Tag Archives: alienists

Brain Troubles

School Children in the Late 1800s, courtesy Aventa Learning

Alienists in the late 1800s believed that too much mental exertion could cause insanity, whether from over-studying at school, constantly dwelling on one topic, focusing too intently on business issues, or from other situations requiring unremitting thought (without adequate rest). This was one reason for the prevailing idea that children could become insane from intense schoolwork.

Dr. Ray V. Pierce, author of The People’s Common Sense Medical Adviser in Plain English: or Medicine Simplified (1886), explained: “No mental effort can be made without waste of nervous matter. The gardener’s hoe wears by use, and so does every part of the animal organism. Otherwise, nutrition would be unnecessary for the adult.

“The production of thought wears away the gray matter of the cerebrum as surely as the digging of a canal wears away the iron particles of the spade. . . . The intellect, whether engaged in observation, generalizations, or profound study consumes the brain and blood, hence intellectual activity implies VITAL EXPENDITURES.”

Dr. Ray V. Pierce

Pierce continued his explanation by saying that all the functions of the body were essential to the production of nerve-energy (including thought). Unlike exercise, which had value because it helped circulate blood, nutrition, and so on, mental labor did not have advantages of this kind. A child who studied too hard “consumes the blood, exhausts the vital forces, weakens, the organic functions . . . .”

The first result of all this expenditure would be anemia, said Pierce, because the brain “appropriated its red corpuscles” and eventually used them up. Because of this weakened state, other dire things could follow.

Image From Pierce’s Book

Though an obviously incorrect explanation concerning the issue of too much schoolwork, Pierce and many others correctly noted long ago the emotional problems in over-pressured children: An uptick in anxiety, depression, and lack of joy.*

*A 2016 survey showed that nearly one in three teenagers told the American Psychological Association that stress drove them to sadness or depression — and their single biggest source of stress was school.

Medical Conditions and Insanity

Leave a reply

John Taylor, Who Was Committed to Lancaster County Asylum (UK) in 1901 for General Paresis of the Insane

Physical conditions like epilepsy sometimes brought their victims a diagnosis of insanity because of the behaviors these conditions manifested. Other diseases and physical problems were likewise misdiagnosed and forced victims into insane asylums rather than more appropriate hospital treatment. A man described in the October 15, 1870 issue of the British Medical Journal was probably typical. He had been admitted after paranoia and hallucinations made it impossible for him to care for himself. He was only 35 at the time of admission, but had “led an irregular life” for many years prior.

“He said he underwent nightly a kind of torture,which he called the “cylinder finish”, and which he described as an excruciating process, by which his brains were whirled round with extreme velocity, mixed into a pulp, and replaced in his skull just in time for his awaking. This, he believed, was ordered by the doctor, who knew of everything that was done to him, and had the power of regulating the amount of his sufferings,” wrote Dr. H. Grainger Stewart. Commitment to an asylum for a patient like this seemed to make perfect sense.

Al Capone Was Released From Prison in 1939 After a Diagnosis of Syphilis of the Brain

Alienists knew there was little they could do for patients with this form of insanity, called general paralysis of the insane (GPI), beyond giving them sedatives to help them sleep. And sadly, by the time these extreme symptoms manifested, patients often did not have long to live.

Much of Syphilitic Insanity Could Have Been Prevented With Prompt Treatment for the Initiating Disease

Physicians were able to make a tentative link between GPI and previous exposure to syphilis, but weren’t certain because syphilitic insanity did not respond to treatment with mercury the way syphilis did. However, when the bacterium that caused syphilis was discovered in 1905, a test was developed shortly thereafter to detect its presence. Doctors finally realized that untreated syphilis was the cause of the deteriorating mental condition known as general paralysis (or paresis) of the insane.

Comparing Insanity Rates

Leave a reply

Black Patients Received Less Funding for Mental Health Care, Montevue Asylum in Maryland, circa 1909

Alienists knew that the rates of insanity for various races differed, and came up with several explanations for it. One particularly condescending theory about the lower rates of insanity found in Native Americans and blacks was that these races didn’t face the responsibilities and pressures that so-called “civilized” races did. Especially for blacks, so long as they remained slaves and had most decisions made for them, the theory went, they were relatively untroubled by insanity. With freedom and its burdens, however, came overwhelmed minds that led to mental breakdown.

