dark and filthy jails they had replaced, and certainly did not help their patients to recover. Coming full circle, reformers again began to agitate on behalf of the insane–to release or “de-institutionalize” them.

 

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Irresponsible and Unaccountable

Lee Moorhouse Was an Indian Agent for the Umatilla Indian Reservation

Lee Moorhouse Was an Indian Agent for the Umatilla Indian Reservation

The United States government always knew that native peoples were important–whether as friends or foes. Early federal practice was to interact with tribes as the country would with other independent nations, but this soon proved cumbersome and restrictive for the domestic policy U.S. leaders wanted to pursue. The Bureau of Indian Affairs (known more generally as the Indian Office or Office of Indian Affairs) shifted its role from negotiating with Indian nations to simply enforcing its will on them.

In 1849, Congress transferred the BIA from the War Department to the Department of the Interior and began to greatly increase its intrusiveness into native affairs. Tribes which had been removed to reservations and forced to farm arid, nonproductive land, soon faced extreme poverty. The BIA distributed food and supervised many services on reservations, but unscrupulous agents took advantage of the people they were supposed to help. Many accusations of fraud and abuse hit the agency, which never suffered a loss of power even after investigations proved many accusations to be well-founded.

Sioux Indian Women Receiving Rations, Pine Ridge Reservation, 1891, courtesy Library of Congress

Sioux Indian Women Receiving Rations, Pine Ridge Reservation, 1891, courtesy Library of Congress

Tulalip Indian School Learning Modern Farming Methods, 1912, photo by Ferdinand Brady, courtesy californiaindianeducation.org

Tulalip Indian School Learning Modern Farming Methods, 1912, photo by Ferdinand Brady, courtesy californiaindianeducation.org

Eventually the BIA became responsible for Indian schools, the issues involved in allotting land, all the contracts associated with providing supplies and service to Indians, and even with  providing justice. Tribal governments were weakened and shunted aside, giving the BIA and particularly its Indian agents dramatic power on reservations. Needless to say, there were agents who did not hesitate to use their power for selfish ends, rather than for protecting people who had been stripped of their own power and rights.

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