“…Men of Massachusetts, I beg, I implore, I demand, pity and protection for these of my suffering, outraged sex!”—Dorothea Dix, Memorial to the Legislature of Massachusetts

Mental illness was no new phenomenon in nineteenth century America, and in reality, it did not discriminate in whom it afflicted. Men and women alike suffered, but society placed a particular emphasis on the “weaker sex” and her mental fragility. From hysteria to depression, the peculiarities of the female body and common beliefs about what women should do and think all factored into views on female sanity.

Antebellum America witnessed the growth of specialized facilities for people suffering from mental illness known as asylums. Reformers believed that the right environment and specialized care could provide some good for this “less-fortunate” class. Unsurprisingly, many of the patients who found themselves in asylums were women. These institutions went through their share of ups and downs, from the promise that came with their initial construction to the detriments of underfunding, overcrowding, unwarranted commitment, and abusive conditions seen by the end of the century. It was an area ripe for the reform impulse of the era, and a multitude of people—many of them female—contributed to the advances seen in that realm. Like other causes of that period (such as abolitionism), the rights of the mentally ill became inextricably intertwined with the rights of women.

Dorothea Dix and the Origins of the Asylum in America

“…I shall be obliged to speak with great plainness, and to reveal many things revolting to the taste, and from which my woman’s nature shrinks with peculiar sensitiveness. But truth is the highest consideration. I tell what I have seen—painful and as shocking as the details often are—that from them you may feel more deeply the imperative obligation which lies upon you to prevent the possibility of a repetition or continuance of such outrages upon humanity. If I inflict pain upon you, and move you to horror, it is to acquaint you with suffering which you have the power to alleviate, and make you hasten to the relief of the victims of legalized barbarity…” —Dorothea Dix, Memorial to the Legislature of Massachusetts

Before the reforms of the nineteenth century, most mentally ill individuals experienced a dire fate. Stigmatized and often treated as criminals, sufferers might even be condemned to a life spent in prison. However, a concept known as “moral treatment” took hold. Its basic premise held that the proper environment, complete with caring staff and pleasant surroundings, could improve the lives of mental patients and even cure cases caught early enough. American proponents, including Dorothea Dix, who fought for the establishment of such places, specifically designed to house and treat the mentally ill.

Below: Remembering Dorothea Dix

This video series, below, highlights some of the major asylums of the Kirkbride architectural style, which were often associated with the “moral treatment” movement.

Fergus Falls from Kirkbrides HD on Vimeo.

Hudson from Kirkbrides HD on Vimeo.

Born in 1802, Dix was a former schoolteacher who became involved with this movement through her own experiences. After a serious bout of tuberculosis—possibly accompanied by depression—she spent her recovery in Europe where she became acquainted with others involved in institutional reform.

U.S. Library of Congress Dorothea Dix. Retouched photograph. [No date found on item.] Biographical File Reproduction Number: LC-USZ62-9797
U.S. Library of Congress Dorothea Dix. Retouched photograph. [No date found on item.] Biographical File Reproduction Number: LC-USZ62-9797
When she returned to America, she saw first-hand the abysmal conditions of the mentally ill in prisons and poorhouses, initiating her diligent advocacy for those suffering. Dix lobbied the Massachusetts legislature by writing a pamphlet that led to improved care for the mentally ill. By the 1830s, private- and publicly-funded mental asylums abiding by the principles of moral treatment were established, initiating a huge first-step forward in treating the mentally ill. However, these advances were soon negated in a changing society. The rise of industrialization and increasing numbers of immigrants moving in every year made it next to impossible to keep up these conditions. Facilities quickly deteriorated and an increasing number of people found themselves in crowded institutions, suffering from abuse and neglect.

Though these institutions were created to house only those suffering from mental illness, there are many examples suggesting that a number of sane people were also unjustly given over to this fate. Two such women who found themselves in the asylum system were Elizabeth Packard and Nellie Bly. Very different circumstances surrounded their admission into these “snake pits,” but both ultimately turned their experiences into works for the literate masses that helped advance the institutional reform cause.

Opinionated Wives, to the Asylum: The Case of Elizabeth Packard

“…The great evil of our present Insane Asylum System lies in the fact, that insanity is there treated as a crime, instead of a misfortune, which is indeed a gross act of injustice…” —Elizabeth Parsons Ware Packard, The Prisoner’s Hidden Life, p. iii.

