Category Archives: Uncategorized

Sherlock Again

Image from Doyle’s Story, The Creeping Man

Sir Arthur Conan Doyle’s Sherlock Holmes stories illustrate several Victorian ideas about insanity and its causes (see last post). In “The Adventure of the Naval Treaty,” Doyle described a case of acute mania which was resolved with prompt and proper care–an entirely understandable outcome. However, with “The Creeping Man,” Doyle’s understanding of the external causes of human behavior seems to be completely awry.

In this mystery from 1923, Professor Presbury’s personal secretary tells Holmes and Watson about his employer’s peculiar changes in behavior. Holmes eventually discovers the bizarre reason for the professor’s changed behavior: Presbury started to behave like a monkey because in a quest for youth, he began using a serum obtained from monkey blood/glands. This serum has given him the animal’s traits.

Insane Asylum at Kankakee

The idea behind this story sounds ridiculous, but Doyle may have been taking a cue from real events. In 1899, the New York Times had reported on Irwin Fuller Bush, a young man considered hopelessly insane and admitted to the Insane Asylum at Kankakee (Illinois). He had been almost miraculously restored to health by Dr. B. P. Roberts, a physician in Greene City, Missouri who treated Bush with animal glands. Roberts said, “Today, through the treatment with lymph from glands of goats, Bush is at home and declared to be completely restored in mind.”

Meeting of the Medical Staff, Kankakee Mental Hospital, circa 1910

The glands were also said to “arrest senility.” Roberts was enthusiastic enough about his treatment to go to Europe and try to convince alienists there to adopt the treatment in their own insane asylums. This real-life event and others using animal glands to cure various ailments, simply reflected the medical community’s imperfect understanding of what caused physical and mental changes in people.

Writing Madness

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Sir Arthur Conan Doyle

Though modern readers can find old treatments for mental health laughable, they made sense to a generation just beginning to move away from even more archaic thought on the topic. Victorian-era conceptions about “madness” are wonderfully illustrated in Sir Arthur Conan Doyle’s Sherlock Holmes stories. Doyle had a medical degree (University of Edinburgh, 1881) and had practiced medicine before writing these mysteries, so his presentation of mental illness and its causes likely reflected his own, educated views on it.

Rather than look at madness as a permanent state deriving from physical roots, newer thought allowed for events like shock, overwork, and stress to precipitate bouts of insanity that could hopefully prove temporary if given correct–and timely–care. This idea played out well in “The Adventure of the Naval Treaty.” In the narrative, a young man in a trusted position lost valuable papers and felt himself ruined over it. He tells Holmes and Watson that upon trying to go home after his discovery: “I had a fit in the [train] station, and before we reached home I was practically a raving maniac.”

Illustration from Doyle’s Story Concerning Temporary Madness

Woman Admitted to Bedlam Hospital for Acute Mania, courtesy The Sun

He went on to tell the two that he had been “raving with brain fever” for nine weeks, but that with the tender care of his fiance and doctor, he had just recovered his reason. This episode clearly fit the modern idea that shocks and emotional turmoil could cause insanity–and that so-called acute (recent/short) episodes of insanity, if acted upon quickly, could be cured.

Overcrowding and the Attendants’ Plight

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Agnews Insane Asylum Patients Eating Lunch, courtesy Detroit Public Library Digital Collections

Overcrowding in asylums created miserable conditions for patients (see last post), but it also made attendants’ workload overwhelming and stressful. They had little time off compared to even today’s harried worker: usually a half day off a month, a couple of evenings off a week, and an entire Sunday off once a month. Additionally, attendants usually lived on-site and could seldom “get away” from their work atmosphere–long hours and stress just added to their own mental burden.

Attendants started their days early in order to get patients up, out of bed, and dressed at 6:00 a.m. or 7:00 a.m. each morning, and perhaps wash and change soiled patients the night shift had missed. They supervised patients’ daily activities, broke up altercations, noted their illnesses or other changing conditions, bathed and/or shaved them, and helped serve meals. Attendants cleaned incessantly, and kept constant watch over their wards for any dangerous conditions stemming from violent, suicidal, or delusional patients.

Male Attendants at Willard Asylum for the Chronic Insane

Attendants also needed to socialize with patients: they gently steered them from obsessive or disturbing thoughts, reassured them when they worried about family and friends, led them into constructive conversation, and so on. Ideally, they could be the trusted friend and mainstay that supplemented the efforts of the asylum’s medical staff.

Attendants at Pennsylvania Hospital for the Insane

Unfortunately, these important therapeutic tasks were usually the first to go when the work of physically caring for patients overwhelmed attendants. Even worse, their own stress and frustration could spill over into their interactions with patients, making a miserable environment even worse for them.

And All The Rest

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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

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

“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

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

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

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

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

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

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

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

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

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

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

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 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.

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

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

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).

Dangerous Confinement

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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

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

Healing, Hell, and the History of American Insane Asylums

The History of Insane Asylums

Category Archives: Uncategorized

Sherlock Again

Writing Madness

Overcrowding and the Attendants’ Plight

And All The Rest

Excellence for the Entitled

What Price for Care?

Escape Was Possible

Saying Goodbye

Was There Any Way Out?

Dangerous Confinement