Category Archives: Mental Health Theory

Phrenology Fowlers

Lorenzo Fowler Completed Cards on His Subjects, Including Lunatics, courtesy Countway Library, Harvard University

The study of head shape and the way it revealed personality and intellect–phrenology–was popular in the U.S. during the 1800s. Three of the most influential figures in this field were two brothers, Orson and Lorenzo Fowler, and their brother-in-law Samuel Wells. The Fowler brothers began their work in the 1830s, and eventually published the American Phrenological Journal. They opened a publishing house called Fowler and Wells and churned out hundreds of short works and phrenological charts, along with casts of heads for students to study.

Mark Twain, who knew plenty about the public’s credulousness and gullibility–having pulled off a number of spectacular hoaxes in his early days as a reporter–decided to expose phrenology for the puff science he thought it to be. Though serious practitioners did not set out to deliberately fool their subjects, Twain believed the whole field mere quackery. During Twain’s European tour in the early 1870s when Lorenzo Fowler was living in England, the two men met.

Phrenology Bust Provided a Three-Dimensional Reference Guide

The reading–in Twain’s words–revealed: “[Fowler] said I possessed amazing courage, and abnormal spirit of daring, a pluck, a stern will, a fearlessness that were without limit, I was astonished at this, and gratified too; I had not suspected it before; but then he foraged over on the other side of my skull and found a hump there which he called “caution.” This hump was so tall, so mountainous, that it reduced my courage-bump to a mere hillock by comparison . . .”

Twain went on, “He continued his discoveries, with the result that I came out safe and sound, at the end, with a hundred great and shining qualities; but which lost their value and amounted to nothing because each of the hundred was coupled up with an opposing defect which took the effectiveness all out of it.” Though Fowler gave the qualified, generic reading Twain expected, Fowler did express one definitive assessment: “However, he found a cavity, in one place; a cavity where a bump would have been in anyone else’s skull . . . . He startled me by saying that that cavity represented the total absence of the sense of humor!”

Mark Twain

Needless to say, Twain was not impressed, though he doubtlessly exaggerated the encounter via the sense of humor Fowler could not find.

Operating on Insanity

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Phrenology Chart, 1883

Phrenology was a so-called “science” which believed that bumps and other physical characteristics of a person’s head (skull) could reveal personality, mental faculties, and character. Though it fell out of favor in Europe by 1840 or so, two American brothers–Lorenzo and Orson Fowler–began “reading heads” about that time and kept this field of study popular in the U.S. until the late 1800s.

In 1896, a seaman named J. S. Doherty became “dangerously and hopelessly insane” after studying spiritualism. A family friend who was also a phrenologist believed that Doherty, who had been interested in spiritualism for ten years, had studied “on this one question of spiritualism until that part of his brain was abnormally developed.”

A Trepanning Operation and Tools For It, circa 1655

By 1899 Doherty had been insane three years, and his family was clutching at straws. They suggested an operation and signed an agreement that they would not hold their phrenologist friend responsible if it was not successful.

Their friend “located the parts of the head which he argued were afflicted by the pressure of the brain against the skull.” The phrenologist then performed a trepanning operation, in which he removed (and replaced) part of the patient’s skull in order to access the brain.

American Phrenological Journal

“When Doherty recovered he was perfectly sane, and his first words were to inquire about a piece of work on which he was engaged three years ago,” wrote a reporter in the September 9, 1899 issue of The Dayton Herald.*

*Other newspapers reported on the Doherty operation as well.

A Focus On Symptoms

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Symptoms Produced a Diagnosis

The field of psychiatry had little science behind it when insane asylums were first established. Many times, alienists (an early name for psychiatrists) had to base their diagnoses on symptoms alone, simply because they did not understand the root causes of a patient’s behavior. Epilepsy presents a good example: Sufferers often had periods of troubling behavior prior to or after a seizure. When doctors looked at these behaviors, they saw insanity rather than a medical condition.

