Tag Archives: alienists

Getting to the Core of Insanity

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Sigmund Freud

When the Canton Asylum for Insane Indians opened at the end of 1902, scientists and researchers were already striving to find ways to treat insanity other than by confinement in an asylum. Sigmund Freud, born in Moravia in 1856, was one of many scientifically-minded academics interested in mental health who did not necessarily want to become traditional, asylum-connected alienists (the nineteenth-century term for mental health specialists). He enrolled in the University of Vienna’s medical school in 1873, and received his medical degree in 1881. He decided to make a career in medicine with a specialty in neurology.

At the time, “hysteria” was a catch-all term for a host of physical symptoms that doctors felt likely originated in the mind. After studying in France with Jean-Martin Charcot, a neurologist researching the use of hypnotism, Freud became interested in the use of hypnotism to treat hysteria. Freud used the technique in his practice, but eventually felt that the procedure couldn’t ensure long-term success. He instead became intrigued with a treatment devised by a medical school colleague, Josef Breuer. Breuer had discovered that allowing hysterical patients to talk freely often abated their symptoms.

Freud came to believe that most neuroses originated from deeply traumatic events. Allowing patients to confront and discuss these traumas (in safe conditions) proved beneficial and relieved symptoms. Freud found that drugs and hypnosis weren’t necessary for the treatment to be effective; just allowing someone to get comfortable and talk was all that was needed. His “talking cure” proved popular with the public, who found much to like about its gentler approach–as opposed to a stay in an asylum. In 1906, Freud and seventeen other men formed the Psychoanalytic Society, which soon fell apart due to the divergent paths members took as they continued to study mental health.

Jean-Martin Charcot

Studies on Hysteria, by Breuer and Freud

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Recent Insanity

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Patent Medicine Like Nervuna Cured Nervous Weakness and Physical Exhaustion

Alienists made a distinction between chronic insanity, which was difficult to cure, and insanity which had only recently manifested and might be cured through quick intervention. An article written in 1900 by Dr. C. B. Burr, medical director of the Oak Grove Hospital for Nervous and Mental Disorders, explained the steps alienists ought to generally take when confronted by a potentially curable case of insanity. The first step was to reduce excitement. That meant that patients should lie in bed in a quiet room, under the observation of a day nurse and night nurse. Family members should be excluded from the sickroom.

Burr then discussed the chronic constipation found among Americans at that time, saying that neglect of the bowels led to a large percentage of nervous diseases. The first order of the day, then, was to administer calomel (a toxic mercury compound) to purge the insane person’s body of impurities, and then to keep it purged with laxatives and/or enemas.

Cocaine Products Were Sold Over the Counter in the U.S.

“Tonics and remedies to promote tissue building are needed in all cases,” continued Burr. Among milder preparations like eggnog and milk punch, Burr also recommended “the bitter tonics and strychnine, capsicum, and nux vomica” (a strychnine preparation). Burr discussed depression separately, saying that general treatment remained the same as for other types of insanity, but “certain drugs like kola, coca, and caffein, are useful also in painful emotional states.”

Nurse at South Carolina State Hospital Nursing School

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Hiawatha Asylum

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Canton Asylum for Insane Indians

One institution that Canton’s “boosters” hoped would put the town on the map was the Canton Asylum for Insane Indians, which was usually called Hiawatha or Hiawatha Asylum by locals. Large asylums for the mentally ill were still the norm across the country, and Hiawatha’s unique patient population seemed to promise renown. Alienists (mental health experts) tended to be very forceful and positive about their field of study, and were eager to add to their knowledge. Town leaders hoped that specialists would come to Canton to study the Indians there, or even conduct their own research.

The facility was smaller than most asylums, but still impressive. It was shaped like a cross, 184 feet long and 144 feet wide, with jasper granite foundations. The outside was of pressed brick with white stone trim on the windows and doors, and inside, a cement-floored basement ran across the entire floorprint. The building had over 100 light fixtures, as well as radiator heat and a modern sewage system. There were also tiled bathrooms and water closets which used range toilets. (This was a unified system which shared a common pipe–toilets flushed at intervals rather than after each use.) Hundreds of trees and bushes were planted on the facility’s acreage, and except for the seven-foot fence around the grounds, nothing indicated that it was a type of prison. Especially for a rural area, Canton’s asylum was a noteworthy structure.

One of the primary reasons the town fought the asylum’s closing was because of the blow it meant to Canton’s economy. During the Depression, the asylum was a reliable source of jobs, and could pay real money for the goods and services it procured. Except for a few local asylum opponents, no one wanted to see the institution shut down.

Center Building, St. Elizabeths, Another Government Insane Asylum

Colorado Insane Asylum, circa 1890

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Female Asylum Patients

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Western Lunatic Asylum, Male Ward 1892, Female Ward, 1893, courtesy Virginia.gov

Women were assumed to be more delicate–mentally as well as physically–than men, and thus would become insane more often. Alienists (early psychiatrists) accepted this as the truth, but there does not seem to be a comprehensive 19th-century study that actually verifies this assumption. If some asylums held more women than men, it may have been because women had fewer legal rights and were easier to commit. And, as homemakers and primary caregivers, women often looked after male household members who were insane and thus kept them out of asylums. Men could not always do the same even if they had been inclined to, since most heads of household had work obligations. It is likely that many women ended up in asylums because no one could take care of them, or it was simply easier on their male relatives.

