Pursuing an Agenda

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American Journal of Insanity

Asylum superintendents tended to support each other and their profession, and presented a united front to the public. Though they published studies and treatment-oriented articles in the American Journal of Insanity (AJA) and other medical organs, the AJA in particular reflected much of their philosophy.

In a July, 1868 article, “Admission to Hospitals for the Insane,” the author contended that it was especially unkind to make the insane endure a public hearing on their sanity. “If we find a man sick or wounded in the street, we take him forthwith to the nearest hospital, without stopping to canvass our legal right to restrain him of his liberty,” the author stated.

With the insane, however, relatives force publicity by requiring “an inquisition to establish the delirium or the lunacy,” the article continued. He said that there was no more reason why a magistrate or civil authority should inquire into treatment [for an insane person] than there was to “rescue a patient from the hands of a skillful surgeon who is binding him to an operating table to perform an amputation.”

This article is only one instance of an ongoing disagreement between the psychiatric profession and private citizens about the value of admitting (or coercing) patients into asylums without due process.

Amariah Brigham, founder of the AJA

Mary Todd Lincoln (Judged Insane by a Jury After a 10-Minute Deliberation)

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Useful Platform

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Missouri State Hospital Nurses, circa 1914, courtesy Missouri State Archives

Many superintendents took the opportunity to observe their patients and write about them, both to enhance their own reputations and to share information with colleagues. The American Journal of Insanity was the most important publication superintendents wrote for, since it had a wide readership among fellow alienists. The titles of their works show far-ranging subject matter:

“The Care of the Insane” by Charles Wagner, Superintendent of Binghamton State Hospital in New York.

“The History and the Use of the Term Dementia” by G. Alder Blumer, Medical Superintendent, Butler Hospital in Rhode Island.

“Night Nurses for the Insane” by C. R. Woodson, Medical Superintendent, Missouri State Hospital.

“The Favorable Modification of Undesirable Symptoms in the Incurable Insane” by A. B. Richardson, Superintendent, State Hospital, Columbus, Ohio.

In his quarter-century tenure as superintendent at the Canton Asylum for Insane Indians, Dr. Harry Hummer wrote one article about insanity: “Insanity Among the Indians.” He read this piece during the 1912 session of the American Medico-Psychological Association, and it was included in the four-volume work, The Institutional Care of the Insane in the U.S.A. and Canada, published in 1916.

Binghamton State Hospital

Butler Hospital for the Insane

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Stable Jobs

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Dr. John Gray, Superintendent of the New York State Lunatic Asylum at Utica

Every insane asylum superintendent faced challenges that made the job more difficult. Lack of funds and overcrowding were two perennial problems, along with shallow labor pools and constant administrative tasks. Most superintendents had to take an active role in overseeing new construction, as well as drumming up support for it in the first place. Still, for many alienists, superintendent was still the plum job.

After taking time out for the Civil War, Dr. Patrick Livingston Murphy graduated as a physician from the University of Maryland at the age of 23. He settled in his home state of North Carolina, in Wilmington, and began his practice. He found “the routine of practice irksome” for some reason–he may have been bored by the types of cases he treated, or his practice may have been too small to support him. When he heard that there would be a new asylum in Broughton (the Western North Carolina Insane Asylum), Murphy immediately applied for a position at the Western Virginia Asylum to obtain experience. As soon as the Western North Carolina asylum opened, he applied for the superintendent’s position. He got it, and remained the asylum’s superintendent for the next 25 years.

Western North Carolina Insane Asylum, circa 1886, courtesy Burke County Public Library

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Later Incompetence

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Dr. Harry Hummer

Dr. Harry Hummer, the second (and last) superintendent of the Canton Asylum for Insane Indians, created most of his own problems. He was a well-trained psychiatrist who had worked at the large government insane asylum, St. Elizabeths. Hummer took over a fairly new facility, but chose to concentrate his attention on administrative details and running the asylum’s farm rather than on his patients. He sought to keep expenses down by not filling the assistant superintendent’s position, thus making himself the only medical person on staff until nurses were assigned to the facility many years later.

Hummer had no excuse for the way patients were mismanaged. He was thoroughly capable of devising therapeutic plans for his patients, but never did. He kept many of the amusements Gifford had initiated and even built on them to a point, but discontinued other occupational-therapy types of activity, like beadwork.

