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.

One Way to Canton

Downtown Albuquerque, circa 1912, courtesy National Archives

Downtown Albuquerque, circa 1912, courtesy National Archives

Admitting a patient to the Canton Asylum for Insane Indians was usually an easy–and fast–procedure. Since patients were not generally committed through legal process, a series of letters was usually sufficient to justify cause, ask for admittance, and give permission for it. Patients’ rights were trampled of course, but records show that many of those who urged a patient’s commitment felt that they were doing the right thing.

Early Class of Young Boys, Albuquerque Indian School, circa 1895, courtesy National Archives

Early Class of Young Boys, Albuquerque Indian School, circa 1895, courtesy National Archives

Lillian Burns, a young Laguna woman at Albuquerque Pueblo Day School, evidently became violent and uncontrollable on June 19, 1912. She was taken to the Laguna sanatorium, but the staff could not supervise her constantly and had to call in various teachers, police, and farmers for help. J. B. Burke, Clerk in Charge at the Pueblo Day School, asked a local doctor for help; Dr. Dillon contacted the Indian Office, and after no response, suggested taking Burns to the State Insane Asylum in Las Vegas.

New Mexico Insane Asylum in Las Vegas, 1904

New Mexico Insane Asylum in Las Vegas, 1904

In his telegram concerning this commitment, Dr. Dillon asked: “Can we bring her on number ten to-morrow. Impossible and inhumane to keep her here longer, otherwise must turn  her over to sheriff.”

Burke wired Dr. Dillon (and evidently the Indian Office as well) to arrange for Burns to be sent to the Canton Asylum, instead. The Indian Office responded with a telegram of its own authorizing $100 to cover transportation and expenses, and Burke acted on that as permission to send Burns to the Canton Asylum.

Lillian Burns, who was taken ill on June 19, was admitted to the Canton Asylum for Insane Indians on June 25, less than a week later. Fortunately, she was a patient who, unlike most, did not spend a lot of time there. She was released in April, 1913.

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He Didn’t Even Try

Texas State Lunatic Asylum, circa 1861

Texas State Lunatic Asylum, circa 1861

By the end of what might be called the “asylum era,” most superintendents or administrators were buried under mountains of paperwork. Almost all public facilities were overcrowded and understaffed, which meant poor care and  more problems and incidents that needed the administrator’s attention than if they had been smaller and better manned. However, the situation at the Canton Asylum for Insane Indians was always somewhat different.

The asylum’s administrator, Dr. Harry Hummer, ran an extremely small facility. The organization of superintendents that developed standardized asylum care in the 1840s decided that 250 patients was the maximum that any good facility should contain. They later raised it to 500, which was still considered a manageable number. During the bulk of his time at the Canton Asylum, however, Dr. Hummer had well under 100 patients.

Canton Asylum for Insane Indians, courtesy Robert Bogdan Collection

Canton Asylum for Insane Indians, courtesy Robert Bogdan Collection

When Canton Asylum was inspected in 1933 by St. Elizabeths’ psychiatrist, Dr. Samuel Silk, he noted that Dr. Hummer could give him next to no information about most of his patients: “the patients’ behavior or other events which led to their admission. . . . Apparently Dr. Hummer did not consider such information necessary and he took no steps to obtain it.

“In the cases of various patients who were alleged to have assaulted others, Dr. Hummer knew nothing about the circumstances of such assault . . . . Many such patients have been in the institution six, eight or more years and for a number of years they have showed no abnormal behavior justifying their detention.”

Danvers State Hospital, circa 1893, Was Huge in Comparison to Canton Asylum

Danvers State Hospital, circa 1893, Was Huge in Comparison to Canton Asylum

Many of Canton Asylum’s patients would have been better off with a jail sentence for their behavior, since a sentence for assault would have come with a limit. At the asylum, Dr. Hummer’s indifference generally led to a life sentence unless some sort of outside intervention occurred.

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Treating Morbid Impusles

Surgeon General William Hammond

Surgeon General William Hammond

In A Treatise on Insanity (1883), author William Hammond (former surgeon-general of the Army) described various cases of intellectual objective morbid impulses and how he had treated them. In one case, a young man developed an overwhelming desire to throw vitriolic acid over women’s beautiful gowns. He considered his actions “immoral and degrading,” but told Dr. Hammond that “a handsome dress acts upon me very much as I suppose a piece of red cloth does on an infuriated bull: I must attack it.” The young man had managed to throw vitriol on three women’s dresses without being caught, but wanted desperately to stop doing it. He could not determine where the impulse came from, but simply found it impossible to control.