At the Canton Asylum for Insane Indians, men outnumbered women as patients over the life of the asylum. From available records, about 212 men and 155 women spent time at Canton Asylum; this figure includes two babies who were confined with their mothers for a period. Though the patient list is doubtlessly incomplete, it does show both the gender imbalance at the asylum as well as how few patients the asylum actually treated over more than 30 years. Though Dr. Hummer pleaded continually for expansion, there does not appear to have been a patient population which would have made expansion justifiable.

Female Ward in Athens, Ohio, Lunatic Asylum circa 1893

Staff, Athens Lunatic Asylum

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Experimental Psychology

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Women Working on Farm as Part of Moral Therapy

In a general sense, patients at asylums were always an experiment in progress. Most alienists didn’t understand why people became insane, and didn’t really know how to cure insanity. Moral therapy, a relatively benign treatment, relied on the idea that a disciplined, busy schedule with plenty of sympathetic conversation, would take patients’ minds off their troubles and help them synch back up with society. Except for the situation itself (being in an insane asylum), this therapy was a fairly gentle attempt to help patients. Many, who perhaps only needed a change of scenery or some diversion to break a melancholy train of thought, probably did benefit from this therapy.

Some twentieth century therapies were more extreme.  The last stages of syphilis produced symptoms of insanity, and the condition was usually called “syphilitic insanity.” Doctors infected patients with malaria, hoping the high fever would stop syphilis’s progress. Julius Wagner-Jauregg won a Nobel prize for this therapy. Another leading psychiatrist gave schizophrenic patients high doses of barbiturates to induce deep sleep as a treatment. Another treatment for schizophrenia was insulin shock, in which doctors injected patients with large doses of insulin to produce comas. This therapy was used until the 1950s.

Fever Therapy

Insulin Shock Therapy

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Other Families

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Interior Staircase, New York City Lunatic Asylum

Early superintendents of insane asylums asked for large, beautiful facilities amid a park-like setting, because they thought the environment within imposing structures would help cure their patients. Asylums were built to serve the poor and middle class, rather than the rich, and these lovely “homes” were deliberately built to be as unlike a patient’s typical home as possible.

Alienists (early mental health experts) believed that insanity was often caused by something in the patient’s home environment. By leaving that unhealthy environment, patients could renew their minds and get well. Family visits were actively discouraged, and it wasn’t until late in the century that superintendents began to consider trial visits home, or furloughs, as beneficial.

Dr. Hummer, the superintendent of the Canton Asylum for Insane Indians for the majority of its existence, did not seem to move with the times. He always discouraged visits by family members, and only once or twice allowed a patient to go home on a trial basis.

Social Room at Arizona Insane Asylum

Visitors Arriving at Missouri State Hospital for the Insane

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Chronic Insane Are a Problem

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Vanderburgh County Poor Farm, circa 1900

Early mental health specialists differentiated between the acute insane–curable–and the chronic insane, for whom they felt little hope. Alienists believed that insanity was curable if it could be caught and treated early, and were eager to get patients into institutions as quickly as possible. The beautiful, elaborate  institutions they supervised were specially constructed to jolt someone who had recently become insane from his or her mindset, and restore it to health.

Even though it was seldom cured, chronic insanity was still a problem society needed to address.  Alienists argued that it was far cheaper to house the insane in large institutions that were nearly self-sustaining, than to throw them in prisons or poorhouses where there was little opportunity for them to help earn their keep. Additionally, some chronic insane would be cured in an asylum, thus saving society the expense of housing them for a lifetime. Because of these arguments, several states built asylums specifically for their chronic insane.

Winnebago County Asylum for the Chronic Insane, 1899

Willard Asylum for the Chronic Insane

 

 

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RELATED POST:

Better Treatment for the Insane


The Incurable Insane

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Waupaca County Asylum for the Chronic Insane, circa 1902, courtesy Wisconsin History and Genealogy website

Waupaca County Asylum for the Chronic Insane, circa 1902, courtesy Wisconsin History and Genealogy website

When asylums were first built, alienists had high hopes that their patients would be quickly cured. Most felt that if families could bring patients in soon after the onset of symptoms, therapy and a changed environment would be helpful. Superintendents tried to get patients, then, during the “acute” phase or within a year of their becoming insane.

Families didn’t usually act this quickly. They often tried to keep family members at home until their symptoms became too difficult to manage. Asylums began to get patients who had been insane for a long time, and there was not as much hope for a cure. At that point, asylums began to differentiate between acute and chronic care. They spent most of their energy with patients they thought stood a good chance of returning to society. Asylums provided little more than custodial care to the chronic insane, and institutionalization became a lifelong fate for these unfortunate patients.

Institutional Check

Institutional Check

Nursing the Insane

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Florence Nightingale

Florence Nightingale

Nurses fill a vital role in caring for patients in any institutional setting, and today’s nurses are trained, skilled, and professional. That was not always the case. In the late 1800s, attendants were typically male, and often incompetent or uncaring. Florence Nightingale set the bar higher for nursing when she went to Crimea in 1854, but twenty years later, medical men were still lamenting the lack of qualified and willing people to help the insane.

One problem the profession faced was a lack of systematic instruction for attendants or nurses. Except for the religious orders, there were no permanent schools to train people for nursing even as late as 1880. Some medical superintendents tried giving lectures on nursing care, but they were often attended by just a handful of people. Alienists (early psychiatrists) understood that they could help the situation by attracting women to nursing.

Stewards and Nurses, Brooklyn Navy Yard Hospital, Detroit circa 1890-1901

Stewards and Nurses, Brooklyn Navy Yard Hospital, Detroit circa 1890-1901

 

Group of Male Attendants, 1890s, Spring Grove Hospital

Group of Male Attendants, 1890s, Spring Grove Hospital

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Those Crazy Kids

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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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