Laundry Room, Northern Michagan Asylum for the Insane

Hummer was also responsible for his own overcrowding. Though he undoubtedly felt pressure to take in as many patients as possible, no one at the Indian Office was likely to have overruled him if he had put up a fight to keep his patient numbers down. Even though the Commissioner of Indian Affairs technically had the sole power to commit or release patients, commissioners nearly always bowed to Hummer’s recommendations.  Hummer continually complained about overcrowding, but used it as a reason to expand his facility. Hummer always had fewer than 100 patients, far less than the caseloads of other superintendents at other facilities. Yet, he quickly abandoned even the most rudimentary psychiatric examinations and relied on unschooled attendants’ notes to keep him apprised of patients’ mental conditions.

Patients at Worcester State Hospital, courtesy Life Magazine

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Management Incompetence

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O.S. Gifford

Overcrowding was not a true reason for the problems the Canton Asylum for Insane Indians experienced. (See last post.) Its first superintendent, O. S. Gifford, took over a new facility with few patients. He reported in June of 1903 that he had received 16 patients that year, one of whom died, and two of whom recovered. He was expecting to have a total of 24 patients by the next month. His fiscal year, 1904 report reflected that he had 16 males and 8 females. In fiscal year, 1905, Gifford had 23 males and 16 females.  He used a fairly commonsense approach to therapy, and felt that he knew his patients well. He allowed fishing and picnicking, dancing, and other pastimes suited to his patients’ inclinations, and took some of his patients to town. Gifford certainly fell in with the model of a superintendent who had enough time to spend with patients.

Though Gifford could send patients home as recovered, based on his and/or Dr. Turner’s assessment, he didn’t have the knowledge to institute any kind of mental health therapy for them. His assistant, Dr. Turner appeared to take a great interest in his patients’ medical conditions, but also didn’t have the background to set up a comprehensive treatment plan. Gifford’s real mistake was in not following Turner’s medical advice. When he would not allow Turner to operate on a patient, that patient later died and Turner was understandably bitter over it. The situation brought to a head many of Turner’s other grievances, and the resultant investigation made it clear that the asylum’s superintendent needed to be an acting physician. That didn’t necessarily help Turner, because he knew he wouldn’t get the job, but he at least felt vindicated.

Small, Early Asylum in New York

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Skimping on Pay

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Patients Working in Laundry Room at Texas State Lunatic Asylum, 1898

How much attendants were paid (see last post) mattered a great deal to superintendents, and generally not for the right reasons. The public began to exert extraordinary pressure on institutions to accept their afflicted family members, which resulted in overcrowding at nearly every insane asylum in the country. Doctors couldn’t cure patients when they had too many to properly care for, and asylums began to lose their roles as sanctuaries and restorative institutions.

With cure rates down, superintendents had to look for other reasons the public should continue to endorse the use of asylums. One argument was that it was much cheaper to keep patients at an asylum than at home or in jails. Many superintendents prided themselves on how cheaply they could run their asylums, and often compared their rates with unfavorably high rates at other asylums. Salaries were nearly always the largest single expense  at asylums, so superintendents had an incentive to hire the cheapest staff they could find. Unfortunately, as Beers pointed out, one could expect very little from an attendant who would work for eighteen dollars a month.

Patients on Floor in Eloise Women's Mental Ward in Michigan

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Pay Matters

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Clifford Beers

Superintendents considered their authority and standing important, but they also appreciated a well-paid job with a cash salary. In the latter part of the nineteenth century, a superintendent’s salary of (usually) a couple of thousand dollars a year was a tremendous step up from the several hundred that many other doctors made. Outside of cities, doctors often had to accept produce or other goods in lieu of cash, or continually dun patients for payment. As the head of an asylum, superintendents were comparatively well-off and secure.

Good salaries did not apply to attendants. Clifford Beers, who described his own mental illness and stay in an asylum (beginning in 1900) in A Mind That Found Itself, said that his institution employed “the meanest type of attendant–men willing to work for the paltry wage of eighteen dollars a month.”

