Author Archives: Carla Joinson

Another Canton Patient History

Front View of Canton Asylum, courtesy National Institutes of Health

Some of the only Canton Asylum for Insane Indians’ patient histories available come from assessments St. Elizabeths staff made when patients were transferred in 1933 (see last two posts). Here is one more sample patient history:

Meda Ensign (Tribe Shoshone)

This patient had been admitted to Canton Asylum in 1913 at age 24, at the request of the Superintendent of Shoshone Agency, Wyoming. Medical certificate states, “Patient was crippled, deaf and dumb and of unsound mind and should be sent to the Insane Asylum for Indians. This girl has no one to look after and care for her and very often runs about in winter weather scantily dressed. She suffers very much from cold and hunger.”

During her residence in Canton she was said to have been quiet, well-behaved, apparently comprehended many things said to her but was unable to articulate words and her actions were those of a young child, showed periods of irritability, times of depression, tried to do some ward work but accomplished very little, was no problem in that she was tidy and clean.

The assessment went on to relate that Ensign had fractured her left leg at one time, and then sustained a second fracture near the first one after slipping on the walk. She also had trachoma (a debilitating eye disease that often led to blindness). Her mental diagnosis was “mental deficiency” or imbecility.

Staff assessment at the time of admission showed that “the patient is quiet, apathetic, disinterested. She appeared quite dully mentally, understood almost nothing that was said to her, could not talk. She was quiet and well-behaved on the ward, neat and tidy in her habits, did not aggravate the other patients or get into fights or show irritability.” St. Elizabeths’ staff also diagnosed Ensign with “imbecility.”

Three Photos of a Hysterical Woman Screaming, courtesy Wellcome Library

Asylum Patients With Various Disorders

Canton’s Patients

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Canton Asylum with Swing Sets

Few patient records from the Canton Asylum for Insane Indians are intact or complete. This is not unusual–many asylums destroyed their records over the years, since early administrators did not see any potentially historical value in them. The Canton Asylum’s records are especially problematic, though, since its superintendent, Dr. Harry Hummer, was faulted several times for a failure to even keep good records. What never existed cannot very well be found, in many cases. There are a few records that remain, and when patients were transferred to St. Elizabeths after the Canton Asylum closed, staff observed them for a period of time and then summarized the patient’s history and current behavior (see last post). Here is an example of their summation of a patient:

Nesba (Tribe – Navajo)

She was admitted to the Canton Asylum . . . at the request of the Superintendent of Southern Navajo Agency, Fort Defiance, Arizona. The medical certificate at the time stated, “The patient has been in present condition for past two years. Present symptoms, feeblemindedness, dementia.” The patient is a congenital defective suffering with cerebral palsies. . . . During her stay in the Canton Asylum she was infantile in her reaction, subject to tantrums during which she cried and yelled, sang, etc. These periods seemed to coincide with her menstrual periods. At one time during her stay there she was quite destructive to clothing . . . she mimicked people and seemed to delight in teasing other patients.

On her admission here the patient was passively cooperative but unable to stand alone due to her physical handicap. She is mute except for guttural noises which she makes in her throat. No definitive mental content can be elicited. She smiles at any attention received, is quite highly pleased at any effort of others to associate with her.

Other remarks continued to assess the patient’s physical condition and mental status, but staff said it was “impossible to determine whether she is oriented or if her memory is better.” She had been admitted to Canton Asylum in 1924 when she was about 20 years old, so would have been around 30 when she came to St. Elizabeths. Her physical condition probably brought her to and kept her in an asylum.

My next post will give one more patient history.

Group of Female Patients, Eastern Hospital for the Insane, courtesy National Institutes of Health

Acute Insanity as Cause of Death

Patient Histories

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Many Physicians Believed Insanity Stemmed from Physical Causes

An important innovation in the treatment of the insane was to obtain a history of patients’ past life and behavior. This allowed doctors to see how much the patient was deviating from previous behavior that was “normal” for that person; it also allowed them to see if anything important might have happened to cause the patient’s decline in mental health. Illnesses, shocks, losses, and so on could be precipitating events, as could lifestyle practices such as alcohol or opiate use. All mental illness wasn’t connected to outside factors, of course, but alienists began to realize that for them to understand and help patients, they had to understand what they had been like before they became insane.

Most patient records are missing from the existing files on the Canton Asylum for Insane Indians. Medical files seemed to have been fairly up-to-date when the asylum first opened, since the asylum’s assistant superintendent, Dr. John Turner, could ascertain the date of a patient’s pregnancy by the menstrual records he kept. When Dr. Harry Hummer took over as superintendent, one report mentioned that his record-keeping was modeled after that of St. Elizabeths, where he had been a physician. However, the doctor was criticized in later reports for poor record-keeping. The reports on patients that he sent to relatives varied little from month to month, and Hummer put a stop to even this slight gesture after a number of years.

When patients were transferred to St. Elizabeths after the Canton Asylum closed, staff reviewed what was known about them and then wrote their own assessments after a short period of observation. Sometimes these short notes are the only ones available, and they at least give a glimpse as to why a patient came to the asylum.

