Category Archives: Patients

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.

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

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 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

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.

Thoughts on Religion

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Causes of Insanity Included Religious Excitement

Causes of Insanity Included Religious Excitement

Discovering the reasons for insanity proved difficult for early alienists. For many years, these mental health experts attributed the origins of insanity to what modern medicine would call laughable causes: excessive novel-reading, masturbation, smoking, religion and so on. Eventually, a few medical men began to question these sorts of factors as true causes of mental issues.

Dr. John Gray, superintendent of the State Lunatic Asylum in Utica, New York, wrote in 1885 that, “Religion, strange to say, is sometimes set down as a cause of insanity . . . . To some it means that a person is insane on the subject of religion; to others that the insanity was caused by religion.”

Dr. John Gray

Dr. John Gray

Gray recognized that the idea of “Religious Insanity” actually meant that religion caused insanity to many people. His belief, though, was that: “What people talk about when they become insane, has rarely anything to do with the real cause of the disease.” Gray gave a couple of examples concerning his theory, one being the case of a severely overworked minister who finally broke down and began raving that he was Zerubbabel and had been appointed by God to preach “to the spirits in prison” and that he had descended into hell to preach the gospel of salvation and redemption.

“This was not Religious Insanity,” said Gray, “but insanity from exhaustion, religion having nothing to do with it except to give tone and character to his delusions.” Gray found that many people who appeared insane due to exhaustion or broken health could often recover when given rest and proper medical treatment.

State Lunatic Asylum, Utica, New York, courtesy National Library of Medicine

State Lunatic Asylum, Utica, New York, courtesy National Library of Medicine

His point of view was a refreshing counterpoint to others in his field who would have labeled a patient like this insane and perhaps never expected a recovery.

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.

What Price for Care?

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In the 1800s Families Could Be as Medically Informed as Most Doctors

In the 1800s Families Could Be as Medically Informed as Most Doctors

The public originally supported insane asylums because they offered genuine hope. Typical at-home care provided little focused psychological expertise for patients, so recoveries within this family system had been few and far between. (One exception might be for conditions  like “melancholia” that could perhaps be treated by a change of scenery.) However, when professionally staffed asylums gave patients the time and attention they needed, recoveries did occur, and the former life-sentence of insanity seemed to have lifted.

John and Thomas Bailey, Father and Son Admitted Simultaneously to an Asylum for Melancholia, courtesy Museum of the Mind

John and Thomas Bailey, Father and Son Admitted Simultaneously to an Asylum for Melancholia, courtesy Museum of the Mind

Asylums were imposing, beautifully constructed, and reassuring. Superintendents who had actually been trained in the treatment of insanity–unlike family doctors who may have read a book or two on the topic–added to that reassurance. Families lost their reluctance to send loved ones to asylums and many times were rewarded for their faith. Even those who knew a family member would never recover could at least have the physical and psychological burdens of care lifted from their own shoulders.

Bloomingdale Asylum Presented a Lovely and Imposing Picture

Bloomingdale Asylum Presented a Lovely and Imposing Picture

That first wave of care paved the way for successive waves of continually poorer care as more and more families took advantage of asylums and stretched their resources too thin. At that point, money made all the difference. My next post(s) will discuss some of the differences money made in the quality of care for the insane.

Escape Was Possible

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Newspapers Often Alerted the Public to Escapes

Newspapers Often Alerted the Public to Escapes

Many patients who were involuntarily committed to asylums were understandably anxious to leave. Though most did not have the wealth and eventual aid that patients like Chanler did (see last post), many still managed to escape. These patient escapes were usually termed “elopements” by the psychiatric community, perhaps because the word “escape” sounded very much like patients were prisoners.

August H. Bloom came to the Hastings Asylum in Minnesota on September 2, 1905 and escaped two days later. The asylum’s superintendent described this patient’s escape and the actions he took subsequent to it, which were probably common to most other institutions. “Whenever a patient elopes, we advise the operator at the depot, who notifies the agent on either side of Hastings; we also send out from two to three attendants looking for them.”

Hastings State Hospital, courtesy Minnesota Historical Society Library

Hastings State Hospital, courtesy Minnesota Historical Society Library

The superintendent would then advise any family members of the escape, and ask to be notified if the patient made his way to relatives. If the patient did manage to return home and the family wanted him/her to remain, the superintendent bowed to their wishes. Otherwise, if the superintendent got word that a patient had been captured away from home, he sent an attendant to get the person. If someone elsewhere brought the patient back to the asylum, the superintendent paid the person’s expenses.

