In 1887, Nellie Bly, considered by many to be a pioneer of investigative journalism, pretended to be insane in order to be committed in a New York City insane asylum. In doing so, she hoped to expose instances of corruption and mistreatment of patients within the confines of the asylum. What she found at the time was incredibly disturbing, and she was able to expose the fact that many of the doctors and caretakers in charge were completely inept in their treatment methods. Her findings were published in New York World later in 1887. Great shock was had in response to her writings, and a grand jury investigation was launched into the practices of New York’s asylums. While many reforms and changes have been made in the nearly 130 years since Nellie Bly’s experiment, much of the same stigma and corruption has still existed along the way. 

Mental illness in itself is an incredible complex and multifaceted topic. In the Journal of Medical Ethics, Roger Scruton questions what truly constitutes a mental illness, and claims that you must examine the “causes, symptoms and treatments” in order to determine the severity or how far the mental illness has gone, we must examine whether or not it responds to medications, or treatments. For starters, Scruton compares them to physical ailments, while stressing the importance that they must be pondered in a much deeper way. He suggests that the pure mental factor itself should not be counted in diagnosing a mental illness, as it is one of the main side effects of your psyche being affected. His main argument from the treatment aspect is that it cannot truly be “mental” if it can be treated with medicine. Scruton goes into detail on this by discussing how a you can’t simply get rid of a cold by talking yourself out of it. Interestingly enough however, he suggests that it is not able to be mental if it’s treated without medicine either. He states on the subject, “Would it be better to say an illness is ‘mental’ if it can be treated without medicines? Say by talking to an analyst or beating up a wife?” While his comparison to domestic abuse is disturbing, it also makes the point that this is not an adequate way of dealing with these problems, and ends up leaving more issues in its wake. One could look through these things and begin to decipher that there are different levels of mental illness, all with different ways of responding to treatments, and amount of awareness with them.

At the time of Bly’s writings, it was no secret that mental health was poorly understood in America, and in the grand scheme of things, was easy to misdiagnose. At the very least, many “diagnoses” would be incorrect, often resulting in mismanaged treatments and greater trauma on the patient. Within Bly’s work, this is highlighted when she first interviews with the doctor, who almost completely ignores each comment she makes, likely chalking it up to her perceived insanity. When Bly tells him he wishes to leave, he makes absolutely no note of it, instead continuing to scribble on his paper. What is more interesting however, is how little he interacted with her to begin with. From the start of their interaction it is quite clear that he is far more interested in what the nurse has to say than what Bly does. Bly describes the interview saying, “He gave the nurse more attention than he did me, and asked her six questions to every one of me.” This is her first mention of general lack of attention paid to patients, and serves as a foreshadow to how the rest of her time at the asylum would go. This serves as problematic both during the time period and while analyzing this through a modern lens. It shows the reader that there is a lack of humanity that sane people deal with when speaking with the mentally ill. It is a clearly inhumane way of dealing with medical patients, and the same treatment would surely not be given to someone with a physical ailment, such as cancer. To draw from what Roger Scruton had said, “you can’t simply think away a cold.” This rings true in Bly’s case as well, the lack of perception to her lucidity leads the doctors to believe all mental patients are the same, and they won’t know the difference between being treated humanely or inhumanely. It boils down to a generalized stigma that all people in an asylum have the same amount of brain power and lack of awareness over their situation.

In a situation eerily similar to Bly’s, but taking place nearly one hundred years later, journalist Geraldo Rivera planned an expose on the Willowbrook State School, which was also located in New York. Unlike Bly, he did not go undercover as someone who is mentally ill, but after almost one hundred years of technology advancement, he had the added benefit of mass media to spread his findings. He went in with a documentary film crew and found almost the same things that Bly had found in the previous century, overcrowding, filthy conditions, and inept staff. This went to show that despite investigations and litigation, things had barely changed since her groundbreaking findings. This begs the question, is mental health care truly on the back burner of American policy? It seems that many think that these people need to just be stuffed in an area and be contained in conditions of squalor. Viewing Rivera’s documentary Willowbrook: The Last Great Disgrace can be instrumental in allowing the reader to make clear connections and analysis between that and Bly’s writings. In 10 Days in a Madhouse, Bly describes almost inedible food, saying “I tried the bread, but the butter was so horrible that I could not eat it.” Similarly in Rivera’s documentary, the food is both described, and visually shown to the viewer, as inedible slop. The interesting advantage that Rivera’s documentary has is that it visually depicts much of the mistreatment and neglect of the patients, and even allows for follow up questions to the nurses and doctors who are running the facility. They seem to believe the main problem is funding, which offers a presumed answer to the previous question and confirms that mental healthcare is not important enough to state lawmakers to necessitate additional funding. After nearly one hundred years, the institutions in place are almost nearly identical to what was originally investigated.

These findings lead us to the present day, the twenty-first century, in which the same questions are often debated. While the days of massively overcrowded, inhumane zoos are almost completely behind us, many systems appear in place that discriminate and stigmatize the mentally ill. In a piece written on 2014, and published in USA Today, author Liz Szabo writes on a “separate and unequal system” where the mentally ill are discriminated against in insurance cases and in receiving Medicare. Due to complete lack of funding, many insurance plans, including Medicare and Medicaid, refuse to cover the necessary costs of treating patients within a hospital. This causes thousands of vulnerable Americans to receive no care whatsoever and be left out on their own. In revisiting an earlier point made, the reader can connect to the fact that those suffering from physical ailments would not receive the same type of treatment, which supports the fact that there is clear belief that mental ailments require less care and treatment. When the reader makes connections to Bly’s original belief that doctors and nurses did not listen to her concerns or worries, they can infer that many of these same beliefs and practices are still alive and well today, nearly one hundred-thirty years later. 

While readers may have assumed that Bly’s findings changed the entire way that the mentally ill are handled in America, upon closer inspection of how these issues were handled over the year, they may come to find that the same system of corruption and discrimination has remained a near constant the entire time. While Bly’s work exposing the asylum was groundbreaking and eye opening to many, little has been done to change the way the mentally ill are perceived in America. Her work however was quite important, as it served as a base, and is one of the first times that this corruption was recorded. In addition, when readers analyze these systems, it is an incredibly poignant piece that describes the context of the situation from a time that is far gone, and serves as an important reminder that these problems still exist.