In my next couple of posts, I will share a few of these patients notes.

Psychoanalysis Is News, courtesy National Archives

Group of Prominent German Alienists

Make it Pretty

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Exhibition of Fancy Work, 1908, courtesy Willard

Exhibition of Fancy Work, 1908, courtesy inmatesofwillard.com

Occupational therapy was an important part of patient care in nearly all asylums. Patients were encouraged to do skilled work that got their minds off their problems/issues and produced a tangible object in which they could take pride. Genteel ladies might do fancy sewing while men engaged in woodwork, even in an elite asylum such as the McLean Asylum for the Insane in Massachusetts.

Indian patients at the Canton Asylum for Insane Indians were also encouraged to do crafts like beadwork and basket weaving if they so desired, to help pass time. (Peter Thompson Good Boy spent time “beading” at St. Elizabeths during his stay there beginning in 1913.) Occasionally, patients like Lizzie Vipont earned a little bit of money with their beadwork by selling items to visitors. Necklaces and handbags seemed to be most popular–or at least are mentioned most often. One report mentions that men whittled wooden objects, but went on to say that women were the primarily crafters. The asylum’s second superintendent, Dr. Harry Hummer, also allowed these kinds of occupations, but apparently stopped encouraging it so that the practice fell by the wayside.

This photo appeared in USA Today. Artifacts left over from the Hiawatha Insane Asylum for Indians in Canton, S.D. are displayed at the Canton Public Library on April 23, 2013. Photo: Elisha Page, Sioux Falls, S.D. Argus Leader

Occupational Therapy, Toy Making in WWI-Era Psychiatric Hospital, courtesy Otis Historical Archives, National Museum of Health and Medicine

Precedent for Asylum Care

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Smallpox Prevention Poster Distributed by the Minnesota Department of Health, circa 1924

In its treaties, the federal government routinely promised many material goods to Native Americans, as well as less tangible goods such as health care and education. Much of the government’s early health care consisted more of record-keeping than anything else: what illnesses were striking Indians in what regions, how many had died, and from what causes? Often, the precipitating factor for providing even minimal health care stemmed from concern for whites: when epidemics (like smallpox) among Indians threatened to spill over into white settlements, federal doctors often gave vaccines and provided what preventative care was available to native populations. Civilian physicians and missionaries sometimes took up the slack, but health care was primarily a federal obligation.

Though that medical care was inadequate in the extreme, the moral obligation to provide it was clear. In 1831, the Supreme Court had described the federal government’s responsibility to Indians when Chief Justice John Marshall wrote: “Their (Native American) relation to the United States resembles that of a ward to his guardian.”

Though many argued over it at the time, the Canton Asylum for Insane Indians did not represent anything outside the bounds of what the government might have been expected to provide. Clearly, provision for mental health fell under a guardian/ward relationship just as physical care did. The problem lay in whether or not a separate facility only for Indians was the answer. For the patients who traveled hundreds of miles to the asylum when they might otherwise have been admitted to a closer state hospital, the answer would probably be a resounding “No!”

Medicine Man Outside His Tepee, 19th Century, courtesy National Institutes of Health

Medicine Lodge on the White Earth Reservation, Date Unknown

Appropriate Care

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Native American Known as Shields Who Served as a Healer or Medicine Man, Crow Creek Reservation, courtesy Blue Cloud Abbey Native American Photograph Collection

Though some patients may have considered their stay at an asylum as a period of respite from the cares of the world, most patients just wanted out. Some understood that they needed help and could agree with the commitment decision, but even these patients wanted to get well and go home. Native American patients would have had these same feelings, but their stay in a facility like the Canton Asylum for Insane Indians probably helped them less than asylums helped Anglo patients. Unless their mental symptoms resulted from physical ailments–which would benefit from nutritious food, rest, and mild medications–asylum medicine was so different from Native American practices that it was not likely to help them.

Both native peoples and newcomers relied on herbs and nature-based tonics to help them get well, but except for certain very well-known ingredients, the herbal preparations of either group could be hit or miss when it came to curing ailments. However, Native Americans derived a great deal of benefit from their culture’s method of treatment as well as from any herbal concoction they might take in conjunction with it. Native peoples were community oriented, and relied heavily on ceremonies, chants, music, dancing, and so on that required many participants. This sort of community medicine varied greatly from the much more private doctor/patient practice of Europeans. When Native Americans went to a non-native hospital (or asylum), they had to step out of their culture and away from all the comfort, security, and faith that it held. Without their customary practices in place, particularly with mental issues, there would be little hope of gaining a cure.

Sand Painting in Sacred Kiva, circa 1890 to 1900

A Navajo Man in Ceremonail Dress, Including Mask and Body Paint, 1904, Edward S. Curtis

A Navajo Man in Ceremonial Dress, Including Mask and Body Paint, 1904, Edward S. Curtis

Policies and Procedures

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Full Men’s Ward, Fergus Falls State Hospital, 1900

No asylums had an overabundance of staff, and asylum administrators walked a fine line between doing what was necessary and convenient for their personnel, and what was best for patients. A 1906 article in The American Journal of Insanity discussed the pros and cons of hiring night nurses and unlocking patients’ doors at night. The superintendent of the Missouri State Hospital No. 2 wrote that after doing away with the system of night watches–who passed through the halls and wards once an hour–and going instead to a full staff of night nurses, the incidence of suicide immediately dropped. Patients were also much more comfortable and quiet.

