 In Nellie Bly's, Ten Days in a Madhouse, she explores cultural themes of dehumanization, infantilization, and gender roles. Living in the late 1800s and early 1900's, Bly was born and raised in a society filled with stigma around women and their "hysteria." Men who always had the upper hand and women who always struggled to follow along surrounded her throughout her life. Bly had always had strong views on women's rights, as her father died when she was a young and her mother was left to support the family and raise fifteen children, without any legal help. By going undercover as an inmate at the Women's Lunatic Asylum on Blackwell's Island she saw, and experienced, first hand the horrible treatment the inmates had to endure. Even though Bly did not have any mental illness, she was able to fake her way into the asylum and believed to be "insane" while she was there. Even if she had not been insane before, the treatment she endured was enough to drive anyone crazy. 

 One of the most horrific cultures in the asylum was dehumanization. The doctor and nurses have no regard for those people, or their well-being because they are "ill." Automatically, these people are put at a drastically lower level, because they are not "normal." These people who need to be cared for, are being abused, and it is utterly sick. "The minimum APA recommendations for physicians in mental hospitals is 1 to every 94 to 98 patients. The actual ratio in 1965 was one physician to every 184 patients, or a shortage of 55 percent," (Public Health Reports, 658). The numbers of assigning doctors, psychologists and registered nurses to the patients do not match up with the number of patients. This ratio shows that the patients are not a priority and that it does not matter if they become cared for and cured. Not treating mentally ill patients the right way with not the right amount of staff will only make their illness worse. These patients were put in this facility where it is meant for them to become cured, but instead, they are treated like animals. They do not get the attention they are needed, and there is not enough staff provided to be able to help each person with what they are personally going through. 

The definition of being mentally ill is ever changing, and everyone has his or her perception of it. But what many people think is "that mental illness is a result of sin or the devil, that it is merely evil or willful misbehavior and that punishment is the only solution," (Journal of Health and Human Behavior, 49). Viewing mental illnesses this way then causes staff and people to treat them terribly as if they are not human beings. The way the patients are treated and the conditions they go through it is evident that they do not decide for themselves whether they are sick and how to be cared for and treated. Instead, their self-worth is eliminated, and their say is taken from them. The doctor and nurses speak to each other using their "Christian" and "baptismal" names, while they call the patients by their patient names, further separating themselves from the ill. By taking away the patient's names, it eliminates their self-worth and makes them feel lost. This is also prevalent in the cold baths when the nurses scrub the inmates very hard as if they are trying to scrub away the crazy. Lastly, even though Bly, or Brown in this text, can read the scale when the nurse cannot, she is still seen as lesser than the incapable nurse, these degrading features that are so rampant in the asylum depict the dehumanizing culture.

 Similarly to this culture of dehumanization, is one of infantilization, as the nurses and doctors treat the patients as children as well as animals, they are practically turning them back into a child. They are taught that they cannot think or speak for themselves. They are unable to take care of themselves. They do not know what they need. It is all up to their superiors, the healthy. The organization of the asylum is similar to that of an elementary school, the inmates are told to "Stop at the heater…, and get in line two by two…, stand still," (The Carolina Reader, 285). These are orders similar of those given to young children in a school hallway or cafeteria. This treatment reduces the patient's agency; they are no longer able to do things for themselves, and they become passive and dependent. They learn that their opinions do not matter. Strangely, the nurses refer to this institution as a "charity," because the city funds it, so the patients "should be thankful for what (they) get" (The Carolina Reader, 287). Usually one thinks of charity, as something that is motivated by goodness and funded by people who want to help make things better, this use of the word is a contradiction, as the inmates are given the bare minimum that they need to survive. Nonetheless, the patients have to do as they are told and deal with what little they have because they are dependent on an outside source. By being treated as children, they are reliant on the nurses and doctors to take care of them and know what is best for them and hope that they will get better.

 Lastly, there is a culture of gender roles. This culture puts men and people of high social standing about the mentally ill. "As men are expected to be protective, rational, objective, active, dominant, and independent, the traditional gender role accentuates the male role as decision maker," (Journal of Marriage and Family, 58). In this case, the patients are brought to the asylum by their husband, and then are checked in by a doctor who is usually male. This reveals that the male is the dominant one over the women whether it is her husband or the doctor. Apparently, the doctor knows what he is doing, being male of the superior gender, and clearly doctors know what they are doing because they went through so much school, they must be smart. 

Nurses and physicians wear different uniforms from the patients and society, in general, to remind us of their power. Even though most nurses are female, what they wear ties into them having a male role since they are more dominant than the patients. Their scrubs and white coats make us listen to them and believe what they tell us. The inmates want to be better, and they feel that the doctors know how to do that, so they just go along with it, hoping they can cure the "insanity." Once the patient is diagnosed, their personality becomes a function of their diagnosis. The longer they are ill, the more they see themselves that way and embody their illness. The patient's insanity is never self-diagnosed; it always comes from that outside source, the man or the doctor. Everyone has a different interpretation of madness, and the perception of reality to the ill individual is different than that of everyone else who is "normal." 

This oppression, this treatment, and these cultures that are associated with mental illness do more harm than good. Patients are more insane before they go into an asylum then when they come out, if they ever come out. The longer they are treated like children or animals or prisoners, the harder it will be for them to adjust back into a normal lifestyle if they can get out. Due to the conditions they are put through in the mental hospitals, they might end up becoming more insane rather than get better in the end. Over many years mental institutions started getting more attention due to ex-patients advocating how they were treated in mental hospitals. Due to their advocating in 1985, "a bill was passed to create a formal advocacy program in each state and territory to serve people with psychiatric disabilities," (Mental Health Advocacy). Having these support groups is helping improve mental hospitals today by letting the people with a mental health condition make their choices regarding their treatment. 

