Tag Archives: overcrowding in insane asylums

A Room of One’s Own

Leave a reply
Blockley Alsmhouse

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

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

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.”

Could Anyone Be Cured Here?

Leave a reply
New York City Asylum for the Insane, Men, Ward's Island

New York City Asylum for the Insane, Men, Ward’s Island

Conditions for newly-arrived immigrants judged to be insane (see last post) were dismal. The emigrant hospital on Ward’s Island was completely inadequate, and it was discontinued after only a few years. New York’s insane population (immigrants included) continued to be housed on these islands, however, and even the most oblivious visitor must have seen that it would be nearly impossible to cure any patient under the conditions there.

“The overcrowding on Blackwell’s Island, even after 400 male patients had been transferred to Ward’s Island, was unbelievable,” says one writer (either a Dr. Parson or Dr. Rowe, who both contributed to a history of New York’s insane asylums). “Not less than 400 beds were made up nightly on the floor.”

Women Eating at Bellvue Hospital, Blackwell's Island, circa 1896, courtesy Museum of the City of New York. 93.1.1.4918

Women Eating at Bellevue Hospital, Blackwell’s Island, circa 1896, courtesy Museum of the City of New York. 93.1.1.4918

Ward’s Island sounds even worse. There were too few attendants, too little food and clothing, inadequate seating–and so few common necessities that patients often had to eat with their fingers. “Nights were hideous with noises and profanity,” the doctor continues. “Patients were locked in their rooms . . . straw-filled ticks, reeking and filthy, lay heaped about. Nurses were unknown and the attendants were coarse and inexperienced.”

The litany of failures went on and on. Of course, no one who could get a better job wanted to work there, and the city was forced to hire convicts as attendants. One can only imagine how these employees “managed” their patients. Finally, a new superintendent in charge worked energetically on the patients’ behalf, and conditions began to change.

Crowded Dining on Blackwell's Island, circa 1896, courtesy Viewing NYC.com

Crowded Dining on Blackwell’s Island, circa 1896, courtesy Viewing NYC.com

My final post on this topic will detail some of the new superintendent’s work.

And All The Rest

Leave a reply
Female Patients Farming in the early 1900s

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

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

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.”