The 19th century was a time of reform in the mental health field. This era saw a fundamental change in the philosophy of care, and the creation of massive new insane asylums along with it. The moral treatment theory of psychiatry sought to minimize the use of restraints, encourage a level of self-sufficiency, and basically treat the insane as humans instead of animals.
This new line of thinking led to the building of large-scale asylum structures that still stand today. These buildings marked a decided improvement for their patients. Previously, the insane were typically kept in small almshouses or even jails, where they might be chained to the walls in rooms with no heating or ventilation. In the 19th century, social reformers like Dorothy Dix made it their mission to construct and improve state-run mental asylums.
But despite some early successes, 19th century mental institutions often fell short of their utopian goals. The idea that these institutions would cure patients proved unrealistic, and they soon turned into a new type of cage for their inhabitants. This is what life was actually like for the patients of these institutions.
The large gothic buildings of asylums resembled penitentiaries in more ways than one. The windows were barred, the grounds fenced in, and the bedrooms were locked. A diagnosis of insanity said that you were not fit to take care of yourself, and thus you became a ward of the state, often whether you wanted to or not. And once you were in, it could be nearly impossible to convince the staff that you were sane.
Nellie Bly recounts just such an instance in Ten Days In A Mad-House. In 1887, Bly feigned insanity to gain access to New York's Blackwell's Island Insane Asylum - she wanted to write about the conditions there. Upon her arrival in the asylum, she found that many of the patients seemed completely sane.
One woman ended up there after her health gave way and her nephew ran out of funds. Other women simply didn't speak enough English to make themselves understood. Bly herself was unable to convince the doctors of her own sanity. It was only after her friends came to take her that she was able to secure release. She described the asylum as "a human rat-trap."
Dr. Benjamin Rush pioneered spinning chair treatment in the 19th century. The patient would be restrained in a chair that hung from the ceiling and then twirled around in that chair around for hours at a time. It was believed that this would reduce blood flow to the brain, relax the muscles, and lower the pulse.
The inevitable vomiting that would be induced was considered a good thing, marking toxins leaving the body.
Keeping a massive population of powerless, mentally ill people in isolated institutions at the mercy of the staff is a recipe for abuse. Unruly patients were often beaten, restrained, and isolated.
As Nellie Bly noted, nurses would often beat patients on a whim. Patients were strangled, had their hair ripped out, and even had their heads held underwater. Staff members would tease and agitate patients on purpose. Complaining of conditions to the doctors and supervisors was one way to instigate the abuse, and the doctors generally wouldn't listen anyway.
Women were especially vulnerable to landing to asylums. They could be committed for post-natal depression, epilepsy, overwork, or even stress.
The tendency to label women "hysteric" or "insane" is rooted in the 19th century mindset. The female reproductive organs were believed to cause mental illness, which could crop up as anything from menopause to a healthy sexual appetite. In other words, you could be committed for simply having a female body.