Category Archives: Patients

Dangerous Confinement

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Harper's New Monthly Magazine, 1866, Showed A Doctor Making His Rounds at Blackwell's Island Lunatic Asylum

Harper’s New Monthly Magazine, 1866, Showed A Doctor Making His Rounds at Blackwell’s Island Lunatic Asylum

The attendants working in insane asylums often had deservedly poor reputations. However, many were dedicated and capable, and performed their duties admirably. We can only imagine the outcome of any number of harrowing situations if attendants had not remained calm and committed to the people who depended on them.

An article in an 1879 issue of the New York Times reported on a fire that had broken out in a large building beside the main asylum on Blackwell’s Island. The building held about 100 female patients, who were locked in rows of cells on each floor. Smoke began pouring out of the cellar late in the evening and attendants gave the alarm. The Medical Superintendent had them unlock each cell and release the patients, but getting them outside to safety could have been quite a task given the unusual circumstances and mental state of the patients.

An Asylum Dance at Blackwell's Island

An Asylum Dance at Blackwell’s Island

However, to calm patients’ fear and excitement, the attendants told the women “there was to be a dance in the Amusement Hall, a building in which concerts and balls were given to the inmates of the asylum,” the paper reported.

The patients exited via fire escapes, and to keep up the pretense that all was well, someone played “a merry air” on the piano in the Amusement Hall. Some of the patients began to dance on the lawn as employees and others fought the fire, and every life was saved.

New York City Asylum for the Insane on Blackwell's Island

New York City Asylum for the Insane on Blackwell’s Island

When Johnny Came Marching Home

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Soldiers Could Never Escape the Suffering Imposed by the Civil War, courtesy Library of Congress

Soldiers Could Never Escape the Suffering Imposed by the Civil War, courtesy Library of Congress

People today understand the after-effects of war on veterans better than previous generations did (though that doesn’t diminish its trauma). Soldiers in previous eras were much more on their own, since medical personnel didn’t recognize the emotional damage and scarring they often suffered. Civil War soldiers in particular faced a changed war environment that greatly contributed to their later trauma.

These young men suffered death and injury on the grandest scale experienced in American history. They endured horrific wounds inflicted by new weapons and then went on to suffer just as intently afterward from assembly-line-style amputations. Many soldiers saw the ground seem to crawl and shift with wounded, struggling bodies after a great battle, or heard cries for help they could never forget. They often carried this trauma back to the battlefield and then home.

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

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

Physicians did recognize that some symptoms occurred specifically to soldiers they saw: heart palpitations, sweating, and/or rapid breathing, and other symptoms of panic attacks. These manifestations were identified by Jacob Mendes Da Costa and called “Da Costa’s Syndrome” or more commonly, “soldier’s heart” or “irritable heart.” Some physicians sympathized with men suffering from it, while others thought they were merely shirking their duty. At home, men who suffered from the after-effects of war trauma were similarly misunderstood.

The Government Hospital for the Insane (later known as St. Elizabeths) had been built specifically for soldiers, sailors, and the indigent of Washington, DC, but many other asylums also saw an influx of veterans who could not cope with their post-war trauma. Most did not get much help beyond the security of three meals a day and a bed to sleep in, along with occupational therapy–usually in the form of work–to help them pass their days.

Brevet Brigadier General Newell Gleason Was Committed to the Indiana State Hospital for the Insane in 1874 andCommitted Suicide in 1886 Some Time After His Release, courtesy Library of Congress

Brevet Brigadier General Newell Gleason Was Admitted to the Indiana State Hospital for the Insane in 1874 and Committed Suicide in 1886 Some Time After His Release, courtesy Library of Congress

These veterans were often traumatized one last time by family members and a society ashamed by the idea of mental illness and the “weakness” of the man suffering from it.

Happier at Home

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The Invalid, circa 1870, by Louis Lang is Highly Idealized

The Invalid, circa 1870, by Louis Lang is Highly Idealized

Most people today don’t enjoy staying in hospitals, and this was doubly true for people in the 1800s. Doctors were not held in high esteem, and neither medical knowledge nor the primitive equipment/technology available were particularly reassuring. Well into the early 1900s, many ordinary people considered hospitals more a place to die than a place to recover.

Instead, home care was the norm, and hospitals were often seen as a last resort for patients without family and friends to care for them. (This is a general statement, of course, and certainly people did go to hospitals with excellent outcomes.) Rather than relying on professional staff, most families expected mothers, sisters, and wives to “nurse” anyone in the family who was ill. Between a doctor’s visit, a few herbs and traditional concoctions, and a consultation with a home medical manual, most families coped well enough with the situations that came their way.

Dr. Thomas Riddle in the 1920s

Dr. Thomas Riddle in the 1920s

Mental health care was different. No one–including doctors–really understood it or knew how to treat it. Consequently, the mentally ill were often neglected. Some families were ashamed of their sick relative and hid him or her away in the traditional attic described in many a melodramatic tale. Other families beat or starved their insane members out of ignorance or exasperation, or turned them out entirely if their behavior became too difficult to handle. Actually treating mental illness with a hope for recovery was nearly impossible in the home.

A Doctor Checking on a Patient, 1800s

A Doctor Checking on a Patient, 1800s

As medical knowledge increased, the idea of “hospitals for the insane” became more acceptable. This blog and the book I’m working on will give information about the early years of psychiatry and its most visible symbol: the insane asylum.