Category Archives: Medical treatments

Medical treatments for insanity were often harsh and punitive. They included the liberal use of narcotics. Doctors and attendants used drugs to sedate patients to make them easier to manage. Physical restraints were often used.

Cultural Considerations

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St. Dymphna

One of the worst problems for patients at the Canton Asylum for Insane Indians was the lack of cultural sensitivity on the part of the institution’s staff (and throughout the Bureau of Indian Affairs). No greater contrast to the BIA’s handling of the insane can be found, perhaps, than the treatment the insane received in Gheel, Belgium.

Though the reality might not have been quite as idyllic as often portrayed, there is little to criticize in the underlying premise behind this town’s attitude toward the insane. Originally, insane patients were brought to the shrine of St. Dymphna (the patron saint of people suffering from nervous and mental afflictions), who is buried at Gheel. Many patients were said to have been healed there, but others were left at the shrine to be cared for by villagers. For nearly a thousand years, mental patients have lived with host families in the town of Gheel or with families in the surrounding countryside. They worked, went into town, participated in amusements, and enjoyed most of the same life events that their hosts did. The result was almost complete de-institutionalization for these patients, and they certainly were given care within their own culture.

Gheel had an asylum where patients received initial care or stayed for a time before being assigned to a family. There were isolation cells at the asylum for the violent insane, but otherwise, no restraints were used. Though many alienists admired the community at Gheel and its method of treating the insane, most acknowledged that it couldn’t be copied very easily elsewhere.

Isolation Cell from Kew Asylum, Victoria, Australia circa 1870

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Worlds Apart

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Sweat Lodge in Use, circa 1880 to 1910, courtesy Library of Congress

Though insanity was rare, Native Americans did sometimes have to deal with tribal members they deemed insane. Their methods were less harsh than European ones (see last post) and Native Americans often tried to cure insanity rather than settle for the long-term confinement of the affected person. Many Native Americans believed that illness came from evil spirits, so their rituals emphasized that aspect of healing. The Shoshones believed that a ghost entering a person’s body caused sickness, and used incantations, prayer, drums, medicine whistles, and sweat lodges to prepare a patient to have the ghost extracted. After preparation, their healer would form a tube with his hands and place them over the patient’s mouth. He then sucked until the patient vomited or belched out the evil spirit. The Creeks sometimes used four white pebbles in water to alleviate insanity. The tribe’s healer performed ceremonies and sang songs, then put some of the water in his mouth and spit violently upon the head of the insane person. The latter then drank from the cup of water four times. This ceremony gave the healer power over the sufferer and allowed him to eventually cure the individual.

Native American cure rates were probably similar to European ones. The important point is that their treatments were culturally acceptable, just as European ones were for New World settlers. European and Anglo-American patients would not have accepted or been comfortable with Native American ceremonies to cure insanity, and it is little wonder that Native Americans were not comfortable with European-derived treatments. One of the great failures of the Canton Asylum for Insane Indians was that it did not take culture into account when staff interacted with patients.

Hupa Female Shaman, 1923, courtesy Library of Congress

Native American Healer, Known as Shields, Served the Crow Creek Reservation, courtesy U.S. Geological Survey

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Another New World

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Pilgrims Entered a Difficult Life In the New World

Europeans coming to the American continents experienced a new world, but Native Americans also experienced new worlds as these strangers introduced their cultural practices and religious beliefs to them. Some, if not many, of these initial exchanges benefited both peoples, as Europeans learned how to survive in this new land and native peoples received European goods they enjoyed using. Over time, Europeans became convinced that their own notions were the right ones, and began to reject much of Native American culture. This rejection included the way insanity would be treated.

Because Native Americans relied on oral histories during colonial times, much of what has been written about them in this period comes from Europeans’ observations. Early accounts indicate that some Native American tribes treated the few insane members they had with great respect and care, while other tribes were indifferent and neglectful toward the insane. What must be remembered is that during this time, Europeans treated the insane quite cruelly. It was common in both Europe and the new colonies to let the insane wander the countryside. Worse, violent or difficult people were chained or locked in outbuildings for most of their lives. Though whites eventually believed that they had moved toward compassion once they took chains away, there is no evidence that Native Americans ever used them. At least during this era, Native Americans treated the insane less harshly–certainly not more so–than Europeans did.

