Category Archives: Insanity

The study of insanity in the latter 1800s and early 1900s was in its infancy. Treatment for insanity was often abusive. Diagnosis of insanity was far-reaching and depended on the white man’s definition of normal.

Difficulties in Examining Patients

For Many Families, Asylums Offered Relief From Difficult Relatives

For Many Families, Asylums Offered Relief From Difficult Relatives

Dr. McDonald tempered his approval of New York’s more stringent commitment laws (see last post) with his recognition that even two qualified doctors called in by the family to make a diagnosis could run into problems. “As a rule you may divide the relatives of an insane person into two classes, those who want to send him to an asylum at all hazards, and those who want to keep him out at all hazards,” McDonald said.

Jean-Martin Charcot Demonstrating Hysteria in a Patient at the Salpetriere Hospital, 1887

Jean-Martin Charcot Demonstrating Hysteria in a Patient at the Salpêtrière Hospital, 1887

McDonald further stated that much of what physicians would hear from relatives would be untrue, irrelevant, guesswork, and blame, which did little to help make a diagnosis. Frequently, the various relatives would blame others for the breakdown; the husband of an insane wife would blame his in-laws for her condition, while they blamed him. For this reason, McDonald advised physicians to try and get information from a servant or family friend, who might be less biased. He also cautioned them not to give in to relatives’ requests for any kind of trickery, but to always present themselves as physicians.

An Article From the Trenton Evening News, November 7, 1898, Showing a Change in Behavior Leading to an Insanity Diagnosis

An Article From the Trenton Evening News, November 7, 1898, Showing a Change in Behavior Leading to an Insanity Diagnosis

McDonald believed that nearly all the insane had delusions of some sort, which would confirm their condition if a doctor could get at what they were. However, he also wrote of a patient coming to his asylum who had been diagnosed with melancholia along with delusions of persecution and injury. The man improved greatly, but held on to a delusion that unknown enemies continually entered the house where he had lived and poisoned his food. Because of this delusion, McDonald and his staff kept the man in the asylum . . . until other members of the household told him that the story was actually true.

Facebooktwittergoogle_pluspinterestlinkedintumblr

Model Law for Commitment of the Insane

Mrs. Packard Was a Well-Known Victim of Coerced Commitment

Mrs. Packard Was a Well-Known Victim of Coerced Commitment

One of the great tragedies for people judged insane was the ease with which they could be committed to institutions. During certain periods in some states, all it took was the word of family members or “respectable citizens” to commit people to asylums–a practice certain to be abused for personal gain, spite, or control. In 1876, Dr. Alexander E. MacDonald, superintendent of the New York City Asylum for the Insane, explained the way that the state of New York had improved its commitment laws.

Referencing other states that didn’t require physicians to examine the person in question, or only required one doctor to determine insanity, MacDonald cited New York’s requirement that two reputable physicians had to testify that the person was insane and “unfit to be at large.” The latter provision was to protect “harmless” lunatics and chronic cases who weren’t endangering themselves and others. Additionally, the doctors called in to make the examination had to have been in practice at least three years. Though neither of these requirements could curtail all unjust commitments, they seemed to be a step in the right direction.

Illustration from Nellie Bly's Ten Days in a Mad-House

Illustration from Nellie Bly’s Ten Days in a Mad-House

Furthermore, the form physicians completed required them to state their reasons for determining that the person in question was insane. Theoretically, this forced doctors to give a somewhat in-depth examination to back up their opinions, and additionally, their remarks would help the doctor at the asylum decide what initial course of treatment to begin.

Hammond May Have Been an Alcoholic or Heavily Medicated

Hammond May Have Been an Alcoholic or Heavily Medicated

Though any of these requirements seem both obvious and fundamental, they came at a time when many doctors simply rubber-stamped family decisions for commitment. Any obstacles to easy, painless commitments had to be a good thing for the helpless people who were often shipped off to asylums for convenience.

