
One might wonder why anyone, let alone a female reporter in the late 1800s would feign her own insanity to gain entry into an infamous insane asylum. Hoping to document the treatment of patients trapped within its morbid walls, Nelly Bly did just that in 1887 when she infiltrated the compound known as the Women’s Asylum on Blackwell’s Island (Bly 1). Not knowing if she would be able to escape once being locked behind the bars of the asylum, Bly set out to collect information on how patients were treated during their often indefinite stay. Bly hoped to unveil the dark shroud of mental health treatment in the United States to the public and ultimately call for reform in the system (Bly 1). To understand why Bly risked her life to investigate the Women’s Asylum, one must realize how the United States mental healthcare system came to stagnate in such a broken and horrid state.

In the 1800s treatment options for the mentally ill were striving to aid those suffering from a vast array of afflictions through moral practices called “Moral Treatment” (Whitaker 34).  Moral treatment of the mentally ill requires compassion and a willingness to allocate monetary resources for their care and curing. This view of treating the mentally ill was at the time positive and led to the success of many budding institutions. In the 1840s and 1850s, a woman named Dorothea Dix began lobbying for reform in the mental healthcare system. In response, state governments underwent a movement of asylum building which ironically would lead to the downfall of proper treatment for the mentally ill. Dix’s reform promised care to many different persons afflicted with physical and mental illnesses such as alcoholics, syphilitics and the senile elderly (Whitaker 34). Unfortunately Dix could not foresee that the influx of patients seeking care into asylums would overstress the staff and lead to the eventual mistreatment of patients. The most important part of Dix’s philosophy was that asylums should be small facilities which provided a homelike atmosphere with a low patient-to-staff ratio to ensure that patients received the individual treatment they required. However, after the vast influx of mentally ill patients into hospitals, state institutions averaged a staggering 432 patients in 1874 where originally there had been a limit of no more than 250 patients per institution (Whitaker 35). With some institutions tipping the scales with over 1000 patients, it became impossible for the superintendent and staff to provide the empathy and guidance that was considered vital to helping the mentally ill get well. 

Unfortunately while Dorothea Dix meant well for the practice of mental healthcare in the United States, her calls for reform led to decline in the quality of care for the mentally ill. As more and more mentally ill patients were admitted to existing institutions, stress on the already overworked and underpaid staff rose to all-time highs. Issues with understaffing progressed which would ultimately cause the quality of care for mentally ill patients to spiral down into the dismal state that Nellie Bly would investigate.

Allison Foerschner’s article The History of Mental Illness: From Skull Drills to Happy Pills outlines the issues with the early mental healthcare system that arose as a consequence of Dix’s calls for reform. Foerschner asserts that “asylums were merely reformed penal institutions where the mentally ill were abandoned by relatives or sentenced by the law and faced a life of inhumane treatment” (Foerschner 1). In line with Whitaker, Foerschner agrees that early mental health institutions were vastly understaffed with unqualified staff. The incompetence and lack of compassion from staff led to horrific instances of human abuse such as individuals being shackled to the walls of their miniscule cells by iron cuffs and collars (Foerschner 1). Foerschner article furthers the idea that mentally ill citizens were treated as sub-human animals forced to wallow in the incompetence of the broken early mental health system. Equally disturbing as Foerschner’s accounts of torture-like treatment is her assertion that the state of mental healthcare was no better than that in the United States. Foerschner states that the few asylums constructed in Africa suffered the same dismal conditions as mental institutions in the United States. Foerschner writes on African institutions, “When asylums were finally established in Lagos and Abeokuta, the conditions were less than pleasant. Common complaints included dark, overcrowded cells, a lack of basic supplies, poor bathing facilities, and the use of chains to restrain patients” (Foerschner 1). Clearly, worldwide mental healthcare was in a dark state that desperately required reform. 

Fortunately for patients seeking care in mental health institutions, new methods of treatment would serve to benefit those afflicted by various mental diseases as the early 1900s approached. The progress of treatment stemmed from the research of Austrian neurologist and psychologist Sigmund Freud. Freud would go on published twenty-four documents detailing his thoughts and research about personality and psychopathology which he dubbed “Psychoanalytic Theory” (Foerschner 3). Important treatments for various mental disorders were created from Freud’s research which were given the title of “psychoanalysis.” Psychoanalysis usually involved a number of “talking cures” which were centered on inducing hypnosis and letting patients speak whatever came to mind in order to develop specific treatments based upon the information gathered in each session (Foerschner 3). While the treatment of psychoanalysis was often regarded as pseudo-science, it was an extremely popular form of treatment in the early 1900s. As research on mental health disorders went on, scientists began to focus on developing somatic treatments for afflicted patients. Popular methods of treatment developed following psychoanalysis included electroconvulsive therapy, psychosurgery, and psychopharmacology. These treatment methods were far more effective and credible due to the fact that they focused on altering biochemical balances in the body which could actually lead to changes in patient’s behavior (Foerschner 3). While first introduced almost 100 years ago, electroconvulsive and psychotropic drug therapies are still used today albeit with significant reforms in the administration of treatment. Nellie Bly’s publication on the horrors of mental health institutions sparked a great deal of reform in treatment and patient care as highlighted in Foerschner’s article.

After reading Nellie Bly’s horrific 1887 publishing of her 10 day tenure within the Women’s Lunatic Asylum on Blackwell’s Island, one cannot help but wonder how public and government officials tolerated the deplorable behavior of nurses and doctors tasked with caring for the mentally ill. Knowledge of the time period in which Bly conducted her research provides insight into the reasoning behind the abominable mistreatment of the mentally handicapped population. In the 1800s, mentally handicapped people were viewed as sub-human creatures and were subsequently treated so as shown by Whitaker and Foerschner’s reports. Bly’s reports of murder, mistreatment and abuse in the corrupt mental health care system targeted at the general public would ultimately lead to some immediate reform however, large scale reform would not take place until much later in the 1930’s and 40s. The United States’ history of treating the mentally ill is stained by the abominable acts that took place behind asylum walls in the mid-1850s. The historical aspect of mental health treatment must be observed to understand why Bly went to such lengths in order to expose the malpractices that 40 years of poorly run mental health institutions had desperately tried to sweep under the rug and out of sight of the American public. 
