In 1900, American psychiatric hospitals were still known as lunatic asylums, and the people locked inside them had few legal protections and even fewer reasons to expect genuine care. Most patients were not there by choice. Up until the 1960s, the majority of people in U. S.
mental health facilities were admitted involuntarily, a sharp contrast to the roughly seventy-one percent of psychiatric patients today who enter treatment voluntarily. The problem was not only medical. The laws of the era allowed families to commit relatives with little or no supporting evidence. An Illinois law from 1860 made it possible for Elizabeth Packard to spend three years in an asylum for no reason other than practicing a different religion from her husband.
In 1883, Henry Fraser was sent to an asylum in New Orleans because his mother called him uncontrollable, saying he played with himself to complete exhaustion. Hospitals also had perverse financial incentives to hold people longer. Families could essentially purchase confinement for relatives they no longer wanted to manage. By 1904, only 27.
8 percent of asylum patients in the United States had been institutionalized for a year or less. The vast majority were long-term residents. Given the conditions inside, it is little wonder that some people tried to hide their conditions to avoid commitment. In 1887, journalist Nellie Bly went undercover in a mental asylum to document what patients actually endured.
She reported horrific treatment from doctors, including hair pulling and solitary confinement. She described how patients were treated like prisoners, writing that when she could not sleep, she lay in bed imagining how horrible it would be if fire broke out in the institution. Every door in the building was locked separately, and the windows were all heavily barred, making escape nearly impossible. A doctor told her that in one building alone, some three hundred women were locked ten to a room, and it was impossible to get out unless the doors were manually unlocked.
Medical treatment at the turn of the century offered little relief and sometimes caused more harm. By the early twentieth century, many mental hospitals routinely tested patients for syphilis. At the Oregon State Hospital, doctors used a treatment for the disease first advocated by Dr. Julius Wagner-Jauregg, intentionally injecting malaria germs into a patient’s bloodstream on the theory that malarial fever could kill the syphilis infection.
Wagner-Jauregg’s research suggested that roughly half of these patients saw a reduction in syphilis symptoms after the malaria infection. But the same research showed that at least fifteen percent died from the treatment. That did not stop the practice. The earliest treatments for mental illness had been brutally physical.
In early nineteenth-century England, asylums used a wheel to spin patients at high speed. Other methods still in use at the end of the century included harnessing patients and swinging them, or branding a patient with hot irons in an attempt to bring them to their senses. Improvements in medical technology did not necessarily mean more humane care. By the 1930s, doctors had begun experimenting with lobotomies and electroshock therapy.
Patients soon learned that the only reliable way out of the asylum was to fake recovery. As one patient put it, you do just what the doctor says if you want to get out of here. But faking it did not cure anyone. That same patient later died by their own hand.
Mental hospitals around 1900 did not treat only adults. Between 1854 and 1900, the Worcester County Asylum screened hundreds of children aged sixteen or younger to determine whether they needed treatment. The asylum admitted nearly two hundred children, recording their violent tendencies and risk of suicide. One study found a high death rate among the children, who rarely saw their families after admission.
Doctors treated the young patients exactly as they treated adults, making no allowances for age. Inside the hospital, patients slept in single rooms or dormitories. Nellie Bly described women sleeping ten to a room with locked doors and bars on the windows. At the Oregon State Hospital, sleeping rooms measured seven by fourteen feet.
The Morning Oregonian reported in 1883 that the hospital contained modern technology, including dumbwaiters that opened and closed as they traveled, supposedly to prevent patients from escaping. Late nineteenth-century reforms had recommended treating mental illness with rest, beautiful buildings, and manicured grounds, which produced majestic architecture on the outside of many asylums. The facilities were sometimes so attractive that they drew asylum tourists. Guidebooks recommended visits to institutions like the Bloomingdale Asylum for the Insane, which one guide praised for having one of the most extensive and beautiful views of any place near the city.
But despite the tranquil exteriors, the conditions inside still reflected the belief that patients were prisoners. Newly admitted patients were often subjected to dehumanizing procedures immediately. At the Oregon State Hospital, patients had to empty their pockets and strip for a bath. After a medical examination, they underwent blood and syphilis tests.
Finally, they might be shown to a room with barred windows and left alone. Women’s institutions sometimes followed different procedures. Nellie Bly’s examination included a physical assessment in which a doctor accused her of taking drugs. Even basic distinctions between patients and staff could be unclear.
At the Oregon State Hospital, the standard white outfits caused confusion. According to one patient, neither patients nor staff wore uniforms. The first person he saw was a man in a white apron. He assumed the man was an attendant and asked him a question.
Later he learned the man in the apron was also a patient, and the two were in the same ward. During his involuntary commitment, he found himself perpetually confused, eventually concluding that the attendants were usually a little better dressed than the patients. Diet was another area of rigid control. At St.
Elizabeth’s, also known as the Government Hospital for the Insane, Dr. Harry Hummer promoted eggs as an important part of the diet, recording that 125 patients went through 17 dozen eggs every day. Patients with epilepsy received a special diet. According to Hummer, they were not allowed to have anything doctors thought would upset them, including corned beef, cabbage, and other so-called heavy indigestible foods.
Nellie Bly described a meal of tea, a single piece of bread, rancid butter, and five prunes. After a ten-day undercover visit to Bellevue Hospital, she reported that the eating was one of the most horrible things. Conditions could vary, though. Patients at another asylum described a dining room that felt more like a restaurant or hotel, with patients sitting together while other patients served them.
Some institutions grew their own food on the grounds, with patients working in the fields in the name of improving their mental health, which also saved the hospital money. State mental hospitals often housed multiple patients in barracks-like conditions with little privacy. One patient at the Oregon State Hospital reported that on his first day, while resting in his room, another patient wandered in to tuck in the sheets. He was followed by two others who simply stared at the new arrival without speaking.
At Bellevue, Nellie Bly described a crying woman who begged for death nearly the entire night, while another woman repeatedly yelled murder. In the days before patient Taylor Benjamin, known as John the Baptist, died at the New Orleans City Insane Asylum in 1893, he reportedly slept very little at night and was constantly screaming. Reformers in the nineteenth century had encouraged states to build insane asylums using tax dollars, and by the 1870s, most states had at least one. The Oregon State Hospital opened in 1883, and by 1936 the state had expanded it with two additional buildings, treating 2,400 patients.
Doctors of the era attributed insanity to many causes. Records from the New Orleans City Insane Asylum in the late 1800s listed reasons for commitment. A man named Frank Cambo was committed because malarial fevers had left him deranged. William Burn was institutionalized after falling from a horse and landing on his head, which doctors said caused a softening of the brain.
Henry Schreiber’s diagnosis was congenital idiocy, with doctors noting he had been an idiot from birth. Jane D. Passe, who apparently drank too much whiskey, was diagnosed with chronic alcoholism as the cause of her insanity. In the year 1900, the American mental hospital was a place where incarceration and treatment were nearly indistinguishable.
Patients faced involuntary commitment on flimsy evidence, brutal experimental procedures, inadequate food, and prison-like conditions. The reforms that built grand buildings and landscaped grounds offered no protection inside the walls. The institutions were full of people who had nowhere else to go and no voice in what happened to them.