Central Lunatic Asylum

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Howard's Grove Hospital

Howard’s Grove Hospital

Virginia’s Central Lunatic Asylum was the country’s first asylum designated exclusively for the “colored insane.” The institution’s first report explained that the state of Virginia had established the asylum for “colored persons of unsound mind” on the grounds of Howard’s Grove near the city of Richmond.

Howard’s Grove Hospital–a former Confederate possession–had been taken over by the Freedman’s Bureau in 1865. The agency used it as a hospital for African-Americans in the area and also for any who wandered in from other places. The Freedman’s Bureau allowed insane patients to stay at the hospital, and in December 1869 the facility was organized as an asylum by order of the military governor of the state, General Canby. At that time, there were 24 males and 45 female patients.

Building for Chronically Ill Females at Central Lunatic Asylum

Building for Chronically Ill Females at Central Lunatic Asylum

Virginia took control of the asylum in 1870 and its governor appointed an 11-person court of directors to oversee it; they supported the superintendent’s request for more money to build additional wards in his first report of November 1870. By then, an additional 110 patients had been admitted (December 1869 – November 1870). Eighteen patients had been discharged, fifteen had died, several “idiots” had been sent to alms-houses while a few remained, and altogether 150 persons were in the asylum for treatment on November 1, 1870.

Shenandoah County Alms House, courtesy Shenandoah County Library Archives

Shenandoah County Alms House, courtesy Shenandoah County Library Archives

Records on many of the patients were incomplete, but besides “unknown” the two primary causes of admission were “religious excitement” and “congenital idiots and imbeciles.” The two primary forms of mental disease were “chronic mania” and “dementia” with “paroxysmal (temporary) insanity” running a close third.

Asylums Were Economical

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Exercise Yard at the Oregon State Insane Asylum, circa 1905, courtesy Mental Health Association of Portland

Exercise Yard at the Oregon State Insane Asylum, circa 1905, courtesy Mental Health Association of Portland

Besides the humanitarian reasons to create asylums–which included more success in curing insanity than any family attempts could hope to achieve–supporters could also point out solid savings for the states which funded them.

By the time asylums became popular for the care and treatment of insanity, states had accepted responsibility for citizens who had no means of support or who caused undesirable disruptions in society. Early on, many of the insane wound up in jails because they had no families or their families simply could not give them proper care. Violent cases, of course, were the most problematic for families to handle.

Willard Asylum Patients Working in the Sewing Room

Willard Asylum Patients Working in the Sewing Room

Asylums were able to hold costs down by using patient labor on a much wider scale than most city or county jails could. Many asylums grew their own food and made or manufactured necessities like clothes and shoes. Charities, clubs, and individuals were far more likely to provide amenities (newspapers and magazines, concerts, clothing, etc.) to asylums than to jails, and states generally could provide the insane better care at less expense in asylums than regional jails.

Central Lunatic Asylum

Central Lunatic Asylum

The Central Lunatic Asylum in Virginia had filled almost as soon as it opened, and after only four months of operation, its first Board of Directors pleaded for money to build additional wards so they could take in patients who had been turned away for lack of space. After making a case for more appropriations based on humanity and the higher quality of care found in asylums versus jails, the Board also said:

“Besides the plea of humanity, economy may be urged as a reason for granting the appropriation. It will cost less to support the colored insane at the Asylum than in the county jails, and the prospect of relieving the State of all expense in each case is increased by promptly affording the Patient the benefits of the Asylum.”

 

What Can We Do?

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1800s Plasters to Induce Blisters, courtesy Library of Virginia

1800s Plasters to Induce Blisters, courtesy Library of Virginia

For much of psychiatry’s history, experts were only able to treat symptoms, rather than the causes of mental illness. When insane asylums first came into public use, most alienists had largely abandoned Dr. Benjamin Rush’s (considered the Father of American Psychiatry) depleting treatments, but they still had to find ways to deal with their patients’ moods and behaviors.

One treatment popular in this beginning era of psychiatry was to use a counter-irritant on patients. Doctors would blister someone who was manic in order to divert his/her attention; they would also blister someone who was melancholic in order to “divert the mind from its morbid train of thought.”