Peaceful Meeting Between William Penn and Native Americans

Indian Village on the Plains, circa 1880 to 1895, courtesy Library of Congress

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New World Medicine

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Joe Pye Weed

Europeans who came to the New World welcomed Native American medical knowledge. Though Europeans had commonly used herbs and other plant preparations to cure illnesses, they were not familiar with many of the plants they found in their new home. Native Americans had used these plants for centuries and generously shared their knowledge. Joe Pye weed (which can be dangerous if used without caution) is a native plant with many medicinal uses. The Iroquois and Cherokee used its roots and flowers as a diuretic to help with urinary and kidney ailments, while the roots and leaves could be steeped in hot water and the liquid taken for fever and inflammation.

This weed’s unusual name has been attributed to a number of sources. One is that Joe Pye was a phonetic translation of jopi or jopai, supposedly an early native American word for typhus. Or, it derived from the name of a 19th century white “Indian theme promoter.” However, the 1822 third edition of the Manual of Botany, for the Northern and Middle States of America states that Joe Pye weed was named after a Native American in Massachusetts. Details of Pye’s life have not always been recounted accurately, but according to research by Richard Pearce, Pye was a Mohegan sachem (healer) who lived in an area where the weed (botanical name: Eutrochium purpureum) was used to cure an outbreak of typhus. Joe Pye weed is a sweat inducer, which is probably the mechanism of cure.

Apache Medicine Man, 1885, courtesy Library of Congress

Drawing of Massachusetts Bay Colony Citizens

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Two Causes of Insanity

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Hippocrates

In ancient times, insanity was seen as a result of spiritual forces working against an individual. A god or demon could either inhabit a body and manifest in some way, or merely cause problems for the victim via spiritual power. Sometimes manifestations were considered benign or even holy, and the person who acted oddly was left alone. If the manifestations went against society’s expectations, then the spirit was deemed evil and attempts were made to get rid of it through ceremonies and incantations. Around 460 BC, the Greek physician Hippocrates argued that the brain was the actual organ of the mind and reasoning. Therefore, insanity could be treated just like any other physical problem. His ideas were generally accepted until the Middle Ages, when once again, authorities began to believe that the spiritual realm controlled the mind. During that time, ideas of witchcraft and demonic possession flourished.

Eventually, Europe once again caught up to ancient Greek thought and began to look at physical causes for mental illness. Because of their evolving beliefs about insanity, European healers stopped dismissing the insane as hopeless cases who should be locked away for life. Instead, they looked for ways to help alleviate what might be just a temporary condition. The insane began to live in asylums rather than prisons and poorhouses, and physicians tried to discover methods of caring for them that would lead to a return of sanity. The early nineteenth century became a very hopeful time in which many doctors believed almost all cases of insanity could be cured.

Demon Leaving the Body of an Epileptic Through His Mouth

Patients With Various Mental Disorders

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Coming Full Circle

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Treatment for insanity remained surprisingly consistent in many ways over hundreds of years (see last post). One great stride in treating the insane came when authorities stopped lumping “lunatics” in with criminals and the poor, either in prisons or almshouses. (Just as often, lunatics were chained or confined even in early hospitals.)

Sketch of an Inmate in Bethlem (Bedlam) Hospital

A more compassionate understanding about the special needs of the insane emerged, and from that, elaborate asylums for their care sprang up. Though asylums eventually deteriorated into little more than holding tanks and warehouses for the insane, their original purpose was founded on kindness.

During the 1960s and 1970s, funding for mental health care was diverted from asylums (which weren’t working well) and funneled into community-based services. Like the asylums before them, community services such as clinics and halfway houses were good ideas which unfortunately never received sufficient funds to work well. As mentally ill patients were turned out of asylums, they often found no help. A 2006 report from the Bureau of Justice shows that in 2005, “more than half of all prison and jail inmates had a mental health problem.” These people included 705,600 in State prisons, 78,800 in Federal prisons, and 479,900 in local jails. Mental health problems were defined by a recent history or symptoms of a mental health problem that occurred within 12 months of the time the survey was taken.

