In addition to being exposed to the public outdoors through asylum tourism, patients could also find no privacy inside the asylums. Patients were routinely stripped and checked for diseases, with no consideration given to their privacy. Patients were, at all times, viewed more as prisoners than sick people in need of aid. Patients also were kept in small sleeping rooms at night that often slept as many as ten people. Mealtimes were also taken communally in large dining areas. Bathing was often seen as a form of treatment and would be conducted by staff in an open area with multiple patients being treated at once.
Given that 1900 was decades before the creation of health care privacy laws, patients could also find no privacy in who was told about their condition and progress. Women’s husbands would be told of their condition and treatment regardless of their relationship with their spouse. An asylum patient could not expect any secrecy on their status, the fact that they were an inmate, what they had been diagnosed with, and so on. With the pervasive social stigmas towards mental illnesses in the era, this lack of privacy was doubtless very harmful to those who found themselves committed.
People with epilepsy, who were typically committed to asylums rather than treated in hospitals, were subjected to extremely bland diets as any heavy, spicy, or awkward-to-digest foods were thought to “upset” their constitutions and worsen their symptoms. One asylum director fervently held the belief that eggs were a vital part of a mentally ill person’s diet and reported that his asylum went through over 17 dozen eggs daily for only 125 patients. A woman who went undercover at an asylum said they were given only tea, bread with rancid butter, and five prunes for each meal. Apparently, that asylum thought starvation was an ultimate cure.
Some asylums took used different, and arguably better, tactics to feed their inmates by encouraging the patients to grow their own food. Extensive gardens were established at some asylums, with the inmates spending their days outside tending to the fruits and vegetables. While gardening does have beneficial effects on mood and overall health, one wonders how much of a role cost savings in fresh produce played in the decision to have inmate-run gardens. Regardless of the cause, these inmates likely had much pleasanter days than those confined to rooms with bread and rancid butter.
In truly nightmarish imagery, former patients and undercover investigators have described the nighttime noises of their stays in state-run asylums. One woman who stayed for ten days undercover, Nellie Bly, stated that multiple women screamed throughout the night in her ward. One woman reportedly begged and prayed for death throughout the night while another woman, in a different room, repeatedly shouted “murder!” She reported that the wards were shockingly loud at night, with many patients yelling or screaming on and off throughout the night.
Taylor Benjamin, also known as John the Baptist, reportedly spent every night screaming in the weeks leading up to his death at a New Orleans asylum. A doctor’s report said he, “slept very little if any at night, [and] was constantly screaming.” One cannot imagine a more horrific scene than hundreds of involuntarily committed people, many of whom were likely quite sane, trapped in such a nightmarish environment. In addition to the screams, one inmate reported that patients were allowed to wander the halls at will throughout the night. He stated one night he awoke to find two other patients merely standing in his room, staring at him. He awoke another night to see a patient tucking in his sheets.
While fiction has often portrayed asylum inmates posing as doctors or nurses, in reality, the distinction was often unclear. In a sadly true case of the inmates running the asylum, the workers at early 20th century asylums were rarely required to wear any uniform or identification. While this is scarcely imaginable now, mental health treatment and organized hospitals, in general, were both still in their relative infancy. This lack of uniform often led to patients and staff being indistinguishable from each other, which doubtless led to a great deal of stress and confusion for both patients and visitors.
A former inmate of the Oregon state asylum later wrote that when he first arrived at the mental hospital, he approached a man in a white apron to ask questions about the facility. It was only later, after he’d been admitted that he realized the man was a patient on the same floor as him. There had been no supervision of this man wandering the premises, nor were the workers dressed differently enough for this man to notice. He later concluded that the only way to tell the staff was that they tended to be marginally better dressed than the inmates.
10. Numerous Patients Were Crammed Into Every Room
Despite being grand and massive facilities, the insides of state-run asylums were overcrowded. Thanks to the relative ease of involuntarily committing someone, asylums were full soon after opening their doors. Viewing the mentally ill and otherwise committed as prisoners more than patients also led to a general disinterest in their well-being. The culmination of these factors was cramming countless patients into small rooms at every turn.
At the Oregon facility, sleeping rooms were only 7 feet by 14 feet, with as many as ten people being forced to sleep in each room. Nellie Bly described sleeping with ten other women in a tiny room at a New York institution. Patients were often confined to these rooms for long hours, with dumbwaiters delivery food and necessities to the patients to ensure they couldn’t escape. While the facades and grounds of the state-run asylums were often beautiful and grand, the insides reflected how the society of the era viewed the mentally ill. The interiors were bleak, squalid and overcrowded. The beauty and grandeur of the facilities were very clearly meant for the joy of the taxpayers and tourists, not those condemned to live within.