A nutritional deficiency called pellagra also mimicked insanity in some people. This is a disease caused by a niacin (B-vitamin) deficiency, lack of tryptophan (an amino acid) in the diet, or a failure to absorb these nutrients. In the early 1900s many Southern poor ate a diet high in corn, molasses, and fat-back. The corn-heavy diet allowed pellagra to develop because Southern preparation methods did not release corn’s niacin. (In contrast, Mexicans soaked corn in limewater–which released its niacin–before making tortillas, and didn’t develop the condition.)

Pellagra Was Recognized As a Serious Problem

Pellagra’s classic symptoms included dermatitis, diarrhea, and…dementia, which frequently took the form of indifference, stupor and melancholy. Victims were sometimes sent to asylums as a result, where fortunately some actually recovered once their diets became less corn-based.

Early Care at St. Elizabeths

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A Four-Horse Carriage Used to Take Male Patients to Town at St. Elizabeths

A Four-Horse Carriage Used at St. Elizabeths to Take Male Patients to Town

The Government Hospital for the Insane–better known as St. Elizabeths–accepted the insane of the District of Columbia but had a special patient population of veterans from the nation’s army and navy. Like most institutions of its kind, the asylum was beautifully landscaped and had pleasing views for the patients.

St. Elizabeths’ first superintendent, Dr. Charles Nichols, did not run to extreme treatments. If a patient were not overtly disturbed, he prescribed tonics and a nourishing diet, warm baths, and treatments for “regularity of all the alimentary functions.” Provided patients could be induced to eat (the first step on the alimentary journey), alimentary treatment consisted primarily of ensuring the bowel excreted waste properly. Physicians sometimes induced vomiting to “clean out” the system, but it was far more likely that they would administer purgatives (very strong laxatives) to make sure the bowel was completely evacuated.

Dr. Charles Nichols

As in most asylums, patients were offered work to occupy their time and distract their minds from their troubles. Patients were allowed visitors, could walk on the grounds, and enjoyed (especially early on) individual treatment plans. Theories of the time supposed that most insanity was caused by environment and habits, so every effort was made to provide “things rational, agreeable, and foreign to the subject of delusion.”

Nurses on the Lawn Across From Building E, St. Elizabeths, courtesy NARA

Whether a patient’s environment had become contaminated by overwork, marital problems, or the many pressures of life, doctors hoped that taking people away from the environment which had created their mental distress would allow them to recover. For at least the initial period of asylum growth, this belief was an overwhelmingly valid reason for insisting patients be committed to an institution rather than receive treatment at home.

Cures are Insane

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Brattleboro Retreat in Vermont, Which Opened for Occupancy in 1836

To modern sensibilities, much of what has been believed in the past about insanity sounds silly and unbelievable. Though we can often follow the logic behind even outlandish ideas, given the lack of research available at the time, the logic behind certain treatments can be a little more difficult to grasp.

In Vermont somewhere around 1800, a man named Richard Whitney became “mentally deranged” and a council of physicians tried its best to help him. They concluded that a temporary “suspension of consciousness” was just what was needed, the theory being that if the patient could be rendered unconscious in a fairly dramatic way, his mind would be diverted from unhappy associations and so remove the cause of his affliction.

As Late as the 1930s, Patients Were Induced Into Low Blood Sugar Comas to Rewire the Brain

As Late as the 1930s, Psychiatric Patients Were Induced Into Low Blood Sugar Comas to Rewire the Brain

The physicians first completely submerged him in water until he “became insensible” and then resuscitated him. This experimental treatment failed, but undaunted, the doctors tried again. The second effort involved opium, selected as “the proper agent for the stupefaction of the life forces.” Unfortunately, this trial killed the patient.*

Thought this extreme example is outrageous, alienists (the first mental health specialists) frequently experimented with new treatments on patients–most probably without consent or oversight. Records will never show how many died or suffered catastrophic harm from them, but researchers can rest assured that much suffering was involved.

The Utica Crib Was a Notorious Restraining Device

*Information about this case came from a work called the History of Brattleboro, published in 1806 and retold in a history of asylums in 1916..

