Category Archives: Medical Treatments

Nostalgia and Insanity

Thomas Nast’s Picture of a Homesick Soldier

America’s Civil War left many soldiers with lingering mental ailments that degraded their quality of life or disrupted it so violently they were considered insane. Today we would likely call these problems post-traumatic stress disorder, but in the 19th century it would have been called soldier’s heart or irritable heart.

Another syndrome that affected soldiers during the war was called nostalgia. Men (and boys) who had never traveled far from home were suddenly in a strange place away from family and friends. Many were so homesick that they fell into depression and despair, stopped responding to the people and stimuli around them, and sometimes became so lethargic and apathetic that they died.

John Clem, a 12-Year-Old Union Drummer Boy, Would Surely Have Had a Hard Time Coping With Homesickness

Nostalgia was recognized in the 1863 Manual of Instructions for Enlisting and Discharging Soldiers. The manual said: “Nostalgia is a form of mental disease which comes more frequently under the observation of the military surgeon… it belongs to the class Melancholia.”

The typical camp treatment for nostalgia was to shame soldiers for it, increase their drilling and other training, or push them into combat to stimulate them. Letting them take leave, or furlough, was also an option, but camp physicians had little use for it. Many were more concerned about the physically ill and wounded–whose symptoms could not be faked–than they were with uninjured soldiers who had symptoms that could.

It Would Have Been Impossible to Treat Nostalgia in a Civil War Hospital Like This

This cold attitude was driven more by the wartime situation than the prevailing attitude of the era. Moral treatment, with its kinder outlook and sympathetic treatment of the mentally ill still dominated treatment in asylums. Unfortunately, the Civil War demanded soldiers so relentlessly that physicians found it hard to justify releasing a relatively able-bodied soldier from the army, for any reason.

Nostalgia was a very old term for the illness it represented, and the Civil War was the last war in which Americans used it as a diagnosis.

Mental Illness and the Civil War

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Civil War Soldier Angelo Crapsey, 1861, Who Committed Suicide in 1864 After a Period of Mental Illness, courtesy Kutztown University of Pennsylvania

Societies have always observed that participating in wars/battles could affect both the soldiers and civilians caught up in the violence, and not only through physical wounds. After America’s Civil War, people called this change in veterans the “soldier’s heart” phenomenon. At the time, observers believed the negative changes were caused by actual physical changes in the heart that had occurred during war, or that the affected soldiers had longed for home so much that the fixation or focus had affected their minds.

Lunatic asylums had been available to the public for over two decades by the time the Civil War ended, but many families were ashamed to send relatives to them. When soldiers returned from the war, however, families sometimes faced overwhelming problems trying to care for them. If the soldiers were badly wounded, for example, physical care would be demanding and expensive, and mental problems in addition might make giving home-care nearly impossible. Some soldiers returned home with alcohol or morphine dependencies which could also make them difficult to nurse. And, many families–particularly in the South–were too impoverished to provide adequate care for their loved ones.

Milledgeville Lunatic Asylum, GA, Received its First Patient in 1842

Some of these issues may have driven families to place their veterans in an asylum. At the time, treatments for the insane consisted primarily of rest, occupational therapy, and adequate care for any existing physical problems. Receiving these things would have helped many patients, as would the relative peace that came from the stability and routine found in an asylum. Little besides some light labor and observance of the rules would have been expected from these patients, and many soldiers possibly welcomed the change and the chance to rest from the uncertainty and stress of the battlefield. Asylum cure rates during this period after the war could be around 30 to 40 percent–high, but possibly accurate.

Soldiers Could Be Traumatized When They Saw Friends and Comrades Die, photo courtesy Library of Congress, 1861

Though many families continued to resist asylums and could not get beyond the stigma of insanity, others who used the asylums possibly saw a benefit. At the very least, many families may have felt that under post-war circumstances, they could have provided no better care, themselves.

Other Ways to Help the Insane

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Wet Sheet Pack, 1902

Alienists considered light labor a welcome change of pace for patients and a great boon to their recovery (see last post) during the Civil War era. However, they also realized that every patient needed an individual plan that might include other therapeutics than labor, or no labor at all. Most specialists hoped that a calm, supportive environment would bring a patient back to health, but did recognize that sometimes more aggressive measures were needed.

If a patient showed signs of violence, there were several courses open to attendants. Restraint might be necessary, but what kind? “The worst form is where patients are held by the attendants,” said Dr. J. Paragot in his article, “General Mental Therapeutics.”

Restraints Could Be Horrifying For Patients

The next worst form of restraint was a cell, because attendants had to use force to place a patient in one, and then left him/her there in a state of frustration. In Dr. Paragot’s opinion, the best form of restraint was a leather strap around the wrists. “. . . the patient may enjoy the liberty of walking in the fields. . . . the patient may be left alone, no offered active violence overpowers him, it is but a passive resistance which annihilates his efforts.”

Moral restraint, imposed through “love, kindness, and reward” could also motivate patients to change their behavior. Hydrotherapy of various sorts–including swimming in tepid pools–could be beneficial, especially if a patient had the will to change but not the ability. Air baths (rambling about in the open air) could take the place of hydrotherapy for “the higher classes” in order to avoid any type of violence to the patient. Finally, a nutritious diet often helped patients enormously, particularly when they had physical problems as well as mental issues.

