Category Archives: General History

A Special Veterans Hospital

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An Early View of the Government Hospital for the Insane

An Early View of the Government Hospital for the Insane

Though Armistice Day (November 11) was renamed Veterans Day only in 1954, veterans with mental health issues did have a special facility to meet their needs quite early on. Though crusader Dorothea Dix had pushed unsuccessfully for federal funding to help pay for America’s (civilian) mentally ill, she and other supporters did manage to get approval for a hospital for the insane of the army, navy, and District of Columbia. On January 15, 1855, the Government Hospital for the Insane received its first patient, Thomas Sessford.

Dr. Charles Nichols was the facility’s first superintendent, and he helped design one of the campus’s earliest buildings, the Center Building. One interesting feature was that the wards used different species of wood for their interiors: the Beech Ward installed woodwork from beeches, and the Cherry and Poplar Wards installed their interior woodwork from like-named trees. The patients had lovely views of the Anacostia River and farmland, and the grounds had extensive trees, shrubs, and flowers to give it a rural feeling of peace.

St. Elizabeths, 1917, courtesy Library of Congress

St. Elizabeths, 1917, courtesy Library of Congress

Allison Building's Sleeping Porches, 1910, courtesy National Archives and Records Administration

Allison Building’s Sleeping Porches, 1910, courtesy National Archives and Records Administration

The Government Hospital for the Insane became known during the Civil War as St. Elizabeths. Sick soldiers quartered in the hospital were embarrassed to write home from an insane asylum and simply substituted the historic name of the land patent on which the hospital stood. The name was made official in 1916.

My next two posts will discuss early care at St. Elizabeths, and its Civil War operation.

 

 

 

Any Problems With This?

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Kansas Pioneers Struggled Constantly

Kansas Pioneers Struggled Constantly

As pioneers pushed westward, mental health issues went with them or developed once settled (see last post). Kansas established its first insane asylum in 1863, which opened in 1866 and was known as the Kansas State Insane Asylum and later as Osawatomie State Hospital. Three trustees managed it until 1873, when a six-member board of trustees appointed by the governor took over. Trustees were paid three dollars a day (about $62 today) and mileage, as was a separate citizen committee which visited the institution at least twice a year.

Image result for early osawatomieOriginally, patients were admitted on a reimbursement plan, either through the county where they lived if impoverished, or through a bond given by their guardians. Private patients paid their own way. Some admissions were voluntary, but otherwise, someone who had been judged incompetent and had an appointed guardian, could be admitted via a jury of six people. One of the six had to be a physician with a regular practice and in good standing. A probate court would determine payment arrangements.

Osawatomie State Hospital's Old Main Building, Constructed in 1869

Osawatomie State Hospital’s Old Main Building, Constructed in 1869

Comprehensive legislation relating to the asylum in 1870 introduced another way of admission. This method did not inquire into a person’s insanity. Instead, a doctor could certify that he believed a patient was insane–and that certification along with a bond for maintenance signed by any individual and approved under a probate court–was enough to admit someone to the asylum. This sort of involuntary commitment could be made only at private expense, so indigent citizens were relatively safe from it.

Not so for patients whose absence may have benefited an unscrupulous relative or guardian in some way. We can certainly speculate about the number of inconvenient spouses, wayward children, and other undesirable relatives who resided in this Kansas asylum.

 

Loneliness Too Much to Bear

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The Vast Plains Could Be Lonely and Unsettling, photo of Kansas Plains courtesy of U.S. Department of the Interior, Geological Survey

The Vast Plains Could Be Lonely and Unsettling, photo of Kansas Plains courtesy of U.S. Department of the Interior, Geological Survey

Traumatic events could lead to madness (see last post) for vulnerable individuals, but other, more passive conditions could also affect mental health. Isolation and loneliness caused great distress in even the hardiest pioneers, as seen in cases of prairie madness encountered by homesteaders during the mid to late 1800s.

Away from familiar surroundings and without social support because of the distance between other settlers, victims could fall prey to great despair and hopelessness.This particular syndrome was not an official one, and had a loose set of behaviors that included depression, crying, apathy, and withdrawal, as well as violence and anger. The condition wasn’t even terribly uncommon: E.V. Smalley, the editor of Northwest Illustrated Monthly Magazine, said in 1893, “An alarming amount of insanity occurs in the new prairie States among farmers and their wives.”

