Category Archives: Uncategorized

Eccentricity or Insanity?

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.

Welcome to America

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View of New York's Emigrant Refuge and Hospital, Ward's Island, courtesy Arno Press and the New York Times, 1969 and Original circal early 1880s

View of New York’s Emigrant Refuge and Hospital, Ward’s Island, courtesy Arno Press and the New York Times, 1969. Original circa early 1880s

When immigrants processed through New York, some were inevitably sick–and some were judged to be insane. Both groups were sent to a hospital on Ward’s Island in New York until they either got well or five years went by. If the insane had not recovered by then, they were sent to the New York City Asylum on Blackwell’s Island.

The hospital on Ward’s Island was a nightmare. The ratio of nurses to patients was typically 1:30, and graduate physicians worked there–usually without pay–simply to gain experience. Obviously, they had little to no experience caring for the insane and only stayed for a short time anyway, thereby depriving patients of any continuity in care.

Inebriate Asylum, Ward’s Island, 1869

The hospital was overcrowded despite occasional attempts to transfer insane patients elsewhere, such as to Randall’s Island and Hart’s Island. Randall’s Island first used an old inebriate hospital for the overflow (1875), but two years later had to use an unoccupied building and also lease an old barrack building from the Emigration Department. This latter building was extremely primitive, being without either individual rooms or “conveniences”. In all these places, cheapness reigned.

Pens at Ellis Island Registry Room. These People Have Passed the First Mental Inspection, courtesy Miriam and Ira Wallach Division of Art, Printing, and Photography Collection,1902 – 1913, New York Public Library

In my next post, I will discuss some of the conditions there and attempts to change them.

Believing Their Own Hype

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Compilation Portrait of Members of the Association of Medical Superintendents of American Institutions for the Insane, courtesy National Library of Medicine

Practitioners in the new field of psychiatry made some expert moves early on that both enhanced their reputations and brought them better incomes than the average physician. In 1844, a gathering of asylum superintendents met to form an exclusive group: the Association of Medical Superintendents of American Institutions for the Insane. They quickly set themselves up as the only doctors–in the only proper setting–who had the knowledge to diagnose and treat mental problems. These asylum superintendents quickly convinced the public that they and their institutions were the real solution to the problem of treating insanity.

The association’s stated objectives were “to communicate their experiences to each other, cooperate in collecting statistical information relating to insanity, and assist each other in improving the treatment of the insane.”

The New York State Lunatic Asylum at Utica Was One of Only 25 Public and Private Mental Hospitals in America in 1844

It was an appropriate goal, because most of these “experts” had little true expertise in running asylums. Many years later, in 1885, Dr. Pliny Earle brought up the question of allowing assistant physicians at insane asylums to join the Association. In his discussion, Earle reminded the organization’s members that in the Association’s early years, only one physician had even ten years’ experience in healing the insane in a public institution. Only five others had five years or more experience as heads of institutions. The reality was, most men running asylums at that early time only had two to four years of experience doing so.

Dr. Pliny Earle, courtesy National Library of Medicine

Dr. Earle suggested that assistant physicians who had worked continuously five years or more in institutions for the insane be admitted to the Association. This proposal was voted on and adopted.

Care for the Insane in Utah

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Map Showing Utah Territory

Though most people going West to follow their dreams (or spouses) into U.S. Territories might have been particularly hardy or adventurous, some succumbed to mental illness along the way or after arriving. These insane were taken either to county poorhouses or admitted to private institutions in Salt Lake until the legislature created the Territorial Insane Asylum in Provo. (Utah did not become a state until January 4, 1896.) The bill to create the asylum was introduced in February, 1880, and the institution opened its doors to admit patients five years later on July 15, 1885.

Of course this insane asylum admitted the insane, but it also accepted feeble-minded patients and non-insane epileptics who were capable of improvement. It would not accept the feeble-minded who couldn’t improve, the senile, “a person in an unconscious condition,” infants, children under ten, and people suffering from contagious diseases.

State Mental Hospital in Provo, Utah, circa 1900, courtesy Utah Department of Human Services

Whether the rules were actually carried out or not, Utah seemed to protect its citizens a bit better than some other states. Anyone wanting a person committed had to fill out an informational form and then face an examination under oath before the district judge. If he were satisfied that there was “reasonable cause” for a person’s admittance to the asylum, the judge held a hearing that required the district attorney to represent the state. The judge had to “summon two practicing physicians” to certify under oath whether or not the person in question was insane. Additionally, any citizen (of the county in which the hearing took place), friend, or relative could oppose the application and appear at the hearing with counsel.

Patients at Utah Territorial Insane Asylum, circa 1900s, couresty Utah State Hospital Museum, courtesy Utah Department of Human Services

Patients at Utah Territorial Insane Asylum, circa 1900s, courtesy Utah State Hospital Museum

Anyone could submit an affidavit to the Board of Insanity saying that a committed patient was not insane or not a proper person to be placed in an asylum. The Board then had to make inquiries. If the person was found to be sane, he/she would be discharged. However, if the patient was deemed insane, the judge “must order his continued detention, and may order the parties demanding the inquiry to pay its cost.” [Emphasis added.]