It seems that once again, prisons constitute the primary housing for the nation’s mentally ill.

The Updated Bethlem (Bedlam) Hospital

An Engraving of Bethlem (Bedlam) Hospital

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Treatments of Long Standing

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Asylum Patients With Various Disorders

Treatments for insanity were surprisingly consistent until the modern era. Bleeding, purging, forced vomiting, and other physical remedies were go-to procedures until the early 1800s. Purging (causing the bowels to evacuate) and vomiting continued into the nineteenth century. Physicians turned to opiates to sedate patients early in the seventeenth century, and they were still popular in the nineteenth.

Even “new” psychological treatments created in the nineteenth century had echoes of this earlier period. Alienists and asylum superintendents in the 1800s recommended a change of scenery and light amusements to divert the troubled mind, particularly for those who fell into depression or melancholy as it was popularly called. Robert Burton, an expert on melancholy who wrote almost 1,400 pages on the subject in 1620, called for those afflicted with the condition to “seek merry company, play at honest amusements, dress gaily, and haunt light and lovely places.” The two treatments are remarkably similar, even though the first was part of the newly emerging “moral treatment” pioneered in the early 1800s.

On a darker note, authorities in the 1600s often beat the insane in much the same way parents would discipline unruly children. Some of the beatings or other forceful remedies for “misbehavior” could be quite painful and dehumanizing. Moral treatment succeeded in reducing or stopping such punishment for the behaviors of the insane, and patients enjoyed much more humane treatment for several decades. Unfortunately, the more crowded insane asylums became, the more often attendants ended up resorting to these primitive methods for controlling behavior. Some of the worst ills of the asylum era ended up being physical abuse and the various restraining devises attendants used.

Robert Burton's Book on the Treatment of Melancholy

A German Book on Melancholy, Published in 1653

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Operations and Options for Insanity

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Insane Asylum at Kankakee

Along with solid advances in science, the late 1800s and early 1900s saw plenty of faddish cures for ailments.

In 1899, the New York Times reported on a young man, Irwin Fuller Bush, considered hopelessly insane, who had been restored to health through an operation. Continue reading →

Sorrow, Vice, and Thyroids

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Many Physicians Believed Insanity Stemmed from Physical Causes

Some of the new ideas about insanity and ways to prevent it helped doctors believe in cures after a long period in which they had resigned themselves to believing that most insanity was chronic.

An article from the November 12, 1922 edition of The Washington Post quoted Dr. Toulouse, a renowned French alienist, who had founded the League for Mental Hygiene and Prophylaxis. He believed that “half the occupants of the world’s insane asylums are not mad, but diseased.” Continue reading →

Advances in Healing

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Lister's New Disinfectant Method in Use

Important medical breakthroughs occurred during the 1800s. Especially important was the idea that disinfectants could help prevent the spread of disease in hospitals. Joseph Lister used carbolic acid to clean wounds and surgical instruments in hospitals, which brought deaths from infection down from 60% to about 4%. Many doctors scoffed at his ideas, but his success forced them to adopt his methods. Just a few years later, Louis Pasteur and Robert Koch developed the germ theory of disease. This was also revolutionary, since many doctors until then had no idea whatsoever about the mechanism of disease. Some thought illness generated spontaneously, while others thought the atmosphere could contain the elements of ill health or that certain personalities and physical attributes predisposed people to certain diseases.

In 1879, researchers developed a vaccine for cholera. Before the turn of the century, vaccines were developed for anthrax, rabies, tetanus, diphtheria, typhoid, and plague. It must have seemed that science had conquered–or would soon conquer–all the ills of mankind. It was a hopeful time, which led both medical doctors and alienists (specialists in treating diseases of the mind) to believe that few conditions were beyond treatment and cure.

Joseph Lister

Robert Koch, courtesy National Library of Medicine

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