Not Just Patients Suffered

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For most of his tenure, Dr. Harry Hummer ran the Canton Asylum for Insane Indians as the only medical person on staff. He resisted trained nurses (probably because they could challenge his own expertise) and immediately undermined and harassed the nurses forced on him by the Indian Service. Grace Fillius reported to the asylum in September, 1928, and her strong personality immediately clashed with Hummer’s.

Fillius had worked as a nurse with the Army during the Great War, and suffered a breakdown in 1918 which apparently required a short stay at St. Elizabeths. When Hummer began his work against her, he brought up this breakdown as a weakness inherent in her character. Though this “cause for concern” was probably produced out of spite, it also fit in with Hummer’s philosophy that a person could never truly be cured of mental illness (see last post).

St. Elizabeths, East and North Facade, courtesy Library of Congress

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Dr. Hummer’s Views on Curability

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Alienists Sought Early Intervention for Insanity

One reason that people throughout time have hesitated to admit to mental illness is because the diagnosis was frequently a lifelong sentence (see last post). Unlike physical illnesses which were cured, people with mental illness were stigmatized long after symptoms subsided or a problematic episode cleared up. One reason alienists and asylums were embraced so eagerly was because they promised a new age of cures. Alienists were so confident that the right environment and treatment could cure insanity that a “cult of curability” developed which waned only when asylums became so crowded that effective treatment became impossible. When alienists could no longer deal only with acute, new cases of insanity, the prospect of a cure became bleaker.

At the Canton Asylum for Insane Indians, Dr. Harry Hummer almost embraced a cult of incurability. He rarely pronounced an individual well, and his letters are full of misgivings about letting patients return home even when their symptoms abated. He wrote to the commissioner of Indian Affairs about Agnes Caldwell: “I recommend that no steps be taken looking to her release, because it is almost certain that she would soon come to grief and have to be returned.” In 1919 he wrote about Allen Owl: “[He] is well-behaved and trusted with parole privileges of the grounds and an occasional pass to town to the picture shows, in addition to which he was permitted to work with neighboring farmers this season, earning about one hundred and fifty or sixty dollars. This, however, does not mean that he could or would do as well were he discharged . . . I believe that it would be but a comparatively short time before there would be a return of more active symptoms which would necessitate his re-incarceration in an institution for the insane.”

Acute Insanity as Cause of Death

Prominent Alienist, Luther Bell

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Stigma Attached to the Insane

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Beggar, created by Jan van der Vliet

Beggar, created by Jan van der Vliet

Most people would not be ashamed of breaking a leg or falling ill with the flu, and their family members likewise would not mind the world knowing about either condition. However, the same kind of acceptance has rarely applied to mental afflictions. There are many reasons for this lack of acceptance, but early issues included the probability of “getting well” or being permanently cured of a mental problem. Continue reading →

Cultural Considerations

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St. Dymphna

One of the worst problems for patients at the Canton Asylum for Insane Indians was the lack of cultural sensitivity on the part of the institution’s staff (and throughout the Bureau of Indian Affairs). No greater contrast to the BIA’s handling of the insane can be found, perhaps, than the treatment the insane received in Gheel, Belgium.

Though the reality might not have been quite as idyllic as often portrayed, there is little to criticize in the underlying premise behind this town’s attitude toward the insane. Originally, insane patients were brought to the shrine of St. Dymphna (the patron saint of people suffering from nervous and mental afflictions), who is buried at Gheel. Many patients were said to have been healed there, but others were left at the shrine to be cared for by villagers. For nearly a thousand years, mental patients have lived with host families in the town of Gheel or with families in the surrounding countryside. They worked, went into town, participated in amusements, and enjoyed most of the same life events that their hosts did. The result was almost complete de-institutionalization for these patients, and they certainly were given care within their own culture.

Gheel had an asylum where patients received initial care or stayed for a time before being assigned to a family. There were isolation cells at the asylum for the violent insane, but otherwise, no restraints were used. Though many alienists admired the community at Gheel and its method of treating the insane, most acknowledged that it couldn’t be copied very easily elsewhere.

