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The Insane in Territories

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Main Street in Norman, OK, 1889, courtesy Emma Coleman Photography Collection, University of Oklahoma

Main Street in Norman, OK, 1889, courtesy Emma Coleman Photography Collection, University of Oklahoma

Several states had created insane asylums while they were still part of a Territory; Oklahoma was one of these. The Cherokee Nation actually established the first asylum in the area when they erected the Cherokee Home for the Insane, Deaf, Dumb, and Blind outside the city of Tahlequah in 1873.

The Territory’s non-native insane were sent to Jacksonville, Illinois for treatment until two physicians created a private company called the Oklahoma Sanitarium Company. The Territorial Legislation awarded them a three-year contract to care for the insane, hoping to cut down on transportation costs for patients going to Illinois. The company constructed a hospital (the Oklahoma State Hospital) at Norman, OK in 1895. The Territory also approved a second asylum (Oklahoma Hospital for the Insane) in Supply, OK in 1905.

Dr. Griffin Was Hired from North Carolina in 1899

Dr. Griffin Was Hired from North Carolina in 1899 and Became Superintendent in 1902

Because Oklahoma’s institutions were created later on in the asylum era (a third one opened in 1913), care was relatively modern: the State Hospital’s staff consisted of both attendants and nurses, as well as a physician-superintendent and assistant physicians. By 1910, it had even adopted the practice of employing women nurses in male wards. Within twenty years of its creation, the hospital had a training school for nurses and a laboratory.

Oklahoma Sanitarium Building, 1897, courtesy Emma Coleman Photography Collection, Oklahoma University

Oklahoma Sanitarium Building, 1897, courtesy Emma Coleman Photography Collection, Oklahoma University

A 1909 report from the institution shows that 94 patients were either released or “restored” and 48 released as “improved.” A number of other patients (71) were paroled, that is, given the opportunity to go home to see how they would do, while 15 managed to escape.

For those in the asylum at the time, a majority diagnosis was hereditary insanity. Other causes for insanity included: ill health; syphilis; inebriates; old age; drugs; child birth; mental worry; privation; injury to brain; epilepsy; sunstroke; pellagra; and self abuse.

Paying the Bills

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Many Eager Dreamers Rushed to California in 1849

Many Eager Dreamers Rushed to California in 1849

The idea that asylums were necessary had been widely accepted in America by the middle of the nineteenth century. Even far-flung regions like California provided for the care of the insane; it established an asylum at Stockton in 1853, only a few years after the 1849 gold rush.

Creating an asylum called for relevant legislation, and California’s first general law regarding the insane gave the responsibility for proper commitment to county judges:

“. . . [the judge shall] upon the application of any person under oath, setting forth that any person by reason of insanity was unsafe to be at large, or was suffering from mental derangement, forthwith cause the said person to be brought before him and cause to appear two reputable physicians, to examine the alleged insane person . . . .”

Though it seems that just about anyone prepared to swear to another’s insanity could begin the application process for commitment, this young state (created just three years earlier in1850) commendably included some practical safeguards. First, the initiator’s desire was not enough to force a commitment, and that person had to go through government channels to continue the process–surely a deterrent to some cases of spite or malice.

Second, not only did the two required physicians have to examine the proposed patient and declare him/her insane, they had to certify under oath that the diagnosis was correct. Then, it was still the judge’s decision to commit the person, based largely on the premise that the suspected person was not safe to be at large. The expenses incurred by any person so committed would be born by the state–and that even included expenses for the patient’s travel to the asylum. The latter may not have been an extremely powerful deterrent against frivolous commitments, but presumably judges in a newly functioning state would be careful about committing people to Stockton without considering the drain on public funds.

Most state institutions were designed primarily to help the poor, though many did take paying patients. California followed this pattern and allowed the non-indigent into its state asylums. However, the State Commission in Lunacy was to collect any appropriate charges for these latter patients, and could “bring action to recover such charges.”

Building at Stockton State Hospital

Building at Stockton State Hospital

Old Photo of Stockton State Hospital

Old Photo of Stockton State Hospital

Schools for Insanity

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Alienist Dr. Isaac Ray

Alienist Dr. Isaac Ray

People today wonder how physicians and other educated people could have believed excessive smoking, masturbation, or reading novels might lead to insanity. Though anything in excess is probably not as healthy for a person as that same thing in moderation, how could something like “excessive study” cause insanity? An extremely prominent alienist, Dr. Isaac Ray, explained:

“Though hard study at school is rarely the immediate cause of insanity, it is the most frequent of its ulterior causes, except hereditary tendencies.” Ray further declared that the chances of recovery [from insanity] were far fewer in the “studious, intellectual child” than in the opposite type. The reason for this, Ray explained, was that “though the immediate mischief may have seemed slight, but the brain is left in a condition of peculiar impressibility, which renders it morbidly sensitive to every adverse influence.”

