
Wrongful diagnosis has been a problem in this world since the beginning of time. Beliefs in medication and ways 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 of the problems with neglectful and incompetent healthcare in the 19th century in the writing of Ten Days in a Mad-House.

In the first paragraph of Ten Days in a Mad-House, Bly immediately notices how poorly the women were being treated, 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 treated. She relates the asylum to a prison early in the story to allow the reader to understand how bad of an institution it is from the start. “Through no fault of their own” depicts the idea that these women have no control over what happens to them. Bly wants to portray the idea that these women are given the worst possible situation. She wants the reader to understand these women were being treated like prisoners, yet they never committed crime that warranted such treatment.

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 gives the reader an image of some of the abuse the women experience by stating “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). Oliver wants the reader to understand the horrible conditions the women were put in. Patients in a health care institution shouldn’t be suffering greatly from the cold, to the point their limbs shake. Bly attempts to help Miss Mayard, she talks 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). Oliver includes the verbal conversations of the staff to show how they constitute the abuse of the patients. The employees have no regard to the betterment of their pateints and would rather let them hurt themselves because they think it may teach them a lesson. The employees abuse the women in the asylum, allowing them to cause harm to themselves without second thought is just as bad as the staff purposely harming them. The abuse didn’t stop with allowing Mayard to harm herself however, Bly learned that Mayard was pinched by the Superintendent in the forehead until “her face turned crimson from the rush of blood to the head.” (Page 295) Bly uses vivid imagery to give the image of how badly the women were being treated. Bly puts emphasis on how badly she is being abused by stating that “Her face turned crimson.” The use of the color crimson instead of simply red, exaggerates how bad the abuse with such descriptive imagery. 

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). On Page 295, Bly states that “I watched the insanity slowly creep over the mind that had appeared to be all right.” She is referring to Mayard, the women who was pinched between the eyes until her face turned crimson. Bly wants the reader to understand how negatively affected the women at the asylum are as they are abused daily. Bly watched as a woman she determined had been sane, started to lose sanity as a result from the abuse and neglect of the staff at the asylum. By including a story of a woman who ended up in a worse mental state after she got to the mental institution than before, the asylum loses all credibility that they are helping these women. The physical and mental abuse from the employees is to the point it is causing the patients to lose their sanity. The women are being mistreated and as a result of no fault of their own, are falling deeper into a poor 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 ultimately 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 absurd that a prison-like hospital was able to operate so long.
