Category Archives: medical history

What Do You Learn?

Female Patient (West Riding Pauper Lunatic Asylum)

Female Patient (West Riding Pauper Lunatic Asylum)

Modern researchers sometimes pass judgment on whether or not a person should have been committed to an insane asylum–but It isn’t always an easy call. Reading patient notes can lead one to believe that disruptiveness rather than insanity caused a commitment (see last post), or that patients were committed for conditions that we realize today have nothing to do with insanity, such as epilepsy.

Some patient notes make it hard to understand what may have been going on with a patient. Notes on a woman at the Southwestern Lunatic Asylum in 1887 show the following: “Symptoms of insanity first appeared about Jan. 1885. She imagines that some one was going to kill her [and] would try to get out of her room and try to hide. The disease appears to increase–sometimes she would not know any of her family–at other times she appears sane and rational.”

This woman’s family may have been worried that she would hurt herself, run away and come to harm, or that she would hurt or otherwise cause trouble for other family members in her delusional state. Sometimes an asylum did seem to be the only solution to 24-hour care if families felt it was needed for a loved one.

Female Patients Exercising at the Metropolitan Lunatic Asylum, Kew, Australia

Female Patients Exercising at the Metropolitan Lunatic Asylum, Kew, Australia

Photo of Another West Riding Patient

Photo of Another West Riding Patient

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So Easy to Leave

Southwestern Lunatic Asylum, Marion, Virginia

Southwestern Lunatic Asylum, Marion, Virginia

Certain patients with mental illness were more difficult to manage than others, and families often grew tired of coping with a disruptive member who perhaps drained them physically and emotionally. An asylum offered a wonderful solution to the problem, and some families were quick to leave a relative at one and never look back. (See last post.) Diagnostic notes from admission records for the Southwestern Lunatic Asylum in Virginia offer a glimpse into the difficulties some families faced, while highlighting the fact that it was disruptiveness rather than insanity that probably drove at least a few commitments. Here are some diagnoses for males from 1887:

— Dissipated habits

— Absent minded, careless

— Noisy, filthy, quarrelsome

— Shows disposition to wander about, begging

— Habits dissipated, intoxicated by the person bringing him in (this patient was cured in less than three months)

Whether or not these patients truly had mental health issues or were just hard to get along with, their commitment likely resulted because the people around them had reached the limits of their patience. It would probably be safe to say that similar situations occurred in insane asylums around the country.

Picture Taken at Southwestern Lunatic Asylum, circa 1890, courtesy Southwestern Virginia Mental Health Institute

Picture Taken at Southwestern Lunatic Asylum, circa 1890, courtesy Southwestern Virginia Mental Health Institute

 

Leisure Time at Southwestern Lunatic Asylum, circa 1890, courtesy Southwestern Virginia Mental Health Institute

Leisure Time at Southwestern Lunatic Asylum, circa 1890, courtesy Southwestern Virginia Mental Health Institute

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Commit and Forget

Alienists Sought Early Intervention for Insanity

Alienists Sought Early Intervention for Insanity

Spectacular cases of involuntary commitment have found their way into newspapers and books and are interesting to read about, but in reality, many families were reluctant to commit their loved ones to an asylum. Authorities hoped that their magnificent buildings and varied amenities would reassure family qualms so that patients would be admitted before their cases became chronic. In asylums’ early years, intervention at the beginning stages of mental illness often did lead to “cures,” or at least satisfactory outcomes. These successes helped families become more comfortable with the idea of commitment and gave them hope for their loved ones’ eventual cure.

However, some families were evidently intent on dumping an undesirable burden and never looking back. In an article about Tennessee’s Eastern State Asylum for the Insane, author Keith Townsend describes a man who entered the asylum in 1886. After some initial reports on his condition, records are silent for 59 years, until the man’s death at age 95 or 99. No one seemed to take an interest in him, nor did the administration of the asylum seem to consider that a different type of institution made more sense for such an elderly man.