irls From Glen Eden Boarding School for Girls, circa 1911

Students From Glen Eden Boarding School for Girls, circa 1911

Ray’s remarks appeared in a September, 1859 issue of the The Atlantic Monthly, within an article strongly admonishing the then-present system of excessive schoolwork for children. A typical schedule in a well-run girls’ boarding school could be something like this: Rise at 5:00 a.m., study for two hours, eat breakfast, spend six more hours in the schoolroom, eat lunch, then spend two hours sewing, writing letters, completing other small tasks, and perhaps walking if weather permitted. Afterward there would be another hour of study, supper, and then two more hours of study–eleven in all. The author later mentioned popular Sunday School contests throughout the country, in which winners memorized up to 5,000 Bible verses.

An 1854 Math Book by Joseph Ray

An 1854 Math Book by Joseph Ray

It’s no wonder that many children fell into ill health, whether or not the excessive study actually led to insanity. However, with this kind of tasking in mind, it’s a bit easier to believe the (unnamed) author’s statement that he had recently heard of “a child’s dying insane, from sheer overwork, and raving of algebra.”

 

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.

Theories About Insanity

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Dr. Edouard Toulouse

Dr. Edouard Toulouse

Today’s newspapers very seldom discuss the actual causes of mental illness, but experts in the past were much more confident about their ability to dig out the reasons behind a patient’s problems. In 1922, The Washington Post ran an article in which a Professor Edouard Toulouse stated that there were three primary causes of madness: sorrow, thyroid deficiency, and vice.

Upon checking into his clinic, patients were interviewed, then given a physical exam to see whether they were born “with an excess of thyroid matter” or whether they had become addicts to vice, which included drugs. The good news was that Toulouse believed patients could be cured no matter how their madness originated.

Vice Was Considered A Cause of Insanity

Vice Was Considered A Cause of Insanity

Sorrow, of course, had many origins, but Dr. Toulouse particularly spoke about the difficulty of curing a patient whose sorrow derived from loss of wealth. He said that “practically the only sedative for a person who has once been wealthy and who finds himself suddenly poverty-stricken is to provide him again with wealth.” This course was often impossible, but diversion and time could be effective in healing.

Though Toulouse may have over-simplified the causes and treatments of insanity, his views gave patients’ families great hope. Toulouse firmly believed that nearly all cases of madness could be cured, which had to be comforting to a patient’s loved ones. Furthermore, he thought many cases of madness could be prevented, and said: “It remains now to coordinate our work so that prophylaxis [meaning the prevention of madness] will become legally obligatory.”

Good Mental Hygiene Was Recognized as a Way to Prevent Insanity

Good Mental Hygiene Was Recognized as a Way to Prevent Insanity

The article did not say what all these preventatives might be, but Dr. Toulouse was president of the Paris League for Mental Hygiene and Prophylaxis and surely had many programs and practices in mind. At least one primary avenue he and the League proposed was to stop sending patients immediately to an asylum, and instead assess their condition in a dispensary first and offer outpatient care in milder cases. This one step would likely have alleviated much sorrow and anxiety for patients and their families.

Goat Glands as Cure for Insanity

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J. R. Brinkley, from The Goat-Gland Transplantation

J. R. Brinkley, from The Goat-Gland Transplantation

The March 14, 1920 issue of the New York American carried an article about Dr. John Brinkley and some of his amazing cures through goat gland transplants. Brinkley had pioneered the use of these gland transplants to cure everything from barrenness in women to aging and hardening of the arteries. Goat gland transplants would also cure insanity, according to a case study discussed in a book: The Goat-Gland Transplantation by Sydney Flower.

A young woman suffering for the past twelve years with dementia praecox (a premature dementia, often beginning in the teens) that included homicidal tendencies and depression, had been treated by many specialists to no avail. However, Dr. Brinkley transplanted goat glands in her, and “the day after the transplantation of the glands this young woman embraced her mother, and talked so rationally to her that she called in Dr. Brinkley, and with tears repeated what her daughter had just said.”

The Dementia Praecox Case and Head Nurse Miss Lewis

The Dementia Praecox Case and Head Nurse Miss Lewis

Brinkley established the Brinkley-Jones Hospital and Training School for Nurses at Milford, Kansas, where he and other doctors performed thousands of goat gland operations. Brinkley had purchased his own medical diploma from Eclectic Medical University of Kansas City, Missouri, which was enough to allow him to operate as a surgeon for many years. Fortunately, Morris Fishbein, editor of the American Medical Association’s journal, finally forced Brinkley into court, where his fraudulent background and ignorance about medical matters became grounds to revoke his license.

Brinkley's Hospital in Milford, Kansas

Brinkley’s Hospital in Milford, Kansas

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.