Unflattering Views on Mental Health Care

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The Journal of the American Medical Association Published Its First Cigarette Ad in 1933

Over a two year period beginning in 1931, Dr. John Maurice Grimes inspected all U.S. institutions caring for the mentally ill. This was done at the request of the American Medical Association. Grimes’ report was so unflattering that he ended up publishing it himself after the AMA withdrew its support. One of the dismaying situations he discovered was how chronic most hospital stays had become. Patients no longer came under care to get well, but to get out of the way of their families.

“The average length of stay of a patient in a state hospital is measured in years,” wrote Grimes. “A patient remaining in a hospital for such a period is not under medical treatment; he is not even under medical observation. …Many of these patients have been practically forgotten by their relatives, and the hospital has made little or no effort to prevent that forgetting or to freshen and strengthen the sense of family obligation.”

Grimes suggested an increase in the number of social workers available to oversee trial “paroles” for patients. The practice of parole or furlough (another common term for visits home) had been adopted by many forward-thinking psychiatrists at the time. The practice served to free up physician time and attention for other patients, and to help the furloughed patient begin to transition back to normalcy. The practice wasn’t as widely adopted as it might have been, because there weren’t enough social workers to help with the process. In some cases, families didn’t really want the burden of caring for their family member again.

At the Canton Asylum for Insane Indians, Dr. Harry Hummer refused to give furloughs. If he thought a patient might relapse, he saw no sense in sending the person home. Unfortunately, there were few cases in which Hummer had complete confidence that a patient had been cured. Though a few patients were discharged, the majority of patients under his care were never allowed home even for short visits. This practice made their homesickness and loneliness much worse.

Patients Create a Lawn at a North Dakota State Hospital

Morningside Hospital Patient Ward, circa 1935

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Ideas About Mental Health Evolved

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Emil Kraepelin, circa 1920, a Modern Alienist Who Identified Schizophrenia

Emil Kraepelin, circa 1920, a Modern Alienist Who Identified Schizophrenia

The notion of insanity  has been around almost since early cultures recognized that a spectrum of human behavior existed. Ideas about insanity have fluctuated throughout time, however. What was considered aberrant behavior in one era wasn’t considered so abnormal in another, just as so-called “normal” behaviors have changed over time. Continue reading →

Other Types of Healing

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Francis Schlatter

Despite the nineteenth and twentieth centuries’ advances in science, people continued to enjoy a variety of world views. This time period experienced an extraordinary rise in spiritualism and faith healing, with some practitioners becoming famous throughout the country. Andrew Jackson Davis had large numbers of dedicated followers who bought his book, The Principles of Nature, Her Divine Revelations and a Voice to Mankind. Davis was so popular that he appeared before the Senate to gain official sanction and support for his methods of healing. (He did not succeed.)

Many other healing cults arose, including that of George O. Barnes, who was popular mainly in Kentucky. He believed that the devil caused disease, and could be counteracted through anointment with oil and religious invocation. Francis Schlatter was another healer who grew so famous that at times four or five thousand people formed a line in front of his house, waiting for the opportunity to touch him. Phineas Quimby used a type of hypnotism to effect his cures, and they apparently worked at times. His system led to a “healthymindedness” philosophy based on positive thinking about health and the person’s control over disease. In turn, Quimby influenced Mary Baker Eddy, who ultimately laid out the principles of Christian Science.

Phineas Quimby

Mary Baker Eddy

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Operations and Options for Insanity

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Insane Asylum at Kankakee

Along with solid advances in science, the late 1800s and early 1900s saw plenty of faddish cures for ailments.

In 1899, the New York Times reported on a young man, Irwin Fuller Bush, considered hopelessly insane, who had been restored to health through an operation. Continue reading →

Sorrow, Vice, and Thyroids

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Many Physicians Believed Insanity Stemmed from Physical Causes

Some of the new ideas about insanity and ways to prevent it helped doctors believe in cures after a long period in which they had resigned themselves to believing that most insanity was chronic.

An article from the November 12, 1922 edition of The Washington Post quoted Dr. Toulouse, a renowned French alienist, who had founded the League for Mental Hygiene and Prophylaxis. He believed that “half the occupants of the world’s insane asylums are not mad, but diseased.” Continue reading →

Medicine and Mental Disorders

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Dr. Isaac Ray, courtesy National Institutes of Health

The nineteenth century saw many medical breakthroughs (see last post), and the public and doctors alike began to think that science could solve all human ailments. Doctors saw that better sanitation and hygiene during the Civil War helped prevent disease,and alienists began to hope that the same strides could be achieved through mental hygiene. Dr. Isaac Ray, a very powerful and prominent insane asylum superintendent, defined mental hygiene (in part) as “preserving the mind against all incidents and influences calculated to deteriorate its qualities.”

