    Throughout history, the perception and treatment of mental disorders has constantly changed. Early civilizations believed supernatural powers were the cause of mental illness and exorcisms were performed by tribe leaders or religious figures in an attempt to remove demonic entities from a person. Advances in medical research have allowed doctors to gain a deeper understanding of their patients and find new methods to improve their overall well-being. The focal points of treatment in modern society include psychiatric medication and forms of therapy such as peer support and social interventions. The History of Mental Illness: From Skull Drills to Happy Pills delves into the evolution of asylums and society’s view of people with mental illnesses.  Furthermore, History of Psychiatry: Moral Management Movement examines the compassionate approach to treating mental used by doctors starting in the late 1800’s. 10 Days in a Mad-House details the experiences of journalist Nellie Bly who pretends to be psychotic in order to be admitted in Blackwell’s Island Lunatic Asylum. During Nellie Bly’s stay in the asylum, she reports on the behavior of both the facilities patients and workers. During the late nineteenth century, limited rights of both women and mental health patients fostered horrid living conditions and mistreatment of females in Blackwell’s Island Lunatic Asylum.

Prior to reading 10 Days in a Mad-House, people may have been aware of some of the hardships endured by mental health patients, but they did not truly grasp the magnitude of these challenges.  Bly describes a building that was part of the Asylum by saying "...the stench was so horrible that I was compelled to hold my breath, and I mentally decided that it was the kitchen" (281).  From Bly’s comment, readers are able to gather an initial impression of the facility as unsanitary and run down. Although mental health facilities were never perceived as state of the art buildings, it was believed that the environment would be clean and suitable to live for patients. The History of Mental Illness: From Skull Drills to Happy Pills enhances the reader’s understanding of living conditions for patients by providing historical information on asylums during the late nineteenth century. The mental hospital, La Bicentrein, in Paris was described as “... no visitors to the cell except to deliver food, and the rooms were never cleaned. Patients had to make do with a little amount of straw to cover the cold floor and were forced to sit amongst their own waste that was also never cleaned up” (Foerschner 2). Readers are able to visualize the disturbing images of La Bicentrein Mental Hospital and the pain experienced by the facility’s patients. Despite the fact that Blackwell’s Island Asylum was located in the United States and La Bicentrein in France, both facilities demonstrate the global issue of poor living standards during the time period.

Society’s view of women in the 1800’s was a major contributor to the poor treatment of females in Blackwell’s Island Asylum. Women were expected to produce offspring and complete all household duties. Furthermore subservience towards all men including one’s husband, brother and male relatives was mandated. History of Psychiatry: Moral Management Movement describes how “women who were not submissive to their husbands would be forced into asylums and declared insane” (Carson). The majority of women admitted to mental health facilities against their will were completely healthy. However, the horrid conditions and treatment inside the asylum deteriorated the mental state of many women. In 10 Days in a Mad-House, Nellie Bly recalls, “Some clothing was flung on the floor and I was told to put it on. I asked for my own but was told to take what I got and keep quiet" (289). Rather than giving Bly a clean set of clothes, the employees at Blackwell’s Island Asylum told her to pick up used garments from the floor. This is a prime example of the way society shapes people’s opinions and attitude toward a specific group. The lack of respect towards women in the asylum was generated by the idea that women were lesser valued individuals than men during the 1800’s.

In the nineteenth century, people with mental disorders were often considered outcasts and isolated from society.   The History of Mental Illness: From Skull Drills to Happy Pills expands on the behavior of families who had a mentally unstable relative by saying “Due to the shame and stigma attached to mental illness, many hid their mentally ill family members...others were abandoned by their families and left to a life of begging and vagrancy” (Foerschner 1). It is evident that families felt that a mentally ill family member was an immense burden and embarrassment. As a result, mentally ill individuals did not receive immediate medical help and would eventually be placed in an asylum for the rest of their life. The absence of care by people towards mentally ill individuals carried over to asylums and mental hospitals. It was not only family who disregarded the well-being of people with mental disorders but also the doctors and employees within asylums. In 10 Days in a Mad-House, Nellie Bly describes the behavior of the doctor by saying “He gave the nurse more attention than he did me, and asked her six questions to every one of mine” (286). It is evident that the main priority of doctors at the asylum was not to improve the health of patients, but rather socializing with fellow employees. Even in a facility whose main purpose is to accommodate mentally ill individuals, workers at Blackwell’s Island Asylum did not attempt to create a comfortable and welcoming atmosphere for patients. Nellie Bly reiterates the poor treatment of patients in the facility by saying “I think I experienced sensations of a drowning person as they dragged me, gasping, shivering and quaking from the tub” (287). Specific time slots were allotted for each patient’s bath time and mentally ill individuals were not permitted to clean themselves. The water used for cleansing was typically freezing cold and women that did not want to bathe at the allotted time would be forcefully put in the bathtub. This compares to the treatment of the mentally ill around the world as patients would be “...shackled to the wall in dark, cramped cells  Iron cuffs and collars permitted just enough movement to allow patients to feed themselves but not enough to lie down at night, so they were forced to sleep upright” (Foerschner 3). Readers are able to envision the atrocious conditions in Blackwell’s Island Asylum and facilities across the globe while understanding that the treatment of patients further damaged their mental health. 

The History of Mental Illness: From Skull Drills to Happy Pills and History of Psychiatry: Moral Management Movement enhance the text, 10 Days in a Mad-House by providing information about the treatment of mentally ill patients and conditions of asylums during the nineteenth century. Utilizing the facts learned from outside sources allows the reader to fully understand the challenges faced by females living in Blackwell’s Island Asylum. Due to the historical context of the text, poor treatment of patients in the facility was strengthened by the fact that mentally ill individuals and women were considered a lower class of people in the 1800’s. Nellie Bly shapes 10 Days in a Mad-House to coincide with the time period by detailing her firsthand experiences of mistreatment by asylum doctors and nurses. Learning about the specific types of behavior towards patients such as chaining individuals to their bed and dragging them to showers develops an emotional connection between the reader and text. Ultimately, the poor living conditions and treatment of patients in Blackwell’s Island Asylum were a result of the public’s negative perception of females and mental health patients.      