The latter provision very likely deterred indigent patients and their friends from contesting even unfair commitments to the institution.

Mania and Medicine

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Woman Forced Into Cold Shower, from Elizabeth Packard’s Book Modern Persecution, or Asylums Revealed

Doctors in the asylum era were breaking ground in a new field, and unfortunately, had few scientific studies to reference when it came to treating patients. Most treatments progressed from fairly benign standards like warm or cold baths, enemas, frequent meals, and so on, to more extreme forms of the treatments (baths that lasted hours or days, force feeding, etc.), and then to medicines. Most physicians were quite comfortable–and felt assured of the safety–of medicines that today we know are quite dangerous. Calomel (see last post) is just one example of a favored medicine with dreadful side effects.

Excited patients–particularly epileptics–might be given bromides to calm them. It worked, but at least one doctor (Chicago physician Dr. J. S. Jewell, writing in an 1881 issue of the New York-based journal The Medical Record) noted that the use of bromides in the treatment of epilepsy actually led to “maniacal furor,” a condition that made the person appear insane.

Skin Eruptions Were Another Side Effect of Bromide Use and Resembled Smallpox, from Materia Medica, 1918

Genetian (which could affect blood pressure and ulcers) was used to stimulate patients’ appetites; hyoscyamia (found in plants like henbane and having an action similar to atropine and belladonna) was used to help patients remain calm or sleep; and ergot ( a fungus which includes a chemical that can cause people eating food contaminated with it to go berserk) was used for “persistent congestion of the brain and cord.”

Painting by Matthias Grunewald of Patient Suffering From Advanced Ergot Poisoning, circa 1512

Of course, many medicines used today would be poisonous if they weren’t compounded properly and given in the proper doses. Doctors must also watch for adverse side effects in sensitive individuals and interactions with other drugs patients might be taking. Unfortunately, in the era under discussion, it is unlikely that doctors were skilled at avoiding these potential problems.

Asylum Patients Under a Doctor’s Care

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Indiana Hospital for the Insane

In 1884 Dr. Joseph G. Rogers, superintendent at the Asylum for the Insane in Indianapolis, wrote in an article (see last post) that nothing remarkable in either the treatment of insanity or recovery of patients had occurred recently. His suggestions for the primary care of acute (recent) mania were rest and nutrition, with the addition of soothing baths and perhaps a dose of medicine to help the patient sleep. These treatments could just as easily be done at home if a family wanted to–so why would they send their loved one to an asylum?

If patients didn’t immediately recover their sanity, of course stronger measures would be necessary. That’s when medical professionals took on more than most families could comfortably embrace.

William Green, a Patient With Acute Mania, Bethlem Hospital

William Green, a Patient With Acute Mania, Bethlem Royal Hospital

Rogers, and most other alienists of the time, believed that patients almost always needed their bowels cleared by a good enema, and he suggested using gallon portions if necessary. The enema should be repeated until deemed successful by seeing proof of the “evacuation of the entire canal.” He called this dramatic enema “hydraulic mining so to speak” and what it would have been like for family members to administer can only be imagined. To aid in the complete cleansing of the patient, Rogers also suggested an active purgative of ten grains of calomel with three of gamboge.

Calomel is a mercury compound which could have devastating side effects and actually kill patients who consumed too much of it over time. Gamboge is a strong laxative (that can also expel worms) with side effects that include vomiting, stomach pain, and loss of potassium–which can damage the heart.

Union Soldier Carlton Burgan, Whose Upper Mouth, Palate, Right Cheek, and Right Eye Were Effected by Calomel Poisoning, courtesy National Museum of Medicine and Health

Union Soldier Carlton Burgan, Whose Upper Mouth, Palate, Right Cheek, and Right Eye Were Affected by Calomel Poisoning, courtesy National Museum of Medicine and Health

Though laypeople of the time probably wouldn’t have known about these side effects, they might still have felt uneasy giving these stronger kinds of medicines to their relatives. And, if patients needed these stronger interventions, it would be because they were becoming increasing difficult to manage–another reason to send them to an asylum.

Though asylums took much of the care-taking burden off families’ shoulders, they may not have actually given the patient better care. In my next post, I will discuss some of the medicines available to doctors caring for the insane.

A New Term for War-Time Trauma

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Patient Suffering From War Neurosis in WWI

Nostalgia (see last post) had been used since ancient times to describe a debilitating depression that sometimes affected soldiers. This was more than a simple longing to see loved ones or get away from the stress of battle; instead, it was an overwhelming emotional condition that could actually lead to illness and sometimes death. The term dropped out of favor after the U.S.’s Civil War, but medical personnel recognized that soldiers faced particular mental challenges during wartime. During WWI, “shell shock” was a descriptive term for the physical effects that constant bombardment took on soldiers in the trenches. Physicians recognized that soldiers could also suffer mentally from war, and called this condition “traumatic neurosis.” However, the public tended to use “shell shock” to describe any after-effects soldiers suffered.