Woodside Building, Eastern State State Hospital for the Insane, courtesy University of Tennessee Libraries

Woodside Building, Eastern State State Hospital for the Insane, courtesy University of Tennessee Libraries

Lunatic Asylum #2 (Missouri) Patients on an Afternoon Stroll, 1902, courtesy Glore Psychiatric Museum

Lunatic Asylum #2 (Missouri) Patients on an Afternoon Stroll, 1902, courtesy Glore Psychiatric Museum

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Who Watches the Watchers?

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Thomas Kirkbride Verbalized the One Man and One Rule Philosophy

Thomas Kirkbride Verbalized the One Man and One Rule Philosophy

The insane asylum at Yankton, SD (see last post) was typical of its time. It had a board  of  men in a trustee relationship who were charged with watching over the running of the asylum. Their duties were varied and wide-ranging, and it is likely that the asylum’s superintendent was not always happy with their oversight. Many of the early alienists resented “laypeople” telling them how to run “their” asylum, and most adopted the attitude that one man and one rule–obviously the superintendent’s--should be the order of the day.

Though many histories focus on the weaknesses of asylum administrators, it was Yankton’s oversight board that caused a problem for the institution. In 1887, the governor removed the majority of the Yankton board “for official misconduct and neglect of duty.” The rest of the board resigned, and a new board of five men were appointed to take their place.

The displaced board members quickly “took legal proceedings to test the power of the governor to make such removals” and found to their chagrin that he could. The new board evidently took up the supervision of two new wings to the facility, and that may have been where the official misconduct lay.

Main Building of the Yankton Asylum

Main Building of the Yankton Asylum

Boards Frequently Reported on the Activities of the Asylum Under Their Charge

Boards Frequently Reported on the Activities of the Asylum Under Their Charge

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Water Treatments

Continuous Bath Room, Kalamazoo Psychiatric Hospital, 1918, courtesy Kalamazoo Public Library

Continuous Bath Room, Kalamazoo Psychiatric Hospital, 1918, courtesy Kalamazoo Public Library

Patients entering an asylum were frequently given sedatives or tonics, depending upon their physical state, as well as a strong laxative to clean them out. Warm baths were thought to be calming and were frequently prescribed for agitated patients. However, what might have begun as a soothing experience could develop into something close to torture in the extreme treatment called continuous bathing, which could last for hours or days.

Cold water was generally thought to be invigorating, acting as a non-pharmaceutical tonic. Cold water might also be used to “shock” patients out of a certain behavior. Wet pack treatments were versatile in that they acted as both a shock and a sedative. Patients were wrapped in wet sheet and shocked by the cold, but the thinking was that the body would soon warm the layer of air directly beneath the sheets and create a calming effect. Attendants particularly favored wet packs, since their supposed calming influence was enhanced by the fact that the patient couldn’t move and struggle if they tied the sheet to the bed.

None of these treatments seem to have been specifically invented for asylum patients. However, there was a world of difference when a patient took a treatment willingly and in relative luxury as part of a medical cure –as the wealthy did at medical spas–or were forced to endure a treatment they did not want, as often happened in asylums. Some treatments were so uncomfortable–or could be made so–that they were viewed as punishments by patients. Since there are many instances of attendants threatening patients with these water treatments, they were obviously misused in this way.

Wet Sheet Pack, 1902

Wet Sheet Pack, 1902

Patients Were Restrained For Hours During Some Hydrotherapy Treatments

Patients Were Restrained For Hours During Some Hydrotherapy Treatments

 

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Water Therapy

Taking the Waters at the Columbian Springs

Taking the Waters at the Columbian Springs

Water therapies, known collectively as hydrotherapy, were popular forms of treatment for insanity. Most people today have relaxed under the influence of a warm, soothing soak in a tub, but it is interesting to note that bathing for health or medical reasons was popular long before bathing as a sanitation practice became nearly universal. Even after bathing for cleanliness was adopted, unless a family had running water, plenty of pots, a means to heat large quantities of water, plus a large enough container to sit in, bathing in a tub was either impossible or a huge undertaking. (Dedicated bathrooms piped for washing were not the norm in most homes until the 20th century.) Washing with a cloth from a basin would have met most people’s needs.