Isaac and others involved in the mental hygiene movement believed that if people could live in a situation and atmosphere that promoted mental health, they would either not fall ill in the first place, or the symptoms might not be as severe. Stress, urbanization, poverty, and industrialization were considered major players in undermining mental health, and these mental health hygienists emphasized the importance of proper rest, diet, exercise, education, self-discipline, and proper surroundings to promote mental health. (The latter is one reason that asylums were built to be magnificent and beautiful.) Though almost everyone could see benefits to these important elements of living, not all alienists agreed that they would prevent or resolve mental problems. Some thought that all mental illness sprang from biological, rather than social, causes. Early hygienists did not institute scientific studies or use methodologies that could support their beliefs, so mental hygiene remained only on the fringes of medicine for decades.

The Principles of Mental Hygiene Had Wide Acceptance, courtesy Johns Hopkins Public Health Magazine

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Advances in Healing

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Lister's New Disinfectant Method in Use

Important medical breakthroughs occurred during the 1800s. Especially important was the idea that disinfectants could help prevent the spread of disease in hospitals. Joseph Lister used carbolic acid to clean wounds and surgical instruments in hospitals, which brought deaths from infection down from 60% to about 4%. Many doctors scoffed at his ideas, but his success forced them to adopt his methods. Just a few years later, Louis Pasteur and Robert Koch developed the germ theory of disease. This was also revolutionary, since many doctors until then had no idea whatsoever about the mechanism of disease. Some thought illness generated spontaneously, while others thought the atmosphere could contain the elements of ill health or that certain personalities and physical attributes predisposed people to certain diseases.

In 1879, researchers developed a vaccine for cholera. Before the turn of the century, vaccines were developed for anthrax, rabies, tetanus, diphtheria, typhoid, and plague. It must have seemed that science had conquered–or would soon conquer–all the ills of mankind. It was a hopeful time, which led both medical doctors and alienists (specialists in treating diseases of the mind) to believe that few conditions were beyond treatment and cure.

Joseph Lister

Robert Koch, courtesy National Library of Medicine

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Who Stayed at Canton Asylum?

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Cato Sells, Commissioner of Indian Affairs in 1921

Admissions to the Canton Asylum for Insane Indians were routed through reservation Indian agents (later superintendents), who performed much of the administrative and supervisory functions concerned with running these population centers. The asylum usually had several dozen applications on file, and tried to fill vacancies with patients who had been waiting the longest. Sometimes urgent or acute cases took precedence, but there were always more applications than room at the asylum. Dr. Harry Hummer was often accused of poor record-keeping, but he was apparently required to take a “census” of patients at the end of each fiscal year (June 30). Not all of these survive, but those that do at least give a snapshot of the asylum population. In 1921:

There were 45 male and 45 female patients. Since opening, there had been 146 male and 114 female patients, so the patient population tended to skew male.

There were 28 tribes represented. Since opening, 50 tribes were represented. The greatest numbers of patients came from the Chippewa, Menominee, and Sioux, with the latter being highest. This undoubtedly resulted because the asylum was located near Sioux reservations; studies had always shown that asylums served more people in close geographic range than farther out. States that tried to locate asylums centrally to be fair to an entire region were frustrated in these attempts because of this natural pattern.

Since opening, 62 patients had died of respiratory diseases, mainly tuberculosis (45) and croupous pneumonia (9). From 1903 to 1921, 115 patients had died.

TB Sanitorium Buildings, Phoenix Indian School circa 1890 to 1910, courtesy National Archives

Alaskan TB Patients, courtesy Indian Health Service

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Other Aspects of the Asylum

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Patients Putting on a Play, Long Island State Hospital

Patients Putting on a Play, Long Island State Hospital

Though Dr. Harry Hummer failed in many important areas when it came to providing care to his patients, he did try to provide occupations for the patients who wanted to be active. Some letters from patients to the Commissioner of Indian Affairs speak of being grateful for chores because being busy helped pass the time. Continue reading →

Physical Environment at Canton Asylum

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Male Ward at Athens Lunatic Asylum, courtesy Ohio University Libraries University Archives

There are only two or three pictures available of the Canton Asylum; since they are only of the outside, it’s difficult to get a good idea about the physical layout of the rooms or what it might have been like to live there. In 1910, there were eighteen buildings associated with the asylum. These included barns, sheds, granaries, and similar structures. The main building was two stories high, with jasper granite stone foundations. Underneath, a basement ran underneath the entire building. The basement was divided into several compartments by brick partition walls. The first and second stories had eleven foot ceilings, which should have made the inside look spacious.

The main building held four wards. Two were on the first and second floor of the east wing (males) and two on the first and second floor of the west wing (females). Each ward had an attendant’s room, plus three private rooms where patients could be secluded if necessary. The superintendent (Dr. Harry Hummer) and eighteen employees lived in the main building, though Dr. Hummer eventually got a detached cottage for his family. The asylum had electricity which came from a small electric plant about two miles away. The facility was heated via radiators and used hard well water, along with rainwater collected in two cisterns.

Physician's Bedroom at One of Willard Insane Asylum's Buildings (The Branch)

Cisterns Held Precious Rainwater Runoff

A nicely maintained lawn surrounded the building, and patients often sat outside during nice weather. Inside, the building was often stuffy and smelly. The hard water made it difficult to launder clothing and sheets and keep them really clean, and eventually the entire facility began to look shabby and rundown.

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