Elizabeth Parsons Ware Packard, like many other women of her era, settled into domestic life as a wife and mother in the decades before the Civil War. Her husband, Theophilus Packard, was a minister, and though she was a religious woman, she found herself at odds with his teachings. This “defiance” led Minister Packard to have her committed to the state asylum at Jacksonville, Illinois. Despite a lack of evidence proving insanity, her husband’s word and wishes were enough to have Packard committed, with the consent of the institution’s superintendent.

Packard spent the next three years in an institution before the hospital finally released her to her husband’s custody. As her “moral insanity” had not abated in the eyes of Theophilus, he subsequently kept her imprisoned in her house and tried to have her transferred to another institution. Only after a trial where Elizabeth was declared sane was she able to begin to escape from the authority of her husband—though her lack of property rights as a married woman still complicated matters greatly.

Elizabeth Packard used her experiences to expose the poor state of mental health care. She was passionate about fixing this system that gave men such authority over women while not taking the time to hear patients’ voices. Never returning to her husband, Packard devoted the rest of her life to this reform. She penned The Prisoner’s Hidden Life (1868), which brought these issues to the public’s attention.  She also travelled around the country, fighting for and succeeding in gaining legislative changes that gave patients more rights. Due largely to her advocacy, laws were passed in places like her native Illinois that made a jury trial to prove insanity a requirement.

“Stunt Girl” Getting the Scoop: The Case of Nellie Bly

I had looked forward so eagerly to leaving the horrible place, yet when my release came and I knew that God’s sunlight was to be free for me again, there was a certain pain in leaving. For ten days I had been one of them. Foolishly enough, it seemed intensely selfish to leave them to their sufferings. I felt a Quixotic desire to help them by sympathy and presence. But only for a moment. The bars were down and freedom was sweeter to me than ever.” —Nellie Bly, Ten Days in a Mad-House, Ch. 16.

Below: National History Day: Nelly Bly

Following revelations by Packard, the nation’s newspapers and magazines of the post-bellum period devoted considerable coverage to the subject of mental illness and the asylum system. Elizabeth Jane Cochrane—pen name, Nellie Bly—by was twenty-three year old and made her way to New York to start her own investigative work for the highly circulated Pulitzer daily, the New York World.

Bly would become one of the most well known journalists of the day, gaining front-page, header billing.

American journalist Nellie Bly, in a publicity photo for her around-the-world voyage. Caption on the original photo reads: "Nellie Bly, The New York WORLD'S correspondent who place a girdle round the earth in 72 days, 6 hours, and 11 minutes." 1890. NYPL.
American journalist Nellie Bly, in a publicity photo for her around-the-world voyage. Caption on the original photo reads: “Nellie Bly, The New York WORLD’S correspondent who place a girdle round the earth in 72 days, 6 hours, and 11 minutes.” 1890. NYPL.

As a woman, Bly had few opportunities in journalism. She started her career in Pittsburgh at The Dispatch, elbowing her way onto projects she considered meaningful though largely relegated to writing society reports and other “women’s” columns. Still, despite her ever-developing talent and drive, making a name for herself in New York proved even harder. An opportunity finally came to break into the largest American press outlet when Bly was asked to feign insanity and expose conditions in a major New York mental institution. Without hesitation, she took this assignment and emerged from it with a series of articles that would turn her into a household name and one of the best-known journalists—male or female—of the day.

Perfectly sane, Nellie Bly managed to convince an array of people—regular citizens, rival reporters, judges, officers, doctors and nurses—that she, posing as “Nellie Brown,” had lost her mind, leading to a confinement for ten days on Blackwell’s Island. Though this asylum had been planned in accordance with the principles of “moral treatment” previously mentioned, by the time of her institutionalization these guidelines had been fully abandoned, and “stunt girl” Nellie Bly was able to show the true state of asylums to readers of the World. Here are some of her graphic discoveries:

 I could not sleep, so I lay in bed picturing to myself the horrors in case a fire should break out in the asylum. Every door is locked separately and the windows are heavily barred, so that escape is impossible. In the one building alone there are, I think Dr. Ingram told me, some three hundred women. They are locked, one to ten to a room. It is impossible to get out unless these doors are unlocked. A fire is not improbable, but one of the most likely occurrences. Should the building burn, the jailers or nurses would never think of releasing their crazy patients…Unless there is a change there will some day be a tale of horror never equaled. (Ch. 11)

I came in and saw Miss Grady with my note-book and long lead pencil, bought just for the occasion.

