Tag Archives: American Journal of Insanity

Understanding Insanity

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Alienist Dr. Allen McLane Hamilton, 1910

Alienist Dr. Allen McLane Hamilton, 1910

Even though alienists (the term for early psychiatrists) treated insanity with vigor and resolution, they usually could not say with any certainty what had caused the condition.

An 1879 article, “Early Indications of Insanity,” in The American Journal of Insanity stated that in general, the cause of all insanity could be found in the neglect of, or an infraction of, the “established laws of physical or mental health.”

Since this could encompass almost anything, the writer went on to the core of his article, which was how to determine that someone was going insane. Continue reading →

The Root of Women’s Mental Disorders

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Death Caused by Childbirth Insanity

Male alienists often thought that women were more susceptible to certain forms of insanity because of their female body organs (see last post). In the American Journal of Insanity, Dr. Fleetwood Churchill describes the evolution of merry childhood into womanhood, when a female becomes more serious and feels more deeply. “In short, under the influence of bodily development, her mind has expanded,” he says. In an article he published titled “On the Mental Disorders of Pregnancy and Childbed,” Churchill quotes other doctors; one noted that “insanity and epilepsy are often connected with menstruation,” and gave a case where a woman who had been confined for sixteen years, suddenly recovered when her periods ceased.

 

In a somewhat peculiar case in which the modern reader might find more than the doctor apparently did, a girl of 17 who had menstruated regularly for a year, suddenly stopped. Her mind became clouded, she spoke of herself as a castaway and doomed, and became completely insane. “Neither medicine nor change of air and scene did her any good,” said the doctor whom Churchill quoted. There was a happy ending, though. “The menses suddenly re-appeared, after eight or ten months absence. and she immediately recovered her mental health.”

Lydia Pinkham, Whose Patent Medicine Vegetable Compound Cured Female Problems

 

A Female Medicine

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The Trouble With Women

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Woman Demonstrating the Stages of a Hysterical Attack, courtesy Wellcome Library

Early alienists (mental health specialists) were men. They attributed much of women’s mental health issues to “female” problems with their ovaries or uterus. In 1893, Dr. Thomas Morton, Surgeon to the Pennsylvania Hospital and Chairman of Philadelphia’s Committee on Lunacy, wrote that surgical advances had made surgeries to the abdominal cavity relatively safe. Consequently, procedures removing the uterus and ovaries had been successful and had provided relief for patients with diseases of these organs. He added: “Frequently, such diseases are complicated by hysteria . . . and various forms of well recognized insanity which are thought to originate in and be maintained by the diseased or disordered state of these organs.”

When female organs were removed for disease, women were often relieved or cured of their accompanying mental disorders, said Morton, but just as often, were not. Some surgeons were evidently jumping onto an ovary-removal bandwagon, and Morton cautioned against an overenthusiastic use of these operations. “In many instances, insanity has resulted from this operation,” he warned. Morton gave a strong opinion that unless female organs were actually diseased, there was no justification for removing them. He included in his article a legal opinion from a colleague on the Committee on Lunacy, who concurred. “I am of the opinion that the operation . . . unless necessary to save life, is not only illegal, but, in view of its experimental character, is brutal and inhuman and not excusable on any reasonable ground.”

These two men had almost remarkable restraint toward women in an age when patronization and coercion were much more often the rule. Morton, in particular, recognized that symptoms of hysteria and other common “female” types of insanity might be associated with their uterine or ovarian distress, without being caused by it.

Hospital Demonstration of Hysteria in 1887, courtesy of Science Museum.org

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Pursuing an Agenda

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American Journal of Insanity

Asylum superintendents tended to support each other and their profession, and presented a united front to the public. Though they published studies and treatment-oriented articles in the American Journal of Insanity (AJA) and other medical organs, the AJA in particular reflected much of their philosophy.

In a July, 1868 article, “Admission to Hospitals for the Insane,” the author contended that it was especially unkind to make the insane endure a public hearing on their sanity. “If we find a man 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,” the author stated.

With the insane, however, relatives force publicity by requiring “an inquisition to establish the delirium or the lunacy,” the article continued. He said that there was no more reason why a magistrate or civil authority should inquire into treatment [for an insane person] than there was to “rescue a patient from the hands of a skillful surgeon who is binding him to an operating table to perform an amputation.”

This article is only one instance of an ongoing disagreement between the psychiatric profession and private citizens about the value of admitting (or coercing) patients into asylums without due process.

Amariah Brigham, founder of the AJA

Mary Todd Lincoln (Judged Insane by a Jury After a 10-Minute Deliberation)

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Useful Platform

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Missouri State Hospital Nurses, circa 1914, courtesy Missouri State Archives

Many superintendents took the opportunity to observe their patients and write about them, both to enhance their own reputations and to share information with colleagues. The American Journal of Insanity was the most important publication superintendents wrote for, since it had a wide readership among fellow alienists. The titles of their works show far-ranging subject matter:

“The Care of the Insane” by Charles Wagner, Superintendent of Binghamton State Hospital in New York.