Isolation Cell from Kew Asylum, Victoria, Australia circa 1870

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Worlds Apart

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Sweat Lodge in Use, circa 1880 to 1910, courtesy Library of Congress

Though insanity was rare, Native Americans did sometimes have to deal with tribal members they deemed insane. Their methods were less harsh than European ones (see last post) and Native Americans often tried to cure insanity rather than settle for the long-term confinement of the affected person. Many Native Americans believed that illness came from evil spirits, so their rituals emphasized that aspect of healing. The Shoshones believed that a ghost entering a person’s body caused sickness, and used incantations, prayer, drums, medicine whistles, and sweat lodges to prepare a patient to have the ghost extracted. After preparation, their healer would form a tube with his hands and place them over the patient’s mouth. He then sucked until the patient vomited or belched out the evil spirit. The Creeks sometimes used four white pebbles in water to alleviate insanity. The tribe’s healer performed ceremonies and sang songs, then put some of the water in his mouth and spit violently upon the head of the insane person. The latter then drank from the cup of water four times. This ceremony gave the healer power over the sufferer and allowed him to eventually cure the individual.

Native American cure rates were probably similar to European ones. The important point is that their treatments were culturally acceptable, just as European ones were for New World settlers. European and Anglo-American patients would not have accepted or been comfortable with Native American ceremonies to cure insanity, and it is little wonder that Native Americans were not comfortable with European-derived treatments. One of the great failures of the Canton Asylum for Insane Indians was that it did not take culture into account when staff interacted with patients.

Hupa Female Shaman, 1923, courtesy Library of Congress

Native American Healer, Known as Shields, Served the Crow Creek Reservation, courtesy U.S. Geological Survey

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Another New World

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Pilgrims Entered a Difficult Life In the New World

Europeans coming to the American continents experienced a new world, but Native Americans also experienced new worlds as these strangers introduced their cultural practices and religious beliefs to them. Some, if not many, of these initial exchanges benefited both peoples, as Europeans learned how to survive in this new land and native peoples received European goods they enjoyed using. Over time, Europeans became convinced that their own notions were the right ones, and began to reject much of Native American culture. This rejection included the way insanity would be treated.

Because Native Americans relied on oral histories during colonial times, much of what has been written about them in this period comes from Europeans’ observations. Early accounts indicate that some Native American tribes treated the few insane members they had with great respect and care, while other tribes were indifferent and neglectful toward the insane. What must be remembered is that during this time, Europeans treated the insane quite cruelly. It was common in both Europe and the new colonies to let the insane wander the countryside. Worse, violent or difficult people were chained or locked in outbuildings for most of their lives. Though whites eventually believed that they had moved toward compassion once they took chains away, there is no evidence that Native Americans ever used them. At least during this era, Native Americans treated the insane less harshly–certainly not more so–than Europeans did.

Peaceful Meeting Between William Penn and Native Americans

Indian Village on the Plains, circa 1880 to 1895, courtesy Library of Congress

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New World Medicine

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Joe Pye Weed

Europeans who came to the New World welcomed Native American medical knowledge. Though Europeans had commonly used herbs and other plant preparations to cure illnesses, they were not familiar with many of the plants they found in their new home. Native Americans had used these plants for centuries and generously shared their knowledge. Joe Pye weed (which can be dangerous if used without caution) is a native plant with many medicinal uses. The Iroquois and Cherokee used its roots and flowers as a diuretic to help with urinary and kidney ailments, while the roots and leaves could be steeped in hot water and the liquid taken for fever and inflammation.

This weed’s unusual name has been attributed to a number of sources. One is that Joe Pye was a phonetic translation of jopi or jopai, supposedly an early native American word for typhus. Or, it derived from the name of a 19th century white “Indian theme promoter.” However, the 1822 third edition of the Manual of Botany, for the Northern and Middle States of America states that Joe Pye weed was named after a Native American in Massachusetts. Details of Pye’s life have not always been recounted accurately, but according to research by Richard Pearce, Pye was a Mohegan sachem (healer) who lived in an area where the weed (botanical name: Eutrochium purpureum) was used to cure an outbreak of typhus. Joe Pye weed is a sweat inducer, which is probably the mechanism of cure.