Birds Eye View, Red Wing, 1907, courtesy LakesnWoods.com Postcard and Postcard Image Collection

Birds Eye View, Red Wing, 1907, courtesy LakesnWoods.com Postcard and Postcard Image Collection

August Bloom apparently bounced around a bit and then settled in Minneapolis. In the summer of 1906 Bloom traveled a short distance away to Red Wing, where he killed the Chief of Police and one of his officers. Even though Bloom had been known to be an escaped asylum patient, no one suspected him of being capable of violence until this incident occurred.

Saying Goodbye

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Bloomingdale Asylum

Bloomingdale Asylum

Patients were often kept in insane asylums far too long because they were friendless or without family to take them in, even after improvement. Wealthier patients could fare better since it was easier for their families to hire attendants for home care, but wealth did not guarantee their welcome back into the family circle.

Millionaire John Armstrong Chanler’s family (part of the wealthy Astor clan) committed him to an asylum probably to prevent him carrying out business plans they thought were risky. He was a resident of Virginia, but was tricked by a friend into going to New York City. There, he was subsequently committed to New York Hospital, also called Bloomingdale Asylum. His family promptly cut him out of their lives.

Chanler seated on a horse, 1912, courtesy Holsinger Studio Collection and U.Va. Digitization Services

Chanler seated on a horse, 1912, courtesy Holsinger Studio Collection and U.Va. Digitization Services

Unfortunately for them, Chanler managed to write an impassioned plea for help and smuggle it out of Bloomingdale via a discharged journalist who had been committed for morphine addiction. The reporter didn’t get the letter to Chanler’s lawyer, but instead wrote a sensational story. Though the story publicized his plight, little help resulted.

Chanler's Scathing Report on His Stay at Bloomingdale

Chanler’s Scathing Report on His Stay at Bloomingdale

Chanler trained himself to walk far and fast, and on Thanksgiving Eve, 1900, he slipped out the gates of Bloomingdale, perhaps with the help of a loyal friend. Chanler made it back to Virginia where his friends helped him pursue a trial to determine his state of mind. The ultimate result: Chanler was declared legally sane in that state. Years later, the New York courts also found him sane.

This is one instance–a rarity indeed–of triumph for someone whose family had been determined to keep him in an asylum.

 

 

Happy Holidays

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Christmas Tree in Wisconsin State Hospital, 1895

Christmas Tree in Wisconsin State Hospital, 1895

Asylum patients were often lonely and neglected by their families during the holidays, though a few superintendents, like Dr. E.H. Williams, the assistant physician at Matteawan State Hospital (1897), didn’t think the holidays mattered much to them. He believed that the insane couldn’t handle changes in routine and wouldn’t appreciate celebrations, anyway.

Most asylum superintendents didn’t believe this, and tried hard to make holidays like Christmas special. Public charities and organizations often helped them. They donated food and clothing, and churches brought groups to visit and sing. Usually, meals were also festive and special. The Milwaukee Sentinel described a dinner meal in 1903 that included rabbit stew, oysters, and plum pudding. The evening before, staff had distributed bags of candy and fruit as patients enjoyed music and danced. Festivities like these undoubtedly meant a great deal to patients burdened by the monotonous regimen that was such a large part of their treatment.

Christmas Turkeys Displayed Outside Spencer State Hospital, formerly Second Hospital for the Insane, circa 1924, courtesy WVU Libraries

Christmas Turkeys Displayed Outside Spencer State Hospital, formerly Second Hospital for the Insane, circa 1924, courtesy WVU Libraries

Very often, asylums would decorate Christmas trees and their public areas; superintendents also made sure that every patient received a gift, using money that had been set aside for that purpose or relying on donations from charities.

Patients and Staff at Christmas Party at State Hospital, Jamestown, courtesy Historical Society of North Dakota

Patients and Staff at Christmas Party at State Hospital, Jamestown, courtesy Historical Society of North Dakota

It  was important that no one be forgotten, and all these efforts to provide a bit of cheer and comfort undoubtedly helped patients through an especially difficult time. Likewise, the staff enjoyed the break in routine, and received the psychic boost that comes from helping others.

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

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

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).