1880 The Treatment Of The Insane by William A. Hammond

“In all ages of the world, the most monstrous abuses have found their defenders among good and noble-minded people; and this is especially true of those acts which a subsequent period regards as outrages against the individual, but which at the time were defended by many on the ground of expediency, the advantage of the country, the glory of God, the progress of humanity, or the ultimate good of the person injured. Thus, the gladiatorial exhibitions of ancient Rome were looked upon as politic amusements, which tended to excite harmless emotions to the exclusion of more dangerous sentiments. The Duke of Alva, and others of his type, professed to be actuated by a laudable desire to put down rebellion; and it is entirely within the range of possibility that they were kind and loving fathers and friends. Witches and heretics were burned at the stake or drowned in the flood at the instigation of tender-hearted women, and by judges of gentle bearing, who honestly thought they were serving God and society; and the insane were loaded with chains, beaten and subjected to many other corporeal sufferings by the orders of learned and humane men, who sincerely believed that they were acting in accordance with the most benevolent instincts, – as in fact they probably were. But as time passes on the acts of those who have preceded us are seen in their true light, and judged by a higher standard. The human nature of to-day is more advanced than the human nature of yesterday, and what were deemed to be great truths then are seen to be vile errors now. It denounces the dungeon, the lash, and the fetters for lunatics, but it clings tenaciously to the strap, the camisole, and the Utica crib. It looks back with horror to the time when the insane were flogged as a therapeutical measure “to beat the devil out of them,” but regards with complacency and even favor the forcible feeding of the poor creatures by ignorant and brutal attendants, and the consequent life-long injury or death of the victims. That those who come after us will regard our conduct in these matters very much as we do that of the mad-house keepers of less than a century ago is not a matter for doubt. Already the revolution has begun.

Holding Chair

Holding Chair – Illustration by Etienne Equirol’s Des maladies mentales considérées sous les rapports médicale hygiénique et medico-legal (Paris 1838), at: Diseases Of The Mind: Highlights of American Psychiatry through 1900. http://www.nlm.nih.gov/hmd/diseases/debates.html.

Few, even among those who have given some attention to the subject, know the depth of wretchedness to which within a comparatively short period the lunatic was consigned, and which, even at the present day, is in some places scarcely lessened. Dr. Conolly, (1) whose advanced ideas of science and humanity led to the uniform adoption in England of the “non-restraint” system of treatment, speaking only thirty years ago on this subject, says: “Very few physicians of education were to be found, until a recent period, devoting themselves to mental disorders. Those occupied in asylums were chiefly distinguished by an eccentricity and a roughness which, unfitting them for other professional vocations, made them willing to undertake to treat mad people. By such persons, ill-educated, prejudiced, and without any resources but methods of violence, and who had never studied the forms and treatment of mental disorders, all attempts to ameliorate the condition of the insane were bitterly and unscrupulously opposed with every effort and every contrivance of vulgar minds. Meantime, the outside walls of an asylum were regarded with awe; the shrieks issuing from it made night hideous; the frantic creatures enclosed in their dens furnished appalling subjects for the artist or the novelist; squalor and dirt, and famine and ferocity were everywhere to be met with.” And now in the latter half of the nineteenth century we find that the methods which Conolly so vigorously denounced, and to the abolition of which he gave his life, are in full use in almost every asylum in the United States; that the attempts to improve the condition of the insane are opposed, as in his day, by those who have the charge of them; that dens are still in existence, chains still employed, blows still inflicted, systematic flogging still practised, the strait-jacket still used as a means of restraint; and that these agencies of subjection are supplemented by The Utica Crib. , – an apparatus not only inhuman, but one which no person possessing a competent knowledge of the physiology of the brain and the pathology of insanity would venture to introduce into the wards of a lunatic asylum.

Dress Camisole - Esquirol Bench

Dress Camisole-Esquirol Bench – Illustration by Etienne Equirol’s Des maladies mentales considérées sous les rapports médicale hygiénique et medico-legal (Paris 1838), at: Diseases Of The Mind: Highlights of American Psychiatry through 1900. http://www.nlm.nih.gov/hmd/diseases/debates.html.

I do not mean to be understood as saying that all these various measures for punishing and subduing a maniac are sanctioned by those in authority. No superintendent, so far as I know, approves of his patients being knocked down, beaten, or put in irons; but, nevertheless, these things and even worse are perpetrated in American institutions for the insane, either through the ignorance, the negligence, or the indifference of their superintendents; and others equally bad are done with their full knowledge and approval. Doubtless many of the outrages against humanity which are committed in our asylums are the direct result of the system by which their officers are appointed. But this only makes the matter worse. If it were individuals only with which those who have undertaken the task of ameliorating the condition of the insane had to contend, the contest would be neither long nor doubtful; but there are trustees and commissioners, and legislatures and political parties to meet, who have an interest – one which appeals with great force to the average American mind: the love of patronage – in keeping things as they are.