In 1914 Dr. Mary O’Malley at St. Elizabeths’ (Government Hospital for the Insane) compared rates of white and black insanity. What she found initially fit right in with the “civilization” theory: In 1860 during slavery, “one in every 5263 colored persons were insane . . . and in 1910 there was one in every 723 colored persons insane.” O’Malley noted that between 1860 and 1910, insanity in the “colored population” had increased 1,670 per cent.

However, when she studied black and white female* patients–an important distinction–at St. Elizabeths, her results were much less skewed. During the previous four years, 345 black and 455 white women had been admitted. Rates of specific mental conditions proved interesting:

Dr. Mary O’Malley in Center Photograph, photo courtesy of Flickr, taken from History of the Medical Society of the District of Columbia, 1817-1909

Dementia praecox: (black) 37%; (white) 37%

Organic brain disease: (black) 16%; (white)13%

Undifferentiated psychoses (black) 6%; (white) 4%

Manic-depressive: (black) 9%; (white) (11%)

Diversional Occupation at Central Lunatic Asylum in Virginia, the Country’s First Institution for Colored Persons of Unsound Mind

Rates for other diagnoses were similarly close. One distinction that O’Malley did find was that black patients had much lower rates of melancholia and suicidal tendencies. This was especially surprising considering the rates of poverty and lack of status for blacks during this time period.

*Because these women were not veterans as most of St. Elizabeths’ male patients would be–and thus coming from widely differing backgrounds and from many birthplaces–they represented a fairly even-matched pool of impoverished women in the Washington, DC area.

A Room of One’s Own

Leave a reply

Blockley Alsmhouse

Few patients in mental institutions were so out of touch with reality that their surroundings made no difference to them. One of the pillars of early psychiatric theory was that a patient’s environment did, indeed, made a great deal of difference. This is a particular reason alienists recommended bringing patients out of their old home environments and into the insane asylum’s new one. The implication, of course, was that the asylum’s was better. Most planners did strive to provide stately, serene buildings within a pastoral country setting. The reality did not always match their hopes.

The October, 1876 issue of the American Journal of Insanity included an article by Dr. John Bucknill, “Notes on Asylums for the Insane in America.” In it, Dr. Bucknill pointed out some glaring deficiencies within Philadelphia and New York asylums.

Dr. John Bucknill

In Philadelphia, a collection of buildings called the Blockley Almshouses, included an insane asylum. The place was constructed to hold 500 patients, and instead held 1,130. Beds were strewn on any available floor space at night to accommodate the extra people, and consequently the air become humid and smelly. Dr. Bucknill noted that there was nowhere for patients to exercise.

The female ward was particularly shameful. In a space designed to accommodate 19 “excited patients” in single rooms, instead held 65 women. The rooms were only six feet by 10 feet to begin with, which was justified by their use to for manic or disturbed patients. Unfortunately, Dr. Bucknill wrote, “. . . these lodging rooms are occupied at night generally by two, and frequently by three persons, and all of them, as I was informed, were regularly put into strait-jackets to prevent mischief during the night.”

Woman Wearing a Strait Jacket in Bed, 1889

How anyone–staff, trustees, inspectors–could have seen this situation and expected patients to recover their sanity says a great deal about the people running it. Dr. Isaac Ray, in an 1873 paper read before the Social Science Association of Philadelphia, said of the conditions: “If homicide is not committed every night of the year, it is certainly not for lack of fitting occasion and opportunity.”

A Focus On Symptoms

Leave a reply

Symptoms Produced a Diagnosis

The field of psychiatry had little science behind it when insane asylums were first established. Many times, alienists (an early name for psychiatrists) had to base their diagnoses on symptoms alone, simply because they did not understand the root causes of a patient’s behavior. Epilepsy presents a good example: Sufferers often had periods of troubling behavior prior to or after a seizure. When doctors looked at these behaviors, they saw insanity rather than a medical condition.

