Author Archives: carla

Teddy Roosevelt’s Nerves

Young Theodore Roosevelt

“Nervous disease” or more generally, neurasthenia (see last post), was a uniquely American disease of the 20th century. It affected mainly high achievers and the wealthy who exhausted themselves by the stress of their pursuits.

Teddy Roosevelt (born in 1858) was from a wealthy family whose mother could not cope with domestic responsibilities and developed neurasthenia. Roosevelt himself was a sickly child who managed to heal through a rigorous exercise program that included boxing. However, his father’s death gave him an emotional and mental blow that was hard to overcome. Roosevelt became depressed, endured drastic mood swings, and fell into heavy drinking at college; he recovered after falling in love with and marrying Alice Hathaway Lee. However, on February 14, 1883, both his wife and his mother died within a few hours of each other.

Roosevelt as a Cowboy in Dakota Territory, courtesy Theodore Roosevelt Collection, Harvard College Libray

Roosevelt as a Cowboy in Dakota Territory, courtesy Theodore Roosevelt Collection, Harvard College Library

Only 25, Roosevelt was devastated and again developed symptoms of neurasthenia. Physician Silas Weir Mitchell typically put women to bed for a rest cure when they developed neurasthenia, but he sent men to the West where they could rope cattle, hunt, explore rugged terrain and ride horses. Roosevelt followed Weir’s protocol and went to Dakota Territory, spending the next two years working cattle and working as a sheriff.

Col. Theodore Roosevelt, of the Rough Riders, 1898, courtesy Underwood & Underwood

Roosevelt’s encounters with cattle thieves and lawless gangs–along with developing the skills needed to break and ride wild horses–changed both his body and mental condition. When he returned East, he married his childhood sweetheart and became the politician and conservationist remembered today. Roosevelt considered physical exercise so important to his well-being that he even brought in a professional sparring partner so he could box at the White House after becoming president.

The American Disease

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Chart From American Nervousness, Its Causes and Consequences, 1881

“Nervous” diseases became prevalent toward the end of the 1800s; most manifestations were lumped under the term neurasthenia. Some public commentators believed the condition was entirely manufactured, since it seemed to affect only the wealthier people in the country. Others were convinced it was a real condition brought on by the stresses of modern life and the burdens of business. Almost all agreed that it was a peculiarly American disease.

Writers tended to mock “nervous” women who went to rest homes, sanitariums, or cruises to recover from neurasthenia, but seemed to find the condition more credible in men. “Americans who make money or achieve marked success generally have neurasthenia at some time in their lives,” said the Fort Wayne Sentinel in 1890. Nervous strain was a natural part of these successful lives, and eventually, the body succumbed to “nervous exhaustion.” Doctors often compared neurasthenia in men to the mental aberration called hysteria in women.

Nerve Medicine Aimed at Men

Symptoms of neurasthenia included fatigue, anxiety, headache, heart palpitations, and depression. Treatment in general terms emphasized rest, a change of scenery, and freedom from responsibility and care. Specifically, treatments could include massage, ocean bathing, electrical stimulation, and hypnosis. Of course, nerve tonics became popular as well. These “secret” formulas often included strychnine, morphine, cocaine, and opium among other questionable ingredients.

This Elixer Said It All

The term neurasthenia has faded, but its symptoms live on as chronic fatigue syndrome, “burn-out”, and similar terms that denote high stress and its effects.

For A Price

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Dr. Boris Sidis

“A good many people are beginning to realize that nervous diseases are alarmingly on the increase …. Nerves are the most ‘prominent’ complaint of the 19th century,” wrote one reporter in an 1887 issue of the Boston Globe.

As always, medical entrepreneurs found ways to accommodate the trend to everyone’s satisfaction. When a case of “nerves” became unbearable to a person or unmanageable for the family, alienists found a way to cater to wealthy patients’ need for privacy and luxury. The Sidis Psychotherapeutic Institute was an example: it was a private asylum containing “beautiful grounds, private parks, rare trees, greenhouses, sun parlors, palatial rooms, luxuriously furnished private baths, private farm products,” according to a brochure designed to appeal to Professor Boris Sidis’ expected clientele.

Images From the Sidis Psychotherapeutic Institute

Sidis also had a reassuring message for them. “It is well known and correspondingly deplored among physicians and psychologists,” Dr. Sidis explained, “that there are fully 50pc. of mentally disturbed cases that cannot be cared for in an insane asylum. These cases are of persons who are not actually insane, but who are on the verge of that condition. Also, they are not physically ill, or if they are ill it is not so serious that they should be sent to a hospital.”

