Tag Archives: Government Hospital for the Insane

Comparing Insanity Rates

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

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

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

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.

 

Superintendents in Danger

Leave a reply
Howard Hall, Government Hospital for the Insane

Howard Hall, Government Hospital for the Insane

Though attendants usually had the upper hand when it came to violent interactions with patients in asylums, patients could also be violent and harbor great animosity toward those in charge of their treatment. The May 22, 1911 issue of the Washington Post detailed what could have been a blood bath at St. Elizabeths (Government Hospital for the Insane) in Washington, DC if not for the loyalty or conscience of an asylum patient.

“The plot was hatched in Howard Hall, the building in which are imprisoned all of the criminally insane patients of the hospital,” the paper explained. A man named Charles Fletcher and “nine other desperate criminals” planned to kill the attendants in the Hall and escape. Another patient, Arthur D. Barnes, overheard the plot, and saw the conspirators hide files, iron bars, and chair legs in preparation for the break.

Dr. William A. White, Superintendent at St. Elizabeths, courtesy National Library of Medicine

Dr. William A. White, Superintendent at St. Elizabeths, courtesy National Library of Medicine

“When he was sure he knew everything about the plot, he told Dr. White [superintendent at St. Elizabeths]. His story was found to be true,” the paper went on. Fletcher was taken to “the United States jail for safekeeping” while the others were confined in separate cells.

President William Howard Taft

President William Howard Taft

Someone on Barnes’ behalf presented a petition for pardon to President Taft, who was to rule on it the day after the story broke. Barnes had originally been sent to the penitentiary at Atlanta, Georgia for life, for killing a man “in a fit of jealous rage. Later, he showed traces of insanity, and was transferred to the government hospital,” the Washington Post explained.

St. Elizabeths and the Civil War

Leave a reply
General Joseph Hooker Received Care at St. Elizabeths, courtesy NARA RG 418-P-717

General Joseph Hooker Received Care at St. Elizabeths, courtesy NARA RG 418-P-717

Before the Civil War began, Dr. Nichols (see last two posts) and his oversight committee decided to open up the unfinished east wing of the asylum to the army’s use for sick soldiers. The space was officially called St. Elizabeth Army General Hospital, but soldiers called it St. Elizabeths when they wrote home. Nichols also opened a building called the West Lodge to the navy.

Nichols was hard pressed to run the asylum and help the military side of the operation as well. For the most part, only the military’s sick came to the hospital, though a few hundred (out of about 1,900) patients were treated for war wounds. In April 1863, however, military hospitals began to send their patients with amputated legs to St. Elizabeths because it had opened up a prosthetic limb shop. Soldiers with leg amputations received surgical treatment there, were fitted for legs, and remained until healed. The patient also learned how to clean and oil his new leg and care for it under the supervision of R. W. Jewett, who had patented the artificial limb shop.

Civil War Cemetery, circa 1897

St. Elizabeths’ Civil War Cemetery, circa 1897

Many inconveniences resulted from the asylum’s accommodation of the military, including prime agricultural land being taken from service for ordnance training. Nichols also found it hard to collect from paying patients whose families lived in the South. (Out of compassion, he did not discharge these patients.) Foraging soldiers stole food from the hospital’s garden, and numerous other trespasses–like stealing coal–frustrated Nichols repeatedly.

The Army Maintained Many Hospitals During the Civil War. This is Ward K of Armory Square Hospital, Washington, DC, 1862, Located Aproximately Where the National Air and Space Museum Stands Today, courtesy Library of Congress

The Army Maintained Many Hospitals During the Civil War. This is Ward K of Armory Square Hospital, Washington, DC, 1862, Located Approximately Where the National Air and Space Museum Stands Today, courtesy Library of Congress

As the war went on, 85 percent of the total number of admissions to the asylum came from the army. The rate of navy admissions was much lower because in Nichols’ words: “. . . the seaman has a more hardy and unsusceptible [sic] constitution than the landsman.”

 

Early Care at St. Elizabeths

Leave a reply
A Four-Horse Carriage Used to Take Male Patients to Town at St. Elizabeths

A Four-Horse Carriage Used at St. Elizabeths to Take Male Patients to Town

The Government Hospital for the Insane–better known as St. Elizabeths–accepted the insane of the District of Columbia but had a special patient population of veterans from the nation’s army and navy. Like most institutions of its kind, the asylum was beautifully landscaped and had pleasing views for the patients.

St. Elizabeths’ first superintendent, Dr. Charles Nichols, did not run to extreme treatments. If a patient were not overtly disturbed, he prescribed tonics and a nourishing diet, warm baths, and treatments for “regularity of all the alimentary functions.” Provided patients could be induced to eat (the first step on the alimentary journey), alimentary treatment consisted primarily of ensuring the bowel excreted waste properly. Physicians sometimes induced vomiting to “clean out” the system, but it was far more likely that they would administer purgatives (very strong laxatives) to make sure the bowel was completely evacuated.

Dr. Charles Nichols

Dr. Charles Nichols

As in most asylums, patients were offered work to occupy their time and distract their minds from their troubles. Patients were allowed visitors, could walk on the grounds, and enjoyed (especially early on) individual treatment plans. Theories of the time supposed that most insanity was caused by environment and habits, so every effort was made to provide “things rational, agreeable, and foreign to the subject of delusion.”

Nurses on the Lawn Across From Building E, St. Elizabeths, courtesy NARA

Nurses on the Lawn Across From Building E, St. Elizabeths, courtesy NARA

Whether a patient’s environment had become contaminated by overwork, marital problems, or the many pressures of life, doctors hoped that taking people away from the environment which had created their mental distress would allow them to recover. For at least the initial period of asylum growth, this belief was an overwhelmingly valid reason for insisting patients be committed to an institution rather than receive treatment at home.

When Johnny Came Marching Home

Leave a reply
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.