Laws Against Insanity

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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

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

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

Maternity as a Cause of Insanity

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Dr. John P. Gray

Mothers today know they have a difficult job, but in the late 1800s some alienists believed maternity could cause insanity. They based this belief on the surprisingly sympathetic premise that the overwork, anxiety, and loss of sleep associated with caring for children could weaken the body–and consequently the mind–enough that a woman could no longer cope sanely with life. Dr. John P. Gray, superintendent of the State Lunatic Asylum in Utica, New York gave an example:

In 1885, a woman with five children came to the asylum with symptoms Gray diagnosed as mania; she had lost her mental balance a few weeks after the youngest was born. The new mother “was incoherent, laughed to herself, expressed no interest or anxiety in her children, [and] wandered from one subject to another.” Her history showed that she had been vigorous and strong, but that she began doing her normal work two weeks after the birth of her last child.

Careworn Mother During the Great Depression, 1936, courtesy Library of Congress Photograph by Dorothea Lange

Unfortunately, four of her children got whooping-cough and then the baby, and this mother was kept awake and was up often at night, “and then for six weeks she was deprived largely of sleep, was anxious, worked constantly, and took little food . . .'” One day she felt strange in her heart and head, then her mind wandered, and “from that time lost self-direction and passed into insanity.”

Money Made a Difference in the Ability to Care for Children

Gray then vigorously took up the cause of mothers. “In all the range of human affairs there is no neglect, no wrong, no cruelty, that compares with the neglect and ignorance associated with motherhood.” He said that this neglect was both a direct cause, and sometimes an indirect cause, of insanity. ” Husbands, he said, must protect their wives and make some sacrifices, themselves, “to shield their wives from undue labor under any circumstances, and especially under such [impending motherhood] and with such a possible outcome.

Strong words for an era in which women could not even vote!

The Dangers of Injury

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Two Men Cooling Off in a Park During the 1911 Heat Wave that Drove Some People to Suicide and Insanity, courtesy New England Historical Society, Library of Congress

Two Men Cooling Off in a Park During the 1911 New England Heat Wave that Drove Some People to Suicide and Insanity, courtesy New England Historical Society, Library of Congress

Alienists (early psychiatrists) believed madness could result from a long list of issues such as heredity, strong emotions, sudden shocks, illness, and physical injury. The latter played a part in many patients going to insane asylums, as newspaper accounts and case studies show:

In 1897:

Maggie Mc. —The doctor in the case testified that she can’t be trusted in public, her conduct not being proper. Five years ago she had a fall that left her unconscious for several hours; her wrist was broken at the time, and now there is a suspicion that her skull must have been fractured. The 28-year-old woman was sent to an asylum.

Phineas Gage Underwent a Personality Change After a Tamping Iron Pierced His Skull in 1848

Timothy O’B. — . . . had acquired a big head, ordering dry goods jewelry in great abundance, with no cash to pay; he also imagines he has valuable property. His trouble began by falling from a ladder two years ago and hurting his back and side, and after developing rough behavior, it is said that he was struck over the head by a policeman, through which he has become a raving maniac.

Probable Causes of Insanity, Missouri State Lunatic Asylum, 1854, courtesy Missouri State Archives

Probable Causes of Insanity Included Injuries, Missouri State Lunatic Asylum, 1854, courtesy Missouri State Archives

Falls from horses, kicks from mules, accidents at work and the like, could all bring on insanity. Most alienists felt that people who did become insane after an injury were predisposed to it anyway, and that the injury brought it out, just as other life experiences like overwork or sudden shock might. An exception would be a traumatic injury to the head which in and of itself could have damaged the brain of an otherwise healthy person.

Eccentricity or Insanity?

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Former Surgeon-General Dr. William A. Hammond

After going through old medical texts about insanity, researchers might be tempted to think that families and doctors believed any odd behavior was a manifestation of insanity. There is a kernel of truth to that, since insanity is usually based on a violation of societal norms. Unfortunately for many asylum patients, their families often took that viewpoint a step further and considered a person insane when they merely disagreed with his or her conduct or beliefs. Dr. William A. Hammond, in his influential book, Treatise on Insanity (published 1883), did try to distinguish between insanity and mere quirkiness.