This may be one of the (many) reasons why asylum hydrotherapy was sometimes fearfully or passionately resisted by patients. Wealthy families were more familiar with immersion bathing at mineral spas and the like, but ordinary people from a crowded city or even a home in the country may have been more used to soaking their feet in a foot-bath each night, or scrubbing up once a week from a basin or small tub. It would have been intimidating to walk (or be forced) into an asylum’s hydrotherapy room with its strange-looking equipment and gushing streams of water.

My next post will look at the reality of various forms of hydrotherapy.

Various Forms of Water Treatment

Various Forms of Water Treatment

Spray Hydrotherapy Room, courtesy University of Western Ontario

Spray Hydrotherapy Room, courtesy University of Western Ontario

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Gender Inequality

Portrait of An Insane Woman, Hugh Welch Diamond, 1852

Portrait of An Insane Woman, by Hugh Welch Diamond, 1852

Treatment for mental disorders was generally hit-or-miss in most insane asylums, and many superintendents embarked on experimental procedures simply because there weren’t any reliable ways to help patients. Some treatments were more bizarre than others, and unfortunately, some of the treatments aimed at female patients were based on mistaken physiology-based causes of insanity.

Many doctors in the nineteenth century believed that the reproductive organs caused insanity, and removed female patients’ ovaries to abate symptoms that seemed to appear during the menses. (Hysteria was another type of female insanity attributed to physiology.) Some doctors applied electrical current to a patient’s uterus, or injected the vagina with hot water. For women who masturbated–often considered a cause of insanity–doctors ensured that the patient would find it extremely painful by cauterizing her clitoris.

Feeble-minded Subjects for Sterilization, courtesy Truman State University

Feeble-minded Subjects for Sterilization, courtesy Truman State University

At the Canton Asylum for Insane Indians, neither superintendent favored these extreme treatments. However, Dr. Harry Hummer firmly believed that female patients in their child-bearing years should not be released unless they could be sterilized.

Since he had no means to do that, he decided to keep many female patients who were otherwise candidates for discharge. Hummer was sometimes overruled in these types of decisions if a woman had a strong advocate, but his policy was most often unchallenged.

Account of A Woman Declared Insane Apparently After a Fortune-Telling

Account of A Woman Declared Insane Apparently After a Fortune-Telling

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Few Patients Came Voluntarily

Elizabeth Packard Being Kidnapped in Broad Daylight and Taken to an Insane Asylum, courtesy National Library of Medicine

Elizabeth Packard Being Kidnapped in Broad Daylight and Taken to an Insane Asylum, courtesy National Library of Medicine

The case of Peter Thompson Good Boy (see last three posts) shows how easy it was for a Native American to lose his freedom. It would be safe to say that few or no patients at the Canton Asylum for Insane Indians actually wanted to be there. Patient Susan Wishecoby thought she was going to a hospital when she agreed to go; she apparently had epilepsy or something like it that gave her “spells” that were disruptive. She wrote plaintively that if she had known where she was going, she never would have agreed to come.

Former Patients Often Wrote Bitterly About Their Experiences in Insane Asylums

Former Patients Often Wrote Bitterly About Their Experiences in Insane Asylums

White patients also resisted commitment to an asylum. Many patients have written about the way they were tricked into asylums. Some went on carriage rides that ended at an asylum entrance; women, in particular, were sometimes arrested unexpectedly (usually at the request of a male relative or husband) and taken to an asylum; other times women or men were asked to accompany a friend or relative to a law office or some such place to help with a legal matter, only to find that the legal proceedings were loose insanity hearings against themselves!