“The idea of locking one, two …seven or eight patients in a room or dormitory, expecting patients to remain quiet, to sleep well, and to get well, is not only absurd,but is inhuman,” Dr. C. R. Woodson wrote. “The morbidly suspicious should certainly not be blamed for imagining that there was danger when locked up in a remote room of an institution with those who may or will domineer over them.”

Woodson went on to say that even violent patients responded well to the unlocked door policy. “The fact that a patient can get up and go to the toilet-room when he wants to, get a drink of water, or even get up and look down the hall, is a source of satisfaction; it makes him less rebellious, less obstinate, and less violent.”

Woodson was doubtlessly correct, and it is strange that it would have taken practitioners in the field so long to circle back to Philippe Pinel’s discovery in the early 1830s that removing chains from the madman did much to subdue his violence.

Restraints for Patients, courtesy National Library of Medicine

Nursing Students at Minnesota’s Third Hospital for the Insane, 1900s

Motherhood and Mania

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Puerperal Mania in Four Stages, 1858

The “baby blues” or its more severe form, postpartum depression, afflicted women well before the modern era. Asylum notes indicate many cases of melancholy in new mothers, as well as other types of difficulties in adjusting to a birth. In 1830 British physician Robert Gooch noted: “Nervous irritation is very common after delivery, more especially among fashionable ladies, and this may exist in any degree between mere peevishness and downright madness.”

Some new mothers may have been depressed, some simply exhausted in an era where families were large and housework involved a great deal of manual labor, while others may have been resentful of the demands motherhood placed on them and the lack of control they had in determining whether or not to have more children. Doctors and midwives alike noted the special mental state, called “puerperal insanity” that women could fall into after labor. Many believed that the stress of labor and confinement caused some mothers to kill their babies.

By 1858, puerperal insanity sometimes made up 25% of female admissions to British asylums. Surprisingly for the era, treatment was not the usual regimen of bleeding, blistering, and purging, but instead incorporated gentle common sense–plenty of rest and quiet, patience and understanding, and a good diet. Particularly for poor women, a stay in an asylum could have meant the only bit of uninterrupted rest they would ever have from the demands of a large family; some women seem to have appreciated their stays very much.

A Woman With Typical Large Family

Puerperal Mania, 1890 Death Record from Michigan

Care For the Body as Well as the Mind

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Buffalo State Asylum for the Insane

Though insanity had been recognized since the country was founded and asylums (both private and state-funded) had been around for almost a hundred years, doctors had not instituted any systematic training for asylum attendants. Attendants were the front line resource for any asylum, and their interaction with patients could greatly contribute to their comfort and recovery–or to their misery and mental distress. Many doctors, of course, made individual efforts, but training could be particularly haphazard at state institutions. One main problem was that there was little status attached to being an attendant, the work was hard, and the pay low. Many times, asylums could only get the type of worker no one else would employ, particularly since able-bodied men typically had a number of other choices.

Women had fewer choices, and it was likely easier for asylums to find female workers of good quality. In 1883, the Buffalo State Asylum began a general course of instruction for women, mainly pertaining to the rules of the institution, with some specifics on caring for the insane. The training was given as an experiment at first, but was successful enough that the asylum’s Board of Managers offered the course formally. Students had to pass a state civil service exam and successfully pass a test after the course. They then received a certificate. A male attendants’ course began in 1885 when the formal program began.

Male Attendants at Willard Asylum for the Chronic Insane, courtesy inmatesofwillard.com

Group of Physicians and Attendants at Willard Asylum for the Chronic Insane, courtesy inmatesofwillard.com

Matters of Size

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Bryan Hall, a Patient at St. Elizabeths Admitted in 1874 and Spent at Least 47 Years There

Bryan Hall, a Patient at the Government Hospital for the Insane, Admitted in 1874 and Spent at Least 47 Years There

In 1903, the Canton Asylum for Insane Indians‘ first year of operation, the American Medico-Psychological Association (the main U.S. organization for psychologists) met in Washington, DC.

During opening remarks, visitors were reminded of the city’s many interesting sights and activities available to them, including a association-sponsored general smoker in the Willard Hotel (a smoker was an informal meeting or a recruiting meeting used by men’s organizations) and a luncheon at the Government Hospital for the Insane (later known as St. Elizabeths). Continue reading →

Indians, Insanity, and American History Blog

Asylums And Insanity Treatments 1800 – 1935

Author Archives: Carla Joinson

Another Canton Patient History

Canton’s Patients

Patient Histories

Make it Pretty

Precedent for Asylum Care

Appropriate Care

Policies and Procedures

Motherhood and Mania

Care For the Body as Well as the Mind

Matters of Size