Tilden's Bromide of Calcium

Tilden’s Bromide of Calcium

Dr. Hammond examined the man, and could find no disease other than “wakefulness.” Hammond prescribed a bromide of calcium (a sedative) and “insisted on his removing himself from further temptation by taking a sea voyage on a sailing vessel upon which there were no women passengers.” The young man did so, and came back after three or four month free of his impulse to ruin women’s dresses with vitriol.

According to Hammond, an intellectual objective morbid impulse is an idea that occurs to a person which is contrary to his sense of right and wrong, urging the person to do something “repugnant to his conscience and wishes.” As in the case of the young man just described, such an impulse “if yielded to . . . is often of a character as to demand the serious consideration of society.” In his case, the man would probably have ended up in an asylum if he had not had his condition nipped in the bud.

Dr. Hammond's Book

Dr. Hammond’s Book

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Trauma Care for the Insane

How to Care for the Insane

How to Care for the Insane

Many asylum patients were ill with various chronic conditions, but accidents and self-inflicted injuries also kept doctors busy. In How to Care for the Insane by Dr. William Granger (1886), the author discusses some particular issues that nurses might confront:

A cut throat: Patients may cut their throats from ear to ear and do really little injury, or they may make a small stabbing wound and divide a large blood-vessel and die almost immediately, or they may cut the windpipe and not cut the blood-vessels. Little can be done by the attendants to stop the flow of blood, even if the great blood-vessels are not cut. The head should be kept bent forward and the chin pressed against the chest.

Injury from Eating Glass: Patients sometimes eat glass . . . In the treatment do not give an emetic or a cathartic. Such food as has a tendency to constipate the bowels, and such as will also enclose the glass and coat its sharp edges, is to be given. Potatoes, especially sweet, oatmeal, or thick indian-meal pudding, are appropriate. Cotton, which is generally at hand, will, if swallowed, engage the glass in its fibres, and so protect from injury.

Patients and Nurses in Female Ward B, Weston State Hospital, 1924, courtesy West Virginia& Regional History Collection

Patients and Nurses in Female Ward B, Weston State Hospital, 1924, courtesy West Virginia & Regional History Collection

State Hospital Nurses, circa 1914, courtesy Missouri State Archives

State Hospital Nurses, circa 1914, courtesy Missouri State Archives

Injury with Needles: This is a self-injury, but it may be severe and require immediate attention. Patients may open a vein or an artery with a needle, or plunge it into the eye. But the more common way is for a patient to stick many needles under the skin, sometimes to the number of several hundred. Sometimes patients introduce them near the heart or lungs, and as a needle will often “travel” when in the flesh, it may work its way into a deeper part, and so a number get into the lungs or the heart, causing death . . . An attempt or desire to so injure one’s self should be guarded against by the attendants, and if accomplished should be at once reported to the physician, that efforts may be made to extract the needle.

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Madness in a Modern World Part Two

Crowded Train Platform in Victorian Era

Crowded Train Platform in Victorian Era

Life has always been stressful, so what was it about the nineteenth-century world that increased stress so much that alienists thought it contributed to a rising rate of madness (see last post)? Change itself brings stress, of course, and nineteenth-century humans were experiencing a great deal of change.

As telegraphs, telephones, locomotives, trolleys, and the like infiltrated daily living, it meant that the pace of life picked up for most people. Additionally, the noise level of society rose considerably as machines became more prevalent (even simple changes like clattering typewriters replacing writing by hand in offices). Studies show that constant noise increases levels of cortisol and adrenaline, which then have their own negative consequences on the body.

Interior of Magnolia Cotton Mills Spinning Room, Mississippi, circa 1912

Interior of Magnolia Cotton Mills Spinning Room, Mississippi, circa 1912, courtesy NARA

Not everyone embraced and trusted all the new inventions, either. Doctors diagnosed “elevator sickness” and “railway neurosis” brought on when people experienced the physical novelty and/or stress of using these new technologies. “Dyspepsia,” a term used to describe intestinal troubles of various kinds, was rampant in the nineteenth century–probably as a reaction to stress. Nervousness with life in general sometimes led to “neurasthenia,” a term encompassing feelings of anxiety, depression, irritability, and other symptoms of mental distress.

Noisy, Crowded Life in a New York Tenement, circa1890

Noisy, Crowded Life in a New York Tenement, circa1890

One of the positive beliefs alienists embraced was that insanity was not an inevitable hereditary condition, as had been previously believed. Instead, they began to believe that certain people were perhaps disposed toward insanity, but that it would only manifest if conditions were right. In the nineteenth century, it appeared that conditions were right for troubling symptoms to appear in many people.