Beers's Account of His Asylum Experience, courtesy Museum of Disability

Beers spoke of one good attendant who was very kind to him, but of others, said: “[they] did not strike me with their fists, but their unconscious lack of consideration…was torture. Another of the same sort cursed me with a degree of brutality which I prefer not to recall.” Another attendant cursed and spat on Beers when he did not promptly obey an order.

Beers graduated from Yale in 1897; this photo is from 1895 but includes students from 1896 and 1897.

Yale Class Photo, 1895.

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Employee Grievances

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Pennsylvania Hospital for the Insane, 1870, Male Staff at Entrance, courtesy Brenner Collection, Brynmawr

Though it is easy to blame attendants for being frustrated and unkind to the patients in their care, attendants were often frustrated themselves. Mary J. Smith (see last post) told an investigator about her workday: “Her work in the morning is as follows, 6 patients to dress before breakfast–2 paralytics, 1 spastic deplegia, and three that are so crazy they do not know enough to put their clothes on; that she has to wait on tables then after breakfast gives medicine to from 6 to 12 patients, four she has to take to closets (bathroom)–that she has to make 11 beds herself.”

In addition to this daily morning routine, on Wednesday mornings, Smith had to scrub 5 small rooms, one large room, one large hall, three short halls, and a pair of steps. On Thursdays, she had to put the clothing from the laundry away. There were 28 patients in the female ward in 1908, and Smith had charge of 15 of them.

Though there could never be an excuse for mistreating patients, Smithwas undoubtedly harried and overburdened. It would have been tempting to just lock up patients so she could give her attention to some of her additional duties. One consequences of the inspection was that the asylum was authorized to add two attendant postions, one female and one male. Unfortunately, to do so, it had to abolish two laborer positions.

Buggy Used at the Colorado Insane Asylum, 1879-1899

Agnew State Insane Asylum (Santa Clara) after 1906 Earthquake

 

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Employee Frustration

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Unruly Patients at Blackwell's Island, from Harper's Magazine, 1860

Employees at the Canton Asylum for Insane Indians didn’t always get along, and the institution’s first big inspection proved that. Dr. Turner had a beef with superintendent Gifford (see last post), but some employees had a beef with Turner.

One attendant in particular, Mary J. Smith, found her work difficult in part because of Turner’s instructions. He did not like to use restraints and wouldn’t often authorize them, but Smith said that she couldn’t do all of her work unless she locked certain patients in their rooms. Her 1908 affidavit stated:

“Doctor had forbidden her to lock certain patients up without his permission . . . ‘he told me if I was doing my duty I would have her (Mary LeBeaux) outside instead of locked in her room, at that time I had locked her in for throwing a cuspidor at me’.” The inspector taking the statement said that “she has marks on her body where the patient has bitten her and has thrown cuspidors at her repeatedly.”

This kind of situation was a quandary for attendants at all asylums: how to handle violent patients without resorting to restraints or reciprical violence. One solution was to call in enough attendants so that the patient could be safely restrained by humans until he/she calmed down. Unfortunately, Canton Asylum had too few attendants for this to be a feasible solution.

Woman Forced Into Cold Shower, from Elizabeth Packard's book Modern Persecution, or Asylums Revealed

Child Patient in Restraints, Georgia State Hospital for the Insane (1940s), courtesy Georgia State University

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Canton Asylum’s Employees

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O.S. Gifford

Like other institutional staff, employees at the Canton Asylum for Insane Indians demonstrated a wide range of ability, attitude, and character. Inspectors sometimes complained that employees weren’t always available when needed; sometimes that happened because the employee was shirking his or her duty. More often, however, there just weren’t enough employees to cover all the work that needed doing, plus provide the necessary patient supervision. During the next few posts, I’ll talk about the work situation and some of the employees at the asylum.

One of the first employees to make a stir at the asylum was Dr. John Turner. He was not from Canton, and felt strongly that superintendent O. S. Gifford favored the rest of the employees (from Canton) over him. Turner complained that the attendants often ignored his orders, and that Gifford didn’t back him up. When a patient became pregnant because employees hadn’t followed Turner’s instructions  during his absence, he filed a complaint in December, 1906, with the supervisor of Indian schools, Charles Dickson. Turner’s complaint resulted in Canton Asylum’s first major (and negative) inspection.

Canton, 1907, courtesy Library of Congress

Government Doctor Giving Trachoma Examination on Stillwater Indian Reservation

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