There have been times I have consider the treatment and care I’ve received in psychiatric inpatient units to be practically medieval; sleeping under blankets so thin I could see through them, eating portions too small to warrant any condiments, and witnessing both incompetent doctors and vicious nurses. Granted, not all of these places have been created equally, and while some psychiatric hospitals or wards have been brought up to date, others remain wanting.
With those feelings in mind, I began a journey listening to the account of a 19 year old woman living in the 1880’s who purposefully had herself committed to the local asylum in a journalistic effort to report on the conditions therein.
I believe I was directed toward Ten Days in a Madhouse by Nellie Bly by an episode of one of my favorite podcasts, Stuff You Missed In History Class. I secured an audiobook version of Nellie Bly’s account through my local library (I’m not sure I would recommend it, the accents done by the recording artists have little bering on the actual places the people in the account are from) but you can also find the entire written version (initially published as several articles and then as a compilation in 1887) for free here.
While the inpatient system these days can still seem somewhat barbaric (especially if you aren’t there voluntarily), Nellie Bly’s account of the Blackwell’s Island Asylum in New York shows how far things really have come. I must warn you, there are some accounts of violence that can be shocking (though not incredibly graphic), and the lack of human decency is completely deplorable. On top of that, if you aren’t familiar with historic language at all (or the fact that anyone suspected of having mental health problems was simply considered “insane”) you might find the language jarring, but I think it is important to realize that the lack in any tasteful language around mental health in the 1880’s came from a real misunderstanding of the issues themselves at the time.
One thing that really stood out to me in this account (aside from the terrible treatment of some 1600 women living confined to an island asylum) was the actions of the citizens, the police, and the doctors. Nellie (who has never seen anyone “insane” before) must convince people she is unwell enough to warrant a trip to the asylum. She pieces together several symptoms concocting a performance including forced insomnia, paranoia/nervousness, and amnesia (with no violence or aggression, primarily just confusion) and within 48 hours citizens have had her brought to the police and a judge has sent her to the Bellevue Hospital staging area before taking the ferry to the asylum.
The “tests” the doctors perform to determine each patient’s level of mental health are laughable, and while one doctor perceives Nellie’s case to be the result of being given drugs, the next doctor concludes,
“Positively demented,” he said. “I consider it a hopeless case.”
In this account there seems to be no knowledge of any of the aspects one might consider “mental health” today. Unfortunately, being sent to the asylum was practically a hit or miss situation, and part of the problem was that even when perfectly rational people ended up there by mistake (being a foreigner and having no translator, or being requested to go to the poor house and accidentally being sent to the asylum) they often became irrational very quickly because of the very harsh, very poor conditions.
In one of my favorite passages, Nellie accounts;
“If the confinement was but for a few days one might question the necessity [of a translator]. But here was a woman taken without her own consent from the free world to an asylum and there given no chance to prove her sanity. Confined most probably for life behind asylum bars, without even being told in her language the why and wherefore. Compare this with a criminal, who is given every chance to prove his innocence. Who would not rather be a murderer and take the chance for life than be declared insane, without hope of escape?”
At this time in history, being declared “insane” (whether you were or not) was pretty much a death sentence unless you had family or friends willing to take care of you.
Even after trying to speak rationally to the doctors in the asylum, Nellie is not given a second chance to prove she is rational, and her claims of not belonging are considered further proof of her insanity.
As I mentioned, her account goes on to describe several vicious and brutal actions by nurses, the inedibility of the food, and how each cell needed to be opened with a key individually; proposing that if there were a fire, all 1600 women would likely burn to death (the nurses would not be willing to risk their lives to try to save any of them). Her description of bathing time is equally as distressing, and the women were likely to only be allowed to change their scant clothing once a month.
After Nellie’s friends come to bail her out (with a tongue in cheek promise to the staff to take care of her) the subsequent articles published by Nellie created a huge outcry from the public and produced an investigation of the Blackwell’s Island Asylum by the grand jury. Nellie’s ten days in a madhouse and her expose of her experiences ultimately resulted in a one million dollar increase in the budget “for the benefit of the insane”.
Though her written account of most patients who did exhibit symptoms of mental illness was one primarily of fear and pity, I must personally consider Nellie Bly to be a true hero of mine. Not only did she singlehandedly plunge herself into an extraordinarily terrifying situation in an attempt to benefit others, she also did go on to help raise the standards in asylums in our country.
If the history of mental health in America is a subject you are interested in exploring, I would call Ten Days in a Madhouse a great reference. The book itself isn’t very long, however if you aren’t used to reading historic writing it can be tedious at times. Some of the violent accounts once inside the asylum -though not extremely graphic, may be triggering, but overall I would say I learned a great deal from this piece of work.