Tartar Emetic Was Definitely Potent

Tartar Emetic Was Definitely Potent

For recent cases of insanity–also called acute cases and the most hopeful of recovery–alienists applied tartar emetic ointment to the back of the neck. This ointment consisted of potassio-tartrate of antimony added to one ounce of lard or other carrier; the compound “will produce an eruption on the skin very similar to small-pox in appearance.” Presumably the pain of the treatment would keep a patient’s mind off his original problem. Cold compresses to the head, cold baths or showers, and warm baths with vigorous rubbing of the extremities were also useful treatments for insanity.

Water Therapy Could be as Confining as Restraints

Water Therapy Could be as Confining as Restraints

Readers will note that all these treatments were uncomfortable if not actually painful for the patients. However, inflicting pain seldom deterred alienists intent on “helping” their patients with mental issues.

(These treatments are discussed by Dr. Edward Cowles in the July, 1894 issue of the American Journal of Insanity in his review of psychiatry’s progress over the past few decades.)

Sherlock Again

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Image from Doyle's Story, The Creeping Man

Image from Doyle’s Story, The Creeping Man

Sir Arthur Conan Doyle’s Sherlock Holmes stories illustrate several Victorian ideas about insanity and its causes (see last post). In “The Adventure of the Naval Treaty,” Doyle described a case of acute mania which was resolved with prompt and proper care–an entirely understandable outcome. However, with “The Creeping Man,” Doyle’s understanding of the external causes of human behavior seems to be completely awry.

In this mystery from 1923, Professor Presbury’s personal secretary tells Holmes and Watson about his employer’s peculiar changes in behavior. Holmes eventually discovers the bizarre reason for the professor’s changed behavior: Presbury started to behave like a monkey because in a quest for youth, he began using a serum obtained from monkey blood/glands. This serum has given him the animal’s traits.

Insane Asylum at Kankakee

Insane Asylum at Kankakee

The idea behind this story sounds ridiculous, but Doyle may have been taking a cue from real events. In 1899, the New York Times had reported on Irwin Fuller Bush, a young man considered hopelessly insane and admitted to the Insane Asylum at Kankakee (Illinois). He had been almost miraculously restored to health by Dr. B. P. Roberts, a physician in Greene City, Missouri who treated Bush with animal glands. Roberts said, “Today, through the treatment with lymph from glands of goats, Bush is at home and declared to be completely restored in mind.”

Meeting of the Medical Staff, Kankakee Mental Hospital, circa 1910

Meeting of the Medical Staff, Kankakee Mental Hospital, circa 1910

The glands were also said to “arrest senility.” Roberts was enthusiastic enough about his treatment to go to Europe and try to convince alienists there to adopt the treatment in their own insane asylums. This real-life event and others using animal glands to cure various ailments, simply reflected the medical community’s imperfect understanding of what caused physical and mental changes in people.

Writing Madness

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Sir Arthur Conan Doyle

Sir Arthur Conan Doyle

Though modern readers can find old treatments for mental health laughable, they made sense to a generation just beginning to move away from even more archaic thought on the topic. Victorian-era conceptions about “madness” are wonderfully illustrated in Sir Arthur Conan Doyle’s Sherlock Holmes stories. Doyle had a medical degree (University of Edinburgh, 1881) and had practiced medicine before writing these mysteries, so his presentation of mental illness and its causes likely reflected his own, educated views on it.

Rather than look at madness as a permanent state deriving from physical roots, newer thought allowed for events like shock, overwork, and stress to precipitate bouts of insanity that could hopefully prove temporary if given correct–and timely–care. This idea played out well in “The Adventure of the Naval Treaty.” In the narrative, a young man in a trusted position lost valuable papers and felt himself ruined over it. He tells Holmes and Watson that upon trying to go home after his discovery: “I had a fit in the [train] station, and before we reached home I was practically a raving maniac.”

Illustration from Doyle's Story Concerning Temporary Madness

Illustration from Doyle’s Story Concerning Temporary Madness

Woman Admitted to Bedlam Hospital for Acute Mania, courtesy The Sun

Woman Admitted to Bedlam Hospital for Acute Mania, courtesy The Sun

He went on to tell the two that he had been “raving with brain fever” for nine weeks, but that with the tender care of his fiance and doctor, he had just recovered his reason. This episode clearly fit the modern idea that shocks and emotional turmoil could cause insanity–and that so-called acute (recent/short) episodes of insanity, if acted upon quickly, could be cured.