Homesteaders Faced Different Conditions Than They Had in the East

Homesteaders Faced Different Conditions Than They Had in the East

Top issues for many settlers was the move away from home and everything familiar–this issue was even greater for immigrants who came from small, tight-knit villages and spoke a language other than English. The intense hardship of living on the prairie exhausted people physically and made it hard to visualize success. The landscape could be bleak and stretched for miles with no trees to break up the magnitude of isolation, while the wind itself blew constantly and irritated raw nerves beyond coping. Only when the Great Plains became more populated, transportation and communication improved, and towns sprang up, did the condition start to disappear.

A Sod House Was a Far Cry From Most Settlers' Former Homes, courtesy Library of Congress

A Sod House Was a Far Cry From Most Settlers’ Former Homes, courtesy Library of Congress

 

Anti-Insane Asylum Society

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Elizabeth Packard

Elizabeth Packard

Elizabeth Packard, who had been committed to an insane asylum by her husband for disagreeing with his religious views, was a fortunate woman–she was actually released from the institution. Afterward she pushed for a jury trial to plead her sanity and won, another uncommon victory for a woman who had been declared insane!

Packard later campaigned tirelessly on behalf of the insane, advocating particularly for laws that made commitment more difficult and writing books informing the public about the reality of treatment in an asylum. She also advocated for an Anti-Insane Asylum Society. Though it never became a popular movement, Packard’s simple Constitution for it would have made life easier for many others if it had been widely adopted. After an explanatory preamble, Packard asked members to pledge the following:

Asylum Where Elizabeth Packard Was Committed

Asylum Where Elizabeth Packard Was Committed

— To never consent to enter an asylum as a patient

— To never consent to have any relative or friend entered into an asylum as a patient

— That if [members] or anyone in their family became insane, they would be taken care of in their own homes

— That these people would be kindly and patiently cared for

— That if relatives of the unfortunates could not provide for their care, the Society would “furnish them the means for doing so”

— That the fund for helping unfortunates should be bestowed by a committee of the Society after investigation of the case.

One of Packard's Books

One of Packard’s Books

Though Packard’s Society never achieved national distinction, it became the forerunner of other ex-patient groups that have persistently arisen to help members who have received care at mental hospitals.

 

Authority Always Wins

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Investigative Reporter Nellie Bly Being Committed to an Asylum

Investigative Reporter Nellie Bly Being Committed to an Asylum

Whether a supposedly “insane” patient really was or was not, the odds were not in his favor when it came to putting up a defense against commitment and treatment. One potent factor against patients was the almost automatic presumption that the diagnosis they suffered was correct. (See last post.) Another factor was the very real authority and influence of an asylum’s superintendent.

Superintendents almost never initiated a diagnosis of insanity unless a person were sent directly to an asylum because of dangerous or noteworthy actions that seemed to put the patient or society at risk. In that case, a superintendent or one of his staff might examine the person and decide whether or not he was insane. Otherwise, some sort of panel or set of doctors/judges made the diagnosis and sent the patient to the (usually) nearest asylum. This certainly gave an appearance of impartiality to the superintendent, who might then be presumed to have only the patient’s best interests at heart.

Reverend Hiram Chase (mentioned in my last post) noted that he had once spoken with a man whose wife had been in an asylum for a long time. Chase asked the man what he thought about “the propriety of keeping one so many years in an asylum.” The man essentially replied that the doctors were wise and skillful, the nurses and attendants well skilled, that “great care and patience were exercised over the patient, and that no stone was left unturned to soothe and comfort these unfortunate victims of insanity.”

Attendants Were Not Nearly So Patient and Skilled as the Public Supposed

Attendants Were Not Nearly So Patient and Skilled as the Public Supposed

Dr. John Gray was Superintendent of the Lunatic Asylum in Utica During Chase's Commitment There

Dr. John Gray was Superintendent of the Lunatic Asylum in Utica During Chase’s Commitment There

Chase cheerfully accepted this husband’s words on the topic. Later, he unfortunately found them to be patently untrue once he was, himself, committed to the Lunatic Asylum in Utica [New York]. Chase stayed there for a little over two years and afterward wrote a measured but unsparing account of his stay that should have made others fearful of too innocent a trust.

 

Doomed From the Beginning

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Illustration of Ellizabeth Packard Being Taken Against Her Will to an Insane Asylum, courtesy National Library of Medicine

Illustration of Elizabeth Packard Being Taken Against Her Will to an Insane Asylum, courtesy National Library of Medicine

Patients who went–or were taken–to insane asylums frequently protested they were not insane and continued to do so during their treatment. Their protests fell largely on deaf ears because two particularly potent forces worked against them. The first was the presupposition of “guilt.” If they had been found insane, then they must be and of course they would protest that they weren’t. Furthermore, any violence, agitation, or emotional outbursts victims demonstrated either at commitment or during treatment would further work against them. Few people put themselves in the patients’ shoes and imagined how they would react if they were in the same situation.

