
Ten Days in a Madhouse is a book where Nellie Bly went undercover to report what was happening in mental asylums.  Nellie Bly was born in 1864, and chose to become a reporter as her career path.  Bly moved to New York City, and feigned insanity to be admitted as a patient at the Women’s Lunatic Asylum on Blackwell’s Island.  Ten Days in a Madhouse started off as a series, but then Bly turned it into her first major book.  Bly was one of the first women to perform stunt journalism, and truly prove women were capable reporters.  Ten Days in a Madhouse is a novel that it not only meant to entertain, but to report on actual events that were happening.  While reading this novel, readers can go one of two ways.  Some will believe Nellie Bly wrote this for pure moral reasons, to stop the unlawful and inhumane treatments of the patients.  Others will believe Bly wrote this for purely selfish reasons.  She is a reporter after all.  Bly wrote the book for the combination of the both, but the idea that the reforms came as a conclusion to what she did is an extreme ideal.

During the 19th century all asylums became a holding cell of sorts for the mentally ill.  They became a place where the mentally ill were sent to live out the rest of their days.  The so-called treatments were unsuccessful and the patients were basically prisoners (Klerman).  Bly documented her time through newspaper articles, that eventually got published into a book.  She spoke about the inhumane way the caretakers treated the patients (Bly).  It was cruel and unusual punishment.  Every patient was treated the exact same, individuality ceased to exist.  She went undercover to bring light to the situation and ultimately change it.  Bly’s believes both her undercover work and the works of fellow reporters helped to establish the new protocols for the mentally ill, and bring mass attention to what was actually happening behind closed doors.  Yet in the book, Bly never tells you about the reforms or even if reforms happened.  The actual history of mental health care helps you to understand the natural progression of the reforms and how they came about.  

Gerald L. Klerman talks about how mental hospitals have changed and how there is still room for improvement.  His article “Foreword” was written during the 1980’s when public policy for the mentally ill was changing.  It was based off Harvard’s University of Health Policy research.  The eighties consisted of a time when public expenditures were decreasing and competition for health and social welfare was increasing (Klerman).  Klerman than talks about how it may now be a time to look into other alternatives for the mentally ill.  Klerman like Bly believed that the mental institutions needed to be updated.  The mentally ill has been a factor of “public policy” since the beginning of our government, yet there was always a need for improvement (Klerman).  During the 1830’s the caretakers for the mentally ill switched from local communities to state governments.  The government then created state mental hospitals.  The treatment did not go according to plan, and was hugely unsuccessful (Klerman).  These hospitals became more of a holding facility for the mentally ill, then a treatment center.  In Ten Days in a Madhouse, Bly speaks of the institutions the same way as Klerman.  It became a place where the undesirables of the cities were held.  After World War II, hospitals began to reform.  The specific changes sparked an increase in the interest of the mentally ill.  

President Kennedy, in 1963, started a “bold new approach” for the mental hospitals (Klerman).  The mental health center program grew rapidly, and many policies that were made to deinstitutionalize the facilities were accepted by most of the state governments.  Benefits were now given to the mentally ill under the Social Security Disability Insurance, Medicare, and Medicaid (Klerman).  The amount of patients being released from mental hospitals greatly increased with these new reforms, which at the time was good, but soon became a negative factor.

Based upon Klerman’s article, one can now see clearly what Bly was speaking about.  In the novel, you don’t get to see the history and the historical context from which she reported on.  Bly speaks about the changes she installed, while the changes happened years later.  Mental health has always been a talking point in the health industry, and the true reforms she speaks about happened long after her novel was written.  The reforms did not only come from her reporting, because they were in the works for a long time after.

The Yale Law Journal, “Requiring Due Care in the Process of Patient Deinstitutionalization: Toward a Common Law” by Jonathan P.  Bach discusses the history of deinstutionalization and the negative effects of it.  From about 1959 to 1989, many psychiatric patients that were formerly treated in the large state mental institutions had been either released or moved to “community settings that had more humane care” (Bach 1153).  In those thirty years, the number of patients in state mental hospitals dropped from 559,000 to 132,000 (Bach 1156).  This exodus had been termed deinstitutionalization and was a part of Kennedy’s new mental health care act (Bach).  Essentially, the deinstitutionalization policy was created to decrease inpatient populations and move them to less restrictive and more humane settings (Bach).                                                                                                                                              

There were quite a few negatives associated with the process of deinstitutionalization and it became one of the most relevant and important concerns of American mental health care policy.  While hospital populations had been quickly lowered, the community care facilities had not been developed in numbers that were able to accommodate the massive patient release (Bach).  Both the communities and the health care facilities were unable to hold the new and quickly increasing outpatient population, so many former patients became dislocated and were then located in inappropriate housing with subpar care “or, at the extreme, [were] homeless and [received] no care at all” (Bach 1153).  Some patients were also being discharged too quickly, and thrown into urban environments that they were not ready for.  There mental states would then deteriorate even quicker, and most would then become homeless (Bach).  The series of moves did not help the mental well-being of the patients.  There were many people still in favor of deinstitutionalization, but many people began to doubt if the process was actually helping or hurting the patients.

This historical context clearly shows how the major reforms in the mental health industry took place over a half century after Bly’s novel was written.  The reform process was not due to the actions of Bly and fellow reporters.  One should believe that the reporters did bring more media attention to the cause, but the reforms came far later.

Both historical contexts, allow the readers to gain a different perspective on the reading Ten Days in a Madhouse.  Each reading, explains both the reforms, and how they came about.  Both came about organically.  President Kennedy’s health act was the main contributor, and allowed for the reforms to take action.  In the article “Foreword”, Klerman discusses how the state mental hospitals were largely unsuccessful, and became far too big.  This is yet again discussed in the Yale Law Journal.  Both discuss that they were holding cells, and needed reform.  This allows the readers too more clearly see what Bly was speaking about.  She in her novel actually states how the asylum was more of a holding cell than an actual care center.  This will give the reader a perspective of clarity, and show that Bly was not fictionalizing anything she wrote about.  Reporters can tend to dramatize and exaggerate what they are talking about.  They all have some sort or form of bias, and this history allows the readers to come to their own conclusions on what to think about the asylums.  The history provides the readers to make their own informed decisions, and see the actual context of what Bly was speaking about

Based off the historical readings, one should believe that the reforms happened as a natural progression and evolution of both the world and mental health care.  People were already getting fed up with the way patients were being treated, and it had already caused quite a stir in society.  President Kennedy chose to initiate his new act, because the issue had become so popular.  The popularity of the cause rose organically, and was fairly grassroots.  Both readings allow the readers to see the history of mental health care.  They got to see what was happening both before and after Ten Days in a Madhouse.  The novel is not only for the bettering of mental health care, but it also meant to be read for entertainment.  The histories allow the reader to see the true factual information about mental asylums during the 19th century.  

Nellie Bly is a great reporter who did bring light to the inhumane treatment centers for the mentally ill.  One could believe she and fellow reporters were the main reason for the reforms, and that would be incorrect.  They did add publicity, but neither historical reference talks about the reporters or how they were a cause for the change.  The change was fairly organic.  Bly did get to bring an emotional touch to the situation, and the “holding cells” of the asylums were not only mentioned in Ten Days in a Madhouse, but in both historical contexts.  Bly’s work truly gave the feel of what it was like in the madhouse, and the historical contexts allow one to put together all the missing pieces and questions one would have while reading the novel.
