Insane asylums did not always exist. They, like all other institutions we know today, were invented by people for one of three reasons: profit, necessity, or progress. It is most commonly thought that these institutions were a necessity built to take care of those who otherwise would not be able to receive the attention they require. The thought process was that by grouping everyone with similar needs together they would receive better care in a more efficient manner therefore benefitting all parties. However, Nellie Bly is skeptical of this when she decides to enter one of these institutions by acquiring four false diagnoses from doctors. How she was able to do so itself shows the state of the system at the time. Regardless, while she is in the institution rather than simply getting an inside scoop for her next work, Bly experiences the harsh realities that exist inside these so called madhouses. In order to understand how these realities came about, outside knowledge of the time period is necessary. Things such as economic conditions, social conditions, and technology all account for the poor conditions that Bly describes.  

In Bly’s opening remarks as she enters the institution she informs the reader of her sanity despite being “pronounced insane by four expert doctors” (Bly 281). Immediately this raises the question of the legitimacy of the psychiatric system at the time. Bly has introduced two key points with this simple phrase. First, she has revealed that they field of psychiatry is so questionable that she is able to trick four, what people consider expert but clearly are not, doctors into diagnoses leading to her being sent to an asylum. Secondly, by using the generic term insane, she has introduced the essential realization that a diagnoses itself is not exactly concrete. Bly repeats this theme using terms such as “chattering lunatics” and “so-called crazy women” which reinforces the fact that the science of psychiatry is not exactly a science (Bly 281). However, she may have done so unintentionally due to the fact that she at the time only had the knowledge of these diagnoses and not the many particular mental health disorders that exist. 

Bly continues this theme when she later tells of Miss Mayard who she believed to be sane and begs to be tested if they have any tests. This questions of whether or not they have tests, which they did not, is what leads to her being “committed without ample trial” (Bly 282). Bly goes on to tell the story of Mrs. Louise Schanz who did not speak English. Despite the fact the nurse at the asylum spoke German, the only tongue Mrs. Schanz was able to speak, the nurse refused to speak it resulting in her being committed “to the asylum without a chance of her making herself understood” (282). It is clear at this point that the women who are supposed to be patients are not being treated this way. Instead, they are being treated as social deviants. Bly receives this impression before even seeing these people be mistreated when she describes the impressions the asylum gave her of “unmerciful bolts and bars” (Bly 281). She more clearly states it when she draws the analogy of a prisoner to a criminal. However, the distinction she makes between criminals and insane classifies them as a new form of deviant. Unlike criminals, the victims of these psychiatric “diagnoses” do not receive the opportunity to prove their innocence. Such a fundamental denial of their rights leads Bly to perceive that a murderer has greater due process then someone diagnosed by a psychiatrist. 

Lastly, Bly discusses the actual conditions within the asylum. Her terrible dining experience, although important, is overshadowed by the physical treatment of the patients. Bly reports women being physically beat including being choked, smothered in closets, and dragged by the hair. The image of a defenseless malnourished women being beat by her nurses is sickening, but Bly reports that even the doctors partook when she details a women being squeezed by the head until her face turned red. When Bly then discusses how she herself was threatened by the nurses if she “made a practice of telling”, the grim realization that these conditions were absolutely unavoidable sets in as even a woman who is accepted to be not insane cannot escape them (Bly 295). 

The British Medical Journal discusses the creation of a society to protect the insane especially those in asylum’s citing the terrible conditions as the necessity for the society. Unlike the beating Bly reports, the journal informs us of a legal practice in which there was “habitual use of mechanical restraint” (19). Understanding this provides the fundamental tone for which these people were treated. Not only is this sort of restraint cruel, it goes beyond anything that is used in prisons. Mechanical restraint is a form of punishment that mirrors the new form of deviant’s experience under the pretext of treatment. This experience was accompanied by conditions so poor every day that after a doctor visited the New York City Asylum they were given an extra “ten thousand dollars a year to the allowances for food” (20). It as well accounts for the fact that these patients, unlike prisoners, were not given the chance to prove their innocence. The question then becomes how were institutions created to aid people, who otherwise couldn’t receive proper treatment, become so contrary to their purpose. 

Andrew Scull attempts to answer this question in his paper “Madness and Segregative Control: The Rise of the Insane Asylum” by describing how he believes the insane asylum developed and how it quickly changed. Firstly, and most importantly, the rise of a capitalist economy widened the gap between the rich and the poor. This, in combination with the industrial revolution that was occurring, created a need for obedience in places such as factories. Therefore, those who couldn’t fit into this area or into jail, the “insane”, were put into asylums. These people became the new class of social deviant. In an almost dystopic manner, any person with power such as wealth could use this to imprison another in an asylum. The asylum was accepted due to the fact that it was viewed as a way of grouping people with similar needs to facilitate their receiving of the treatment they needed. This rapidly led to the popularization of the new field of psychiatry. This field of study “lent scientific legitimacy’ to asylums and some of the methods used as treatment without the field of study itself ever being legitimate (Scull 344). This is due to the fact that the field itself was extremely new and what Scull refers to as mad-doctors were more concerned with the exploitation of the patients for their own personal gain than the treatment of the patients themselves. This exploitation and the lack of legitimacy are very apparent in Bly’s account by not only her four misdiagnoses but also her lack of a real diagnoses and the fact that the doctors paid more attention to the nurses than the patients. As for why the physical conditions such as food and the dining area were so poor, Scull asserts that the “influential classes’” emphasized both space and cost efficiency of each asylum to benefit themselves meaning as many people in as little space with as little money going in as possible (Scull 347). 

The explanation Scull provides of the way in which asylums are built are particularly apparent the passage in which Bly lies sleepless in her bed. She reflects on the fact every door is locked individually which means if there were to be a fire all of the patients would die because “the jailers” would never release the crazy patients even if they were able to (Bly 288). A nurse would have to risk her own life to save theirs and simply wouldn’t be able to unlock all of the doors because of the design. The reason for this poor design is, as Scull explained, the asylums were built with the cost in mind not the patients. As well, Bly asserts that a fire “is not improbable”, yet another flaw in safety that can be accounted for by cost (288). Bly estimated that there would be almost 300 deaths in one building alone which is due to the way the asylums were built for efficiency in keeping as many patients as possible in as small of an area as possible. 

Bly’s account of the institution is not only accounted for by The British Medical Journal and Andrew Scull, but also new information as to the internal conditions is given complimenting her account. The use of mechanical restraint is as shocking as the beating that Bly describes. It is almost physically repulsive thinking about defenseless people being treated this way. However, Scull’s explanation of how the doctors were in fact not legitimate doctors and their methods were not legitimate methods is a slight consolation. Furthering this is his explanation for how the physical conditions became so poor. With the understanding that there were outside forces propelling the creation in such a poor manner, it makes more sense that people were able to accept this. Of course, this acceptance comes from their own personal gain and the fact they themselves were not affected by it. However, in the end it is clear that the patients were treated worse than prisoners without the rights of prisoners all due to peoples greed. 
