Canton Asylum

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. “Today, through the treatment with lymph from glands of goats, Bush is at home and declared to be completely restored in mind.” Dr. Roberts, a physician in Greene City, Missouri, had discovered the miraculous properties of goat glands and treated young Bush. The glands were also said to “arrest senility.” Roberts was enthusiastic enough about his treatment to go to Europe and try to convince alienists there to adopt the treatment in their own insane asylums.

Bush had been committed to the Insane Asylum at Kankakee (Illinois). In that same asylum, that same year, Dr. J. B. Murphy planned to remove a tumor from the brain of another patient held there. This man, “the son of wealthy parents, has been confined in that institution for six years and has been regarded as incurable.” The tumor had shown up on an X-ray, and Murphy and his assistant were convinced their operation would be successful. “There is no doubt that this discovery [of tumors on the brain] will lead to the removal of the causes of insanity in many cases,” said Murphy.

The Kankakee asylum appears to have been especially proactive in searching out new treatments for insanity. Undoubtedly they had permission to perform these two treatments, but one wonders how many friendless patients they may have experimented on, as well.

Meeting of Medical Staff, Kankakee Mental Hospital, circa 1910

Another Proponent of Goat Glands, Dr. Brinkley Used Them to Invigorate Aging Men

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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.” Like most other alienists, Toulouse also believed that early intervention was critical; he set up a clinic where people could go when they felt their “nerves giving way.”

Toulouse believed the three great causes of insanity were sorrow, thyroid deficiency, and vice. Patients at his clinic would be questioned at length so that Toulouse could arrive at a life history for the individual. A physical exam would then determine whether they “were born with an excess of thyroid matter” or whether they had become addicts to vice–including drugs. Though all three (main) causes of insanity could be cured, Toulouse felt that madness caused by sorrow was the most difficult to resolve successfully.

Sorrow caused by bereavement or crosses in love could be healed after time, but sorrow caused by loss of money was the hardest to cure. “Practically the only sedative for a person who has once been wealthy and who finds himself suddenly poverty-stricken is to provide him again with wealth,” said Toulouse. This was obviously an impractical course of treatment.

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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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Front View of Canton Asylum, courtesy National Library of Medicine

For non-wealthy patients entering an insane asylum, both admitting procedures and accommodations were much different than for the wealthy (see last post). Alienists did not have as much time to spend with new patients, and often took short personal histories  solely from family members’ who were often biased. Patients may then have been taken straight to their rooms and left by themselves to sort out their new, distressing situation. Some patients would first face a bath and delousing–neither of which would have been done with delicacy.

At the Canton Asylum for Insane Indians, language barriers would complicate the process for many patients. They, too, were frequently deloused and/or bathed. Their clothes were inventoried, and any money they had brought with them was taken for safekeeping. In many insane asylums, patients with similar behaviors were grouped together, and as patients recuperated, they would be moved to appropriate wards or floors. Canton Asylum never took that approach, partly because they never had a high concentration of single-gender patients who could be combined that way. Therefore, quiet patients might room with violent ones, or well-oriented patients be shut in with people who raved or hallucinated. This mismatch could only serve to make the experience worse for patients who were aware of their surroundings.

Committal Document from Ireland

A List of Patients in St. Louis Asylum

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East House Dining Room, circa 1903, courtesy harvardmuseums.org

The wealthy at McLean Asylum for the Insane enjoyed many amenities that less affluent patients did not (see last post). Some patients lived in single-dwelling cottages with several bedrooms, a dining and living room, modern bathrooms, and sometimes even servants’ quarters. Typically, these cottages were paid for by the patient’s family and later deeded to McLean, in exchange for the relative’s care. Though many patients appreciated their surroundings, what they and their families benefited most from was the time that their alienists and physicians could give them.

Doctors caring for a wealthy patient had the time to give detailed instructions on how a particular person was to be treated; for instance, one patient’s entry stated that she could come and go from her cottage as she pleased, read whenever she wanted, and shampoo her own hair when it suited her. Alienists at McLean could take their time with patients’ histories, noting what pleased and displeased them, what might have caused the onset of their disorder, how they reacted to certain situations, etc. More than that, the nursing and attendant staff were not so hurried and harried. They could accompany patients on leisurely walks, talk to them and assist them in numerous ways, and retain the patience and kindness that other hospitals drove out of its staff by overwork. Many of McLean’s patients undoubtedly were helped simply by the respectful treatment they received.

First Graduating Class of McLean Nursing School, 1886, courtesy McLean Hospital

Hope Cottage at McLean Hospital, 1903, courtesy Harvard Art Museum

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Room in a Cottage for Women at Michigan Asylum for the Insane, circa 1891, courtesy kalamazoo public library

The great majority of insane asylum superintendents did not set out to be deliberately cruel to patients. They understood that newcomers to the institution would be frightened and/or confused, and made an effort to meet new patients as soon as as possible so they could welcome and reassure them. Even when asylums grew too large to permit this, superintendents and staff looked at ways to make their asylum more homey and comforting. Some set up cottages or separate buildings where the number of patients could be kept small, or moved patients to wards where similar patients stayed. Quiet or reserved patients would therefore stay with others like themselves (no matter what brought on their condition) versus mixing with loud and/or violent patients who perhaps had the same complaint as theirs.

As always, money made a difference. Wealthy families could often keep their family members at home, cared for by a private nurse or attendant. However, if the patient grew too violent or uncontrollable, even wealthy families might find it better to take their loved one to an asylum. The majority of asylums were state-run, and took patients at low-income levels; however, a few asylums catered to paying clientele. The McLean Asylum for the Insane was such an asylum, and its lush accommodations began with its exterior. Rain gutters were copper, views were spectacular, and the golf course was ready for play.