Facebooktwittergoogle_pluspinterestlinkedintumblr

Additional Markers of Insanity

Images of Different Types of Insanity by J.E.D. Esquinol, courtesy Wellcome Images images@wellcome.ac.u

Images of Different Types of Insanity by J.E.D. Esquinol, courtesy Wellcome Images images@wellcome.ac.u

In the April, 1879 issue of the American Journal of Insanity, Dr. Judson Andrews gave some tips for family physicians to use in monitoring the possible development of insanity in their patients (see last post). The physical symptoms were disturbingly commonplace, but Dr. Andrews seemed to hit a bit nearer the mark when he described certain mental signs that might indicate the development of insanity. (In general, he thought these mental symptoms would develop after the physical ones.)

— Emotions might be exaggerated (a little or a lot) or the person might be unable to control expression of the emotion even when he tried.There might not be a cause for laughing or crying in a situation, or the reaction might be out of character for the individual.

An Emotional Patient, Seacliff Lunatic Asylum, New Zealand

An Emotional Patient, Seacliff Lunatic Asylum, New Zealand

— Depression might develop, either as a loss of spirits or a “shading off from the natural cheerfulness of disposition.”

— Patients could experience “forebodings of some indefinite, indefinable evil impending, from which no way of escape lies open.”

–Later, patients would begin to be overly introspective; in reviewing their actions, they would judge themselves far too harshly and negatively.

— Patients could develop difficulty making decisions about simple tasks (like what to wear) and important ones alike; any course they decided upon then yielded to “agonies of doubt” or vacillation.

Other changes might be in personality, dress and personal appearance, and “exaltation or exaggeration.”

Insanity Continued to be a Misunderstood Subject, from a Toronto Newspaper, circa 1915 - 1919

Insanity Continued to be a Misunderstood Subject, from a Toronto Newspaper, circa 1915 – 1919

Unfortunately, many of these symptoms could develop so slowly they would be hard to detect; in other cases they might just be an intensification of the person’s normal personality and also hard to spot. At least, though, concluded Dr. Andrews, insanity had lost its mystery and dread, and “the insane man stands forth simply as a sick man: one, who by reason of cerebral disease, is unable to use his brain.”

This viewpoint was undoubtedly kinder than the fear and judgment insanity had faced in the past.

Facebooktwittergoogle_pluspinterestlinkedintumblr

Predicting Insanity

An Article from the Trenton Evening New, Nove 7, 1898, Showing a Change in Behavior Leading to an Insanity Diagnosis

An Article from the Trenton Evening New, Nov. 7, 1898, Showing a Change in Behavior Leading to an Insanity Diagnosis

Toward the latter part of the nineteenth century, mental health specialists (alienists) began to alter their approach to diagnosing insanity. Instead of looking at specific behaviors in patients and making a diagnosis from them, doctors thought it made more sense to look at changes in patients’ ordinary behaviors. To paraphrase one expert: Performing a dangerous tightrope stunt would not be considered insanity in a circus performer, but might be in someone who had never done such a thing and suddenly decided to try it.

Of course, neither alienists nor families wanted to wait until someone actually became insane before they intervened. Could there possibly be ways to predict the development of insanity? An article in the April, 1879 issue of the American Journal of Insanity gave some tips for family physicians to use in monitoring the possible development of insanity in their patients. In the words of the article’s author, Dr. Judson Andrews, early indications that might be considered precursors of insanity included:

Front Entrance, New York State Lunatic Asylum Where Dr. Andrews was Assistant Physician

Front Entrance, New York State Lunatic Asylum Where Dr. Andrews was Assistant Physician

— morbid dreams

— impairment of sleep

— a symptom cluster that included loss of appetite and indigestion, with pain, belching, flatulence, heartburn, and offensive breath

— a symptom cluster that included an increased action of the heart, full and strong pulse, a flushed face and slightly elevated temperature of the skin; the appetite might remain the same or even increase, but there would almost always be weight loss

— diseases which might cause the heart to “fail to supply the amount of blood necessary for the nutrition of the brain” or the lungs to “supply the purifying and exhilarating oxygen”

— headache [descriptions of the types of headache people might experience are similar to migraines]

— restlessness in either the extremities or “in the general movement of the whole body”

American Journal of Insanity

American Journal of Insanity

Though it might be alarming to consider any of these physical symptoms an indication of impending insanity, the emotional tips–discussed in my next post–actually could have been red flags.

