Tag Archives: alienists

The Mechanical Treatment of Insanity

Kings County Lunatic Asylum in Flatbush, NY

Kings County Lunatic Asylum in Flatbush, NY

Dr. William Hammond (who was not a fan of insane asylums) was appalled at the widespread use of restraints in U.S. facilities, comparing these institutions unfavorably with those in England which had just about abandoned the practice. He wrote: “At present [1883] ignorant and brutal attendants, some of them selected from the very lowest class, can, at their option, from whim, caprice, anger, or any other inadequate cause, order or place a lunatic in the camisole, crib, or other mechanical restraint.”

Hammond did not necessarily argue that all restraints be abolished, but his suggestions followed the course that British alienists used when they began to eliminate restraints. For patients who always took off their clothes, for instance, attendants could use “strong dresses which were secured around the waist with a leathern belt, fastened by a small lock.” Patients who were violent toward themselves or others, could wear “a dress, of which the sleeves terminated in a stuffed glove without divisions for the fingers and thumb.

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

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

One of Hammond’s suggestions to the state of New York, which asked his advice as it investigated the management of its insane asylums, was to keep the decision to use restraints out of the hands of attendants. Only the medical officer should decide to use mechanical means of control, and Hammond said that even with that safeguard in place, every order for restraint should be documented in a record book. That book, in turn, should be open to inspection.

Postcard of the Athens Lunatic Asylum

Postcard of the Athens Lunatic Asylum

The only two asylums in the U.S. which did not use restraints at all at the time of Hammond’s writing were the Kings County Asylum at Flatbush, Long Island and one in Athens, Ohio (Athens Asylum for the Insane) which he did not specifically name.

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Common Sense

Annie Payson Call

Annie Payson Call

Laypeople were interested in mental health, and by the early 1900s had recognized that their lives might be happier if they could overcome and control some of the mental distress which seemed rampant in their complex and hurried world. Annie Payson Call wrote articles for the Ladies’ Home Journal in which she offered advice to women who suffered various nervous afflictions. In her book Nerves and Common Sense (1909), she gave a case study of a woman’s problem and cure in her relationship with an irritable husband.

A brokenhearted woman complained to a friend about her husband’s unkindness and hard heart; after hearing her out, the friend helped her understand that the situation was essentially her own fault. Because she had been trying to please her husband and he didn’t notice her efforts, she had become emotionally distressed. “Now it is perfectly true that this husband was irritable and brutal,” said Call. However, because the woman was “demanding from her husband what he really ought to have given her as a matter of course,” she was wearing herself out and suffering to no avail.

Ladies' Home Journal Offered Women Advice

Ladies’ Home Journal Offered Women Advice

“She was a plucky little woman and very intelligent once her eyes were opened,” said Call. “She recognized the fact that her suffering was resistance to her husband’s irritable selfishness, and she stopped resisting.

“As his wife stopped demanding, he began to give,” Call related. “As his wife’s nerves became calm and quiet his nerves quieted and calmed.” It turned out that business worries had been at the root of his brutishness; once his wife stabilized her emotions he suddenly turned to her and confided his troubles. After that, all was well.

Patent Medicines Helped Nerve

Patent Medicines Helped Nerve

Call’s advice must at times have been trying in the extreme to her readers, but since she wrote many articles of this sort, they were obviously well-received enough that Ladies’ Home Journal continued to publish them. Many of her suggestions urged changes in attitude and thought, which probably worked well for readers who could not visit alienists (experts in mental health) or find sympathy at home.

 

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Madness in a Modern World Part Two

Crowded Train Platform in Victorian Era

Crowded Train Platform in Victorian Era

Life has always been stressful, so what was it about the nineteenth-century world that increased stress so much that alienists thought it contributed to a rising rate of madness (see last post)? Change itself brings stress, of course, and nineteenth-century humans were experiencing a great deal of change.

As telegraphs, telephones, locomotives, trolleys, and the like infiltrated daily living, it meant that the pace of life picked up for most people. Additionally, the noise level of society rose considerably as machines became more prevalent (even simple changes like clattering typewriters replacing writing by hand in offices). Studies show that constant noise increases levels of cortisol and adrenaline, which then have their own negative consequences on the body.

Interior of Magnolia Cotton Mills Spinning Room, Mississippi, circa 1912

Interior of Magnolia Cotton Mills Spinning Room, Mississippi, circa 1912, courtesy NARA

Not everyone embraced and trusted all the new inventions, either. Doctors diagnosed “elevator sickness” and “railway neurosis” brought on when people experienced the physical novelty and/or stress of using these new technologies. “Dyspepsia,” a term used to describe intestinal troubles of various kinds, was rampant in the nineteenth century–probably as a reaction to stress. Nervousness with life in general sometimes led to “neurasthenia,” a term encompassing feelings of anxiety, depression, irritability, and other symptoms of mental distress.