9. Patients Were Often Stripped and Tested for Diseases
The admission process for new asylum patients was often profoundly dehumanizing. Patients were forced to strip naked in front of staff and be subjected to a public bath. After being searched and having their possessions searched, patients would be forced to submit to a physical examination and blood testing, including a syphilis test. Patients would also be subjected to interviews and mental tests, which Nellie Bly reported included being accused of taking drugs. At her commission hearing, the doctor noted her pupils, enlarged for nearsightedness, and accused her of taking Belladonna. This was used against her for the goal of committing her.
One is genuinely thankful for our new privacy and consent protections when reading the list of what these early asylum patients went through. We are now protected from warrant-less search and seizure, blood draws and tests that we do not consent to, and many other protections that the unfortunate patients of 1900 did not have. Once again, it becomes clear how similar to criminal these patients were viewed given how similar their admission procedures were to the admissions procedures of jails and prisons. One cannot even imagine the effect that such mistreatment must have had on the truly mentally ill who were admitted.
It is hard enough to consider all of the horrors visited upon the involuntarily committed adults who populated asylums at the turn of the 20th century, but it is almost impossible to imagine that children were similarly mistreated. The Worcester County Asylum began screening children in its community for mental health issues in 1854. By 1900, the asylum had involuntarily committed over 200 children that the staff believed were mentally ill. Violent tendencies and risk of suicide were the most common reasons given for involuntarily committed children to this facility. As was documented in New Orleans, “misbehavior” like masturbation could also result in a child being committed by family.
Once committed, the children rarely saw their families again. It is not clear if this was due to visitors not being allowed or if the stigmas of the era caused families to abandon those who had been committed. One study found that children committed to the asylum had a noticeably higher death rate than adult prisoners. Children were treated in the same barbaric manner as adults at the time, which included being branded with hot irons and wrapped in wet, cold blankets. No exceptions or alterations were made for an age when deciding upon treatment.
7. Doctors Gave Mental Patients Malaria On Purpose
Given the correlation between syphilis and the development of mental health symptoms, it is perhaps unsurprising that many of those committed around the turn of the 20th century were infected with syphilis. What is surprising is how the asylums of the era decided to treat it. Dr. Julius Wagner-Jauregg was the first to advocate for using malaria as a syphilis treatment. In the age before antibiotics, no reliable cure had been found for the devastating disease. Dr. Wagner-Jauregg began experimenting with injecting malaria in the bloodstream of patients with syphilis (likely without their knowledge or consent) in the belief that the malarial parasites would kill the agent of syphilis infection.
Doctors began using Wagner-Jauregg’s protocol, injecting countless asylum patients with malaria, again, likely without their knowledge or consent. Wagner-Jauregg’s research found that about half of the patients injected with malaria did see at least somewhat of a reduction in syphilis symptoms after the treatment. However, about 15% of those “treated” with malaria also died from the disease. One patient of the Oregon asylum reported that, during his stay, at least four out of every five patients was sick in bed with malaria.
The interchangeable use of patient, inmate, and prisoner in this list is no mistake. Patients of early 20th century asylums were treated like prisoners of a jail. From the dehumanizing and accusatory admissions protocols to the overcrowding and lack of privacy, the patients were not treated like sick people who needed help. Instead, they were treated like dangerous animals in need of guarding. The public knew the ill-treatment well enough that the truly mentally ill often attempted to hide their conditions to avoid being committed. The idea of being involuntarily committed was also used as a threat.
Nellie Bly wrote of the prison-like environment of Bellevue asylum in New York, saying, “I could not sleep, so I lay in bed picturing to myself the horrors in case a fire should break out in the asylum. Every door is locked separately, and the windows are heavily barred so that escape is impossible. In the one building alone there are, I think Dr. Ingram told me, some 300 women. They are locked, one to ten in a room. It is impossible to get out unless these doors are unlocked.” Bly’s fears would be realized in 1947 when ten women, including the wife of F. Scott Fitzgerald, Zelda, died in a fire at an asylum.
Imagine that you are a farmer’s wife in the 1920s. You work long hours, your husband is likely a distant and hard man, and you are continually pregnant to produce more workers for the farm. Your husband’s family are hard working German immigrants with a very rigid and strict mindset. You come from a Norwegian family and are more liberal-minded. You do not immediately acquiesce to your husband’s every command and attempt to exert some of your own will in the management of the farmstead. Your mother-in-law does not care for your attitude or behavior. She worries you’ll be a bad influence on her grandchildren. She picks you up one day and tells you she is taking you to the dentist for a sore tooth you’ve had. Going with her, she instead takes you to the large state-run mental asylum in Fergus Falls, Minnesota and has you removed from her son’s life through involuntary commitment.