 

Facebooktwittergoogle_pluspinterestlinkedintumblr

Food for Thought

Farm With Hospital Buildings on Western North Carolina Insane Asylum, circa 1886

Farm With Hospital Buildings at Western North Carolina Insane Asylum, circa 1886

A man suffering from acute melancholia and admitted to Stockton State Mental Asylum (likely in the late 1890s or early 1900s) mentioned  that his first noon dinner (lunch) consisted of soup, beans, and potatoes. His 6:00 p.m. supper was only tea and bread. This meager menu was a far cry from the original intentions of asylum founders, who strove to provide nourishing meals to patients as part of their treatment programs.

Weston Insane Asylum Farm, circa 1892, courtesy West Virginia and Regional History Collection

Weston Insane Asylum Farm, circa 1892, courtesy West Virginia and Regional History Collection

Farms were usually incorporated into asylum grounds, both to provide fresh produce for patients and staff, and to provide useful “occupational therapy” for able-bodies patients. Superintendents proudly reported the pounds of produce they had raised, as in Dr. Harvey Black’s report for Southwestern Lunatic Asylum (Virginia) at the end of fiscal year 1887. He noted that their gardens had produced 400 bushels of turnips valued at 25 cents/bushel, 12,000 heads of cabbage at 5 cents each, and 62 dozen squash at 15 cents/dozen. Altogether, the gardens produced nearly $2,000 worth of goods for the asylum’s kitchen.

Piggery at Athens Asylum

Piggery at Athens Asylum

Since the asylum had treated only 162 patients that year, the amount of food grown (Black mentions 16 different crops) probably allowed for a reasonably healthy diet–perhaps better than some patients were able to get at home. Though working on a farm sounds distasteful today, some patients undoubtedly enjoyed it: they got outside, the work was meaningful, and they could both see, share, and enjoy the fruits of their labor.

Facebooktwittergoogle_pluspinterestlinkedintumblr

Healthy Minds and Bodies

Oregon State Insane Asylum, circa 1900

Oregon State Insane Asylum, circa 1900

Factors in the way alienists (early experts in mental health) treated the insane arose from the medical field’s understanding of the mind. In certain ways, physicians (and alienists) were surprisingly ahead of their time, since they believed that the mind profoundly affected the body. However, they often over-emphasized this aspect of the mind-body connection to arrive at simplistic or sometimes surprising conclusions.

In her 1906 book, The Perfect Woman, Mary R. Melendy discusses this mind-body connection during pregnancy. ” . . . we met with a youth who had finely molded limbs and a symmetrical form throughout,” she says. Melendy stated that the mother did not have this same symmetry or beauty and then continued, “The boy is doubtless indebted for his fine form to the presence of a beautiful French lithograph in his mother’s sleeping apartment, and which is presented for her contemplation the faultless form of a naked child.” Melendy likewise attributed the presence of so many beautiful Italian girls to the prevalence of Madonna images throughout the country.

Melendy's Book on Womanhood

Melendy’s Book on Womanhood

Gibson Girls Were Considered Ideal Images for Womanhood in the 1800s

Gibson Girls Were Considered Ideal Images for Womanhood in the 1890s

This belief that the mind could affect the body so profoundly was one reason alienists felt it was important to take patients from their homes–where their mental illness originated–and shelter them in asylums. There, new habitats and calming scenery could lead disturbed minds toward a new perspective. Recreational activities, mild distractions, and (and at least in the early days of asylums) quality time with a sympathetic asylum physician, were ways to divert a patient’s thoughts from “wrong” views and toward a more beneficial outlook.

Facebooktwittergoogle_pluspinterestlinkedintumblr

And the Living Wasn’t Easy

Lewis Hines Photo of Oyster Shuckers in Port Royal, South Carolina, early 1900s, courtesy Library of Congress

Lewis Hines Photo of Oyster Shuckers in Port Royal, South Carolina, early 1900s, courtesy Library of Congress

When reformers first began to champion the use of insane asylums in the 1830s, these institutions really did tend to operate as the havens they were meant to be. Life was harsh everywhere for most people: there were few protections for workers, public aid for the weak or disabled scarcely existed, and bodily comfort might mean no more than a slice of bread and a straw-filled sack to sleep on.