McLean Asylum for the Insane Began as a Mansion Purchased from Joseph Barrell

McLean Asylum for the Insane in Charlestown, Massachusetts Began as a Mansion Purchased from Joseph Barrell

For families wishing to avoid the stigma of insanity, a private “institute” or sanitarium was far preferable to a crowded state-run asylum manned by poorly paid and trained staff. These private asylums probably gave patients–many of whom undoubtedly had genuine mental illness–the relief they needed and served the purpose for which they were created. However, they came with a price most of the country couldn’t afford. Sidis charged today’s equivalent of $1,000 a week–out of reach for all but the wealthy. No matter how desperate they might have been to put their loved one in the best place possible, most families had to settle for state asylums.

Mothers and Madness

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Puerperal Mania in Four Stages, 1858

Alienists in the 1800s believed that most madness stemmed from a physical cause that then created mental symptoms. Women, because they were physically weaker, were more prone to madness and had to be sheltered or restricted from many stressful situations. Unfortunately, motherhood–woman’s highest calling in the minds of many and almost unavoidable for married women–could be an “exciting cause” of insanity because of its physical strain on the body.

Madness associated with pregnancy fell under the general term “puerperal insanity” and was further divided into three categories: gestation, lactation, or parturition (childbirth). The insanity of gestation tended to be rare and usually manifested during first pregnancies; its symptoms included melancholia, suicidal thoughts, and apathy. It was generally cured upon the birth of the child. The insanity of lactation had similar symptoms but tended to occur during subsequent pregnancies. This type could be more serious and end with complete dementia, though it typically resolved within a few months. The insanity of parturition was quite different–women manifested manic symptoms rather than melancholy. These mothers talked incessantly, couldn’t sleep, rejected their children or husbands, cursed, and otherwise dismayed and dumbfounded the males in their lives.

Admission Statistics, Including Puerperal Insanity, courtesy Missouri State Archive

Women were often committed to asylums during these problematic episodes. Fortunately, physicians generally treated puerperal insanity with–for the time period–restraint and common sense: rest, food, purging, and sedation. Depending upon the symptoms, patients might also be closely watched or confined to prevent them harming themselves.

1890 Death Record from Michigan

Though the diagnosis of puerperal insanity probably stemmed largely from the male gender-bias that expected women to be gentle, subdued, and “ladylike” at all times, male physicians did recognize that in most cases, the condition would be short-lived. Rather than being confined in an asylum for years, most women recovered in six months or so and resumed a normal life.

Unhappily Ever After

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Charles Dickens Tried to Have His Wife Committed to an Asylum During His Affair With a Young Actress, photo circca 1850 of the Charles, Catherine, and Two of Their Children

Charles Dickens Tried to Have His Wife Committed to an Asylum During His Affair With a Young Actress, photo circa 1850 of Charles, His Wife, and Two of Their Children, courtesy Smithsonian Magazine

Most families hesitated to commit their loved ones to insane asylums until they became violent, uncontrollable, physically ill, or burdened with conditions that required constant care (hallucinations, suicidal tendencies, etc.). Unfortunately, men sometimes sent the inconvenient women in their lives to asylums, and married women were especially vulnerable.

In 1882, Mrs. Martha J. Collins suspected her husband of infidelity, and when she actually gained proof of it, he retaliated by sending her to the Kings County Lunatic Asylum in NY, and later, to Bloomingdale Asylum. Doctors released her as sane almost immediately from each institution, but her husband pressed on and sent her to the Buffalo State Asylum for the Insane. After five weeks, she managed to get a letter delivered to her legal counsel.

Buffalo State Asylum for the Insane

Mrs. Collins’ attorneys argued that she had been committed illegally, and the asylum’s authorities considered her sane enough to be released into the care of her husband. After discussion (probably rather heated on her part) Judge Smith of the Superior Court released her unconditionally. When her husband approached her, she said, “Mr. Collins, I will shake hands with you: but that is all,” and refused to return home with him unless he agreed not to imprison her again.

A Desperate Elizabeth Packard Tries to Change Her Husband’s Mind About Committing Her to Jacksonville State Hospital in Illinois

Refusing to return home was a courageous step for a woman of that time, who likely had little money of her own or any way of earning a living. She did keep a diary about her asylum experiences, and planned to have it printed. Hopefully, the publicity protected her from any further bullying by her husband.

Medical Conditions and Insanity

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John Taylor, Who Was Committed to Lancaster County Asylum (UK) in 1901 for General Paresis of the Insane

Physical conditions like epilepsy sometimes brought their victims a diagnosis of insanity because of the behaviors these conditions manifested. Other diseases and physical problems were likewise misdiagnosed and forced victims into insane asylums rather than more appropriate hospital treatment. A man described in the October 15, 1870 issue of the British Medical Journal was probably typical. He had been admitted after paranoia and hallucinations made it impossible for him to care for himself. He was only 35 at the time of admission, but had “led an irregular life” for many years prior.

