Category Archives: General History

Work and Money

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Clarinda State Hospital Was Impressive

Clarinda State Hospital Was Impressive

Even new insane asylums–presumably built by the demands of a state’s constituents–often had money woes. For many institutions, funds were only provided every two years via legislative appropriations. This meant that they were built piecemeal, seemingly always a step or two behind the real needs of patients and their families. Clarinda State Hospital in Iowa is probably typical.

Iowa’s General Assembly passed an Act to establish the asylum in April, 1884 and the Iowa Grand Lodge of Masons laid the cornerstone in July. A central building and supervisor’s department were nearly finished by December, but it wasn’t until the 1886 session that money was appropriated to go further. The institution opened late that year and accepted its first patients: 222 males received from other asylums. As legislative sessions continued, the asylum received additional funds for building and continued to complete the design which had been planned for it. Finally, in 1897, the asylum stood as a complete entity.

Patients Working in Laundry Room at Fulton State Hospital circa 1910, courtesy Missouri Archives

Patients Working in Laundry Room at Fulton State Hospital circa 1910, courtesy Missouri Archives

As soon as patients arrived, they began working. They graded, sodded, planted, and farmed–hard work rather than the “light” therapeutic work that alienists sincerely believed helped patients occupy their time, divert their minds, and heal both mind and body. Besides the outdoor toil, patients helped a hired tailoress make all the clothing worn by patients (except for white dress shirts, hose, and hats). The asylum’s residents also made their own furniture and shoes, brooms, and mattresses under the supervision of professionals assisted by patients.

Patients Worked at Useful Tasks at Most Asylums, photo courtesy Buffalo Psychiatric Center

Patients Worked at Useful Tasks at Most Asylums, photo courtesy Buffalo Psychiatric Center

Though work did help patients–especially if they wanted to do it–the probability remains high that many patients were subtly coerced into labor they would not have done otherwise. For superintendents charges with controlling costs, the proximity of so much free labor was likely a temptation they didn’t always resist.

Ways to Treat the Insane

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Leisure Time at Southwestern Lunatic Asylum, circa 1890, courtesy Southwestern Virginia Mental Health Institute

Leisure Time at Southwestern Lunatic Asylum, circa 1890, courtesy Southwestern Virginia Mental Health Institute

Around the time of the Civil War, alienists were still hammering out the best ways to treat the mentally disturbed. Asylums were much more common, and a great majority of alienists felt that removal to one would benefit most patients more than home care. What they particularly stressed was an immediate change of scenery–either to an asylum or by travel–for a patient in the first stage(s) of insanity. By getting this person away from the environment that had brought on the problem, doctors could often snap the person out of the state of mind causing the insanity.

Labor of some kind was also beneficial for the physical health and mental recovery of the insane, which led most asylums to set up gardening and workshop programs for their patients. The author (Dr. J. Parigot) of an 1864 article “General Mental Therapeutics,” did stress that labor must be voluntary. “Free-will labor has the advantage that patients instinctively choose occupations in accordance with their state of health,” Pargot noted. But he also gave the following caveat: “. . . patients ought never to be converted into machines and tools for private speculation.” He was very much against using patient labor to keep down expenses so that an asylum could be self-paying or profitable.

Interior of Shoe Shop, Willard Asylum for the Insane

Interior of Shoe Shop, Willard Asylum for the Insane

Unfortunately, therapeutic labor soon came to include drudge work and difficult farm and dairy tasks that most patients probably did not enjoy. As asylums took in more patients with less per capita state funding, they had to rely on patient labor to offset the costs of food and other goods.

Patients Picking Cotton at Alabama Insane Hospital

Patients Picking Cotton at Alabama Insane Hospital

My next post will continue to discuss therapeutics during the Civil War era.

Plight of the Attendant

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Stephen Smith, State Commissioner of Lunacy in New York, courtesy Appletons Encyclopedia

Stephen Smith, State Commissioner of Lunacy in New York, courtesy Appletons Encyclopedia

Most asylum accounts deal with the hardships patients faced, but the employee side had difficulties as well. Dr. Stephen Smith, the State Commissioner of Lunacy in New York, wrote about a particularly difficult type of patient for a paper submitted to the National Conference of Charities and Corrections in 1885. In his “Care of the Filthy Cases of Insanity,” Smith explained the problems caused by this particular “class” of patients.

Filthy patients were those who constantly soiled themselves (whether by accident or design) and required a great deal of any conscientious attendant’s time. In his paper, Smith wrote:  “I have seen patients in the asylums of this State who were thoroughly bathed, and had a complete change of under-clothing, and two or three times of their external clothing, eighteen times in a single day. And this occurred in spite of constant watchfulness to anticipate their wants.”

Male patients being washed by hospital orderlies. Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org Male patients being washed by hospital orderlies, Long Grove Asylum, Epsom. In the Royal College of Psychiatrists. circa 1930? Published: - Copyrighted work available under Creative Commons by-nc 2.0 UK, see http://wellcomeimages.org/indexplus/page/Prices.html

Male patients Being Washed by Hospital Orderlies, courtesy Wellcome Library, London. Wellcome Images
images@wellcome.ac.uk

Smith encouraged asylums to place filthy patients on a toilet training and personal care program. He also recommended that sufficient staff for a “night service” be employed, their duties being to help with this training program and to ensure messes were promptly cleaned so as not to disturb other patients in the room. When these measures were adopted, Smith had seen wonderful improvements in ward cleanliness, neat and tidy patients, and a much more pleasant atmosphere. Though constant vigilance would have been burdensome, it is still easy to believe attendants would rather have watched these patients closely than clean them up after an accident.

Executive Committee of the National Conference of Charities and Correction, courtesy of the social welfare library, vcu.edu

Executive Committee of the National Conference of Charities and Correction, courtesy of the social welfare library, vcu.edu

Because many asylums cut their night staffs to provide simple monitoring rather than active care, the financial burden to provide more attendants was likely rejected by most asylums. Day attendants were also stretched thin to save money, but without these measures in place,  the stress of time-consuming and unpleasant clean-ups very likely caused more than a few attendants to snap–either at the offender or a handy target.

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.”

 

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.