Hammond began his discussion of eccentricity with the example of a man who had left his considerable fortune to the “funding of a hospital for sick and ownerless dogs.” In this case–and particularly in this era–the man’s wish would be puzzling to say the least. However, Hammond says that if the man had endured circumstances in life that “weakened his confidence in human nature,” his will would be much more understandable. In his eyes, dogs were “the most faithful creatures I have ever met, and the only ones if which I have confidence.” Hammond said firmly that such a man was not insane; there was a rational motive for his conduct.

Nikola Tesla Could Not Stand Jewelry, Especially Pearls

Hammond regarded this form of eccentricity, in which the person “sets himself up above the level of the world” and marks out a line of conduct which he consistently follows, as fairly harmless. Indeed, he stated, “All great reformers are eccentrics of this kind.”

Eccentricity of a more personal nature, adopted only to draw attention could be problematic. Hammond described a woman who “would have no other material except copper for her table furniture . . . who “carried this fancy to such an extent that even the knives and forks were of copper.” She enjoyed the attention her eccentricity gave her, but she was intelligent and talented in other areas and there seemed no cause for alarm.

Mary Todd Lincoln’s Extravagance and Embarrassing Behavior Earned Her an Insanity Trial

One day she read in a newspaper that “a Mr. Koppermann had arrived at one of the hotels.” She determined to meet him, though her friends tried to talk her out of it. She went to the hotel, was told Koppermann had left for Chicago, bought a rail ticket and started after him. “The telegraph overtook her” Hammond states–whether sent by her or as a warning from her friends–and “she was brought back from Rochester raving for her love of a man she had never seen.” She died of acute mania within a month.

Incidents like the latter could occur due to an inherent tendency surfacing for some reason, but Hammond did not discuss the phenomenon any further.

The Problem of Inebriates

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A Temperance Poster by Frank Bellew, 1874

In the 19th-century mind, excessive use of or dependency on alcohol was closely related to insanity. Dr. Hills, superintendent of the Central Ohio Lunatic Asylum wrote in 1888, “Intemperance is a frequent direct cause of insanity . . . but many instances come to light in which even temporary intemperance in the parent has caused constitutional defects in the offspring–sometimes physical and at other times mental.”

Hills went on to relate a case in which a father with six sons had been a hard drinker in his earlier years. One son was born with a dull intellect, another went insane at age 30 “and is probably incurable” the third “was demented from an early age,” and the fourth was epileptic and “is imbecile.” Two older sons were married and had children, said Hills, “some of whom can hardly hope to escape the penalty in after years.”

Americans imbibed huge quantities of liquor beginning with colonial times, but frowned on public drunkenness. In general, society considered excessive drinking a sin and a moral failure. Eventually medical men (and others) began to look on alcoholism in a different way. Many could not keep from feeling that because drinking was voluntary it had to be a related to morals, but eventually people came to take a more hybrid view that it was a moral failing that led to a physical condition that couldn’t be controlled.

The Victims of Alcohol, Film Poster, 1911

People who became alcoholics or met with public attention during a binge were often sent to insane asylums and diagnosed with “alcoholic insanity.” Reformers began to call for separate inebriate asylums where people with alcohol problems could be helped in a deliberate way. They could make the same arguments that had been made for treatment in asylums: it was cheaper to cure a man than for the public to absorb a lifetime of costs associated with drunkenness; medical staff could provide better care than family members could; alcoholics could be watched at all times and intoxicating drinks kept out of their hands, and so on.

New York State Inebriate Asylum

As with the insane, alcoholics could be committed to an asylum against their will. It took affidavits from two physicians and two “respectable citizens” that the person in question was lost to self-control, unable to attend to business, or “dangerous to remain at large,” to send that person before a judge for determination. For the New York State Inebriate Asylum, there was at least one safeguard: An involuntary commitment could not be for longer than one year.

Healing, Hell, and the History of American Insane Asylums

The History of Insane Asylums

Category Archives: Mental Health Theory

Phrenology Fowlers

Operating on Insanity

A Focus On Symptoms

Early Care at St. Elizabeths

Cures are Insane

Laws Against Insanity

Maternity as a Cause of Insanity

The Dangers of Injury

Eccentricity or Insanity?

The Problem of Inebriates