Reverend Hiram Chase wrote in 1868: “I had never heard them [asylums] described , except in one instance, and that by a man who was so unfortunate as to be carried there by force by his neighbors, as most patients are carried there. He gave me a most horrible description of his treatment . . . . I heard his sad and tragical tale, but I disposed of it as most men do, by regarding the whole story as imaginary, the effect of a disordered mind, believing that such things could never be tolerated in a Christian country.”

Called a Belgian Cage, This Wooden Cage Has a Small Opening For the Patient's Meals, Showed Just How Cruel Confinement in an Asylum Could Be, courtesy National Library of Medicine

This Belgian Cage With a Small Opening For the Patient’s Meals, Showed Just How Cruel Confinement in an Asylum Could Be, courtesy National Library of Medicine

Chase’s view was shared by many. Obviously, someone who was insane would imagine all sorts of terrible things that weren’t true. Of course a patient might be paranoid and imagine the medicine or treatment was unjustified or made him or her feel badly. Unfortunately, the frustration patients felt, their anger at injustice and sometimes false and unfair imprisonment, could lead to violent outbursts, frantic emotional responses, or negative attitudes that seemed to make it apparent that they indeed needed help.

This 1910 Article Shows That Some Former Patients Fought Back

This 1910 Article Shows That Some Former Patients Fought Back

The second factor working against patients was just as potent, and I will discuss this one in my next post.

Laws Against Insanity

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Society Believed in Better Breeding

Society Believed in Better Breeding

Even early societies realized that traits could be passed from parents to children. This belief, though based in fact, presented a problem because people did not–or more probably could not–differentiate between conditions that were actually inherited and traits that cropped up in offspring because of upbringing and environment.

Parents who had a genuine mental illness could model behavior that their children picked up and displayed, for example, though the children were not themselves mentally ill. The community, unfortunately, would believe that the mentally ill parent(s) had passed the condition to their offspring–with the children’s behavior as proof. Men and women who saw mental illness in their immediate families were often afraid to marry because they believed their children might inherit insanity–and potential mates were just as often scared off by the prospect. Families of the mentally ill became wary of letting the community know about their loved ones’ condition because all relatives might be stigmatized.

Eugenics Advocacy Poster From the Philadelphia Sesqui-Centennial Exhibition, 1926

Eugenics Advocacy Poster From the Philadelphia Sesqui-Centennial Exhibition, 1926

As time went on, these ideas were upheld by law. An important immigration law which went into effect in 1882 prohibited entry into the U.S. of any “lunatic, idiot, or any person unable to take care of himself or herself without becoming a public charge.” Not satisfied with preventing undesirable people from entering the country from other lands, the U.S. began to adopt a mindset that felt it acceptable to prevent the reproduction of “undesirables” who were actually citizens. Eugenics* laws made it legal to forcibly sterilize people who were “insane, idiotic, imbecile, feebleminded or epileptic”–all in the public interest.

Immigration Laws Stopped Undesirables From Entering the U.S., courtesy Cold Spring Harbor Laboratory

Immigration Laws Stopped Undesirables From Entering the U.S., courtesy Cold Spring Harbor Laboratory

*Eugenics is the the science of improving a human population by controlled breeding.

Privacy Did Not Apply

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Chicago's Inter Ocean Newspaper

Chicago’s Inter Ocean Newspaper

Mental illness can still be a touchy subject today, but society has made great advances in de-stigmatizing its discussion. We look back on the shame and secrecy surrounding mental illness in earlier times and wonder at it, but families may have had good reason to keep a loved one’s condition secret. Today we have enough privacy concerning our medical status that it can be difficult to find out if a friend is in the hospital, but in centuries past, a person’s condition could be discussed in the newspaper. Here are two examples from 1897 issues of Chicago’s Inter Ocean:

Catherine T. is 56, and has been a terror to her family for seventeen years, or since the birth of her last child. Her doctor testified that she was something like a wild cat, when he was called in to see her; has been ill for six months, her husband thinking at first it was temper from her scolding so much. . .The woman was sent to an asylum, and although no last name was used, neighbors certainly could figure out who it was.