Now let us see what kind of atrocities are permitted by the system which prevails throughout this country. In this survey, it will not be necessary to go back farther than two or three years, or to refer to more than a few examples of the number which have been unearthed by legislative committees, casual visitors, and newspaper reporters, or which have been revealed by mere accident.

Within about a year four homicides occurred in the New York City lunatic asylum on Ward’s Island. In one of these a patient was beaten to death by an attendant; in another, an attendant was killed by a patient; in the third, a patient was thrown off the wharf and drowned by another patient; and in the fourth, one lunatic was ordered to give a hot bath to another, not only insane, but paralyzed. After getting him into the bath-tub he turned on the hot water and walked away leaving the poor wretch actually to be boiled to death. In the asylum at St. Peter, Minnesota, a patient who refused to eat had his mouth filled with food by a nurse, and the mess pushed down into his stomach with the handle of a knife, while another nurse held him down. On one occasion he ran away, yelling that they wanted to kill him. He was caught and laid on a bench; one attendant held his hands, and sat across his body; another attendant and a patient helped to hold him; his mouth was plugged to prevent his closing it. The food (soup) was poured in from a pitcher; his breath was heard to “gurgle” as the soup went into his windpipe, and in five minutes he was dead.

Force Feeding

Force Feeding

Owing to an erroneous idea that the food is poisoned, to some other delusion, or to a determined intention to commit suicide, it frequently happens that lunatics refuse to eat. The operation of forcible feeding is a delicate one, requiring anatomical skill; and yet it is one which in American asylums is often left to be performed by ignorant and brutal attendants, a physician not even being present. Thus, at the Bloomingdale Asylum in New York, a lady while being fed by a nurse had the soft parts of the roof of her mouth torn away by the spoon being rammed violently down her throat. From the testimony taken in this case, preliminary to a suit for damages, and which has not yet been published, I make the following citations:

Mrs. Cochran says she saw both Jane Eaton and Jane Gordon, nurses in Bloomingdale, forcibly feeding a patient. They had a wooden wedge which they put into her mouth, and then they fed her with a spoon (folio 93). Dr. Choate says it is done by attendants in asylums (folio 119). Jane Eaton, a nurse, puts on the camisole without instructions from the physician (folio 125). Was told to use force in feeding (folio 127). Used a spoon or a wedge to force open the mouth. “The most difficult person I ever had to feed” (folio 132), – and yet the duty was left to a nurse; the doctor was never present when she was fed (folio 133). The nurse does not always report to the physician when she uses the camisole. Has seen blood come from Mrs. N’s mouth when she was feeding her (folio 138). Was taken naked from her room to the bath-room (folio 146). The doctor says forcible feeding is delegated to an attendant (folio 150).

Last winter, rumors in regard to the bad management of the Longview Asylum, in Ohio, became so prevalent that the legislature appointed a committee to investigate them. From the report made on the subject I make the following extracts: –

According to the testimony of several eye-witnesses, a punishment frequently and sometimes gleefully resorted to by attendants in this asylum is one known as “taking down.” “Taking down,” in the words of the testimony, consists in tripping or throwing the patient to the floor, holding her down (for “taking down” is a female punishment; the men being usually knocked down) with the knee on the chest, while another employé gags the patient, and still another holds the patient’s hands. The patient is held down till she is quite weak and exhausted, becomes purple in the face, and the breath is almost gone.

Another punishment is to make a “spread eagle” of a patient. This consists in stripping a patient to nakedness, and making attendants whip him with wet towels. This is a punishment inflicted for a refusal to work. It is described as very painful, and is practised because it leaves no marks.

There is testimony as to ducking, kicking, beating, black eyes, and other marks of cruelty. It is in evidence that weak patients are overworked, and all inmates have not been properly fed and cared for. Hard work has been needlessly compelled in a room in which the mercury stood at one hundred and twenty degrees. The use of “cribs” and the “strong room” is shown. Loathsome vermin in loathsome numbers have been allowed to accumulate upon the bedding, the apparel, and the person of patients. All of these things and others told with a painful plainness is the testimony that is made part of this report.

The report then goes on to speak of the profanity of the attendants; that “the superintendent has been guilty of inattention to his duties and gross neglect;” and that the evidence “seems to the committee to destroy entirely the suggestion that the various hideous things were done without his knowledge and consent.” The Ohio legislative committee appears to have performed its work thoroughly; and it is the more to be commended for this, inasmuch as the superintendent was appointed on political grounds, and the majority of the committee was of the same political faith as this official.”