Superintendents at insane asylums had every incentive to cure patients, since high cure rates brought both prestige and validation to their institutions. This is one reason that they urged families to get their loved ones into an asylum quickly, before the mental illness became established and more difficult to alleviate or cure. Continue reading
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. Continue reading
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. Continue reading
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. Continue reading
No one could be pleased to find him or herself unexpectedly in an insane asylum (see last post) and it is remarkable that so many patients (who later wrote about their experiences) managed to stay calm enough to protect themselves. Patients able to keep their cool and observe the situation quickly saw that protests did them no good, nor did stubbornness or resistance in any form. Continue reading
The Canton Asylum for Insane Indians was inspected many times throughout its life. However, inspectors tended to focus on “things” rather than people. In a January, 1912 report that discussed some sewer problems at the asylum (see last post), Inspector Jacob Breid also discussed–in detail–the physical condition of the building.
“The floors are hard maple but they have not been oiled. They have been scrubbed frequently and the dirty water has gotten into the spaces between the boards and caused the edges to become dark. This gives the floor a dirty appearance . . . .” Breid suggested that the spaces between the boards be filled with a material like wax and the floors oiled. (He also suggested that these floors be mopped with a “cloth moistened with kerosene” rather than with soap and water.)
In the wards, Breid noted that the beds didn’t have castors and therefore scratched and marred the floors whenever they were moved. He suggested using pegs with rounded ends in each bed post and oiling them so that they would glide across the floor. Most of Breid’s comments and suggestions concerned the physical state of the asylum.
So far as patients were concerned, Breid made a list of how many patients held various diagnoses. He also noted that several patients had tuberculosis and needed to be isolated to a greater degree than the building allowed. Breid completed his review of patients with the hopeful thought that the asylum’s new hospital would be erected soon and alleviate this problem of isolating contagious patients.
Alienists stressed that the prompt treatment of insanity was imperative to a cure. They cautioned the public that it was far wiser to bring an afflicted person to an asylum for a cure as soon as possible, rather than let the patient languish at home for years until an asylum became a last resort. By that point, the disease might have too strong a hold and never be shaken.
Despite their sharp division of “acute” and “chronic” cases of insanity, few alienists wanted to shunt the chronic insane into separate asylums. First, few alienists wanted to be in charge of hopeless cases that gave them no scope for meaningful treatment and possible success. Second, alienists hated to pass sentence on patients, fearing that a “chronic” label would take away any chance for recovery that the patient might have had. Rather than give a patient a life sentence to custodial care, alienists preferred to keep these patients with their more hopeful cases on the remote chance that he or she could still make a recovery.
Lawmakers did not often share the alienists’ concerns. Custodial care was far cheaper than active treatment, and state legislatures usually felt that chronic patients unlikely to respond to treatment should not use up the state’s precious monies in a facility that actively treated acute cases. Against most alienists’ wishes, several asylums for the chronic insane were built. (Willard Asylum for the Chronic Insane in New York is perhaps the most well-known of these.) And, as the alienists had foretold, most patients in them spent the remainder of their lives in custodial care.
Most modern readers would consider the mid-1800s a fairly rough and rugged period, inhabited by correspondingly rough and rugged individuals. However, changes in the treatment of insanity during this period point to the idea that people in the middle 1800s believed they had declined from the vigor of their ancestors.
When Dr. Benjamin Rush began treating the insane during the late 1700s, most of his treatments were aimed at depleting patients. Because of the vigorous nature of American society at the time, physicians believed that men and women tended to be out of balance on the side of too much “excitement” in their bodies. Excitement irritated blood vessels and resulted in inflammation, fevers and breathing difficulties that could only be relieved by the intense bleeding and purging protocols that Rush practiced all his professional life. In contrast, people of the mid-1800s had become more lethargic, weak, and nervous. Treatments for the insane tended toward tonics, physical exercise, and regimented days full of activity to invigorate the patient.
Even though alienists’ views on why insanity occurred and how it affected the body changed over time, they still knew too little about the causes of insanity to do much more than treat its symptoms. Rush bled and purged his manic patients, while later alienists gave them opium and morphine to calm them. The emphasis on treating symptoms may be a reason for the multitude of techniques alienists used–they simply experimented until they found something that seemed to work.
Food was not the only way to treat physical illnesses (see last few posts), though healthy eating may have been the least harmful way to ward off sickness.
The turn of the 20th century saw many innovations and experimental treatments by physicians who were working on new ways to help patients. The August, 1907 issue of The New Albany Medical Herald monthly journal ($1/year for a subscription) reported that:
“[Dr.?} Stuver has used galvanic electricity with splendid results in chronic rheumatism.
He uses a current of from 6 (?) to 20 mp. for a person, 20 minutes to a half-hour and says that the results are better if a thin layer of cotton, wet with a solution of cocaine, is placed under the positive pole.”
Another article in the same issue concerned the treatment of tuberculosis. The writer, a Dr. Thos. P. Cheesborough, from Asheville, NC, noted that he usually received patients who were far along in the condition, due to their home physicians either missing the diagnosis entirely or being reluctant to tell their patients the bad news about their health.
Dr. Cheesborough then says, “One of the greatest disadvantages that I have found in treating this disease is that the poor unfortunate, when at last his disease has been diagnosed, and he has been sent from home and its comforts, has been advised by the home physician not to consult anyone here, but to exercise and drink whisky and to come home in a few months cured.”
Obviously, medical care could sometimes be hit or miss.
Non-urban communities had always held the harvest season in high esteem: good crops meant sufficient food for the winter; there was satisfaction in seeing hard work pay off; and perhaps not least, harvest meant an end to the constant labor involved with maintaining a healthy garden. Continue reading