Tag Archives: melancholia

Difficulties in Examining Patients

For Many Families, Asylums Offered Relief From Difficult Relatives

For Many Families, Asylums Offered Relief From Difficult Relatives

Dr. McDonald tempered his approval of New York’s more stringent commitment laws (see last post) with his recognition that even two qualified doctors called in by the family to make a diagnosis could run into problems. “As a rule you may divide the relatives of an insane person into two classes, those who want to send him to an asylum at all hazards, and those who want to keep him out at all hazards,” McDonald said.

Jean-Martin Charcot Demonstrating Hysteria in a Patient at the Salpetriere Hospital, 1887

Jean-Martin Charcot Demonstrating Hysteria in a Patient at the Salpêtrière Hospital, 1887

McDonald further stated that much of what physicians would hear from relatives would be untrue, irrelevant, guesswork, and blame, which did little to help make a diagnosis. Frequently, the various relatives would blame others for the breakdown; the husband of an insane wife would blame his in-laws for her condition, while they blamed him. For this reason, McDonald advised physicians to try and get information from a servant or family friend, who might be less biased. He also cautioned them not to give in to relatives’ requests for any kind of trickery, but to always present themselves as physicians.

An Article From the Trenton Evening News, November 7, 1898, Showing a Change in Behavior Leading to an Insanity Diagnosis

An Article From the Trenton Evening News, November 7, 1898, Showing a Change in Behavior Leading to an Insanity Diagnosis

McDonald believed that nearly all the insane had delusions of some sort, which would confirm their condition if a doctor could get at what they were. However, he also wrote of a patient coming to his asylum who had been diagnosed with melancholia along with delusions of persecution and injury. The man improved greatly, but held on to a delusion that unknown enemies continually entered the house where he had lived and poisoned his food. Because of this delusion, McDonald and his staff kept the man in the asylum . . . until other members of the household told him that the story was actually true.

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Motherhood and Mania

Puerperal Mania in Four Stages, 1858

Puerperal Mania in Four Stages, 1858

The “baby blues” or its more severe form, postpartum depression, afflicted women well before the modern era. Asylum notes indicate many cases of melancholy in new mothers, as well as other types of difficulties in adjusting to a birth. In 1830 British physician Robert Gooch noted: “Nervous irritation is very common after delivery, more especially among fashionable ladies, and this may exist in any degree between mere peevishness and downright madness.”

Some new mothers may have been depressed, some simply exhausted in an era where families were large and housework involved a great deal of manual labor, while others may have been resentful of the demands motherhood placed on them and the lack of control they had in determining whether or not to have more children. Doctors and midwives alike noted the special mental state, called “puerperal insanity” that women could fall into after labor. Many believed that the stress of labor and confinement caused some mothers to kill their babies.

By 1858, puerperal insanity sometimes made up 25% of  female admissions to British asylums. Surprisingly for the era, treatment was not the usual regimen of bleeding, blistering, and purging, but instead incorporated gentle common sense–plenty of rest and quiet, patience and understanding, and a good diet. Particularly for poor women, a stay in an asylum could have meant the only bit of uninterrupted rest they would ever have from the demands of a large family; some women seem to have appreciated their stays very much.

A Woman With Typical Large Family

A Woman With Typical Large Family

 

Puerperal Mania, 1890 Death Record from Michigan

Puerperal Mania, 1890 Death Record from Michigan

 

 

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A New Asylum

Patient Dining Room at West Virginia Hospital for the Insane, 1912

In his first official report, when the asylum was new and Superintendent Oscar Gifford had fewer than 20 patients, his glowing words probably did not fall too fall short of what was actually going on at the Canton Asylum for Insane Indians. “The patients are provided with a healthful, well cooked diet” which included eggs, milk, and fresh vegetables grown in the asylum garden. It is not too difficult to believe that a cook could have provided such meals for the relatively small staff and patient population that existed, and at that point, actually took great pride in her part of the new enterprise.

“The medical treatment has been tonic in character excepting in such cases and at such times, where antispasmodics, eliminants or other special treatments were indicated. . . . .In the treatment of melancholia an unlimited amount of patience and forbearance is required to insure good results, and our work in this regard I think has been a success. The epileptics require constant oversight, but the convulsions have been largely controlled, not alone by sedatives but by tonics . . . .”

Though no one likely wanted to come to the asylum, patients probably did receive far more individual attention from the full-time physician on staff (Dr. John F. Turner) than they would have received at any reservation.

A Sample Eliminant

Various Tonics, courtesy National Library of Medicine, National Institutes of Health

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Hummer Made Exceptions

Images of Melancholia and Recovery

Though Dr. Harry Hummer did not seem to consider anyone ever completely cured of insanity (see last two posts), he was sometimes willing to let patients return home if they could be cared for properly by family. In this, he probably had some genuine concerns for the patient. He was likely aware of the many instances in which Native Americans had lost property due to unscrupulous outsiders, and he knew that some of his patients had allotments that needed protection. Hummer also felt that certain conditions required care that might be too much for naive family members who didn’t understand the burdens of round-the-clock attention.

When convinced that patients would do well under family care, Hummer did sometimes release them willingly. In 1911, Lucy Gladstone came to the Canton Asylum for Insane Indians because of a suicide attempt. For several months, Hummer treated her for depression and some sort of seizures. Gladstone grew better and worked in the sewing room and with the laundry; she was tidy and quiet, and gradually came out of her depression. Within the year, Hummer considered her so much recovered that he released her to the care of her brother and felt confident enough to let her travel to his home without an escort.

Patients Working in Laundry Room at Texas State Lunatic Asylum

Patients in Sewing Room at Willard State Hospital for the Insane

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Those Crazy Kids

Harry Cherkos, Feeble-Minded Child, Selling Papers, 1910, courtesy Library of Congress

Harry Cherkos, Feeble-Minded Child, Selling Papers, 1910, courtesy Library of Congress

Twentieth-century psychiatry embraced many conditions as madness, including epilepsy, alcoholism, and melancholia (what we now call depression). Early psychiatrists, called alienists at the time,  did not hesitate to stick an “insanity” label on a host of conditions, nor did they excuse any member of society.

Dr. John H.W. Rhein began a 1915 article in the American Journal of Insanity by discussing insanity in children. He stated that few children were in asylums because it was easier to treat them at home. The youngest case of insanity in children (on record) was nine months, said Dr. Rhein. Of 39 cases he had personally studied, five were in 5-7 year-olds.

Neurotic and Epileptic Child, courtesy Library of Congress

Neurotic and Epileptic Child, courtesy Library of Congress

Here is a typical case: Female, age 5. “After being threatened with being shut up in a closet and having heard tales of dark places where witches live and the like, was very much frightened…and for months thereafter raved and muttered about hobgoblins. When she recovered she was very much changed.”

A Case of Paralysis in an Insane Child, 1899, courtesy National Institutes of Health

A Case of Paralysis in an Insane Child, 1899, courtesy National Institutes of Health

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