Tag Archives: alienist

The Need for Treatment

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.

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An Old Standby Treatment

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.

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Empty Yourself

Bloodletting As a Treatment for Agitation in Insanity, courtesy Burns Archives

Bloodletting As a Treatment for Agitation in Insanity, courtesy Burns Archives

Early alienists typically believed that an insane person needed to eliminate something from the body in order to get well. Copious bleeding and/or purging were popular ways to deplete a maniac’s excessive energy or excitement, but many alienists soon came to believe the procedure was too extreme. Instead, they turned their attention to the bowels.

Samuel Woodward, former superintendent of the Massachusetts State Lunatic Hospital, wrote in 1846 that it was “common for the bowels to be constipated in mania,” and advised a round of laxatives to help solve the problem. He also urged that these laxatives be gentle, but unfortunately turned to poisonous mercurial compounds to do the job. A popular concoction was “blue pill” which was generally a mixture of about one-third mercury, one-third rose oil, and small proportions of licorice, milk sugar, and possibly another quarter portion of hollyhock or marshmallow derivative. Two or three of these pills might represent close to a hundred times the level of exposure that the EPA considers safe today.

Calomel Preparation, Flavored

Calomel Preparation, Flavored

Benjamin Rush's Bilious Pills

Benjamin Rush’s Bilious Pills

Mercury poisoning usually shows up first with headache, nausea, stomach pain, and later, with sore gums and loose teeth. Eventually, symptoms move on to the brain and cause loss of memory and insomnia, and often irritability, depression, and paranoia as well. Since the alienist’s goal for his patient was a daily evacuation of the bowels, patients could take something like calomel or blue pill for quite some time. And, the psychological type of symptoms as a result of mercury poisoning might well keep the sufferer both in an asylum and taking the medicine indefinitely.

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Anyone Could Be Insane

Alsa Thompson, Age 4

Alsa Thompson, Age 4

Early alienists did not spare many conditions when it came to assessing insanity. Alcohol abuse, syphilis, and epilepsy, were often considered forms of insanity, as were the physical manifestations of a severe form of niacin deficiency called pellagra. Women with severe PMS or menopausal symptoms, or even too much interest in sex, could also be considered insane. Children did not escape that label, either.

Publicity Surrounded This Unusual Case

Publicity Surrounded This Unusual Case

In 1925, seven-year-old Alsa Thompson confessed to poisoning her family by putting sulphuric acid and ant paste in their evening meal. Fortunately, her intended victims found the taste so awful that they didn’t eat more than a bite or two of the meal, but the child’s troubled psyche had been exposed. Further investigation found that she had slashed her five-year-old sister’s wrists with a safety razor (which didn’t kill her), and had poisoned two canaries and a cat.

Judge Walter Gates dismissed the insanity complaint that had been brought against Alsa, but he did feel she needed to be under observation. He remanded Alsa into the custody of parole officer Jean McCracken of the local lunacy commission until she could be transferred to a state institution.

Some Contemporaries Obviously Doubted Alsa's Confession

Some Contemporaries Obviously Doubted Alsa’s Confession

Newspaper accounts of the time mentioned that she did not seem bothered by the accusation and simply stated, “I like to see them die,” when questioned about her motives. Her father vigorously defended her, and others thought she was simply impressionable and confessed to a crime she did not commit.

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How to Test for Insanity

Alienists Sought Help for the Insane

Alienists Sought Help for the Insane

Insanity is an elusive condition, and alienists (early psychiatrists) spent time and effort studying ways to detect it. In an article in the October, 1865 issue of the American Journal of Insanity, Dr. John Tyler admitted that “men differ so widely in their conduct and habits, that what would be manifest insanity in one man, might only be the natural and healthy and common conduct of another.” He also noted that insanity could be recognized more easily than described…one could look at deviations in a person’s normal behavior and recognize insanity. It was much more difficult to describe the person’s insanity in absolute or factual terms, however.

That did not stop Tyler from going on to give some guidelines for assessing insanity in a person:

1. Though he may not abandon friends or former occupations, the insane person begins to see the world and hold ideas only through his own inner lens or “personal laboratory.” Tyler said that these convictions were “coined by him, and not received by another.” That person will be inwardly convinced of something, rather than persuaded to it by outside facts or situations.

2. The madman is inconsistent. Tyler described a patient who insisted he was dead, yet ate, talked, and did other things inconsistent with being dead.

3. The insane person will have a “changed and peculiar expression of the countenance, of the eye, of the manner, movements, attitudes, etc.” Tyler admitted that this type of proof was hard for the layperson to recognize, but that it could be learned through “an acquaintance and domiciliation [sic] with the mentally diseased.”

There was certainly a prevalent belief at that time that a trained professional could detect an insane person just by looking at him. Eccentricity or a vibrant personality may have been a bit dangerous under the watchful eye of one of these self-confident alienists.

Isaac Ray, Asylum Superintendent and Alienist

Isaac Ray, Asylum Superintendent and Alienist

Depiction of Various Types of Insanity by J.E.D. Esquirol

Depiction of Various Types of Insanity by French alienistĀ  J.E.D. Esquirol

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In the Long Run

Pliny Earle, courtesy National Library of Medicine

Pliny Earle, courtesy National Library of Medicine

Insane asylums were initially embraced because they held out the hope of curing the insane, rather than merely incarcerating them. Recovery rates were high at first, in the typically small asylums where doctors could devote themselves to patient care and set up individualized plans. Continue reading

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Stigma Attached to the Insane

Beggar, created by Jan van der Vliet

Beggar, created by Jan van der Vliet

Most people would not be ashamed of breaking a leg or falling ill with the flu, and their family members likewise would not mind the world knowing about either condition. However, the same kind of acceptance has rarely applied to mental afflictions. There are many reasons for this lack of acceptance, but early issues included the probability of “getting well” or being permanently cured of a mental problem. Continue reading

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Sorrow, Vice, and Thyroids

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

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Advances in Healing

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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Attitude Is Everything

Officials Wanted to Keep Unfit People Out of the U.S., courtesy missouri.edu

Many people, both lay and professional, passionately debate the very essence of insanity. Some people believe that insanity is mainly a social construct, which can change over time as society itself changes. That is, what was once considered insane is now accepted as normal, or vice versa. Are there truly “insane” behaviors which every society, in every time period, agrees are insane? If not, how can insanity really be established if its definition changes over time?

This societal construct particularly gave trouble for those who didn’t fit mainstream society and weren’t protected by laws or tests which took culture or country into account. Early immigrants often faced criticism as they tried to integrate into American culture. Their different ways were either seen as merely odd or “foreign” and tolerated, or were actively disdained and suppressed. The real problem arose when someone with particularly odd behavior came to the attention of authorities. When the question of insanity arose, the standard that immigrants were judged against was not their own culture and what was accepted within it, but by the Anglo-based white culture in their new country. When immigrants came before an insanity commission or a typical alienist, they often did not present themselves to advantage. If the suspected lunatic could not speak English well, acted out nervousness and fear in odd ways, or refused to answer questions due to fear or confusion, heĀ  helped build a case for his insanity.

Ellis Island, courtesy Library of Congress

Immigrants Waiting Examination, courtesy Library of Congress

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