 

 

 

Overcrowding and the Attendants’ Plight

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Agnews Insane Asylum Patients Eating Lunch, courtesy Detroit Public Library Digital Collections

Agnews Insane Asylum Patients Eating Lunch, courtesy Detroit Public Library Digital Collections

Overcrowding in asylums created miserable conditions for patients (see last post), but it also made attendants’ workload overwhelming and stressful. They had little time off compared to even today’s harried worker: usually a half day off a month, a couple of evenings off a week, and an entire Sunday off once a month. Additionally, attendants usually lived on-site and could seldom “get away” from their work atmosphere–long hours and stress just added to their own mental burden.

Attendants started their days early in order to get patients up, out of bed, and dressed at 6:00 a.m. or 7:00 a.m. each morning, and perhaps wash and change soiled patients the night shift had missed. They supervised patients’ daily activities, broke up altercations, noted their illnesses or other changing conditions, bathed and/or shaved them, and helped serve meals. Attendants cleaned incessantly, and kept constant watch over their wards for any dangerous conditions stemming from violent, suicidal, or delusional patients.

Male Attendants at Willard Asylum for the Chronic Insane

Male Attendants at Willard Asylum for the Chronic Insane

Attendants also needed to socialize with patients: they gently steered them from obsessive or disturbing thoughts, reassured them when they worried about family and friends, led them into constructive conversation, and so on. Ideally, they could be the trusted friend and mainstay that supplemented the efforts of the asylum’s medical staff.

Attendants at Pennsylvania Hospital for the Insane

Attendants at Pennsylvania Hospital for the Insane

Unfortunately, these important therapeutic tasks were usually the first to go when the work of physically caring for patients overwhelmed attendants. Even worse, their own stress and frustration could spill over into their interactions with patients, making a miserable environment even worse for them.

And All The Rest

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Female Patients Farming in the early 1900s

Female Patients Farming in the early 1900s

Care in private insane asylums could be quite nice (see last post), but quality care in public institutions usually went downhill once they became popular enough for the public’s demand to lead to overcrowding. Many superintendents held costs at bay by growing their own crops, making patients’ clothing, rearing livestock, and so on, with free patient labor. This labor was at first genuinely believed to be therapeutic, but as work shifted from “light” and enjoyable to strenuous and ongoing, these activities lost much of their therapeutic value. Some patients did note, however, that they appreciated work because it helped pass the time and made them tired enough to sleep.

Overcrowding at Philadelphia State Hospital, courtesy 1946 Department of Welfare Report

Overcrowding at Philadelphia State Hospital, courtesy 1946 Department of Welfare Report

Staff interaction is typically where overcrowding made the biggest impact, particularly with attendants. Staff became overwhelmed with their workloads and simply couldn’t provide the level of care that many patients needed. A paragraph in the March 28, 1900 issue of The Washington Post gives just a glimpse of this issue:

St. Elizabeths' Center Building, circa 1900, courtesy National Archives

St. Elizabeths’ Center Building, circa 1900, courtesy National Archives

“The conditions existing in the disturbed ward of the women’s department are especially deplorable . . . it is necessary to keep the most troublesome under constraint, but, owing to the fact that the accommodations in the sleeping rooms are now entirely inadequate and it is impossible to confine those who are most troublesome, it is necessary to use the straight [sic] jacket or the sleeved vest, binding the arms of the patient while he or she is mixed up with the others in the corridors of the wards. Their cries and piteous struggles make the other disturbed patients more and more uneasy, until all rest is impossible and the chances for cure there made more remote.”

 

Excellence for the Entitled

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Sidis Psychotherapeutic Institute, courtesy Sidis Archives

Sidis Psychotherapeutic Institute, courtesy Sidis Archives

Early asylum care was dramatically better than what families could provide at home (see last post), but institutional care began to fail once asylums became popular enough to be overcrowded. Legislators were aghast at the public’s demand for more admissions, which consequently meant more available rooms, buildings, staff–and public funding. State governments typically met this challenge by insisting that asylums make their money go further, which often meant skimping on amenities and staff.