Elixer of Opium Promoted Restful Sleep and Composure and Relieved Nervous Excitement

Tonics and stimulants had their place for patients needing that kind of help, but Paragot generally urged the mildest means possible when doing anything more than counseling a patient. He recognized that hydrotherapy and various types of restraint options were often accompanied with violence toward a patient, which he found particularly negative in terms of a therapeutic outcome. If his enlightened views had prevailed, asylums might not have earned the disdain and dismay that haunt them to this day.

Ways to Treat the Insane

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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

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

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

Plight of the Sane

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Part of the Original Asylum, Previously Known as the Asylum for the Insane. The Facility Opened in 1818 as a Division of Massachusetts General Hospital

People who were tricked into an asylum by relatives or friends have given heartbreaking accounts of the experience, and Elizabeth T. Stone was no exception. After attending a family gathering on Thanksgiving, she went with her brother to what she thought was a boarding house. She was puzzled by the odd way she was treated upon arrival, the barred windows, and the regimented meals and bedtimes, but it was not until her second day that she learned she was at McLean Asylum and that her brother had had her committed there.

Stone’s despair was enormous, but she had the wit not to show her frantic emotions. She knew her protests and defensive statements would be put down to her “derangement” and that this easy label would not help her with the physicians there. Stone attributed her commitment to the asylum from the religious disagreement she had with her family, but her experience is so much more a lens on the easy commitment laws that prevailed at the time.

A Gilbert Stuart Painting of John McLean, Who Bequeathed a Fortune to the Asylum

A Sketch of the Life of Elizabeth T. Stone and of her persecutions

Stone apparently broke down within a short time and and made up her mind to commit suicide by tearing off a strip of her sheet so she could hang herself. The sheet gave way before she actually died, but the incident brought her more restriction. She continued to deteriorate mentally and lost a degree of self-control, though she was always aware of her surroundings. Stone eventually was released to one of her brothers and wrote a bitter account of her stay at McLean. Her book, A Sketch of the Life of Elizabeth T. Stone, was published in 1842.

What Can We Do?

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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

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

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

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

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

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.

Overcrowding and the Attendants’ Plight

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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

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

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.

Was There Any Way Out?

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Force Feeding a Patient at the Willard, Asylum for the Insane, llate 1800s, courtesy The Inmates of Willard

Force Feeding a Patient at the Willard Asylum for the Insane, late 1800s, courtesy The Inmates of Willard

Horror stories abound about the cruelty and sadness of life in an asylum. Especially as asylums became overcrowded and less well-run, it was hard for patients to recover from whatever condition had sent them there. Even worse, the patients’ relatives often had no desire or incentive to bring them home–whether they did get better or not. Sometimes, patients simply had no relatives or friends to return to.

Physicians at asylums had more incentive to discharge patients so that their “cure rates” could go up, but if they had nowhere to send an “improved” or “cured” patient, they might feel they had no choice but to keep them in the asylum. Additionally, many physicians were too busy–or didn’t care enough–to spend much time with patients and couldn’t determine whether or not they had improved. All these factors could lead to a lifetime of treatment for what had been a temporary problem.

Doctors and Administrators at the Florida State Hospital, circa 1920s, courtesy State Archives of Florida

An 1880 report from the Insane Asylum of California summed up the facility’s overall cure rate (since its creation) as just under 47%. This was certainly an admirable rate, but the superintendent also pointed out that very sadly, some patients were being sent to the asylum who more properly belonged to a state hospital or infirmary. He was speaking specifically about patients who were senile or had chronic diseases, but he also mentioned a state law against sending “cases of “idiocy or imbecility, or simple feebleness of mind” to asylums. The law was obviously being ignored.

An Advocate Went a Long Way Toward a Patient’s Release, courtesy Portraits of Eloise blog

Some patients did manage to get out of asylums even though the odds were stacked against them, and I will discuss these cases in an upcoming post(s).

Goat Glands as Cure for Insanity

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J. R. Brinkley, from The Goat-Gland Transplantation

The March 14, 1920 issue of the New York American carried an article about Dr. John Brinkley and some of his amazing cures through goat gland transplants. Brinkley had pioneered the use of these gland transplants to cure everything from barrenness in women to aging and hardening of the arteries. Goat gland transplants would also cure insanity, according to a case study discussed in a book: The Goat-Gland Transplantation by Sydney Flower.

A young woman suffering for the past twelve years with dementia praecox (a premature dementia, often beginning in the teens) that included homicidal tendencies and depression, had been treated by many specialists to no avail. However, Dr. Brinkley transplanted goat glands in her, and “the day after the transplantation of the glands this young woman embraced her mother, and talked so rationally to her that she called in Dr. Brinkley, and with tears repeated what her daughter had just said.”

The Dementia Praecox Case and Head Nurse Miss Lewis

Brinkley established the Brinkley-Jones Hospital and Training School for Nurses at Milford, Kansas, where he and other doctors performed thousands of goat gland operations. Brinkley had purchased his own medical diploma from Eclectic Medical University of Kansas City, Missouri, which was enough to allow him to operate as a surgeon for many years. Fortunately, Morris Fishbein, editor of the American Medical Association’s journal, finally forced Brinkley into court, where his fraudulent background and ignorance about medical matters became grounds to revoke his license.

Brinkley’s Hospital in Milford, Kansas

Healing, Hell, and the History of American Insane Asylums

The History of Insane Asylums

Category Archives: Medical Treatments

Nostalgia and Insanity

Mental Illness and the Civil War

Other Ways to Help the Insane

Ways to Treat the Insane

Plight of the Sane

What Can We Do?

Sherlock Again

Overcrowding and the Attendants’ Plight

Was There Any Way Out?

Goat Glands as Cure for Insanity