




The care of mentally ill patients has drastically changed multiple times in the last two hundred years. From keeping mentally ill people locked at home their whole lives, to the high level of care they receive today, and everything in between. In the late nineteenth century, this care was in a peculiar place, while efforts were being made to properly care for patients, often times they were neglected or abused. “Ten Days in a Mad House” tells the story of how the author, Nellie Bly, feigned insanity to get a firsthand look in an insane asylum. In 1887 she was committed to New York’s Women’s lunatic asylum on Blackwell’s Island. When she was released ten days later, she published an expose which helped spur a movement to reform mental institutions.

The article “A Home Away from Home,” by Ellen Holtzman, explains the shift from caring for someone with mental illness at home, to the establishment of state run mental institutions. Originally, these institutions were to be a healthy environment for those who needed care. They were to have "Beautiful grounds, private parks, rare trees, greenhouses, sun parlors, palatial rooms, luxuriously furnished private baths, private farm products,"(Holtzman) but because of the lack of funding and increasing patient population turned into horrible places where patients were kept away from the rest of society, were abused by the staff, and often times sane patients were kept there against their will. Holtzman goes on to explain that environments like this would only damage the patients further, and that the original design of the institutions is what was needed. The conditions and treatment in these places are what lead to small private institutions. Patients in these institutions were much better cared for, and were in an environment much better suited to recovering, or at least improvement. But, these private institutions were very expensive, costing fifty to one hundred dollars per week, which is equivalent to one thousand dollars per week in today’s money. This lead to very few patients being admitted, mostly women This is because of the social stigma of a man being sent away to a comfortable, homey setting to be cared for. These institutions became more and more popular, and it wasn’t until after World War I that mental health treatment turned to psychotherapy instead of baths and electricity.

This article is significant because the description of the ideal place for the care of a mentally ill patient is vastly different to the reality of public mental institutions as described in “Ten Days in a Mad House.” It shows that in the late nineteenth century people were more concerned with keeping mentally ill people away from the general population than the actual care and treatment of the patients. The public mental institutions were under funded and were staffed by cruel nurses, and uninterested doctors. It was not known what truly happened in the institutions until people like Nellie Bly told the public, it was at this point that reform of the institutions slowly started. It is also significant in that knowing what the best environment for the patient’s is, makes the reality of the situation even worse. The treatment is clearly not helping, and is even harming the patients. A change not just in the treatment, but in the ideology of mental health care, was desperately needed.

Another article very relevant to mental health in the nineteenth century is “The Treatment of Women for Mental Illness 1850-1900: The Reasons For It, Methods Used and Personal Accounts.” This article details how women were diagnosed for mental illness in very different ways than men. In this time period women were seen as the weaker sex, both physically and mentally. Because of this, women could be deemed insane and sent to mental health care facilities for many different reasons. Sometimes even advocating for women’s rights could land a woman in a mental institution. The article also describes different types of hysteria that were diagnosed, these include lactational insanity, “a name given to the delirium of poor mothers who nursed their babies for long periods of time in order to save money and prevent conception; it was caused by malnutrition and anemia” (Gale). At the time hysteria was also linked to biological life cycles such as puberty, pregnancy and menopause, this was called reflex insanity in women. In addition to the misguided ways to diagnose a woman, there were strange and often inhumane methods of treatment carried out in mental institutions. These include leeching, ice cold baths and purgatives.

This article further displays the cruel treatment of patients, specifically of women, in late nineteenth century mental institutions, it bolsters the argument made in Nellie Bly’s “Ten Days in a Mad House,” and gives new information as well. Women in this time period were treated as second class citizens and were expected to obey the orders given to them by men. At the time a man could even have his wife locked in a mental institution if she got on his nerves, not requiring any judge or doctor to deem her insane. This lack of respect for women was also very evident inside the institutions. Only men could receive the training to treat mentally ill patients, and they would often attribute the mental illnesses to hormonal changes in a woman’s body. The methods of the doctors were horribly punishing and demeaning, this supports some of the claims made in Bly’s piece. It is clear that these methods were ineffective and that change was the only thing that would help the patients heal. It is also clear that the methods for the diagnosis of a person was terribly flawed. Sane people who were simply from another country and spoke a different language were admitted, as well as people who were simply depressed because of the neglect they received in their daily lives. Almost every facet of these mental institutions needed to be changed. 

While mental health care took a step in the right direction in the nineteenth century, the lack of funding and knowledge of mental illness caused many people to be misdiagnosed, mistreated and abused by the doctors. Rather than being a place where the mentally ill could heal or be safe, the institutions became a place to lock them away from the rest of society. It was not until people like Nellie Bly published firsthand accounts of what truly happens in the institutions that the necessary change came about. The deplorable conditions and inhumane treatment would finally be a thing of the past.




