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.

Attempts at Christmas Cheer

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Christmas Tree in Wisconsin State Hospital, 1895

Christmas Tree in Wisconsin State Hospital, 1895

Even when overcrowding and underfunding began to eat away at the effectiveness and relative comfort of asylum care, superintendents often went to great lengths to create a festive atmosphere during Christmas and other major holidays. These efforts eased the monotony of asylum life for patients as well as for staff.

 

Ward Decorated For Christmas, Fulton State Hospital, 1910

Ward Decorated For Christmas, Fulton State Hospital, 1910

 

 

At Northern Hospital for the Insane, staff decorated the chapel with a Christmas tree and placed evergreens and candles throughout the room. Many patients had received presents from their friends and family, and the superintendent, Dr. Wigginton, and his staff had purchased additional gifts to place under the tree so that no one would be forgotten.

Christmas at Morningside Hospital, Portland, Oregon, circa 1920s, courtesy Oregon Historical Society

Christmas at Morningside Hospital, Portland, Oregon, circa 1920s, courtesy Oregon Historical Society

At the Canton Asylum for Insane Indians, patients also celebrated Christmas with a decorated tree, special meals, and stockings filled with edible treats. In 1927, the asylum received additional holiday help from the Chilocco, Oklahoma YWCA; its girls gathered (and likely contributed) gifts like dolls, games, and books to the asylum’s patients as a service project. These were delivered on Christmas Eve, to the delight of the patients. Hummer asked the coordinator to continue with the service project, and the girls evidently did so, since there is record of the asylum receiving gifts again in 1932 or 1933.

A Favorite Project

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Epilepsy Was a Feared Condition

Epilepsy Was a Feared Condition

Dr. Harry Hummer, superintendent of the Canton Asylum for Insane Indians, almost continually made and implemented plans to expand the facility. One building that he especially wanted and never received was a separate cottage for epileptics. Though it came out near the end of his career at the asylum that he had erroneously classified anyone with seizures as “epileptic,” Hummer definitely wanted patients with these symptoms separated from the others.

In a letter dated January 15, 1916, he discussed his vision for such a cottage: “The structure should be two-story, one for males and one for females, and the sleeping-space should be an open dormitory arrangement, with one room for disturbed cases and one room for the employee, on each floor. If possible, it would be an excellent plan to surround the structure on three sides with sleeping porches, and we should have a day (living) room, separate from the dormitories.” Hummer asked that the building be constructed of brick and stone or brick and concrete so that it would match the other buildings on site.

Epileptic Hospital in Kansas

Epileptic Hospital in Kansas

Epileptic Asylum in Abilene, Texas

Epileptic Asylum in Abilene, Texas

Hummer’s rationale for a separate building was that: “All institutions for the insane make an effort to segregate the patients, and it [is] a well known fact that epileptics get along much better when to themselves than when housed with other classes.”

His first statement was probably true, but the second had little data to support it.

 

The Mechanical Treatment of Insanity

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Kings County Lunatic Asylum in Flatbush, NY

Kings County Lunatic Asylum in Flatbush, NY

Dr. William Hammond (who was not a fan of insane asylums) was appalled at the widespread use of restraints in U.S. facilities, comparing these institutions unfavorably with those in England which had just about abandoned the practice. He wrote: “At present [1883] ignorant and brutal attendants, some of them selected from the very lowest class, can, at their option, from whim, caprice, anger, or any other inadequate cause, order or place a lunatic in the camisole, crib, or other mechanical restraint.”

Hammond did not necessarily argue that all restraints be abolished, but his suggestions followed the course that British alienists used when they began to eliminate restraints. For patients who always took off their clothes, for instance, attendants could use “strong dresses which were secured around the waist with a leathern belt, fastened by a small lock.” Patients who were violent toward themselves or others, could wear “a dress, of which the sleeves terminated in a stuffed glove without divisions for the fingers and thumb.

