         Hysteria in the nineteenth century was a diagnosis given to people, mainly women, who’s symptoms did not fall under a specific illness. In Nellie Bly’s book Ten Days in a Madhouse, Bly provides her audience with an insight into the Blackwell Island Asylum, and all that comes along with being a female patient in one of the largest psychiatric wards in the country.

Once given diagnoses, women were thrown into asylums, and faced lousy care from their doctors and physicians, and unfair treatment from authorities and management.

          In the nineteenth century, the purpose of asylums was to cure the diagnosed, and release them back into their everyday lives so they could function alongside normal people. However, between the period of 1815-1865, an influx of immigrants from Northern and Western Europe arrived in the New York area, conveniently neighboring a few asylums (one including Blackwell Island Asylum – the asylum that Nellie Bly visited in her novel previously mentioned). The immigration movement brought over many bilingual, and monolingual, minorities whom most times were sent to asylums if the language barrier between an American and the immigrant was too large; these immigrants would be sent to mental institutions, with no knowledge of where they were being taken or why they were being taken there. Due to this strategy by superintendents and doctors, overcrowding in the asylums flourished. The overcrowding of the psychiatric hospitals led to the decrease in curability factor, the primary reason why they were put into place. Thus, by the 1870s, a little over one hundred years after the first asylum was put into place, all mental institutions were deemed by state legislature that “the primary purpose (of asylums) was custodial care and community protection; treatment was secondary” (Morrissey and Goldman 16). Nellie Bly ran into this during her time in the Blackwell Island Lunatic Asylum, witnessing a Spanish speaking patient and even a German speaking patient struggling to communicate the reason they came to America, only to be mocked by their nurses and doctors. Most often than not, the women who faced language barriers also faced a lifetime in the asylum, as they were not “given a chance to prove their sanity” (Bly 282).

          Once inside an asylum, patients were usually taken by a nurse to see their doctor, whom would relay a “diagnoses plan” (if applicable for the patient’s disorder) and any additional information to the patient. During the nineteenth-century, mental institutions in the United States were undergoing a reform, known as the “Moral Treatment Reform”. This reform provoked nurses and doctors to only treat “mild, acute” patients within the walls of an asylum; allowing no chronic cases or patients. This first reform was put into place to “perfect human beings by manipulating their social and physical environments” (Morrissey and Goldman 14). After meeting with their doctors, patients would be stripped of their clothes, given a new wardrobe (courtesy of the hospital), bathed, and be taken to their rooms; it was common for rooms to be filled with more than 10 women, due to the excess of patients. Part of the reform consisted of a belief that “distracted” patients, or ones who do not accept the care they were previously being given, would be better cared for in smaller, pastoral-like asylums. This theory did the exact opposite of the claimed purpose; patients faced lousy care from nurses, and often were forced to participate in study trails by their doctors. As hysteria had no known treatment or cure, this usually consisted of torturous methods of treatment. Housing an excessive number of patients, and taking into consideration the shortage of funding for doctors in the nineteenth century due to the Panic of 1873, large custodial institutions emerged that provided mediocre care to patients, leading to the imposition of an “uniform routine” to all patients, resulting to a “total dependency on the asylum” (Morrissey and Goldman 17). 

          To be released from an asylum, a patient would have to be pronounced “cured”. In Nellie Bly’s novel, she mentions encountering a handful of people who seemed ordinary, causing her to question why they continued to be lumped in with actual lunatics. Since hysteria (the disorder most women were admitted into asylums under) was deemed incurable during this time, and lacked any successful treatment in the mid to late 1800s, many patients were unable to liberate themselves from the asylum. Even if a doctor had hope in the patient, and believed them to have been fully disburdened from their original diagnosis, there was no way to physically prove that the person had been cured. Some circumstances focused on subjects who did not wish to leave the asylum; in cases like the one discussed in chapter one of “Theaters of Madness: Insane Asylums and Nineteenth-Century American Culture”, the patient viewed institutionalized life as one that exceeded his life outside of the asylum. This was not an uncommon thing that occurred in a mental hospital; often, patients who were brought in under mild diagnoses made a new home for themselves at the asylum, under the impression that they wouldn’t be leaving any time soon. In Bly’s novel, she even admits her consistent difficulty to repress feelings of insanity, just from the overwhelming surroundings she was being engulfed by. 

          One of the preeminent reasons Nellie Bly mentions for going undercover at Blackwell Island was to expose the unfair treatment patients received from the authorities and management, and to critique the decisions made by superintendents associated with the asylum. In 1873, a woman named Elizabeth Parsons Ware Packard wrote an autobiography about her time spent in the walls of an asylum. In this book, she mentions “the desire to limit the power of superintendents” (Walter 1). Superintendents in charge of the McLean Asylum in Boston wrote of “benevolent care and desires to cure the insane” (Walter 38), which later turned out to be the exact opposite of what was occurring in the asylum. In the nineteenth-century, superintendents of asylums did not play a huge role in the mental hospital, but received mostly all credit for running the thing. Mostly all were white males, who took advantage of the salary and authority that came along with running a psychiatric ward. The salary for a superintendent was very good for what it was worth, and benefits included housing, food, and clothing. Most times, superintendents were detached from their work, and disregarded the requests of patients and doctors. Bly reported that after bringing a question up to her doctor about the care of another patient, the doctor then relayed the offer to the superintendent, who blatantly ignored the appeal. It was common for patients to feel vulnerable around their superintendents; it was not uncommon for nurses to beat the patients that brought up issues with their care to the director. 

          Superintendents were faced with difficulties regarding governmental and economical setups that limited their control over the entirety of the asylum. By reason of low government funding to medical advancements, management stressed the urge to obtain custody of the largest number of patients at the lowest cost. Therefore, when doctors took Bly’s case to the superintendent, he answered with “...her (Bly’s) face was the brightest he had ever seen for a lunatic” (Bly 294). Although they were encouraged to provide long-term assistance to poor, spontaneous patients, they were responsible for providing better institutions to those willing to pay an excessive amount for their treatments. Holding this position revolved solely around the money and the power that came along with the profession. The way authorities treated patients reflected the disinterest in the situation altogether. The benefits that superintendent’s reaped from the occupation received much more concern than did the patients in need of assistance.