It was an age when a professor at the Paris Faculty of Medicine could safely state: “The abolishment of pain in surgery is a chimera. It is absurd to go on seeking it . . . Knife and pain are two words in surgery that must forever be associated in the consciousness of the patient.”

When surgeons scoffed at the idea of easing pain for (presumably) paying patients, what comfort could lunatics–who supposedly did not feel pain, cold, or hunger–expect? When Dorothea Dix began her crusade to provide compassionate care to the insane, she wrote graphically about the filth and misery she found in jails and outbuildings where the mentally ill were held as prisoners. Once asylums were established, however, these patients could expect decent food, clean bedding, warmth and ventilation, and human attention.

Reformer Dorothea Dix

Reformer Dorothea Dix

Newspaper Article from April 14, 1940

Newspaper Article from April 14, 1940

Conditions deteriorated quickly as families filled asylums with relatives they either did not want or could not handle. Some asylums became little better than the dark and filthy jails they had replaced, and certainly did not help their patients to recover. Coming full circle, reformers again began to agitate on behalf of the insane–to release or “de-institutionalize” them.

 

Facebooktwittergoogle_pluspinterestlinkedintumblr

Still A Prisoner

Asylum Ward, New York, 1866, courtesy History of Disability in America

Asylum Ward, New York, 1866, courtesy History of Disability in America

One of the best reasons reformers gave for creating asylums was that the insane were often housed in jails despite having committed no crime. With this argument, reformers in the 1830s pleaded for more humane places (and ways) to treat people who were merely sick rather than criminal. For a period, patients likely reaped the benefit of this new stance; they were taken from prisons and punitive treatments and given the rest, wholesome food, and attention they needed to get well. Then, conditions changed.

Sometime in the 1870s, a female patient named Adeline Lunt gave her perspective on asylums. In discussing the so-called convalescent galleries, which had a pleasant appearance to visitors, Lunt said: “To-night that lady will be bound, chest, arms, hands, will be compressed, tied into a sleeved corset . . . ” When the miserable woman doesn’t sleep well as a result, Lunt said, her attendants report that she has had no sleep and the patient is consequently locked into the building the next day.

Types of Restraining Devices

Types of Restraining Devices

In Lunt’s opinion, patients were detained far too long, merely against the possibility that something negative could happen to them or that they might do something risky. However, the detention itself could bring apathy, hopelessness, or an inability to function. In her words, there should be a dictionary entry that said:

Restrained Female Patient, courtesy LIFE

Restrained Female Patient, courtesy LIFE

“Insane Asylum. A place where insanity is made.”

Facebooktwittergoogle_pluspinterestlinkedintumblr

The Patient’s Voice

Reverend Chase's Book

Reverend Chase’s Book

A number of [insane] asylum patients eventually wrote about their experiences once they were released. A commonality that many of these accounts reveal is the lack of due process in the commitment process. In 1868, Reverend Hiram Chase wrote about his experience:

“. . . on the 20th of August, 1863, about 9 o’clock in the morning, I was called out of my room to dress and take a ride as far as the depot. . . I got into the wagon with three men besides myself. As I got into the wagon and saw my trunk, I enquired where they were going. Mr. Harvey told me I was going to the asylum in Utica.”*

Postcard of the Utica State Hospital for the Insane, 1907

Postcard of the Utica State Hospital for the Insane, 1907

Chase had previously described what was probably an episode of deep depression, brought on by hearing some unkind gossip about himself from church members. His own physician and another one had called upon Chase, and discussed an incident in which he had tried to get rid of a solution of silver nitrate, fearing that it would harm someone or some animal. His wife and family may have thought Chase had obtained the bottle of silver nitrate solution in order to hurt himself, though he had evidently made it abundantly clear he was getting rid of the contents. Regardless, the doctors got a warrant from the local judge after this interview, to take Chase to Utica.

Utica Crib, a Restraining Device Developed at the Utica

Utica Crib, a Restraining Device Developed at the Utica

Chase ends his first chapter with this: “We arrived there the same day, and I was locked up in the third story of the building, with about forty raving maniacs. Others may judge of my feelings when I sat down and looked around me. . . .”

*Two Years in a Lunatic Asylum; Van Benthuysen & Sons’ Steam Printing House.

Facebooktwittergoogle_pluspinterestlinkedintumblr