In an excerpt taken from 10 Days in a Mad-House, readers receive a first-hand account experience of mental illness in the late 19th century from author Nellie Bly. Bly goes undercover as a patient within an asylum. This results in a text that is influential for a variety of reasons, including unmasking the flaws within the medical care system for the mentally ill and sexist practices that may or may not still exist today. To better understand the topics discussed within the book, as well as the implications resulting from the misconducts and mistreatment of patients, it is essential for readers to command a strong understanding of historical background from the 19th century – in particular, how 19th century society viewed the mentally ill, treatment of mentally ill women in asylums, and the gender bias of psychiatric nosology. 

 Immediately upon reading Ten Days in a Mad-House I began to question why Bly would want to be committed into a madhouse. What would she hope to gain from this experience? Initially, I was dumbfounded, knowing that asylums were not pleasant places and nobody would willing choose to commit themselves. And yet, this is exactly what Bly did.  After extensive research, I found the answer to this question in the article, “The Archaeology of Mental Illness from the Afflicted and Caretaker Perspective: A Northern California Family’s Odyssey”.  From both my research, which provided slim results detailing accounts of asylum life, and this article, it became apparent that not much is known about the inner-workings of mental health institutions, better known as asylums, in the 19th century. This is why the information that Bly was able to provide is of such importance and a complete rarity. Many families honestly believed that by committing loved-ones their conditions would improve and they would soon return home completely “normal”. Visitors were confined to certain areas and never truly learned of possible malpractices that may have been occurring within the facilities (Sunshine, 2011). On top of this, the topic of mental illness was taboo within society. It was general belief during this time period that “insanity” was hereditary or caused by bad mothering skills. Societal belief was that “the mad” were a burden on everyone, which led to the ironic stigmatization and rejection of both parents and families of the mentally ill, but still relying on them to care for their “feeble-minded” members (Sunshine, 2011). By knowing this historical background of how society viewed mental illness, readers are better equipped to understand why the staff at asylums, such as the one in the book, was able to mistreat patients, treating them unjustly and going unpunished. Society had shunned the mentally ill as a burden and was perfectly able to completely forget about them, locking them up in asylums. 

Throughout the excerpt from Ten Days in a Mad-House we are given example after example of medical incompetence and malpractice by both physicians and nurses alike. In chapter 9, after Bly is completely ignored during her asylum intake, she raises the question, “Compare this with a criminal, who is given every chance to prove his innocence. Who would not rather be a murderer and take the chance for life than be declared insane, without hope of escape?” This insight makes one question whether the asylums of the 19th century were more helpful or hurtful to its patients. By doing historical research, it is evident that medical malpractice was not confined to the asylum that Bly was committed to. In Sunshine’s article, we learn of multiple crimes committed by medical staff and superintendents in the asylums of California, such as Dr. Sponogle of Agnews State Hospital. The concerns that Bly raises in chapter 11, stating “unless there is a change there will some day be a tale of horror never equaled,” becomes a reality at Agnews during the 1906 earthquake, where 101 patients and 11 staff members died (Sunshine, 2011). The buildings had been a poor design, constructed from cheap quality materials and horrible workmanship. This historical background information allows present day readers to understand the every-day realities of an asylum. 

From Mrs. Louise Schanz being deprived of proving her sanity without an interpreter to the beating and choking of Urena Little-Page by Miss Grady and the other nurses, the reader learns of the horrors of life within an asylum for women within the 19th century from Bly. Not only did the staff abuse their positions of power, but their methods of treatment were also horrific. The 1880 US Census listed data by institution, documenting the percentages of patients restrained by: “straight jackets (44%), straps (22%), muffs (21%), handcuffs (7%), and cribs (5%).” In addition to restraint, patients often endured “new and innovative therapies”, which sound a lot more like inventive torture techniques than methods of treatment. These included hydrotherapy, by which patients were soaked in baths or wraps in either scalding hot or freezing water for several hours to two days! In continuous bath hydrotherapy, patients were locked into a bath of hot water, completely covered, with only a small hole for the patient’s head (Sunshine, 2011). Despite inconclusive evidence that therapies such as restraints and hydrotherapy were helpful for treating patients’ ailments, they continued to be used for years. In chapter 13, Bly mentions the suffering that Miss Mayard experienced from the cold, stating, “I watched insanity slowly creep over the mind that had appeared to be all right.” Although Miss Maynard did not immediately die while at the asylum, she did turn mad from the refusal of warmth and horrid treatment that she received while institutionalized. According to Sunshine, the main character of the article, Tillie, became a patient at Agnews State Hospital and died of septicemia, within a matter of weeks from admittance, due to the restraints that the facility had imposed on her. From the research conducted of treatment of mentally ill women in this time period, such grotesque negligence was standard in asylums across the US, which shapes the reading of the text because it reveals that the maltreatment of mentally ill women was not confined to the asylum that Bly was committed to.

By understanding the gender bias in psychiatric nosology, the issues revealed in Bly’s novel are revealed to be a mere tick on a timeline of women’s psychological right’s suffrage that stretches far and vast. When first reading Ten Days in a Mad-House, I believed the 19th century to be the worst time period for the psychological treatment of women, with the diagnosis of “hysteria” running rampant. In reading “Diagnosing Difficult Women and Pathologising Femininity”, I learned how “outspoken, difficult” women of the 16th century were castigated as witches, became labeled hysteric in the 19th century, and finally described as ‘borderline’ or having PMDD (premenstrual dysphoric disorder) in the late 20th-21st century – all of which are stigmatizing labels irrevocably tied to being a woman in a particular point of history. In understanding this historical context and its implications for current psychological treatment of women, the reader is able to understand that the plight Bly survives is not an issue of the past. Women are still being misdiagnosed as mentally ill just for being women. When men exhibit these same symptoms, it is considered to be related to situational factors, such as “having a bad day”. Thus women’s emotions are deemed a sign of pathology, whereas men’s are understandable (Ussher, 2013).

By implementing a strong understanding of historical background regarding the treatment of mentally ill women during the 19th century, we are able to better grasp the concepts and issues discussed within the book. Through a better knowledge of the time period and medicinal practices of the time, we relate to the strife of the characters within the book who represent countless other women in situations just like theirs. In understanding the gender bias of psychiatric nosology, we learn that stigmatism against women was present in psychology long before and after this stunt-journalism piece was published. With all of this historical knowledge and understanding, readers are able to enact a change in the psychological suffrage of women, working from the foundation built by Bly. 