While this reads like an excerpt from a mystery or horror novel, it is one of many real stories of involuntary commitment from the early 20th century, many of which targeted wayward or “unruly” women. The vast majority of the patients in early 20th century asylums were there due to involuntary commitment by family members or spouses.
4. Branding and Spinning Were Common (and Torturous) Treatments
The history of mental health treatment is rife with horrifying and torturous treatments. The early 20th century was no exception. Asylums employed many brutal methods to attempt to “treat” their prisoners including spinning and branding. Spinning treatment involved either strapping patients to large wheels that were rotated at high speeds or suspending them from a frame that would then be swung around. It is unclear why on earth anyone thought this would help the mentally ill aside from perhaps making them vomit.
Branding is exactly what it sounds like: patients would be burned with hot irons in the belief that it would “bring them to their senses.” While these treatments, thankfully, began to die off around the turn of the 20th century, other horrifying treatments took their place including lobotomies and electric shock therapy. In 1941, John F. Kennedy’s sister, Rosemary, was subjected to a lobotomy after having been involuntarily committed for mood swings and challenging behavior. The lobotomy left her unable to walk and with the intellectual capabilities of a two-year-old child. It also caused a loss of speech and permanent incontinence. The surgery was performed at her father’s request and without her consent.
There was no process or appeal system to fight being involuntarily committed to an asylum. The doctors and staff would assume that you were mentally ill and proceed under that belief, unflinchingly and unquestioningly. Any attempt to persuade them of one’s sanity would just be viewed as symptoms of the prevailing mental illness and ignored. Patients quickly discovered that the only way to ever leave an asylum, and sadly relatively few ever did, was to parrot back whatever the doctors wanted to hear to prove sanity.
In episodes perhaps eerily reminiscent of Captain Picard’s “four lights” patients would have to ignore their feelings and health and learn to attest to whatever the doctors deemed “sane” and desirable behavior and statements. Doctors at the time had very rigid (and often deeply gendered) ideas about what acceptable behaviors and thoughts were like, and patients would have to force themselves into that mold to have any chance of being allowed out. Even those who were truly well, like Nellie Bly, were terrified of not being allowed out after their commitment. She and her editor discussed various emergency plans on how to rescue her from the asylum should they not see fit to let her go after her experiment was complete.
Unsurprisingly, given the torturous and utterly ineffective treatments practiced at the time, the lucky few patients allowed to leave an asylum were no healthier than when they entered. No actual care was given to a specific patient’s needs or issues; they were instead just forced to perform the role of a healthy person to escape the hell on earth that existed within the asylum walls. For those who were truly mentally ill before they entered, this was a recipe for disaster. Many depressed and otherwise ill patients ended up committing suicide after escaping the asylums. Doubtless, the horrors they witnessed and endured inside the asylums only made their conditions worse.
Thanks to actual psychiatric science, we now know that the time immediately after discharge from an inpatient facility is the most dangerous time for many patients. Suicide risk is unusually high when patients are out of a controlled setting and reintegrate into the outside world abruptly. One study found that women were 246 times more likely to die within the first week of discharge from a psychiatric institution, with men being 102 times more likely. Given the ignorance of this fact in 1900 and the deplorable treatment they received, one wonders how many poor souls took their lives after leaving asylums.
Perhaps one of the greatest horrors of the “golden age” of the massive public asylums is the countless children who died within their walls. Many children were committed to asylums of the era, very few of whom were mentally ill. Children with epilepsy, developmental disabilities, and other disabilities were often committed to getting them of their families’ hair. These children were treated exactly like adults, including with the same torturous methods such as branding. Due to either security or stigmas of the era, children involuntarily committed were rarely visited by family members and thus had no outside oversight of their treatment.
It is perhaps unsurprising, given these bleak factors, that children had an unusually high rate of death in large state-run asylums. Some of this may be attributable to natural deaths from untreated or under-treated epilepsy. However, one wonders how many more were due to abuse, suicide, malarial infection, and the countless other hazards visited upon them by their time in asylums. The obsession with eugenics in the early 20th century added another horrifying element, with intellectually disabled and “racially impure” children also being institutionalized to help society cleanse itself of the undesirable.
Where did we find this stuff? Here are our sources: