The book, Ten Days in a Mad-House, written by Nellie Bly in 1887, allows the reader to take on the persona of a woman in the mid 19th century confined to an insane asylum. The author was a female reporter for the New York World, living in an era that did not support women's rights. She faked insanity to be placed in the Woman's Lunatic Asylum on Blackwell Island, New York to investigate the treatment of patients and the living conditions. The author accurately represents the 19th century atmosphere and opinions concerning women's rights as do other articles and books addressing this same topic and time period. The book affords the reader a deeper understanding of the topic, as opposed to a general historical overview of the facts, by narrowing the viewpoint to only a ten-day time span. The text provides the reader with a new understanding that women's rights were exploited during the 19th century in America through the use of unjustifiable commitment procedures, physical and mental abuse against female patients, and deplorable living conditions in insane asylums. 

The book narrows the broad perception of the 19th century mental health system to that of a more specific problem of women being improperly committed into insane asylums. It exposes the flawed admittance procedures which occurred during this volatile time in the history of human rights and specifically women's rights. This was a critical time in history because the Civil War had ended. Freed slaves were given more rights than women to include the right to vote in 1870 with the 15th Amendment. The plight of female patients was often compared to slaves during this era as there was no oversight or regulation of the confinement procedures, unlike all other detention facilities and jails where hearings and appeals were readily available (Reiss 173-174). Reform movements for prison restructure, voting rights for women, labor reorganization, and many other social issues were supported by outspoken women; however, "the most female asylum referrals originated from families (husbands, fathers, or brothers) who...found themselves unable to tolerate or provide care for a troublesome member" (Sutton 667). "One might view the convergence of feminism and the critique of institutional authority that came ...suggesting that institutional confinement was mainly a method of controlling-or abusing-women" (Reiss 175). Women were not granted the right to vote until 1920, almost thirty years after this book was written. These historical events inspired a feminist journalist to expose the exploitation of women in the mental health care system. Ten Days in a Mad House devotes an entire chapter to the irrational method of quick commitment exams and the undefined designation of "insanity". The author personally witnessed the arbitrary detention of a foreign woman, who did not speak English and could not respond to the examination questions. "Confined most probably for life behind asylum bars, without ever being told in her language the why and wherefore...Compare this with a criminal, who is given every chance to prove his innocence" (Bly 283). Another woman, admitted for mere exhaustion from a recent illness was totally coherent. "She begged that they try all their tests for insanity, if they had any, and give her justice" (Bly 282). The author was an entirely sane reporter who protested her rights, but was utterly ignored, "he (the doctor) wrote my fate in the book before him" (Bly 284). Another chapter in the book is dedicated to disputing the medical staff's competence. During the intake assessment, the doctor continuously flirts with a nurse, who is incapable of even reading weight and height measurements. The doctor pays more attention to the nurse than the author, "he took no notice of my remarks...said that would do, and with my companions, I went back to the sitting room" (Bly 284). The psychiatric doctors had very limited abilities to identify the insane without precise medical procedures (Sutton 667). "Madness was an elastic status that could be applied to persons whose major problem was poverty, homelessness, or physical disability" (Sutton 667). Through the eyes of a sane woman, the reader sees that women in the 19th century were unjustifiably committed, exploited in the intake process, and had no rights in a time in history when America was supposed to be a free nation with high ideals.

The investigative report vividly describing physical brutality and mental abuse of female patients allows the reader to experience the culture inside the asylum and relate it to the historical components occurring outside the barred windows. After the author's release, she wrote a series of articles in the newspaper which later were published as a book. Society responded with shock at the revelations of the abuse and cruelty, and "many others came to view the civilizing mission of the mid-nineteenth-century asylum as at best an anachronism and at worst a positive threat to humanity" (Reiss 173). The stories were horrifying with tales of the nurses choking, beating, teasing, and spitting in the ears of the helpless patients. The text intensely portrays bathroom rituals as inhumane. The same, dirty, cold water was used to bathe all the women. "I got one after the other, three buckets of water over my head-ice-cold water, too-into my eyes, nose, and mouth. I think I experienced some of the sensations of a drowning person as they dragged me, gasping, shivering, and quaking, from the tub. For once I did look insane" (Bly 287). The same combs and towels were applied to all patients sick or healthy. "Nearly every former patient who published a memoir protested that her incarceration in an asylum was a matter of disciplining deviant political and/ or religious views" (Reiss 169). The practice of taking advantage of women in asylums clearly exemplifies the status of women in America during such time.

The historical setting for this book gives the reader a more explicit understanding that this was a crucial time in history for women's rights, so much so, that a feminist reporter would dangerously plunge herself into a dreadful situation just to publicize the truth of the asylum's shameful living conditions in an attempt to effectuate change. "Between 1880 and the 1920s, unprecedented numbers of people were confined in mental hospitals, leading many contemporary observers to conclude that the nation was experiencing an epidemic of madness", while others argued "the expansion of the asylums was a product of organizational and political forces ...that asylums were forced to absorb increasing numbers of the aged poor who could no longer be confined in almshouses" (Sutton 665). During this period, " mental hospitals grew faster and larger than state and federal prisons, juvenile reformatories, and almshouses...the number of asylum inmates increased...from around 40,000 in 1880 to over 263,000 in 1923" (Sutton 666). As these asylums grew, the care declined and the rate of deaths increased (Sutton 667). According to the author, there were over 1600 insane women crammed into the small asylum on Blackwell's Island in 1887 (Bly 292). Once inside the institution, she describes the building as more like a prison than a restorative, cultural, and safe environment as had been intended by society. The buildings were made of stone, a stench permeated the rooms, the walls were bare, the benches were hard with no backs, the windows were barred and everything was dreary and cold. The food was not edible and described as cold broth, spoiled meat, hard bread, and dirty water. There was only one bed in the room with a sheet and a scratchy wool blanket. One of the most troubling aspects of the living conditions was that every door was locked separately with a key and the windows were barred. "As I say, in case of a fire, not a dozen women could escape. All would be left to roast to death" (Bly 288). The reader has a new appreciation for the historical battle over women's rights as the author unashamedly illustrates that the women were stripped of all their rights and dignity inside the asylum.

Nellie Bly exposes the exploitation of women in the 19th century insane asylum through her book, Ten Days in a Mad House. Her stories demonstrate that the asylums were nothing more than "slaves pens...far from representing the American ideals of life, liberty, and the pursuit of happiness...institutions more worthy of the Inquisition than of the American Republic" (Reiss 169). Historical and cultural research helps guide the reader through the bigger issues of this time, but this text goes to the heart of the matter by explaining the everyday life of women imprisoned in asylums. The text brought about tangible effects to include investigations into the asylum and changes in policies and procedures concerning the entire system of medical care of the insane (Bly 280). It also provides readers with a reminder that one should not allow injustice against the weaker members of society. Nellie Bly, a woman who gave up her freedom to combat the 19th century mental illness institution for the mistreatment of woman, so aptly puts, 

What excepting torture, would produce insanity quicker than this treatment? Here is a class of women sent to be cured. I would like the expert physicians who are condemning me for my action, which has proven their ability, to take a perfectly sane and healthy woman, shut her up and make her sit from 6 a.m. until 8 p.m. on straight back benches, do not allow her to talk or move during these hours, give her bad food and harsh treatment, and see how long it will take to make her insane. Two months would make her a mental and physical wreck (Bly 293).