Athens Female Ward, 1893, courtesy Athens County Historical Society and Museum

Athens Female Ward, 1893, courtesy Athens County Historical Society and Museum

One of Hammond’s suggestions to the state of New York, which asked his advice as it investigated the management of its insane asylums, was to keep the decision to use restraints out of the hands of attendants. Only the medical officer should decide to use mechanical means of control, and Hammond said that even with that safeguard in place, every order for restraint should be documented in a record book. That book, in turn, should be open to inspection.

Postcard of the Athens Lunatic Asylum

Postcard of the Athens Lunatic Asylum

The only two asylums in the U.S. which did not use restraints at all at the time of Hammond’s writing were the Kings County Asylum at Flatbush, Long Island and one in Athens, Ohio (Athens Asylum for the Insane) which he did not specifically name.

The Need for Treatment

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Professional Nurses Would Have Looked Reassuring

Professional Nurses Would Have Looked Reassuring

Before the advent of insane asylums, most families by necessity had to simply accommodate a person’s mental health problems as best they could, and then wait to see what the future held. Once asylums became both established and accepted, medical intervention became much more the norm. Though some doctors believed strongly that many patients might not benefit at all from a stay in an asylum (one said that forcible confinement in an institution “would tend strongly to cause the disease to pass into some more intense form”), most saw institutional care as far superior to home care.

Probable Causes of Insanity, Missouri State Lunatic Asylum, 1954, courtesy Missouri State Archives

Probable Causes of Insanity, Missouri State Lunatic Asylum, 1954, courtesy Missouri State Archives

Alienists had several reasons for feeling this way. Most believed that the home environment was almost always at least partly to blame for an individual’s problem. Either something was going on that directly fed the mental problem, or associations the patient couldn’t get away from wouldn’t allow recovery. Doctors believed that simply getting a patient away from the situation and into a calm environment that didn’t make demands on him, would go a long way toward nipping the problem in the bud. They also felt that patients’ families didn’t have the knowledge or skill to handle mental illnesses, and certainly couldn’t make instant judgments concerning medicine, restraints, and the like.

Patients in Kalamazoo, Michigan Asylum, circa 1870s

Patients in Kalamazoo, Michigan Asylum, circa 1870s

Alienists, themselves, had four basic forms of treatment: mechanical, moral, hygienic, and medicinal. My next few posts will explore these types of treatment.

An Old Standby Treatment

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FLorence Nightingale Suffered from Crimean Fever, Taking to Her Bed at Age 38 But Not Dying Until 90

Florence Nightingale Suffered from Crimean Fever, Taking to Her Bed at Age 38 But Not Dying Until 90

Many of us refer casually to hypochondria as a condition in which a person thinks he’s ill when he’s not. Though the victim’s friends or family may see perfect health, the hypochondriac constantly fears or suffers feelings of illness. Hypochondria has afflicted people through the ages, but alienists in the twentieth century differentiated its degrees of seriousness.

The first stage of hypochondria was entirely mental: the person thought he was ill when he was not. The second stage began when he started to act ill and displayed symptoms consistent with the particular problem he believed he had. The third stage occurred when the person started to suffer from the actual condition; as one alienist noted, “Real disease, is, therefore, induced.”

Jacobus Schroeder van der Kolk

Jacobus Schroeder van der Kolk

Dr. William A. Hammond recalled a woman who believed she had suffered a disease of the tongue which caused it to fall off. Of course,the tongue was still there, but Hammond could not persuade her that it really was. Eventually, he decided to treat her with an aloetic purge, which he had seen recommended by a European alienist, Jacobus Schroeder van der Kolk. This purge consisted of a succotorine aloe (a medicinal aloe from Africa), castile soap, and a simple syrup, along with whatever else a doctor might choose to mix in. It was essentially a harmless concoction, but fell right in with the era’s belief that a good purge could do a world of good.

Aloe Succotrina

Aloe Succotrina

The purge dislodged “large quantities of hardened fecal matter” and restored the woman’s menstrual cycle, and within a month, “she was entirely free from all perceptional, intellectual, or emotional derangement,” said Hammond. To his credit, Hammond didn’t clash wills with the patient, but instead worked in a way that accommodated her illness and caused her the least harm.