A nutritional deficiency called pellagra also mimicked insanity in some people. This is a disease caused by a niacin (B-vitamin) deficiency, lack of tryptophan (an amino acid) in the diet, or a failure to absorb these nutrients. In the early 1900s many Southern poor ate a diet high in corn, molasses, and fat-back. The corn-heavy diet allowed pellagra to develop because Southern preparation methods did not release corn’s niacin. (In contrast, Mexicans soaked corn in limewater–which released its niacin–before making tortillas, and didn’t develop the condition.)

Pellagra Was Recognized As a Serious Problem

Pellagra’s classic symptoms included dermatitis, diarrhea, and…dementia, which frequently took the form of indifference, stupor and melancholy. Victims were sometimes sent to asylums as a result, where fortunately some actually recovered once their diets became less corn-based.

Cures are Insane

Leave a reply

Brattleboro Retreat in Vermont, Which Opened for Occupancy in 1836

To modern sensibilities, much of what has been believed in the past about insanity sounds silly and unbelievable. Though we can often follow the logic behind even outlandish ideas, given the lack of research available at the time, the logic behind certain treatments can be a little more difficult to grasp.

In Vermont somewhere around 1800, a man named Richard Whitney became “mentally deranged” and a council of physicians tried its best to help him. They concluded that a temporary “suspension of consciousness” was just what was needed, the theory being that if the patient could be rendered unconscious in a fairly dramatic way, his mind would be diverted from unhappy associations and so remove the cause of his affliction.

As Late as the 1930s, Patients Were Induced Into Low Blood Sugar Comas to Rewire the Brain

As Late as the 1930s, Psychiatric Patients Were Induced Into Low Blood Sugar Comas to Rewire the Brain

The physicians first completely submerged him in water until he “became insensible” and then resuscitated him. This experimental treatment failed, but undaunted, the doctors tried again. The second effort involved opium, selected as “the proper agent for the stupefaction of the life forces.” Unfortunately, this trial killed the patient.*

Thought this extreme example is outrageous, alienists (the first mental health specialists) frequently experimented with new treatments on patients–most probably without consent or oversight. Records will never show how many died or suffered catastrophic harm from them, but researchers can rest assured that much suffering was involved.

The Utica Crib Was a Notorious Restraining Device

*Information about this case came from a work called the History of Brattleboro, published in 1806 and retold in a history of asylums in 1916..

The Dangers of Injury

Leave a reply

Two Men Cooling Off in a Park During the 1911 Heat Wave that Drove Some People to Suicide and Insanity, courtesy New England Historical Society, Library of Congress

Two Men Cooling Off in a Park During the 1911 New England Heat Wave that Drove Some People to Suicide and Insanity, courtesy New England Historical Society, Library of Congress

Alienists (early psychiatrists) believed madness could result from a long list of issues such as heredity, strong emotions, sudden shocks, illness, and physical injury. The latter played a part in many patients going to insane asylums, as newspaper accounts and case studies show:

In 1897:

Maggie Mc. —The doctor in the case testified that she can’t be trusted in public, her conduct not being proper. Five years ago she had a fall that left her unconscious for several hours; her wrist was broken at the time, and now there is a suspicion that her skull must have been fractured. The 28-year-old woman was sent to an asylum.

Phineas Gage Underwent a Personality Change After a Tamping Iron Pierced His Skull in 1848

Timothy O’B. — . . . had acquired a big head, ordering dry goods jewelry in great abundance, with no cash to pay; he also imagines he has valuable property. His trouble began by falling from a ladder two years ago and hurting his back and side, and after developing rough behavior, it is said that he was struck over the head by a policeman, through which he has become a raving maniac.

Probable Causes of Insanity, Missouri State Lunatic Asylum, 1854, courtesy Missouri State Archives

Probable Causes of Insanity Included Injuries, Missouri State Lunatic Asylum, 1854, courtesy Missouri State Archives

Falls from horses, kicks from mules, accidents at work and the like, could all bring on insanity. Most alienists felt that people who did become insane after an injury were predisposed to it anyway, and that the injury brought it out, just as other life experiences like overwork or sudden shock might. An exception would be a traumatic injury to the head which in and of itself could have damaged the brain of an otherwise healthy person.

