The thirst for power and position is unquenchable. Afflicted with these two maladies man converts the whole world in a madhouse,” once stated Sri Sathya Sai Baba. The articles “Liberty and Lunacy: The Victorians and Wrongful Confinement,” “Perspectives on the History of Women's Education in the United States” and “The Checkered History of American Psychiatric Epidemiology” enhance the reading of the text “Ten Days in a Mad-House” by Nellie Bly by analyzing certain elements of 19th century asylums. The physicians of Blackwell Island’s Women’s Lunatic Asylum, where Nellie Bly was kept for 10 days, maintained three motives behind the wrongful confinement and mistreatment of their patients: the incentive for profit, the segregation and oppression of the immoral, nonconformist individuals, and the maintenance of the gender hierarchy. 

Because asylum institutions obtain financial gain through the number of individuals they keep at the asylum, the asylum doctors maintained monetary motivation for keeping patients at their institution. The doctors and nurses behave coldly and selfishly toward the patients. The nurses, especially, seek to upset the patients and provoke responses that will appear to worsen their “condition.” “At this I saw Miss Grupe sit down on her and run her cold hands over the old woman’s face and down inside the neck of her dress. At the old women’s cries she laughed savagely, as she did the other nurses, and repeated her cruel action. That day the old woman was carried away to another ward” (Bly 295).  As Miss Mayard took a fit, the nurses said, ‘Let her fall on the floor and it will teach her a lesson’” (Bly, 295). Another patient, Miss Grady, “claimed to be eighteen, and would grow angry if told to the contrary. The nurses were not long in finding this out, and then they teased her” (Bly, 296).  By instigating reactions from patients that would insinuate that their condition was worsening, the nurses’ actions exemplify the need to keep patients at the institution, regardless of the approach, in order to optimize their profits. The doctors of this time period constantly attempted to “enlarge the boundaries of insanity, constantly adding to the symptoms that indicated mental derangement” (McCandless, 368). Psychiatric doctors of this time period actually had little knowledge of mental illness or how to treat them. Because the doctors lacked such knowledge, they used characteristics of the individual that deviated from social norms or what society deemed immoral to judge if an individual was insane. The physician’s intentions and abilities became continuously questioned due to their lack of ability to differentiate mental disease and non-conformist behavior. Despite a doctor questioning the declaration of insanity placed on Nellie, Superintendent Dent suggests that in cases such as Nellie’s, usual tests for insanity would not work (Bly, 292). The lack of acknowledgement that Nellie Brown is sane in order to keep her at the asylum exemplifies the asylum’s desperation to keep patients. Because doctor’s only needed to sign a certificate without much evidence in order to commit an individual to an asylum, it was easy to keep the numbers high at the institutions. 

The mistreatment of patients stems from the desire to suppress inferior qualities, such as immorality, the mentally ill patients were believed to harbor. Some doctors claimed an “association between poverty and insanity; both were traceable to an ‘imperfectly organized brain and feeble constitution’” (Horwitz and Grob, 631). During the 19th century, psychiatric physicians believed immigrants were “particularly susceptible to insanity because they were ill adapted to the physical and cultural conditions of American society” (Horwitz and Grob, 631). Immigrants were also targeted due to some social and religious values that differed from the American natives’ Christian beliefs.  Bly witnessed a German woman, Mrs. Louise Schanz, being neglected of her right to know why she was placed in the asylum and the chance to prove herself sane. Miss Grupe, a native German and a nurse at the asylum, refused to acknowledge her true nationality. She would not speak in German until forced and even then she would only speak a few words before she stated she would no longer speak it. This proves that if an individual discarded and suppressed her foreign nationality, she would be accepted by society, not deemed insane, and even given a job. The woman who did not disregard her German nationality, was declared insane and had her rights taken away. Asylums were constructed to separate the “insane” from the rest of society in order to prevent spreading the mental diseases to native Americans, and to create a controlled environment for individuals to undergo treatments (Horwitz and Grob, 633). “Moral therapy” included all of the medicines and treatments an individual would receive in order to correct their patients’ nonconformist behavior (Horwitz and Grob, 631). The name of the treatment for the mentally ill, “moral therapy,” exemplifies how the 19th century believed mental disease was due to immorality. Because the general population of mentally ill individuals were considered inferior, they were treated as such. The patients at the Women’s Lunatic Asylum received spoiled food infected with insects, clothing that stripped away individuality, and abuse from their caretakers.

 The nurses lack of basic skills symbolizes the gender hierarchy established in this time period and more relevantly, this asylum. Because the nurse, Miss Grupe, could not perform any nurse activities without the doctor’s help, it can be assumed that the asylum hired nurses that could not perform their jobs. When taking Bly’s measurements, the nurse admitted that she was unable to and told the doctor to do it himself. “By her voice I knew she did not understand yet, but that was no concern of mine, as the doctor seemed to find a pleasure in aiding her” (Bly, 284). This represents a manipulated male domination by the doctors. Many women during this time period were not educated to be a man’s equal. Instead, they were educated to service men, “who were to evangelise the frontier and keep America from falling away from Christian culture” (Conway, 5). If women became educated in the sciences, her range of occupations became restricted to the sex stereotypical roles of this period. At Oberlin College, women’s presence was for the mental health of the males (Conway, 6). There also appears to be an inappropriateness in the way the doctors and nurses interact. “He gave the nurse more attention than he did me, and asked her six questions to every one of me” (284). In Nelly Bly’s recount of her time in the asylum she described doctors flirting with nurses, asking when they had time off and suggesting what would improve their looks. The relationship displayed between the doctors and nurses exemplifies the hierarchy of gender due to hiring nurses that are uneducated in the sciences, therefore unable to do their jobs without a man’s help, and are mainly employed for the doctor’s amusement. 

The articles explored help identify the asylum’s monetary, discriminatory, male gender domination motives the Women’s Lunatic Asylum had for the mistreatment and confinement of patients, and also more specifically, ensuring the continuation of the institution. Many factors including immigration, lack of knowledge on mental disease, and societal gender roles of the 19th century played a role in the construction of madhouses. By analyzing certain aspects of this time period, the reader gains an understanding of how these factors cultivate the culture that shaped this text. Hunter S. Thompson once stated, “If you're going to be crazy, you have to get paid for it or else you're going to be locked up.”