Tub Therapy

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Dr. Charles Pilgrim, 1908

Dr. Charles Pilgrim, 1908

Physicians used hydrotherapy (various sorts of baths and showers) extensively in the treatment of the insane. The treatments could sometimes be helpful; a nice, warm bath might relax a patient or help him sleep, or a bracing shower could stimulate a patient who felt sluggish and tired. Dr. Charles Pilgrim, however, took water treatments to an extreme with what he called “Tub Therapy.”

Dr. Pilgrim arrived at the Hudson River State Hospital from the Willard Asylum in1893. He quickly made physical improvements to the institution, installing electric lights to replace the gas lamps, and building new 50-bed cottages for patients, a new mortuary, and a lab. In 1908, Pilgrim introduced Tub Therapy, a form of the continuous bath. Patients entered the tub room and reclined on a canvas hammock in a tub of warm water, a rubber pillow behind their necks for additional comfort. Water temperature was monitored so that it remained at the proper therapeutic level.

Tub Therapy at Pilgrim State Hospital, the Former Hudson River State Hospital

Tub Therapy at Pilgrim State Hospital, the Former Hudson River State Hospital

Most patients would have enjoyed this for an hour or two, but Pilgrim’s treatment was of much longer duration. A September 17, 1908 article in The Beaver Herald (Oklahoma) stated: “You sleep for six hours . . . next morning breakfast is served to you in the tub, then dinner, then supper.” Occasionally the doctor would come in to chat or take a blood sample, and the patient grew calmer, more rested, and more cheerful all the while. After at least several days (the title of the article was “Live for Weeks in the Bathtub”), the patient finally got out of the tub with the help of a nurse and found him or herself well again.

This treatment was primarily for patients who felt madness coming on, either just fearing a breakdown or actually close to one in their own or others’ opinion. The therapy was voluntary, though it is hard to see anyone in good physical health actually enjoying the forced inactivity.

Hard Decisions

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Cato Sells, Commissioner of Indian Affairs in 1913

Cato Sells, Commissioner of Indian Affairs in 1913

Many people cared about the insane in their midst and tried to do their best by them. Though there were certainly abuses, many of the family and friends who sent their loved ones to insane asylums thought they were doing the right thing or acting in the patients’ best interests. Even after asylums began to lose their initial glow and were seen for the imperfect places they were, many people still felt mentally ill people were better off in them simply because they could receive consistent, professional care.

The Canton Asylum for Insane Indians was representative of its times in this matter. in 1913, the superintendent of the Shoshoni [sic] Indian Reservation asked the commissioner of Indian Affairs to admit Meda Ensign to the asylum. At the time, this asylum was overcrowded, as most were. The asylum’s superintendent, Dr. Hummer, still replied that he would admit her once authorization was given. Many would question this decision, since another patient would only lead to greater overcrowding.

Shoshone Encampment, Wind River Mountains, Wyoming, Photographed by W. H. Jackson in 1870

Shoshone Encampment, Wind River Mountains, Wyoming, Photographed by W. H. Jackson in 1870

Dr. Hummer did need his headcount to go up so he could supervise a bigger, more prestigious asylum, and typically did not like to discharge patients or reject new ones. However, that consideration very likely wasn’t the only thing on his mind. In his letter to the commissioner of Indian Affairs, Hummer points out the overcrowding, but adds: “If the conditions under which she is living are as bad as portrayed by Superintendent Norris, this authority (to admit Ensign) should be sent me without delay.”

Crowded Ward at Hudson River State Hospital

Crowded Ward at Hudson River State Hospital

More patients led to overcrowding, which worsened patient care but could justify more money and more buildings so that more patients could be admitted and helped. Superintendents at asylum everywhere juggled these issues, just as Dr. Hummer did. It had to be difficult not to accept patients when it was obvious they would be very poorly cared for elsewhere.

One Way to Canton

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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.

He Didn’t Even Try

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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.

Treating Morbid Impusles

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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