Believing Their Own Hype

Leave a reply

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.

Where Are the Breakthroughs?

Leave a reply

The Public Hospital for Persons of Insane and Disordered Minds, Virginia, in the 1800s

In the January, 1884 issue of the American Journal of Insanity, author Joseph G. Rogers, MD, noted: “The past year has not been marked by the discovery of any remarkable special methods in the treatment of insanity, nor any very remarkable advance in results.”

This had to be discouraging for physicians at these facilities, who wanted to help their patients recover as well as make names for themselves and perhaps do a little empire-building. By this time, too, the public had been scandalized by a number of exposés concerning asylum conditions–and this led to its lessened enthusiasm and support for them. Asylum superintendents very much wanted to keep the public’s confidence, and longed for better treatments and cure rates.

This DeKalb Crib, circa 1905, Was the Type of Device That Could Create Scandal Concerning Asylum Care, courtesy Maryland State Archives

Acute mania (mania that had only recently manifested) had the greatest chance of cure, so alienists tended to concentrate on these cases. What could they do? In Dr. Rogers’ words, the tendency for patients with this condition was to “Wear and Waste,” and he suggested “Rest and Food” to help them. Unfortunately this treatment could be done at home, by family, so asylums also needed to look at treatments that most families couldn’t give.

Even though Rogers admitted that rest and food were the primary treatments for acute mania, he also suggested “the speedy committal to a proper hospital”–meaning, of course, an asylum. There patients could receive the “soothing, easeful [sic] influence of the bath at 90° Fahr.” He noted that the patient would probably have an empty stomach, which should be filled with nutrients, followed by a rest. If the patient were delirious, a hypnotic like chloral could be used to bring about the rest.

Though From a Later Date, This Type of Bath Was Considered Therapeutic

So far, most of this treatment could be given at home by the patient’s family. In my next post, I will continue to give Dr. Rogers recommendations for treatment, which were progressively more complicated and medical in nature.

Work and Money

Leave a reply

Clarinda State Hospital Was Impressive

Even new insane asylums–presumably built by the demands of a state’s constituents–often had money woes. For many institutions, funds were only provided every two years via legislative appropriations. This meant that they were built piecemeal, seemingly always a step or two behind the real needs of patients and their families. Clarinda State Hospital in Iowa is probably typical.

Iowa’s General Assembly passed an Act to establish the asylum in April, 1884 and the Iowa Grand Lodge of Masons laid the cornerstone in July. A central building and supervisor’s department were nearly finished by December, but it wasn’t until the 1886 session that money was appropriated to go further. The institution opened late that year and accepted its first patients: 222 males received from other asylums. As legislative sessions continued, the asylum received additional funds for building and continued to complete the design which had been planned for it. Finally, in 1897, the asylum stood as a complete entity.

Patients Working in Laundry Room at Fulton State Hospital circa 1910, courtesy Missouri Archives

As soon as patients arrived, they began working. They graded, sodded, planted, and farmed–hard work rather than the “light” therapeutic work that alienists sincerely believed helped patients occupy their time, divert their minds, and heal both mind and body. Besides the outdoor toil, patients helped a hired tailoress make all the clothing worn by patients (except for white dress shirts, hose, and hats). The asylum’s residents also made their own furniture and shoes, brooms, and mattresses under the supervision of professionals assisted by patients.

Patients Worked at Useful Tasks at Most Asylums, photo courtesy Buffalo Psychiatric Center

Though work did help patients–especially if they wanted to do it–the probability remains high that many patients were subtly coerced into labor they would not have done otherwise. For superintendents charges with controlling costs, the proximity of so much free labor was likely a temptation they didn’t always resist.

Healing, Hell, and the History of American Insane Asylums

The History of Insane Asylums

Tag Archives: alienists

Brain Troubles

Medical Conditions and Insanity

Comparing Insanity Rates

A Room of One’s Own

A Focus On Symptoms

Cures are Insane

The Dangers of Injury

Believing Their Own Hype

Where Are the Breakthroughs?

Work and Money