Problems and wrongful diagnosis has been a problem in this world since the beginning of time. Beliefs in medication and the way people are diagnosed is something that is always evolving. The 19th century was a time period filled with a lack of medical knowledge. Until the 21st century, there have been an abundant amount of misdiagnosis and unorthodox ways to help the sick. Nellie Bly decided she was going to uncover the issues patients faced in 19th century mental institutes. Nellie Bly, a completely competent woman, faked insanity in order to be placed into an insane asylum, where she shares her experience through writing Ten Days in a Mad-House.

In the first paragraph of Ten Days in a Mad-House, Bly notices how the women were being treated right away, stating that they were “Poor women, they had no hopes of a speedy delivery. They were being driven to a prison, through no fault of their own, in all probability for life.” (Page 281) It is obvious that she doesn’t agree with the way these women are being handled. By relating the insane asylum to a prison she makes it obvious from the beginning that the asylum is not a considerate establishment. Bly mentioned that they are going to this place “through no fault of their own.” (Page 281) to show that these women can’t help the fact that they are losing their mind, and that they can’t help the fact they’re being sent to this horrible place. 

On page 283, Bly includes her interaction with a doctor who is evaluating her mental state. The commentary between the doctor and the Bly show the competence and utter lack of concern the employees had for the patients. She is first asked basic questions about herself such as her name, and where she is from. She answers and moments later she is interrupted by the doctor who is flirting with the nurse in the room. It is blatantly obvious that he does not care about the exam as he walks out of the room moments later. The perceived definition of insanity in the 19th century was defined as “Madness consisting in a morbid perversion of the natural feelings, affections, inclinations, temper, habits, moral dispositions, and natural impulses, without any remarkable disorder or defect of the interest or knowing and reasoning faculties, and particularly without any insane illusion or hallucinations." (Dr. Hack) In the evaluation, there was absolutely no discussion on a single characteristic of insanity, which again shows the lack of concern and laziness in caring for the patients. 

The staff at the asylum didn’t just stop at being incompetent, they deliberately abused patients as well. On page 295, a woman named Miss Tillie Mayard is mentioned. Bly states “she suffered greatly from the cold. One morning she sat on the bench next to me and was livid with the cold. Her limbs shook and her teeth chattered.” (Page 295). Bly attempts to talk to the three attendants in the room who were all in coats. She says “It’s cruel to lock people up and then freeze them” and the attendants ignored Bly, saying “she had on as many clothes as the rest, and she would get no more”. Moments later Mayard “took a fit” and the attendants didn’t do anything, saying “let her fall on the floor and it will teach her a lesson.” (Page 295). The employees are now abusing the women in the asylum and allowing them to cause harm to themselves without second thought. The abuse didn’t stop with allowing Mayard to harm herself. Bly learned that Mayard was pinched by the Superintendent in the forehead until “her face was crimson from the rush of blood to the head.” (Page 295) Physical abuse almost always has a philological effect on someone. Anxiety disorders, depression, migraines and self-abuse are among many symptoms of abuse. (J Gen Med) Bly states that “I watched the insanity slowly creep over the mind that had appeared to be all right.” (Page 295) At this point the asylum has lost all of its credibility. The physical and mental abuse from the employees has gotten to the point it is actually causing the patients to lose their sanity, rather than a safe place to hopefully improve their mental state. 

The problem in the asylum isn’t just the quality staff however, they are also under supplied in resources, and understaffed. In the showers they didn’t have enough shampoo, soap, and they had a patient washing down other patients in the asylum. A lack of funding and resources certainly contributed to a lot of the problems in the asylum. Without enough money for soap, or bed sheets, or even enough money to have an employee bathe the patients, finding quality staff on a cheap budget is nearly impossible. Along with supplies and staff, the asylum couldn’t get a translator for a German woman who couldn’t speak any English. When the German woman had her evaluation she wasn’t properly evaluated in the slightest. The doctor without being able to understand what the woman is saying, still deemed the woman insane. This again shows the incoherence of the employees of the asylum. A woman was again trapped against her will for something she had no control over. Strictly because of the fact someone was too lazy to find a translator for Mrs. Schantz. If the asylum had proper funding the entire operation would improve significantly. Patients would have proper food and nutrients that would certainly improve mental and physical health or all patients. They would also have more humane living conditions with improved beds, enough clothing to stay warm and improved facilities. The most important thing proper funding would give patients are medical facilities and a coherent staff. They would receive proper treatment and actually be able to progress in the direction of sanity. 

Patients who entered the asylum were doomed. They were given horrible conditions with almost no chance of making it out. The women were treated as if they were prisoners. They were given horrible food, uncomfortable sleeping arrangements, kept in the cold and their general health wasn’t cared for at all. The employees at the insane asylum had a negative impact on the patients. In Bly’s 10 days, a woman was admitted because no one could speak her language, another was abused and became more mentally ill as a result, and Bly herself was kept there for 10 days despite the fact she was completely sane. There have always been problems in the medical field but an utter lack of competence and concern for patients was the problem in insane asylums in the 19th century.  With better funding and people who actually cared about their patients, insane asylums, and more importantly the people who were admitted into them would have suffered as much as they did. To think that women were held against their will, with a staff that had no regard for its patients it is amazing that a prison-like hospital was able to operate so long.
