In an excerpt taken from “10 Days in a Mad-House,” written by Nellie Bly, readers receive a first-hand account of mental illness in the late 19th century from the author’s undercover reporting as a patient in an asylum. This results in a text that is influential for a variety of reasons, which include unmasking the flaws of the medical care system for the mentally ill and sexist practices during that time period. 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 questioning why Bly desired to be committed into a madhouse. What did 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. From my research, which provided slim results detailing accounts of asylum life, it became apparent that not much is known about the inner-workings of asylums from the 19th century. After extensive research, I found the answer to my question. The article “The Archaeology of Mental Illness from the Afflicted and Caretaker Perspective: A Northern California Family’s Odyssey” provides great insights about mental illness during the 19th century. Many families honestly believed by committing loved-ones who exhibited psychosis that their conditions would improve and they would soon return home “normal.” Visitors were confined to certain areas and were never truly exposed to possible malpractices that may have been occurring within the facilities (Sunshine, 31). This research highlights the importance of Bly’s stunt-journalism. Due to the lack of information regarding 19th century asylums, the insight Bly is able to provide is a rarity. Bly most likely chose to be a patient within an asylum to inform everyone about female patients’ experience. 

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, 21). By knowing the 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 and go unpunished. Society had shunned the mentally ill as a burden, completely forgetting about them by locking them up in asylums. 

Throughout “Ten Days in a Mad-House,” we are given example after example of medical incompetence and malpractice by both physicians and nurses alike. After Bly is completely ignored during her asylum intake, she poses 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?” (283). This harsh opinion makes one question whether the asylums of the 19th century were more helpful or harmful 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, stating “unless there is a change there will some day be a tale of horror never equaled” (289), becomes a reality at Agnews during the 1906 earthquake, where 101 patients and 11 staff members died (Sunshine, 26). The buildings were poorly designed, constructed from cheap quality materials and shoddy workmanship. These examples confirm the poor conditions that patients braved. This historical background information allows present day readers to understand society’s detached, callous feelings towards the treatment of mentally ill patients in asylums.

The asylum staff abused their positions of power and used horrific methods of treatment. From Mrs. Louise Schanz’s inability to prove her sanity without an interpreter to the beating of Urena Little-Page by Miss Grady and the other nurses, the reader learns of the horrors of life within an asylum for women during the 19th century from Bly. 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%)” (Sunshine, 24). In addition to restraints, 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, 24). Despite inconclusive evidence that therapies such as restraints and hydrotherapy were helpful for treating patients’ ailments, they continued to be used for years. Bly mentions the suffering that Miss Mayard endured due to the cold, stating “I watched insanity slowly creep over the mind that had appeared to be all right.” (295). 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. From the research conducted of treatment of mentally ill women in this time period, such grotesque negligence was standard in asylums across the US. This 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 noted 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, then 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 undergoes is not an issue of the past. Women today are still being misdiagnosed as mentally ill simply 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 an improved 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 similar to theirs. In understanding the gender bias of psychiatric nosology, we learn that stigmatism against women was present in psychology long before this stunt-journalism piece was published and continues to be a problem today. 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. 

 