 

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Madness in a Modern World

Edison and Light Bulb

Edison and Light Bulb

Politicians who supported an asylum exclusively for Indians often justified the need by parroting the claims of alienists. These specialists in mental illness maintained that the pressures of the modern world led to an increase in insanity. The fact that reservation agents couldn’t even find a hundred “insane Indians” at the end of the nineteenth century did little to support that notion. However, the rate of insanity was increasing among the rest of the population. And, alienists may not have been completely off-track in their thinking.

From the earliest times, people had lived in much the same way: they walked or used animals and boats for transportation, wrote messages to one another by hand, and planned their daily activities by the rising and setting of the sun. Suddenly, around 1830, tremendous changes occurred.

The Tom Thumb, courtesy Bureau of Public Roads, Department of Commerce

The Tom Thumb, courtesy Bureau of Public Roads, Department of Commerce

In 1827, the Baltimore & Ohio Railroad began transporting people and goods mechanically with a little steam engine called the Tom Thumb. In 1869, workers completed the first transcontinental railroad, which reduced a difficult wagon or stagecoach ride of several weeks or months to one week. Samuel Morse patented the telegraph in 1840, Bell patented the telephone in 1876, and Edison introduced the light bulb in 1879. These changes absolutely revolutionized daily living, especially in cities.

Horse-drawn Ambulance in Front of Fire Station on Race Street in Philadelphia, 1865

Horse-drawn Ambulance in Front of Fire Station on Race Street in Philadelphia, 1865

Even though these new inventions were embraced by the public, they also created distrust, stress, and fear as people began to accommodate and use them. An “Age of Anxiety” began in which there were new dangers everywhere–and the stress did indeed lead to mental breakdowns. (The prevalence of these inventions in cities is probably why alienists considered rural areas better for asylums.) My next post will examine this modern phenomenon further.

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A Rational Solution

Almshouse Occupants at Meal Time, circa 1911

Almshouse Occupants at Meal Time, circa 1911

Wealthy families with an insane member could usually afford to pay someone to care for their unfortunate relative; they also had accommodations for him or her. It was an entirely different matter for the poor or even the middle class, whose homes were often small and cramped by today’s standards. A working family found it almost impossible to spare an able-bodied member to care full-time for someone who was sick, whether physically or mentally. Consequently, illness of any kind sometimes drove a family into poverty, or into the dreaded poorhouse.

Residents of an Almshouse Making Shoes, courtesy Library of Congress

Residents of an Almshouse Making Shoes, courtesy Library of Congress

Poorhouses were set up to care for people who had no one else to support them. Mentally ill people with no support also wound up in poorhouses, and nobody benefited when that happened. The insane person disrupted the routine of the poorhouse and very likely frightened the other people in it. That person could get no real help, either, because a poorhouse wasn’t set up to help people with mental illness. Consequently, no one benefited from the arrangement, and the victim of insanity often suffered terribly when the poorhouse caretaker simply confined him or her to a room or an outbuilding (see last post).

Kings County Almshouse, Brooklyn, NY, circa 1900, courtesy the Museum of the City of New York

Kings County Almshouse, Brooklyn, NY, circa 1900, courtesy the Museum of the City of New York

One of the arguments for asylums was that jailers and poorhouse managers didn’t have the accommodations to adequately care for the insane, or the expertise to do it even if they had the space. Asylums, where trained personnel in buildings constructed specifically for keeping the insane comfortable, were supposed to be an enlightened solution to an age-old problem.

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Undefended and Alone

Dorothea Dix

Dorothea Dix

Compassion for the insane has been in short supply through most of history, particularly since the general public (until fairly recently) felt that somehow madness was the victim’s own fault. Accommodations for the insane have never been more than merely comfortable, and even that was not often the case until the mid-1800s. When reformer Dorothea Dix began her survey of the insane in Massachusetts, she saw victims of mental illness in horrific conditions. In her Memorial to the Massachusetts legislature, she wrote that in Groton:

“A few rods removed from the poorhouse is a wooden building upon the roadside…it contains one room, unfurnished, except so far as a bundle of straw constitutes furnishing.” The room had no window except for a small slit covered with a board shutter. A young man was confined inside.