Still From a 1917 Documentary of War Neuroses, Netley Hospital in Southampton, Hampshire, England

WWI-era physicians understood more about war-related mental trauma than their Civil War counterparts, and they knew that it would occur if the U.S. entered the war. In 1917, the National Committee for Mental Hygiene formed a task group called “the committee on furnishing hospital units for nervous and mental disorders to the United States Government” which began to canvas likely facilities in which to house mentally ill soldiers. Veterans Hospitals were obvious sites, but the committee also contacted the officials at the federal government’s two insane asylums: St. Elizabeths Hospital in Washington, DC and the Canton Asylum for Insane Indians in South Dakota.

Volunteers at St. Elizabeths Hospital Working With Shell Shocked Soldiers, courtesy George Washington University

St. Elizabeths had been created specifically for the military’s insane (and the indigent insane of the District of Columbia), but the Canton Asylum was created solely for Native Americans and had far fewer resources to treat shell-shocked veterans. Most soldiers who went to a government-run asylum went to St. Elizabeths.

Nostalgia and Insanity

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Thomas Nast’s Picture of a Homesick Soldier

America’s Civil War left many soldiers with lingering mental ailments that degraded their quality of life or disrupted it so violently they were considered insane. Today we would likely call these problems post-traumatic stress disorder, but in the 19th century it would have been called soldier’s heart or irritable heart.

Another syndrome that affected soldiers during the war was called nostalgia. Men (and boys) who had never traveled far from home were suddenly in a strange place away from family and friends. Many were so homesick that they fell into depression and despair, stopped responding to the people and stimuli around them, and sometimes became so lethargic and apathetic that they died.

John Clem, a 12-Year-Old Union Drummer Boy, Would Surely Have Had a Hard Time Coping With Homesickness

Nostalgia was recognized in the 1863 Manual of Instructions for Enlisting and Discharging Soldiers. The manual said: “Nostalgia is a form of mental disease which comes more frequently under the observation of the military surgeon… it belongs to the class Melancholia.”

The typical camp treatment for nostalgia was to shame soldiers for it, increase their drilling and other training, or push them into combat to stimulate them. Letting them take leave, or furlough, was also an option, but camp physicians had little use for it. Many were more concerned about the physically ill and wounded–whose symptoms could not be faked–than they were with uninjured soldiers who had symptoms that could.

It Would Have Been Impossible to Treat Nostalgia in a Civil War Hospital Like This

This cold attitude was driven more by the wartime situation than the prevailing attitude of the era. Moral treatment, with its kinder outlook and sympathetic treatment of the mentally ill still dominated treatment in asylums. Unfortunately, the Civil War demanded soldiers so relentlessly that physicians found it hard to justify releasing a relatively able-bodied soldier from the army, for any reason.

Nostalgia was a very old term for the illness it represented, and the Civil War was the last war in which Americans used it as a diagnosis.

Mental Illness and the Civil War

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

Societies have always observed that participating in wars/battles could affect both the soldiers and civilians caught up in the violence, and not only through physical wounds. After America’s Civil War, people called this change in veterans the “soldier’s heart” phenomenon. At the time, observers believed the negative changes were caused by actual physical changes in the heart that had occurred during war, or that the affected soldiers had longed for home so much that the fixation or focus had affected their minds.

Lunatic asylums had been available to the public for over two decades by the time the Civil War ended, but many families were ashamed to send relatives to them. When soldiers returned from the war, however, families sometimes faced overwhelming problems trying to care for them. If the soldiers were badly wounded, for example, physical care would be demanding and expensive, and mental problems in addition might make giving home-care nearly impossible. Some soldiers returned home with alcohol or morphine dependencies which could also make them difficult to nurse. And, many families–particularly in the South–were too impoverished to provide adequate care for their loved ones.

Milledgeville Lunatic Asylum, GA, Received its First Patient in 1842

Some of these issues may have driven families to place their veterans in an asylum. At the time, treatments for the insane consisted primarily of rest, occupational therapy, and adequate care for any existing physical problems. Receiving these things would have helped many patients, as would the relative peace that came from the stability and routine found in an asylum. Little besides some light labor and observance of the rules would have been expected from these patients, and many soldiers possibly welcomed the change and the chance to rest from the uncertainty and stress of the battlefield. Asylum cure rates during this period after the war could be around 30 to 40 percent–high, but possibly accurate.

Soldiers Could Be Traumatized When They Saw Friends and Comrades Die, photo courtesy Library of Congress, 1861

Though many families continued to resist asylums and could not get beyond the stigma of insanity, others who used the asylums possibly saw a benefit. At the very least, many families may have felt that under post-war circumstances, they could have provided no better care, themselves.

Healing, Hell, and the History of American Insane Asylums

The History of Insane Asylums

Category Archives: Uncategorized

Eccentricity or Insanity?

The Problem of Inebriates

Welcome to America

Believing Their Own Hype

Care for the Insane in Utah

Mania and Medicine

Asylum Patients Under a Doctor’s Care

A New Term for War-Time Trauma

Nostalgia and Insanity

Mental Illness and the Civil War