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

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

Though outrageous tricks were played on men and women alike, women were particularly vulnerable to abuses of authority. Many women wrote about how easy it was for husbands to commit their wives to asylums. In her book, Behind the Scenes, or Life in an Insane Asylum* (1878), Lydia A. Smith writes: “If a man tires of his wife .  . . it is not a very difficult matter to get her in an institution of this kind. Belladonna and chloroform will give the appearance of being crazy enough . . . .”

*Available today as a reprint or free ebook.

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New Reasons for Insanity

Blackfoot Family

Blackfoot Family

Many (white) observers over the years believed that insanity was rare among Native Americans. Their conclusion was born out during the Indian Bureau survey that tried to assess the need for a special asylum for insane Indians; among the thousands and thousands of Indians living on reservations, fewer than a hundred could be identified with mental problems.

Though J. Lee Humfreville (see last post) had nothing to do with this survey, he backed up earlier thoughts about the prevalence of insanity with his own observations made during his Army career. In speaking about the scourge of smallpox among the Blackfeet, Humfreville told of their extreme reaction to smallpox scars.

“. . . they were so humiliated at sight of these blemishes and scars [from smallpox] that some of them committed suicide. As suicide was almost unknown . . . one may obtain from this some idea of the distress of the Blackfeet over their disfigured appearance.”

Humfreville continued, “Some of the survivors of this dreaded disease became insane; as insanity was something new to them, they believed that the anger of the Great Spirit was especially directed to those who had had the disease.”*

Clearly, mental illness among Native Americans was not common at all if even an Army captain could make that case when speaking about another matter entirely.

Manifestation of Smallpox

Manifestation of Smallpox

* Italics mine.Native American Boy in Yukon Territory Receiving Smallpox Vaccine, circa 1900

Native American Boy in Yukon Territory Receiving Smallpox Exam and Vaccine, circa 1900

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The Insane as News Items

Doctor's Parlor, Willard Asylum for the Chronic Insane

Doctor’s Parlor, Willard Asylum

Though early alienists did a great deal to de-stigmatize insanity and help families feel better about seeking help for their mentally ill members, insanity was still a delicate subject that most families preferred to keep private. Asylum superintendents understood this. They tried to be as soothing and discreet as possible, often bringing families into nice parlors for a private chat to quiet their embarrassment and fears and to find out more about the patient’s problem. Many asylums also had fences around them, not just to keep patients inside, but to keep the curious public out while patients walked or worked on the grounds.

A Work Train Transporting Patients at Willard Insane Asylum

A Work Train Transporting Patients at Willard Insane Asylum

When patients were transferred from one asylum to another, as often happened when a new asylum opened to alleviate overcrowding, the public usually came out in force to watch the transfer. When the East Tennessee Insane Asylum received fifty female patients from the Nashville institution, the Knoxville Daily Journal (March 21, 1886) said that, “The curiosity of about one hundred men, women and children, who had hovered around Erin station all yesterday afternoon was gratified when the train of female lunatics arrived at 4:00 o’clock.”

Postcard of Patients at Asylum Number 3, in Missouri

Postcard of Patients at Asylum Number 3, in Missouri

A few weeks later, the same paper ran an article about two new patients–referred to as inmates–brought to the asylum. A woman was brought by her daughter, and a man by the sheriff of Campbell county. A third person who had gone “crazy about religion” had been tied hand and foot in a train that then passed through town on its way to Wytheville (Virginia) where the man was to be incarcerated. He was accompanied by two sisters and a brother, but spent his time sitting in his seat “singing, cursing and gesticulating frantically.”

The paper called the latter a sad case, but went ahead and printed the man’s name–as well as the names of the other two patients–and as many details about them as it could. It surely did not make anything easier for these patients or their families to receive so much publicity about a situation they would rather have remained private.

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