“He said he underwent nightly a kind of torture,which he called the “cylinder finish”, and which he described as an excruciating process, by which his brains were whirled round with extreme velocity, mixed into a pulp, and replaced in his skull just in time for his awaking. This, he believed, was ordered by the doctor, who knew of everything that was done to him, and had the power of regulating the amount of his sufferings,” wrote Dr. H. Grainger Stewart. Commitment to an asylum for a patient like this seemed to make perfect sense.

Al Capone Was Released From Prison in 1939 After a Diagnosis of Syphilis of the Brain

Alienists knew there was little they could do for patients with this form of insanity, called general paralysis of the insane (GPI), beyond giving them sedatives to help them sleep. And sadly, by the time these extreme symptoms manifested, patients often did not have long to live.

Much of Syphilitic Insanity Could Have Been Prevented With Prompt Treatment for the Initiating Disease

Physicians were able to make a tentative link between GPI and previous exposure to syphilis, but weren’t certain because syphilitic insanity did not respond to treatment with mercury the way syphilis did. However, when the bacterium that caused syphilis was discovered in 1905, a test was developed shortly thereafter to detect its presence. Doctors finally realized that untreated syphilis was the cause of the deteriorating mental condition known as general paralysis (or paresis) of the insane.

Comparing Insanity Rates

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Black Patients Received Less Funding for Mental Health Care, Montevue Asylum in Maryland, circa 1909

Alienists knew that the rates of insanity for various races differed, and came up with several explanations for it. One particularly condescending theory about the lower rates of insanity found in Native Americans and blacks was that these races didn’t face the responsibilities and pressures that so-called “civilized” races did. Especially for blacks, so long as they remained slaves and had most decisions made for them, the theory went, they were relatively untroubled by insanity. With freedom and its burdens, however, came overwhelmed minds that led to mental breakdown.

In 1914 Dr. Mary O’Malley at St. Elizabeths’ (Government Hospital for the Insane) compared rates of white and black insanity. What she found initially fit right in with the “civilization” theory: In 1860 during slavery, “one in every 5263 colored persons were insane . . . and in 1910 there was one in every 723 colored persons insane.” O’Malley noted that between 1860 and 1910, insanity in the “colored population” had increased 1,670 per cent.

However, when she studied black and white female* patients–an important distinction–at St. Elizabeths, her results were much less skewed. During the previous four years, 345 black and 455 white women had been admitted. Rates of specific mental conditions proved interesting:

Dr. Mary O’Malley in Center Photograph, photo courtesy of Flickr, taken from History of the Medical Society of the District of Columbia, 1817-1909

Dementia praecox: (black) 37%; (white) 37%

Organic brain disease: (black) 16%; (white)13%

Undifferentiated psychoses (black) 6%; (white) 4%

Manic-depressive: (black) 9%; (white) (11%)

Diversional Occupation at Central Lunatic Asylum in Virginia, the Country’s First Institution for Colored Persons of Unsound Mind

Rates for other diagnoses were similarly close. One distinction that O’Malley did find was that black patients had much lower rates of melancholia and suicidal tendencies. This was especially surprising considering the rates of poverty and lack of status for blacks during this time period.

*Because these women were not veterans as most of St. Elizabeths’ male patients would be–and thus coming from widely differing backgrounds and from many birthplaces–they represented a fairly even-matched pool of impoverished women in the Washington, DC area.

Debating Restraints

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Illustration Showing a Black Man Sitting in a Chair Wearing a Straitjacket, courtesy National Library of Medicine

When British physician Dr. John Bucknill visited U.S. insane asylums and wrote an article about his observations for the October, 1876 edition of the American Journal of Insanity (see last post), he discussed the issue of restraining patients. British asylums had done away with restraints almost entirely, and Bucknill did not like to see them used as freely in the U.S. as he saw during his visits. In his discussion about their use in America, he made the following observations:

Dr. Green of the Georgia State Asylum said that he did not like to use restraints, but did with four classes of patients. These were: suicidal patients, persons who will not remain in bed, persons who persistently denude themselves of all clothing, and inveterate masturbators.

Bucknill also mentioned that Dr. Ranney, who prided McLean Asylum with bringing its use of restraints down to a very low level, still used mechanical restraints on the following types of patients: those exhibiting acute mania; patients who wound themselves, creating ulcers that would never heal themselves unless their hands were confined; epileptic patients who so often became violent; persons whose feelings are greatly perverted and prone to see insults or evidence of conspiracy, who were sometimes little less ferocious than wild beasts; and persons in the throes of acute delirious mania.

McLean Asylum, courtesy Boston Public Library, Digital Commonwealth

“It will be observed,” said Dr. Bucknill, “that . . . we already have nine classes of lunatics who need mechanical restraint, in America.” He added that Dr. Slusser of the Ohio Hospital for the Insane added another class: “. . . those who persistently walk or stand, until their extremities become swollen, and they give evident signs of physical prostration. I have no way of controlling such, but by tying them down on a seat.”

