Category Archives: Patients

Any Problems With This?

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.

 

The Forces of Nature

Scene From an 1886 Issue of Harper’s Weekly Depicting Charleston’s Massive Earthquake

We know today that traumatic events can create mental health issues, and encourage victims to seek help after disasters of all kinds. Even a hundred years ago, medical professionals recognized that people could experience profound reactions to disaster–they just couldn’t offer preventative assistance.

In August, 1866, a massive earthquake centered around Charleston, South Carolina created havoc from Maine to Florida. Of course, people were physically hurt as a result, but many also experienced what we would now term post-traumatic stress disorder. At least three women seem to have literally died of it–the newspapers reported they were “frightened to death”–and others suffered nervous conditions that required sedation. They consumed medicines containing morphine, laudanum, valerian, and/or alcohol for relief, or simply went straight to bars for comfort.

Destruction in South Carolina

Destruction in South Carolina

The Savannah Morning News reported that at least a dozen people went insane and had to be sent to lunatic asylums, though it didn’t mention whether or not the stays were short or long-term. Continued aftershocks kept people anxious–and presumably on medication–for several months afterward.

Photograph Taken After the 1906 Earthquake, courtesy Sonoma County Library

Photograph Taken After the 1906 Earthquake, courtesy Sonoma County Library

Similar cases of “earthquake madness” have been reported elsewhere. The 1906 Santa Rosa (California) earthquake also left a number of victims insane. Mrs. L. W. Stebbins died in 1907: “Her awful experiences in those April days racked and wrecked her mind and body, ” reported the Press Democrat. “Her reason failed, and she was taken to the state hospital for treatment, but steadily declined in health…” At least six others from Sonoma County went into an asylum and three died there. Jacob H. Schlotterback of Santa Rosa was one of them, and his cause of death was listed as: “earthquake of April 18, 1906.”

Another Kind of Hell

This Undated Postcard Shows the County Poorhouse Which Later Became the Strafford County Asylum

This Undated Postcard Shows the County Poorhouse Which Later Became the Strafford County Asylum

Most people would consider living in an insane asylum to be a sort of hell in and of itself, but when conditions in these institutions were unsanitary, unkind, or unsafe, life took on an especially hellish aspect. Though most asylums were–at least originally–built to be safe, they did not always stay that way and staff were not always as protective as they might have been. Disaster could result.

The Strafford County Asylum in New Hampshire came into being when the county decided to move its pauper insane from its poorhouse into a separate asylum where patients could be better accommodated. All went well for twenty years, until a personality clash of some kind occurred between superintendent Charles E. Demeritt and his assistant manager, William P. Driscoll. Demeritt gave up control of the asylum to Driscoll.

Though the building was not that old, almost all repairs and renovations had been made using pine. This wood had dried over the years and shrunk to the point that patients could see each other between the floors and cells. The windows had bars in them and the patients’ rooms were locked up at night.

Account of Asylum Fire

Account of Asylum Fire

On February 9, 1893 the night watchman saw a fire in the room of a patient named Mary La Fontaine.  Wilbur Chesley, the watchman, immediately ran into the building and awakened Driscoll, who began to unlock the patients’ doors. The building material was so combustible that Driscoll could only get to some of the first floor rooms before the building was engulfed in flames. He, his family, and only three patients escaped.The rest , some forty or forty-one, were burned alive.

Investigation showed inexcusable ineptness: dangerous conditions had been allowed to exist for years, and the watchman had not even known that a fire hose and fire buckets were available in the building. Even worse, the fire was so small–no bigger than a bushel basket–when Chesley and Driscoll had rushed to the patient’s room, that they could easily have extinguished it. Instead, Chesley ran for help and Driscoll began unlocking rooms. And finally, the matches which probably started the fire, had been given to the patient (who smoked) by Driscoll himself.

Another Dreadful Fire Had Previously Occurred January 7, 1881 at the Strafford County Almshouse

Another Dreadful Fire Had Previously Occurred January 7, 1881 at the Strafford County Almshouse

As a result of this disaster the state’s legislature abolished county asylums and placed the care of the insane under the state.

Cures are Insane

Brattleboro Retreat in Vermont, Which Opened for Occupancy in 1836

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

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..

Anti-Insane Asylum Society

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

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

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.

Privacy Did Not Apply

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.

Maternity as a Cause of Insanity

Dr. John P. Gray

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

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

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!

Asylums Indeed

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