Category Archives: Mental Health Theory

A Crazy Cure

Medicine for Asthma Went Straight to the Lungs Via Cigarettes

Many nineteenth-century theories about disease and mental illness were based on assumptions that made sense within the limited knowledge of the time. Unfortunately, quacks could pick up on ill-founded theories and make a fortune if they were good salespeople–and of course, most were excellent. Dr. Edwin Hartley Pratt’s theory about chronic disease resulting from irritation of bodily orifices (see last post) is a case in point.

Dr. Frank E. Young took on the orifice problem and created rectal dilators with exaggerated claims: they were good for anemia, constipation, sallow skin, acne, insomnia, anorexia, headaches, and on and on. These rubber plugs–shaped somewhat like a torpedo–also cured insanity. In promoting his cure, Young asserted, “three-fourths of all the howling maniacs of the world” were curable “in a few weeks’ time by the application of orificial methods.”*

Dr. Young’s Rectal Dilators

Though the medical world scoffed, Young’s devices were popular (primarily for constipation) until the FDA began to regulate and oversee medical devices in 1938. In 1940 the agency seized a shipment of Young’s dilators as misbranded (because of their claims to cure so many conditions) and Young’s company fell out of favor.

Arsenic for Beauty Typified the Errors in 1800s Medical Knowledge

*Reported in The Medical News, April 29, 1893, p. 471.

Nerve-Waste and Insanity

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Dr. Edwin Pratt

Medicine in the 1800s was not always founded on firm data; it often based cures solely on (what someone thought) were reasonable assumptions. Dr. Edwin Hartley Pratt was a homeopathic physician who eventually wrote in his 1891 book, The Philosophy of Orificial Surgery, that there was one predisposing cause for all forms of chronic diseases: “and that is a nerve-waste occasioned by orificial irritation at the lower openings of the body.”

In the September, 1893 issue of a journal called The New Way, an unattributed article presented an example of “orificial philosophy.” The author referred to an article in the Journal of Nervous and Mental Disease which discussed the abatement of insanity in cholera patients. Sixty patients were sickened by the disease at the Bonneval Asylum in France. During its peak manifestation in their bodies, “maniacs” were relieved of all symptoms of insanity, though they gradually returned as the victims got well. Melancholics were also helped, and patients who were melancholic or only slightly insane seemed to recover their sanity permanently.

Pratt’s Book on the Treatment of Chronic Diseases

Though the Journal of Nervous and Mental Disease didn’t speculate about why cholera helped relieve insanity, The New Way did. “Cholera is a disease of the bowels, and results in their violent and complete evacuation and dilatation of the anal sphincter. Following this comes a compete relaxation of the whole muscular system.”

This gave the brain relief “and reason was restored while the condition lasted,” the author continued. “But as soon as the patient recovered from the cholera the relaxed condition of the muscular system disappeared and the sphincter became tight again.”

One of Pratt’s Sanatoriums

The result? The inhibition of the sympathetic nervous system, “deranged circulation and a return of insanity.” The anonymous author then wrapped up his case with the declaration that “seven-tenths of the cases of insanity, irritation and derangement will be found at the outlets of the body.”*

September 1893, Vol 1, No. 5, p. 125

Brain Troubles

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School Children in the Late 1800s, courtesy Aventa Learning

Alienists in the late 1800s believed that too much mental exertion could cause insanity, whether from over-studying at school, constantly dwelling on one topic, focusing too intently on business issues, or from other situations requiring unremitting thought (without adequate rest). This was one reason for the prevailing idea that children could become insane from intense schoolwork.

Dr. Ray V. Pierce, author of The People’s Common Sense Medical Adviser in Plain English: or Medicine Simplified (1886), explained: “No mental effort can be made without waste of nervous matter. The gardener’s hoe wears by use, and so does every part of the animal organism. Otherwise, nutrition would be unnecessary for the adult.

“The production of thought wears away the gray matter of the cerebrum as surely as the digging of a canal wears away the iron particles of the spade. . . . The intellect, whether engaged in observation, generalizations, or profound study consumes the brain and blood, hence intellectual activity implies VITAL EXPENDITURES.”

Dr. Ray V. Pierce

Pierce continued his explanation by saying that all the functions of the body were essential to the production of nerve-energy (including thought). Unlike exercise, which had value because it helped circulate blood, nutrition, and so on, mental labor did not have advantages of this kind. A child who studied too hard “consumes the blood, exhausts the vital forces, weakens, the organic functions . . . .”

The first result of all this expenditure would be anemia, said Pierce, because the brain “appropriated its red corpuscles” and eventually used them up. Because of this weakened state, other dire things could follow.

Image From Pierce’s Book

Though an obviously incorrect explanation concerning the issue of too much schoolwork, Pierce and many others correctly noted long ago the emotional problems in over-pressured children: An uptick in anxiety, depression, and lack of joy.*

*A 2016 survey showed that nearly one in three teenagers told the American Psychological Association that stress drove them to sadness or depression — and their single biggest source of stress was school.

Teddy Roosevelt’s Nerves

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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.

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.

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.

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

Category Archives: Mental Health Theory

A Crazy Cure

Nerve-Waste and Insanity

Brain Troubles

Teddy Roosevelt’s Nerves

The American Disease

Mothers and Madness

Medical Conditions and Insanity

Comparing Insanity Rates

A Room of One’s Own

Notes on the Past