In 1887 a writer named Nellie Bly had herself committed to an insane asylum, but she was not suffering from a mental illness. Bly’s objective was to get an inside look at how the facility was operated. Upon leaving the asylum she wrote a book titled “Ten Days in a Mad-House” in which she gave a detailed account of her time there. The tragic scenes that Bly witnessed during her time at the asylum are a result of the state of the mental health practice in the United States in the 19th century. At the time, the practice was just beginning to become popular in the country and the system was almost entirely unregulated. As a result, the system was being flooded with patients and, in order to accommodate this, private institutions were being built all over the country. These asylums were not required to report their business to any outside party. This led misuse of funds by the administration and the exploitation and mistreatment of patients. 

The overwhelming number of patients in the system at the time was a result of a combination of issues. In an article titled “The History of Mental Illness”, Kimberly Leupo provides an excellent account of the influence that the time period had on the growth of mental health in the United States. When the Civil War ended in the mid-1860s, many of the soldiers returned home suffering from mental issues stemming from their experiences. These men were sent to facilities run by the state. This began a period of increased awareness and spending in the field of mental health. The states started to build large fancy facilities to house patients. These new asylums became known for their impressive care and treatment. Their reputation, along with the fact that almost anyone could be admitted, caused another influx of patients. These patients came in the form of homeless people looking for a place to stay as well as families looking for a place that would care for their elderly, along with those who truly needed care. The facilities were run by the state so there was no direct cost to the public. As a result, there was little incentive to look for alternative treatments. Each time the system became overburdened, the patient care decreased. The overpopulation led to patients being housed in rooms with multiple other people. Also, the need to feed all of the extra patients led to a decline in the quality of the meals provided.  Many institutions were unable to provide an adequate number of staff members to care for the patients. In order to compensate for this the asylums often resorted to using old techniques, such as using physical restraints, to keep the population under control (Luepo). When the state facilities became overcrowded, privately funded institutions were built.

Many problems arose from the way in which privately owned asylums were operated. They were run almost completely from the inside. The people that funded the prison were responsible for appointing all staff positions as well as determining salaries. Dorman B. Eaton wrote an article titled “Despotism in Lunatic Asylums” for The North American Review in 1881. In it he states that asylum owners, “report to the legislature the only authorized version of their own conduct. Neither their report nor that of their subordinate, the treasurer, is required to contain such particulars as would disclose extravagance or any other abuses. As private owners of the institution, they could not have power more absolute and irresponsible” (269). This describes a total lack of accountability among those in control of the system. All of the people in charge of running the facility were personally profiting from its existence. As a result, when the people working under them treated patients poorly it usually went unreported (270). There are also cases of this lack of oversight resulting in diversion of funds to accommodating the workers rather than the patients. Eaton cites as an example the building of an asylum in Massachusetts, for which almost one third of the funds were used to build facilities for the workers (266). Rather than use funds to increase to quality of care, the money was spent on improved conditions for employees.  Also, by packing multiple people into one room the institutions could collect more profit at little to no cost to the owners. Situations such as these led to an overall decline in the quality of treatment for patients in mental health institutions in the United States. 

The impacts of overcrowding and corruption are readily apparent in Bly’s account of the time she spent at the Women’s Lunatic Asylum on Blackwell’s Island. She makes multiple references to the overwhelming number of patients at the asylum. In one passage Bly recounts waiting in a crowd of women just to get her dinner (285). In another she describes the scene outside the building during the time when all of the patients are taking their walk around the yard. She states, “We had not gone many paces when I saw, proceeding from every walk, long lines of women guarded by nurses. How many there were! Every way I looked I could see them in the queer dresses…” (291). This account provides a powerful image of the unmanageable number of people housed in some of these institutions. There are several examples of the effects that the amount of people had on the quality of patient care. Some of the patients in the asylum were housed in rooms with up to nine other people (288). Bly repeatedly references the almost inedible food and drink they are served for meals. The need to feed such a large number of people could cause the low quality of the food. It is easier to feed patients with cheap food that requires little preparation then it is to provide fully cooked meals. However, the poor conditions brought about by overcrowding pale in comparison to those that resulted from the inhumane treatment of patients by the workers.

A corrupt system allowed the doctors and nurses that worked in the asylum to treat patients as they pleased with little risk of retribution. Bly witnessed many examples of this corruption during her stay on Blackwell’s Island. She recounts the chores given to the patients, which included the cleaning of the worker’s living areas as well as washing their clothes (290). In another passage she describes walking by the kitchen and seeing the food that was prepared for the workers. While the patients ate stale and poorly prepared meals, the food served to the workers included fresh fruits, bread and meat (293). While these accounts show unfair conditions for the patients, the examples of physical mistreatment provide a much more disturbing picture of the corruption within the system. Bly remembers being sat on a bench in the bathroom with at least forty other women. The nurses then went around and forced a comb through their hair with such force that Bly had to grit her teeth to prevent from yelling out in pain (290). In another case, the Superintendent was informed that a patient was in need of medical attention. His solution was to grab her forcibly by the bridge of her nose, causing her a “terrible headache” (295). However, this is not the worst example of a patient being physically mistreated. In her first days at the asylum, Bly tells of a girl being strangled and presumably beaten into silence in a closet, by the nurses, after she began crying. Even worse is that she was crying as a result of verbal abuse from the nurses. Bly states that the beating seemed to excite the nurses to the point that they grabbed another woman, who was guilty of nothing, and brought her into the closet and beat her as well (297). The doctors in the asylum were made aware of these offenses, but nothing was done. The fact that the workers were allowed to continuously behave in such a manner shows how corrupt the system was at that time. There was no way for the patients to inform people outside the institution of these occurrences. Since the people working in the asylums were not held responsible by their superiors, many of these events were never reported.

The atrocities Nellie Bly experienced during her time at the Women’s Lunatic Asylum were the result of a poorly managed system. While lack of proper diagnosis’ and an influx of patients that were not mentally ill resulted in an overflow of people in the state institutions. The private asylums were being overcrowded due to the increase in profits. These mental health facilities took advantage of an unregulated system to increase profits and participate in despicable acts without consequence. Bly’s decision to go undercover to unveil the malpractice within the system was undoubtedly brave. She willingly sacrificed her freedom, and potentially her sanity, in order to speak out against a system that had turned on the very people that it was promising to help. 
