It is presumed that the mentally ill is a class within society who are extremely misunderstood and oftentimes taken advantage of. Before even being given a chance, they are thrown into these structures where inside, they are driven madder than they were to begin with, and they are treated extremely immorally and unfairly. Nowadays, this information is a complete misconception. Thanks to Nellie Bly and her popular but controversial publication, “Ten Days in a Madhouse,” the mental health community has completely turned around and is now more efficient than it was during the entirety of the 19th century. Often, individuals living inside of 19th century asylums would leave these institutions more mentally unstable than they had started, and sometimes, they would not be released at all. Nellie Bly describes her experience in the insane asylum to create public awareness and concern to how unjust the treatment of these individuals was. The mentally ill were treated as if they were not humans, and it was important that Bly brought this issue to the public’s attention. As argued by Bly, patients who left 19th century insane asylums were more mentally unstable than they were when they were first admitted due to the unfair, unsettling conditions and treatment, which had detrimental effects on these individuals’ mental health. Knowing the historical background of 19th century insane asylums creates a more in-depth image for readers to be able to fully envision the unfair treatment of admitted patients. 

 From the actual process of being admitted to the treatment of the patients, as well as the conditions that they were living in, olden day insane asylums were not fit to care for those with true mental health issues. 

19th century insane asylums are among the most well-known historical structures. This is likely because of the horror stories people hear from what went on inside these buildings. Individuals that were locked in insane asylums dealt with severe mental and physical abuse. The article “Founding Friends: Families, Staff, and Patients at the Friends Asylum in Early Nineteenth-Century Philadelphia,” written by Gerald N. Grob, focuses in on the moral treatment of individuals living inside insane asylums in the late 19th century. They were driven more insane each day spent inside. With an understanding of the history of the way these individuals were treated, readers can see what those placed in mental facilities had to go through, and specifically, what Bly had to go through during her stay. They had almost no power as; “…families continued to play an important role. They decided when it was necessary to send a distressed relative to the Asylum, and its members negotiated with the staff over their care and treatment.” (Grob 406). Due to this, a lot of individuals who were not actually insane were forced to live in these institutions. Once inside, they were treated like animals, as the asylum staff had no regard for the patients’ well-being and instead only cared about curing their diseases or disorders. This went on for years before there was any public knowledge of what was truly going on inside. Nellie Bly’s publication was among the first texts to publicize and expose insane asylums during the 19th century. 

One of the key issues with 19th century insane asylums was the process of being admitted into the institution. There was no real structure or proof that the person who was placed inside was clinically diagnosed as “mentally insane.” As Bly communicates with individuals locked in the asylum, she learns that a lot of patients were not actually insane. She asks patient Tillie Mayard; “Are you crazy?” to which Mayard replies “No…but as we have been sent here we will have to be quiet until we find means of escape. They will be few, though, if all the doctors, as Dr. Field, refuses to listen to me or give me a chance to prove my sanity” (Bly 281). Cases like this were extremely common not just in the institution Bly stayed at, but in institutions across the country because there were no legitimate standards that proved insanity. It is unfortunate that a lot of the say of whether or not an individual should be admitted was made by close family, who had no real knowledge of what it meant to be insane. Danielle Terbenche writes an article to share the research she found regarding the treatment of the patients in her article, “Benefits of Patient Treatment at the Asylum for the Insane.”  As soon as this controversy was brought about, research was conducted to see if the government was over-committing people into these asylums. What researchers found was that; “avoiding revisionist images of helpless populations of custodial patients, these historians identified the powers of families and patients to initiate committal, influence treatment and act as agents in the implementation of asylum policies” (Terbenche 30). Therefore, it is very probable that a lot of patients were never actually insane, and instead were just driven to be that way once inside, due to neglect and brainwashing. 

Nurses and doctors mistreated patients constantly. While inside the asylum, Bly herself experienced extremely inhumane treatment, treatment that would drive any normal person insane. Patients were hit, locked in dark rooms, and given no say on anything. This behavior had to have had a mental and psychological toll on humans, stable or not. As Bly lived through it and experienced it, she could see just how often and the extent that this was occurring  

Almost every aspect of 19th century insane asylums were cruel. Just by walking into the building, one could see how unsetting it was. Bly was extremely disturbed by the set-up of the asylum as she describes; “Barred windows, built about five feet from the floor, faced the two double doors which led into the hall” (284). By forcing individuals to stare at blank walls and sleep on rock hard beds, this created a constant state of being uncomfortable, leaving no room for psychological growth.

Nurses, doctors, and caretakers working inside of these asylums struggled to balance between providing morally correct and ethical treatments with finding a cure to their mental disorders (Grob 406). In the end, they failed to do this because all that was of true concern was to find a way to rid the patients of their mental diseases. They believed their unrealistic treatments and exercises with the mentally ill would be successful. Yet, it proved to do the exact opposite. Those deemed mentally ill were driven even more crazy the longer they stayed in these asylums. Instead of dealing with each patient individually, and taking into consideration each person’s needs, asylum staff grouped everyone together and intended to treat them as a whole. Rather than reaching out to each patient; “equally significant, the distinction between care and cure, while admittedly gendered, may in fact be artificial” because cure was the first priority (Grob, 406).  Even when they were aware that this was not always an attainable and realistic goal, this was still the basic structure of most insane asylums in the late 19th century. 

One of the most important aspects of the treatment of these people, was discipline. Rather than the well-being and the true passionate care for these individuals, the most important thing to the workers was an extremely structured and obedient environment. Due to this, nothing improved except compromising the welfare of those confined within the walls of the institution. A study was conducted to see if the way doctors and nurses had treated the mentally ill was not just beneficial, but successful as well. Per these studies, in almost all the cases, it was assumed that a lot of the patients left the insane asylums crazier than they were when they were admitted as; Terbenche “studied a selected group of 240 women admitted to the Asylum for the Insane in Kingston, ON, between 1878 and 1884, examining the asylum's treatment program during the late nineteenth century and its influence on the outcomes of committal” (29). By doing this, the public could see into insane asylums and visualize just how cruel the treatment was. The negative effects of this treatment caused such insanity in those admitted.

Bly’s publication sparked extreme controversy, as it was the first in depth criticism of the government’s take on mental health that opened the eyes of the public. It could be deemed a historical turning point for mental health nationwide. Between the treatment, setup, and standards of these asylums, nearly everyone agreed that insane asylums were extremely unfair and immoral. With a basic understanding of what went on inside these insane asylums, this will help readers fully visualize what Bly was discussing and had to go through during her stay in the asylum. The text becomes clearer with knowledge of the history behind 19th century insane asylums because the conception and ability to see what truly went on, becomes a lot more definitive.  It is very clear that placing a person, sane or insane, into a 19th century asylum had detrimental psychological effects on their brain and essentially, did not help their mental stability or well-being. Nellie Bly’s publication, “Ten Days in a Madhouse” could easily be considered the reason for the much-needed reform within the mental health community. It is important to note that because of her exposure to ineffective 19th century insane asylums, modern day mental hospitals have become much more humane and less prison-like. Individuals nowadays go through extremely professional screenings to see if they belong in a hospital and then once admitted, they are treated with respect and dignity until they are released. 
