Tag Archives: acute melancholia

Food for Thought

Farm With Hospital Buildings on Western North Carolina Insane Asylum, circa 1886

Farm With Hospital Buildings at Western North Carolina Insane Asylum, circa 1886

A man suffering from acute melancholia and admitted to Stockton State Mental Asylum (likely in the late 1890s or early 1900s) mentioned  that his first noon dinner (lunch) consisted of soup, beans, and potatoes. His 6:00 p.m. supper was only tea and bread. This meager menu was a far cry from the original intentions of asylum founders, who strove to provide nourishing meals to patients as part of their treatment programs.

Weston Insane Asylum Farm, circa 1892, courtesy West Virginia and Regional History Collection

Weston Insane Asylum Farm, circa 1892, courtesy West Virginia and Regional History Collection

Farms were usually incorporated into asylum grounds, both to provide fresh produce for patients and staff, and to provide useful “occupational therapy” for able-bodies patients. Superintendents proudly reported the pounds of produce they had raised, as in Dr. Harvey Black’s report for Southwestern Lunatic Asylum (Virginia) at the end of fiscal year 1887. He noted that their gardens had produced 400 bushels of turnips valued at 25 cents/bushel, 12,000 heads of cabbage at 5 cents each, and 62 dozen squash at 15 cents/dozen. Altogether, the gardens produced nearly $2,000 worth of goods for the asylum’s kitchen.

Piggery at Athens Asylum

Piggery at Athens Asylum

Since the asylum had treated only 162 patients that year, the amount of food grown (Black mentions 16 different crops) probably allowed for a reasonably healthy diet–perhaps better than some patients were able to get at home. Though working on a farm sounds distasteful today, some patients undoubtedly enjoyed it: they got outside, the work was meaningful, and they could both see, share, and enjoy the fruits of their labor.

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What Do They Say?

American Journal of Insanity

Their own writings provide fascinating insights into the mental health profession’s ever-changing understanding of insanity and how to treat it. Although it was not the only vehicle by which to express current thoughts on the topic, the American Journal of Insanity did have the backing of many authorities in the field. Articles in it ranged from purely practical matters to theoretical speculation concerning the root causes of insanity. My next few posts will give a sampling of what was on the minds of leading alienists in the nineteenth and early twentieth centuries.

In 1863, Dr. John Bucknill wrote an article, “Modes of Death Prevalent Among Insane,” in which he advocated consistency in the way asylum superintendents registered cause of death. Bucknill found that the term exhaustion served as a catchall word that gave little clue as to the actual disease or condition that  took a patient’s life. Reading from asylum obituary tables, Bucknill noted that at one asylum a physician attributed 30% of deaths to exhaustion. “In another report, I find a number of deaths attributed to ‘prostration,’ which is perhaps a synonym for exhaustion; while in another report the terms ‘gradual decay’ or ‘general decay’ appear often to be used to express the same facts.”

The vagueness of words like exhaustion and decay kept asylum physicians from keeping accurate records concerning causes of death among their patients. Bucknill urged physicians to give the names of the disease that killed their patients, and then simply add the precise mechanism that shut them down if they wished. Bucknill gave an example of a patient who died from refusing food because of his delusions. Under the system he currently saw, doctors would say the person died of exhaustion, but Bucknill urged, instead: “Let us say that the patient died of acute mania, or acute melancholia, adding, if we think fit, that the mode of death was anemic syncope from refusal of food.”

Though Bucknill’s concerns might seem trivial today, he was part of a movement to bring consistency and order to a field which had little science or tradition behind it. Because psychiatry was a new field, early practitioners had to hammer out details on such fundamental issues as how to build insane asylums, what to call them, and then how to classify the illnesses they saw within their walls. Actual therapeutic treatment was then another huge issue.

Dementia Praecox Patients, from Emil Kraepelin's textbook, 1899 edition

Religious Melancholia and Convalescence, from John Conolly's book, Physionomy of Insanity, 1858, courtesy Brown University

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