Noisy, Crowded Life in a New York Tenement, circa1890

Noisy, Crowded Life in a New York Tenement, circa1890

One of the positive beliefs alienists embraced was that insanity was not an inevitable hereditary condition, as had been previously believed. Instead, they began to believe that certain people were perhaps disposed toward insanity, but that it would only manifest if conditions were right. In the nineteenth century, it appeared that conditions were right for troubling symptoms to appear in many people.

 

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Madness in a Modern World

Edison and Light Bulb

Edison and Light Bulb

Politicians who supported an asylum exclusively for Indians often justified the need by parroting the claims of alienists. These specialists in mental illness maintained that the pressures of the modern world led to an increase in insanity. The fact that reservation agents couldn’t even find a hundred “insane Indians” at the end of the nineteenth century did little to support that notion. However, the rate of insanity was increasing among the rest of the population. And, alienists may not have been completely off-track in their thinking.

From the earliest times, people had lived in much the same way: they walked or used animals and boats for transportation, wrote messages to one another by hand, and planned their daily activities by the rising and setting of the sun. Suddenly, around 1830, tremendous changes occurred.

The Tom Thumb, courtesy Bureau of Public Roads, Department of Commerce

The Tom Thumb, courtesy Bureau of Public Roads, Department of Commerce

In 1827, the Baltimore & Ohio Railroad began transporting people and goods mechanically with a little steam engine called the Tom Thumb. In 1869, workers completed the first transcontinental railroad, which reduced a difficult wagon or stagecoach ride of several weeks or months to one week. Samuel Morse patented the telegraph in 1840, Bell patented the telephone in 1876, and Edison introduced the light bulb in 1879. These changes absolutely revolutionized daily living, especially in cities.

Horse-drawn Ambulance in Front of Fire Station on Race Street in Philadelphia, 1865

Horse-drawn Ambulance in Front of Fire Station on Race Street in Philadelphia, 1865

Even though these new inventions were embraced by the public, they also created distrust, stress, and fear as people began to accommodate and use them. An “Age of Anxiety” began in which there were new dangers everywhere–and the stress did indeed lead to mental breakdowns. (The prevalence of these inventions in cities is probably why alienists considered rural areas better for asylums.) My next post will examine this modern phenomenon further.

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Insanity is Lucrative

Oscar Gifford

Oscar Gifford

Early alienists tried to keep their profession closed from outsiders, both to maintain prestige and to ensure adequate salaries. They were very successful for many years, and superintendents of insane asylums were among the highest paid physicians in the field of medicine.

At a time when many family doctors earned annual salaries in the hundreds of dollars, asylum superintendents almost always earned at least two thousand.

 

Dr. John W. Givens, Idaho's First Licensed Alienist

Dr. John W. Givens, Idaho’s First Licensed Alienist

The superintendency of the Canton Asylum for Insane Indians was a plum position, particularly for the sparsely-populated area in which it was located. Its first superintendent, Oscar Gifford, was appointed strictly through political favoritism, since he was not a medical doctor. With only one or two exceptions over many decades, other asylum superintendents held medical degrees that were often from prestigious universities abroad.

Bloodletting As a Treatment for Agitation in Insanity, Essex Lunatic Asylum, 1860, courtesy Burns Archives

Bloodletting As a Treatment for Agitation in Insanity, Essex Lunatic Asylum, 1860, courtesy Burns Archives

In 1901, the Sioux Valley News triumphantly announced Gifford’s appointment while noting that it “was one of the best jobs in sight.” The position paid $2,500 annually. According to one inflation calculator, that salary would translate to $69,444.44 today. For someone without the proper education, training, or experience to hold it, the position was indeed a financial windfall. Gifford must have realized quite soon that he wasn’t qualified to run an asylum, but he held onto the job for as long as he could. His lack of medical knowledge cost at least one life, however, and the consequences of his mistakes eventually forced him out.

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Arbitrary Commitment

Elizabeth Packard Being Taken to an Asylum Against Her Will, courtesy National Library of Medicine

Elizabeth Packard Being Taken to an Asylum Against Her Will, courtesy National Library of Medicine

Alienists were notorious for their self-confident belief that they knew what was best for anyone with mental illness. In an essay from the July,1868 issue of the American Journal of Insanity, the (anonymous) author makes a case for doing away with legal procedures for commitment: “. . . other diseases, except those of a highly contagious type, do not call for civil interference nor court publicity.

We do not demand a commission or an inquest to decide whether a man has a fever raging into delirium, or whether he has a general paralysis, or whether a surgeon shall be permitted to amputate his limbs or trepan his skull.”