Newspaper Accounts Spared Few Details

Newspaper Accounts Spared Few Details

Catherine L. is about 35; she never speaks except under provocation, then she throws things at the head of any one within reach, and calls vile names, her language being very rough; talks to herself, and is often furious; she threatened to throw a burning lamp at a neighbor; her best friend seems to be herself, with whom she talks and laughs. . .

Public Care for the Insane Was Not Always Better Than That Provided at Home

Public Care for the Insane Was Not Always Better Than That Provided at Home

The unsympathetic tone of these snippets, along with publicly printing such embarrassing details, would make any family–at least in that day and age–anxious to hush up a relative’s awkward behavior.

Asylums Indeed

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A History of Rhode Island

A History of Rhode Island

Though insane asylums faced abuse charges after they became overcrowded, they were sanctuaries of peace measured against the care many insane patients had received in city-provided institutions. Cases written about in the book, State of Rhode Island and Providence Plantations at the End of the Century: A History (edited by Edward Field) is probably typical of treatment during the middle-1700s:

Rebecca Gibbs had been under the care of “the Towne of Newport” for 30 years and, “She seemed to be in a sense folded together, her lower limbs being drawn up to her breast so that her knees and her chin met and from this position there was never a change.” A physical deformity would have been bad enough, but Rebecca’s condition was caused by “her having been for several winters shut up in a cell without fire and without clothes, where she had drawn herself as compactly as possible together as a protection against the cold and had so continued till sinew and muscle were unable to relax.”

Thomas R. Hazard Wrote a Ground-Breaking Report on the Treatment of Rhode Island's Insane in 1851, courtsy Rhode Island Historical Society Library

Thomas R. Hazard Wrote a Ground-Breaking Report on the Treatment of Rhode Island’s Insane in 1851, courtesy Rhode Island Historical Society Library

In a different town, a man was chained and “so wrapped in bagging that when an apple was placed within his reach he could only gnaw it like an animal as it rolled about the floor and he rolled after it.”

Though some towns did treat the insane more kindly, that may have been the exception rather than the rule. Until the new idea of “moral treatment” based on kindness and retraining made its way to America in the 1830s, the insane could not expect comfort or help from society.

Rhode Island State Hospital for the Insane, Stone Hall, courtesy Rhode Island Department of State

Rhode Island State Hospital for the Insane, Stone Hall, courtesy Rhode Island Department of State

 

 

 

Changes at Last

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Collection of Dr. Alexander E. MacDonald's Papers, courtesy New York Academy of Medicine

Collection of Dr. Alexander E. MacDonald’s Papers, courtesy New York Academy of Medicine

In 1874 Dr. Alexander E. MacDonald accepted an appointment as superintendent for Ward’s Island’s insane asylum. Conditions there were dreadful (see last two posts) and MacDonald requested a new wing to the main building in 1878 to relieve some of the chronic overcrowding. Both patients and convicts worked on the new construction–not necessarily unusual for the period.

Cheapness had prevailed since day one, and professionals believed that many of the asylum’s cases became chronic because they had not been helped adequately from the start. Even meals were excessively frugal: “Dry bread was a staple article of diet, few accompaniments were permitted and much was diverted by the so-called “cook,” who was selected from the workhouse prisoners,” wrote one of the doctors compiling a history of New York asylums. His assessment is underscored by the fact that when an additional five cents was added to the dietary allowance, along with an improvement in cooking, more patients recovered.

A Supper of Bread, Butter, and Tea on Blackwell's Island, from an 1866 Illustration in Harper's Weekly

A Supper of Bread, Butter, and Tea on Blackwell’s Island, from an 1866 Illustration in Harper’s Weekly

Dr. MacDonald also improved patients’ clothing, bedding, and ward furniture and he fought for a “more liberal” amusement fund to help divert patients’ minds from their problems and give them some enjoyment during their stay. He also fought for attendants, saying that “$20 a month with board was too small compensation for 15 hours [a day] spent in the companionship of the insane.” He called for a whopping 50% increase in pay to $30 a month. Along with this, MacDonald protested using convicts as attendants and managed to get at least the female ones withdrawn. By 1880 he had stopped the use of restraints like manacles, wristlets, and seclusion.

Nellie Bly Posed as an Insane Woman for Her Expose

Nellie Bly Posed as an Insane Woman for Her Exposé

Though MacDonald tried with probably the best will in the world, the four institutions in the Manhattan region were often investigated for a variety of failures. Nellie Bly’s exposé in 1887 is probably the best-known, though many other scandals made it into public knowledge.