This addition made ten classes of patients needing restraint, but Dr. Bucknill continued with a list of other reasons doctors restrained their patients until he named “fourteen classes of the insane altogether who absolutely need mechanical restraint in the State Asylums of America.” Bucknill noted some ways that British asylums found to avoid restraints, but realized that the American mindset was simply different on this issue.

Mock-up of a Patient in a Restraining Device Called a Utica Crib

Bucknill did say, “Is it surprising that, at the present time, the management of asylums for the insane in America is the subject of mistrust with the people?”

A Room of One’s Own

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Blockley Alsmhouse

Few patients in mental institutions were so out of touch with reality that their surroundings made no difference to them. One of the pillars of early psychiatric theory was that a patient’s environment did, indeed, made a great deal of difference. This is a particular reason alienists recommended bringing patients out of their old home environments and into the insane asylum’s new one. The implication, of course, was that the asylum’s was better. Most planners did strive to provide stately, serene buildings within a pastoral country setting. The reality did not always match their hopes.

The October, 1876 issue of the American Journal of Insanity included an article by Dr. John Bucknill, “Notes on Asylums for the Insane in America.” In it, Dr. Bucknill pointed out some glaring deficiencies within Philadelphia and New York asylums.

Dr. John Bucknill

In Philadelphia, a collection of buildings called the Blockley Almshouses, included an insane asylum. The place was constructed to hold 500 patients, and instead held 1,130. Beds were strewn on any available floor space at night to accommodate the extra people, and consequently the air become humid and smelly. Dr. Bucknill noted that there was nowhere for patients to exercise.

The female ward was particularly shameful. In a space designed to accommodate 19 “excited patients” in single rooms, instead held 65 women. The rooms were only six feet by 10 feet to begin with, which was justified by their use to for manic or disturbed patients. Unfortunately, Dr. Bucknill wrote, “. . . these lodging rooms are occupied at night generally by two, and frequently by three persons, and all of them, as I was informed, were regularly put into strait-jackets to prevent mischief during the night.”

Woman Wearing a Strait Jacket in Bed, 1889

How anyone–staff, trustees, inspectors–could have seen this situation and expected patients to recover their sanity says a great deal about the people running it. Dr. Isaac Ray, in an 1873 paper read before the Social Science Association of Philadelphia, said of the conditions: “If homicide is not committed every night of the year, it is certainly not for lack of fitting occasion and opportunity.”

Notes on the Past

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Friends’ Asylum for the Insane

Though it is impossible to fully understand a patient’s real state of mental health from a hundred years’ distance, old doctors’ notes and similar memorandums offer tantalizing clues to researchers today. The case of Caroline Stille is such a case.

A long note concerning the history of her insanity includes the fact that Mrs. S. “has been insane, at short intervals, ever since the age of puberty, at which time she was in the Friends’ Asylum near Philadelphia.” (This note was written in 1878, and put the patient’s age at 50, so the patient was probably born in 1828.) Mrs. S. transferred to another hospital and then into Massachusetts General Hospital in 1841, which put her at about 13 years old.

Oddly, the sentence immediately after the statement that she was in Massachusetts General in 1841 continues: “After her marriage in the same year she exhibited evidence of mental obliquity and moral perversions which rendered her domestic relations extremely unhappy.” Did this mean she married at 13, or merely that her mental symptoms occurred the same year she married?

Addiction Was a Huge Problem in America During the 1800s

And the note then continues, “At this time it was (?) that she was and had long been in the habit of using large quantities of opium and perhaps of alcohol.” Could this woman have become addicted to opium while a patient at one of the various hospitals she stayed in during her puberty? Did she take it routinely for some reason as a young married woman? Whether her marriage was actually in 1841, or later, she never left an asylum after 1857 when she would have been 29.

Opium Was Used Routinely for Women’s Complaints

Did doctors not recognize the symptoms of opium addiction? Or, did they believe Mrs. S.’s symptoms stemmed from some other cause? Whatever happened, by the time this unfortunate woman was 50 years old in 1878, the writer of her mental history could only say: “I earnestly desire that, for the sake of her children, the grievous scandal of their mother’s conduct may be prevented by her permanent restraint in an Institution for the Insane.”

The writer merely signed with the initials “A. S.” and was probably her husband.

Healing, Hell, and the History of American Insane Asylums

The History of Insane Asylums

Author Archives: carla

Teddy Roosevelt’s Nerves

The American Disease

For A Price

Mothers and Madness

Unhappily Ever After

Medical Conditions and Insanity

Comparing Insanity Rates

Debating Restraints

A Room of One’s Own

Notes on the Past