“The History and the Use of the Term Dementia” by G. Alder Blumer, Medical Superintendent, Butler Hospital in Rhode Island.

“Night Nurses for the Insane” by C. R. Woodson, Medical Superintendent, Missouri State Hospital.

“The Favorable Modification of Undesirable Symptoms in the Incurable Insane” by A. B. Richardson, Superintendent, State Hospital, Columbus, Ohio.

In his quarter-century tenure as superintendent at the Canton Asylum for Insane Indians, Dr. Harry Hummer wrote one article about insanity: “Insanity Among the Indians.” He read this piece during the 1912 session of the American Medico-Psychological Association, and it was included in the four-volume work, The Institutional Care of the Insane in the U.S.A. and Canada, published in 1916.

Binghamton State Hospital

Butler Hospital for the Insane

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The Alternative Meal

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Though meals at asylums ranged in quality, it was far better to voluntarily eat a meal than to decline one. Doctors were concerned when patients refused to eat, often considering the refusal part of their mental condition. No matter how unpalatable a meal was, the alternative was probably worse.

An article in the American Journal of Insanity gave one doctor’s recipe for a meal delivered through a tube in the nostril: “A mixture of  two or three eggs, half an ounce of sugar, half an ounce of olive oil, and one pint milk or beef tea, strained through coarse linen cloth.”

The whole concoction could be administered within a few minutes. The doctor made no comment on his  patients’ reactions to the procedure.

forcefeeding2.JPG

These pictures show the trauma involved in force-feeding.

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New Ideas About the Insane, 1903

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Dr. G. Alder Blumer, courtesy Stanford Medical History Center

The last post discussed the confidence which characterized the field of psychiatry in its early years, specifically 1903. During the American Medico-Psychological Association meeting for that year, members could congratulate each other on the 750 pages of journal material which had been submitted and printed in the American Journal of Insanity. Though some topics or hypotheses might seem off-target to modern readers, they represented an attempt to understand and help patients in asylums recover their reason and return to society.

On a darker, note, however, was the Association’s discussion of insanity in general. The group’s president, Dr. G. Alder Blumer, had addressed the problem of “curtailing the evil of insanity” in one of the sessions. Curtailing insanity did not lie in bettering the treatment of the insane, according to Blumer. That merely perpetuated the problem. Dr. A. B. Richardson followed up these sentiments with this: “The general result [of charity toward the insane] is that the survival of the unfit is extended . . . they are nursed, protected, and housed, brought to a procreative age, and then turned loose on the community.” These prominent psychiatrists feared that the population of the insane would swell, since “they show a greater tendency to rear a proportionally larger family than the normal classes.”

This meeting was held the same year that the Canton Asylum for Insane Indians began its first full year of operation.

Crowded New York Lunatic Asylum

Waupaca County Asylum for the Chronic Insane, circa 1902

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Insanity Diagnosis

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Insane Epileptic Patient Eliza Whitfield, age 28 in 1889

Epilepsy always puzzled alienists (early psychiatrists) because of the strange behavior victims exhibited in contrast to the rationality they often also displayed between episodes. The American Journal of Insanity was full of articles about epilepsy, and continued to explore the topic after it became the American Journal of Psychiatry. One article in 1923 explored the question of psychotic symptoms in epilepsy.

The writers noted that patients were often described as having a “typical epileptic disposition.” An author they referenced described this disposition: “The whole life of the epileptic shows hatred. It bursts forth in all its brutality on the slightest provocation; the horrid the brutal, and all that is evil…”

It is no wonder that with this prejudice against them, many epileptics were confined to insane asylums based on their behavior during and after convulsions.

 

Admission Notes Showing Epilepsy, courtesy Gutenberg.org

An Epileptic Boy, courtesy Gutenberg.org

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Power at an Insane Asylum

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Dr. John Gray

Dr. John Gray

Superintendents were responsible for almost everything at an asylum. Though their responsibility might bog them down with administrative details, it also made their word law in the asylum. John Gray, superintendent of the New York State Lunatic Asylum at Utica, was arguably one of the most powerful of these powerful men.

Gray fired anyone on his staff who disagreed with him, and carried on ill-natured vendettas against fellow doctors and superintendents whose policies he disliked. Gray enjoyed the limelight and was criticized for spending too much time testifying in trials as an expert witness. He edited the American Journal of Insanity for many years, but was often accused of refusing to publish articles about insanity and its treatment when they differed from his own.

Gray spent 34 years at Utica. In 1886, after testifying as an expert witness, Gray returned to his office in the evening. Henry Remshaw, who may have been temporarily insane, walked into Gray’s office and shot him in the face. Gray never fully recovered from the attack and spent his remaining four years of life in poor health.

New York State Lunatic Asylum at Utica

New York State Lunatic Asylum at Utica

Utica Crib, used for disruptive patients

Utica Crib, used for disruptive patients

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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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