Apache Medicine Man, 1885, courtesy Library of Congress

Drawing of Massachusetts Bay Colony Citizens

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Medical Attitudes

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Isaac Ray, Asylum Superintendent

Once asylum superintendents gained a measure of respect and prestige (see last post), they used their power to secure their positions within both the medical community and their own specialty. They wanted no meddling or advice from outsiders–especially non-medical outsiders–and fought against any kind of oversight that involved community laypeople. Boards comprised of leading citizens often oversaw the running of asylums, but many times they acted as rubber stamps for whatever the superintendent decided was best. Superintendents could accept a few suggestions, of course, but they particularly resented laypeople making any kind of staff appointments. They did not want to see superintendent or assistant superintendent positions filled through committees of laypeople or appointed by the state governor. Instead, these specialized alienists wanted to establish and maintain a closed circle of “members” who controlled all aspects of asylum management.

This attitude marked their whole approach to management. Besides being very involved with the architectural details and physical construction of the asylum (superintendents were often appointed well before an asylum opened), superintendents imposed their own treatment philosophy on their institutions. “One man, one rule” defined their medical attitude–they wanted all decisions to go through them. They were usually quick to dismiss suggestions from patients’ families, even though these people undoubtedly had valuable insights to offer. This top-down, “I’m the expert” attitude was firmly entrenched by the time the Canton Asylum for Insane Indians opened, and its patients were in a particularly poor position to have their voices accepted.

Asylum Plans

Kirkbride's Plan was Used for Many Asylums

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The Superiority of Superintendents

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Medical School Class Card

In the early 1800s, physicians were not particularly respected by the public. The educational requirements to become a doctor were minimal and no licensing was required; any ambitious young man could apprentice under a doctor for a couple of years or attend three or four semesters of lectures and then launch into his own practice. Few cures for disease existed, and many doctors knew no more about illness, its prevention, or its cure than an observant mother or wise and experienced grandmother. Medicines were another matter–many families relied on herbal and other natural preparations to ease symptoms of illness, but doctors could concoct and dispense stronger remedies full of alcohol or narcotics. Even with this patient incentive to visit a physician (or to request a house call), few doctors made a good living. Competition was fierce because of the lax requirements to enter the field, and many doctors found themselves sharing too few patients with far too many physicians.

When insane asylums were built, however, a few lucky physicians found a wonderful niche for their specialized medical interest. For alienists (doctors who made a special study of mental illness), managing an asylum was a secure, well-paying position with plenty of prestige and power. Rather than competing with any number of other physicians in a family practice, alienists were regarded everywhere as experts in their field and relied upon as such. Asylum superintendents enjoyed their authority and guarded it well. Besides protecting their own turf, they were united in opposing interference in their business from non-medical officials.

Doctor with Horse and Buggy, 1894

Insane Asylum with Some Members of Staff

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Public Responsibility for the Insane

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A Painting of a circa 1625 Colonial Home in Jamestown, by Sidney King

Responsibility for helping dependent persons was largely a family affair, though some charities or benevolent individuals did step in to offer assistance. Small towns depended on nuclear farm families to meet their obligations, and authorities only stepped in for the few exceptions that occurred. However, as towns grew into cities, people without families or other support networks flocked to them for work and opportunity. If single or friendless people became insane, no individual had a legal responsibility to care for the person. Officials had to step in, and Massachusetts’ “An Act for the Relief of Idiots and Distracted Persons” in 1694 seems to be one of the earliest pieces of legislation enacted in the colonies for the care of the insane.

City officials began to pay small sums to the lowest bidder for the disabled person’s care, which tended to be dismally inadequate. Insane patients were still chained for convenience, and left to stagnate in cold, dark rooms. Their poorly paid “keepers” made no attempt to treat or cure them, and these unfortunate men and women could only mark time in what was essentially solitary confinement in a cell, until death.

Public Care for the Poor

Fairfax, Virginia Courthouse in Colonial Times

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