Dining Room at Sidis Psychotherapeutic Institute

Dining Room at Sidis Psychotherapeutic Institute

This didn’t need to happen at private establishments where patients could pay for the level of care they wanted, or for private-pay patients at public institutions. Boris Sidis, who opened his private institution, the Sidis Psychotherapeutic Institute in New Hampshire in 1910, knew to emphasize the luxurious accommodations available. “Palatial rooms, luxuriously furnished private baths, green houses, sun parlors, and private farm products” were just some of the amenities sure to delight his patients and set their families’ minds at rest.

Boris Sidis, courtesy Atlantic Monthly, 1922

Boris Sidis, courtesy Atlantic Monthly, 1922

Sidis charged between what would be (in today’s dollars) $1,000 – $2,000 a week for his services. One can only imagine how nice life could have been there, and what a pleasant retreat his institute was for  patients who went there voluntarily, as many did.

What Price for Care?

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In the 1800s Families Could Be as Medically Informed as Most Doctors

In the 1800s Families Could Be as Medically Informed as Most Doctors

The public originally supported insane asylums because they offered genuine hope. Typical at-home care provided little focused psychological expertise for patients, so recoveries within this family system had been few and far between. (One exception might be for conditions  like “melancholia” that could perhaps be treated by a change of scenery.) However, when professionally staffed asylums gave patients the time and attention they needed, recoveries did occur, and the former life-sentence of insanity seemed to have lifted.

John and Thomas Bailey, Father and Son Admitted Simultaneously to an Asylum for Melancholia, courtesy Museum of the Mind

John and Thomas Bailey, Father and Son Admitted Simultaneously to an Asylum for Melancholia, courtesy Museum of the Mind

Asylums were imposing, beautifully constructed, and reassuring. Superintendents who had actually been trained in the treatment of insanity–unlike family doctors who may have read a book or two on the topic–added to that reassurance. Families lost their reluctance to send loved ones to asylums and many times were rewarded for their faith. Even those who knew a family member would never recover could at least have the physical and psychological burdens of care lifted from their own shoulders.

Bloomingdale Asylum Presented a Lovely and Imposing Picture

Bloomingdale Asylum Presented a Lovely and Imposing Picture

That first wave of care paved the way for successive waves of continually poorer care as more and more families took advantage of asylums and stretched their resources too thin. At that point, money made all the difference. My next post(s) will discuss some of the differences money made in the quality of care for the insane.

Escape Was Possible

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Newspapers Often Alerted the Public to Escapes

Newspapers Often Alerted the Public to Escapes

Many patients who were involuntarily committed to asylums were understandably anxious to leave. Though most did not have the wealth and eventual aid that patients like Chanler did (see last post), many still managed to escape. These patient escapes were usually termed “elopements” by the psychiatric community, perhaps because the word “escape” sounded very much like patients were prisoners.

August H. Bloom came to the Hastings Asylum in Minnesota on September 2, 1905 and escaped two days later. The asylum’s superintendent described this patient’s escape and the actions he took subsequent to it, which were probably common to most other institutions. “Whenever a patient elopes, we advise the operator at the depot, who notifies the agent on either side of Hastings; we also send out from two to three attendants looking for them.”

Hastings State Hospital, courtesy Minnesota Historical Society Library

Hastings State Hospital, courtesy Minnesota Historical Society Library

The superintendent would then advise any family members of the escape, and ask to be notified if the patient made his way to relatives. If the patient did manage to return home and the family wanted him/her to remain, the superintendent bowed to their wishes. Otherwise, if the superintendent got word that a patient had been captured away from home, he sent an attendant to get the person. If someone elsewhere brought the patient back to the asylum, the superintendent paid the person’s expenses.

Birds Eye View, Red Wing, 1907, courtesy LakesnWoods.com Postcard and Postcard Image Collection

Birds Eye View, Red Wing, 1907, courtesy LakesnWoods.com Postcard and Postcard Image Collection

August Bloom apparently bounced around a bit and then settled in Minneapolis. In the summer of 1906 Bloom traveled a short distance away to Red Wing, where he killed the Chief of Police and one of his officers. Even though Bloom had been known to be an escaped asylum patient, no one suspected him of being capable of violence until this incident occurred.