My next post will describe McLean further.

Portrait of John McLean, courtesy harvard.edu

Frederic Packard, a Member of McLean's Staff and Later Superintendent, circa 1920, courtesy harvard.edu

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A Book Written by a Former Asylum Patient

One of the worst kinds of abuse patients at insane asylums suffered occurred simply because of the situation. Many patients were tricked into accompanying relatives or friends to an asylum, or to a sanity commission that had been convened to arrange for commitment. Elizabeth Stone recounted her own commitment as this kind of deception. Her brother asked her to take a ride with him and conveyed her to McLean Asylum , where he abruptly left her without telling her where she was and what was going on. Stone was distressed beyond words when she finally realized what had happened, and later wrote: “O! That a dagger had been plunged into my heart in the midnight hour!”

Once in an asylum, many patients were frightened, angry, and bewildered. Many were distraught and emotionally overwhelmed by a sense of betrayal and shock at what had occurred. Women from sheltered homes were often terrified by the chaos around them. Patient accounts speak of real fear–of both patients and doctors whom they did not trust–and fear that they would never be released. Some learned to adapt and become model patients, hoping that by exhibiting desirable behavior, they might be set free. For far too many, the trip to the asylum was the last trip they would every make. By the time family members committed a person to an asylum, they were generally ready to be rid of him or her for a very long time.

McLean Asylum for the Insane

Scene From New York Lunatic Asylum, Blackwell's Island, 1898 Woodcut

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Locks Were Common at Insane Asylums

From accounts by former patients, it seems probable that many cases of cruelty and abuse were deliberate. Attendants were often uneducated, uncaring, or of a type who found it impossible to get a job anywhere but in an asylum. Those who enjoyed dominating weak or helpless patients often had  little oversight to prevent their doing what they liked; patients reported beatings and punishments which were clearly typical and sustained rather than lapses in judgment or reactions during a crisis. However, attendants often used restraints and other methods of control because they were convenient. Attendants in a short-staffed ward might reasonably believe that it was better to restrain a violent patient or lock him up, rather than let him hurt himself or other patients. Attendants might force feed a patient that they feared would starve because she wouldn’t eat of her own accord. Many attendants undoubtedly did these kinds of things with a perfectly clear conscience.

At the Canton Asylum for Insane Indians, both types of abuse occurred. A few patients complained of witnessing cruel teasing that would make the targets upset, or of seeing patients treated with unnecessary force or bullied. Attendants more frequently treated their patients badly out of convenience. The asylum was usually short of attendants, particularly under Dr. Harry Hummer. One attendant might have to take care of an entire ward, or at night, an entire building. It was vastly easier to lock patients in their rooms or put them in a restraint, than forgo a meal or get behind on chores for which they would be disciplined if they didn’t complete. Though restraints were supposed to be used only with the permission of the superintendent, the restraints at Canton Asylum were kept in the financial clerk’s office and given out to any attendant who asked for one.

A DeKalb Crib, circa 1905, Used for Patient Restraint, courtesy Maryland State Archives

Exhibit of Patient Restraints From Glore Psychiatric Museum

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Dr. William A. White, Superintendent at St. Elizabeths, courtesy National Institutes of Health

Though many abuses toward patients  were either condoned or ignored by senior staff, some doctors cared very much about patient abuse. When Dr. William A. White took over as superintendent of St. Elizabeths (the federal government’s hospital for insane soldiers, sailors, and citizens of Washington, D.C.), he immediately issued a terse letter absolutely revoking use of the saddle (a harness fashioned around a patient in bed and tied so that he/she could not raise up) as a restraining device.

Anna Agnew (see last post) witnessed an amazing scene when a new superintendent (Dr. Fletcher) arrived at the asylum where she stayed. Fletcher banned all restraints and then went a step further. He gathered up the various devices in the asylum and made a bonfire of them in front of the patients. Fletcher’s action to abolish restraints was generally applauded, except for the spectacular way he did it. Newspapers reporting on the incident suggested that the matter might have been handled with a little less sensation, though they agreed that restraints were usually a bad idea.

Picture of Patients Under Restraint, courtesy National Institutes of Health

Utica Crib, an Early Restraining Device

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Nervous Prostration Was a Recognized Condition; Ad circa 1895

Not all asylum patients resisted their incarceration. Some recognized that they were struggling with mental issues they could not control on their own, and did not resent the help that an asylum promised to provide. Like Catharine Beecher (see last post), Anna Agnew felt herself falling into a condition where she could not function. In 1876, Agnew remembers that she woke one morning “bathed in a cold, clammy perspiration (with an inexpressibly horrible sensation, as though falling–falling into some dreadful place of darkness!).” She couldn’t speak or move, and felt that a horrible, cold shadow had fallen upon her. She called her condition nervous prostration, and concluded that she was insane.

In her own words, she says that: “Unfortunately, for all concerned, I was not taken to the asylum for a period of several years.” Though this view seem incredible, Agnew explained that if she had been committed earlier or more quickly, she might not have had to eventually stay in an asylum for seven years. She felt that staying at home in her condition caused her to create misery for herself and those around her. Her family and friends treated her sometimes as a willful child, sometimes as a hypocrite, sometimes as a shirker, and sometimes as a woman “not wholly responsible.”

Once inside an asylum, Agnew saw many abuses which enraged her. Still, she appreciated her recovery and the privileges she enjoyed, such as access to the asylum’s medical libraries and the opportunity to earn a small sum through sewing.

Cottage at Willard Asylum

Patients in Sewing Room at Willard Asylum for the Insane

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