The writer went on to point out that if anyone saw a person sick or wounded in the street, “we take him forthwith to the nearest hospital, without stopping to canvass our legal right to restrain him of his liberty.”

Charles Guiteau Said He Was Temporarily Insane When He Assassinated President Garfield

Charles Guiteau Said He Was Temporarily Insane When He Assassinated President Garfield

The author lamented that a patient stricken with insanity was sometimes met with a suspicious relative who wasn’t convinced of his illness even though his other relatives were. Because of this suspicion, the patient, “against the wishes and judgment of the rest,” was then liable to the “questioning of the law and its ministers.” This then led to publicity, which might be detrimental to the patient’s recovery.

Though She Had a Trial, Mary Todd Lincoln Was Involuntarily Committed to an Asylum

Though She Had a Trial, Mary Todd Lincoln Was Involuntarily Committed to an Asylum

 

Most people, of course, would not want to be committed involuntarily to an insane asylum, and welcomed legal safeguards to prevent it. It is amazing to consider how differently alienists and laypeople considered the matter–it almost certainly boiled down to who was in control of the situation.

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Intervention in Insanity

Eliza Josolyne, Insanity Caused by Overwork, courtesy Bethlem Royal Hospital Archives

Eliza Josolyne, Insanity Caused by Overwork

Alienists (early psychiatrists) believed in actively treating insanity. Most believed that it was beneficial to a patient to completely remove him or her from familiar surroundings; the change would allow new thought patterns and behaviors to form more easily.

Many times, asylums were the change in environment alienists selected, but some recommended travel as a way to change a patient’s surroundings and get his mind focused on new things. Of course, early intervention was paramount, since all alienists believed “acute” insanity (active, new cases) were easier to cure than chronic ones of long duration.

 

Children's Dayroom at Byberry (Philadelphia State Hospital), circa 1938, courtesy Historical Society of Pennsylvania

Children’s Dayroom at Byberry (Philadelphia State Hospital), circa 1938

 

Dr. J. Parigot believed in the value of intervention to the extreme. Writing in 1864, he made the case that marriage should be avoided when undesirable traits were found in potential parents. This belief wasn’t strictly because he felt the traits would be inherited; it was additionally founded on a belief that parents with those traits couldn’t properly raise a child. He gave an example of intemperate parents who would have to be particularly careful to educate and develop their children so that they wouldn’t degenerate into intemperance themselves. Likewise, he said, “nervous and fidgety persons are incompetent to the direction and control of petulant and sometimes mischievous children.”

Children's Ward, 1927, Byberry (Philadelphis State Hospital), courtesy Historical Society of Pennsylvania

Children’s Ward, 1927, Byberry (Philadelphis State Hospital), courtesy Historical Society of Pennsylvania

To counteract the influence of tainted parents in cases of insanity, Parigot stated that: “Children who have inherited germs of mental disease should be separated from their parents, and educated under the eye of the psychiatrist. Sometimes their locality should be changed at the time of their birth. . . .”

Fortunately, such thinking was not generally accommodated by the public.

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Interesting Cases

Alienists Could Be Prominent Public Figures

Alienists Could Be Prominent Public Figures

Alienists (psychiatrists) wanted to provide good care for the insane in their midst, and in the early years offered assistance primarily¬† through therapeutic stays at insane asylums. These doctors’ favored regimens of rest, occupational therapy, and structured time probably served many patients well, but such programs could not help everyone. Alienists were still exploring the causes and treatments of insanity, and some of their thoughts missed the mark widely.

In an 1871 paper on mental disease (reported in the Transactions of the Medical Society of the State of North Carolina), the author described a “case of violent cerebral excitement” in a 5-year-old, which had been relieved by an oral dose of bromide of potassium. This case of “mental disease” seems to be clearly a case of epilepsy, and we can only wonder if the child was tagged for life as insane.

Another paper in the same publication discussed “Mania Transitoria,” or insanity of very short duration. During this type of mania, people could be fully aware of their surroundings (or not) and actions. It was brought on by such things as physical disease or the “accumulation of harbored feelings over a number of years.” The author seems to be describing explosions of temper or momentary passionate outbursts, but he attributed this type of insanity’s cause–or attributed it at least in part–to masturbation and petit mal epilepsy.

Craig Colony for Epileptics, courtesy museumofdisability.org

Craig Colony for Epileptics, courtesy museumofdisability.org

Cures For Epilepsy Were Plentiful

Cures For Epilepsy Were Plentiful

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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. Continue reading

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The Chronic Insane

Outagamie County Asylum for the Chronic Insane, Wisconsin, circa 1889

Outagamie County Asylum for the Chronic Insane, Wisconsin, circa 1889

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. Continue reading

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