Worcester County Almshouse, 1908, African-American Building, courtesy Maryland State Archives

Worcester County Almshouse, 1908, African-American Building, courtesy Maryland State Archives

“He can move a measured distance in his prison; that is, so far as a strong, heavy chain, depending from an iron collar which invests his neck permits.” Dix mentioned that on the particular day she saw him, the weather was pleasant and the door open so the man could see outside. However, she pointed out that in New England, “the portion of the year which allows of open doors is not the chiefest part.” She asked her audience what it must be like for that young man to sit in a dark room, chained and alone for months, with nothing to do and no one to talk to.

Dix Discussed Her Findings in This Memorial to the Legislature of Massachusetts

Dix Discussed Her Findings in This Memorial to the Legislature of Massachusetts

Dix witnessed similar situations wherever she went. Reformers often stressed how unfair it was that victims of insanity–who had committed no crime–often wound up in jails, punished for life.

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Early Madness

A Typical Way to Treat Lunatics, circa 1848

A Typical Way to Treat Lunatics, circa 1848

Early treatments for madness were as crude as those for physical ailments (see last two posts) and seldom involved physicians. Restraint would be a primary means of control. Households often chained a violent member or confined him or her in a strong building. No one gave much thought to the victim’s comfort, and reformers found many sad cases of men and women housed outdoors in winter without heat, proper shelter, or adequate clothing.

Thomas G. Hazard wrote in 1844 about the treatment of a lunatic named Abram Simmons in Rhode Island: “His prison was from six to eight feet square, built entirely of stone. . . the internal surface of the walls was covered with a thick frost, adhering to the stone in some places to the thickness of half an inch.”

Utica Crib, Another Notorious Restraining Device

Utica Crib, Another Notorious Restraining Device

The man’s bed was cloth sacking stuffed with straw. The flimsy cloth covering it was frozen stiff from the wall drippings, and the straw bed beneath it was wet through and through. The writer said the man lay in utter darkness (since the two iron doors to this dungeon didn’t admit light), and: “encased on every side by walls of frost, his garments constantly more or less wet, with only wet straw to lie upon, and a sheet of ice for his covering, has this most dreadfully abused man existed through the past inclement winter.”

Peabody Poorfarm, Kansas

Peabody Poor Farm, Kansas

The writer noted that the poor man constantly chattered: “Poor Tom’s a-cold!”

Public facilities like poor farms or jails could also house lunatics. In these, lunatics might at least find shelter and food.

 

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Reasonable Rehabilitation

Amariah Brigham was Utica Asylum's First Superintendent

Amariah Brigham was Utica Asylum’s First Superintendent

The change in attitude between the old-style treatment of the insane and the new moral treatment’s philosophy (introduced by Pinel and Tuke) cannot be emphasized enough. Though some of the worst cruelties and neglect had fallen out of favor by Benjamin Rush’s time (December 24, 1745 – April 19, 1813), the man considered the “Father of American Psychiatry” believed that any physician treating an insane person had to first dominate that individual–usually through fear. Hence, threats and coercion were considered perfectly acceptable ways to gain the necessary control and authority.

One of the pioneers in American psychiatry, Dr. Amariah Brigham (December 26, 1798 – September 8, 1849) urged a completely different style of treatment. He and others of like mind developed the (then) modern insane asylum, which was capable of putting their ideas into action. For instance, Brigham believed that mental occupation was useful in effecting a cure, and suggested engaging patients’ minds in learning. He urged every institution to have something of a school within it, containing books, maps, scientific apparatus, and so on. Patients could learn reading, writing, drawing, music, arithmetic, history, philosophy, etc. The instructors in these schools would engage with patients constantly: they would teach, of course, but would also eat with patients, join them in recreational activities, and generally become their comrades. This type of engagement was for patients who were curable.

Interior of Shoe Shop, Willard Asylum for the Insane

Interior of Shoe Shop, Willard Asylum for the Insane

Patients Making Rugs, Hammocks, etc. at Hudson River State Hospital, 1909

Patients Making Rugs, Hammocks, etc. at Hudson River State Hospital, 1909

For those who weren’t (the chronic insane), manual tasks such as farm work, basket-weaving, sewing and embroidery, painting, printing, shoe-making, etc. would go a long way toward engaging patients’ attention and re-directing their thoughts in a positive manner. The physical work would also preserve their health by keeping them active.

In either type of patient, this kind of moral management, with its regular schedule, mental diversions, and lack of coercion, could be expected to help patients much more than the fear-based management of preceding philosophies. If the public had provided enough money to implement these programs effectively, the early hopes of the new psychiatric profession might have been realized.

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