“I want my book and pencil,” I said, quite truthfully. “It helps me remember things.”

I was very anxious to get it to make notes in and was disappointed when she said:

“You can’t have it, so shut up.”

Some days after I asked Dr. Ingram if I could have it, and he promised to consider the matter. When I again referred to it, he said that Miss Grady said I only brought a book there; and that I had no pencil. I was provoked, and insisted that I had, whereupon I was advised to fight against the imaginations of my brain. (Ch. 11)

…On bathing day the tub is filled with water, and the patients are washed, one after the other, without a change of water. This is done until the water is really thick, and then it is allowed to run out and the tub is refilled without being washed. The same towels are used on all the women, those with eruptions as well as those without. The healthy patients fight for a change of water, but they are compelled to submit to the dictates of the lazy, tyrannical nurses. The dresses are seldom changed oftener than once a month. If the patient has a visitor, I have seen the nurses hurry her out and change her dress before the visitor comes in. This keeps up the appearance of careful and good management. (Ch. 17)

Although she was only one voice among many who were bringing to light the injustices in the asylum system, Bly’s recount of her experiences resonated with the public. Following her investigation, Bly testified before a grand jury and more funding was ultimately put into the state asylum system. As she herself stated at the end of her series:

I have one consolation for my work–on the strength of my story the committee of appropriation provides $1,000,000 more than was ever before given, for the benefit of the insane. (Ch. 17)

Her newspaper puts it even more bluntly:

The expose was fruitful of good results and a number of much-needed reforms were introduced into the asylum as a direct result of The World’s efforts. (“Reforming the Insane Asylum,” The evening World, 11 May 1889, p. 4)

Nellie Bly’s experience certainly differs in a significant way from Elizabeth Packard’s, for unlike Packard, she was not forced into this fate. Instead, she purposely exposed herself to life in an asylum to get a great story and break into a working realm that few women had been able to thus far. Still, both women—equally sane—found themselves in an environment where they did not belong and were able to use their experiences to convince others that changes needed to be made regarding how the country diagnosed, treated, and cared for the mentally ill.

They also, along with Dorothea Dix and others, proved to varying degrees that women deserved respect and value in new roles. Dix got political, leading lawmakers to appropriate money for the building of asylums. Packard made her independent views known and did not give in to those of her husband, even when it meant confinement to an institution. Furthermore, she went beyond the domestic sphere by writing and promoting views about her experiences that publicly challenged male authority. Bly fought her way into a traditionally male field, subverting male authority and accepted expertise, just as Packard did, as she went along. Mental illness and femininity have often been associated with one another, but rather than following the stereotypes of women as feeble patients, these ladies brought these realms together to bring about reform and subversion of common thought in both.

For more information:

  • Read the primary sources online: Dorothea Dix, Memorial to the Legislature of Massachusetts (1843) (excerpted, full-text); Elizabeth Parsons Ware Packard, The Prisoner’s Hidden Life (1868) (full-text); Nellie Bly, Ten Days in a Mad-House (1887) (excerpted, full-text); Charlotte Perkins Gilman, The Yellow Wallpaper (1892) (full-text) This fictional account drawing from personal experiences shows a woman’s descent into madness due to a “treatment” of imposed isolation forced upon her by her husband/doctor.
  • Visit the U.S. History Scene reading lists for the Gilded Age/Progressive Era and Gender History.
  1. Joseph P. Morrissey & Howard H. Goldman, “Care and Treatment of the Mentally Ill in the United States: Historical Developments and Reforms,” Annals of the American Academy of Political and Social Science Vol. 484, Mar., 1986: 14-15
  2. Manon S. Parry, “Voices from the Past: Dorothea Dix,” American Journal of Public Health 94, no 1 (January 2004), pp. 624-625
  3. Morrissey & Goldman, pp. 15-17
  4. Benjamin Reiss, Theaters of Madness: Insane Asylums and Nineteenth-Century American Culture. Chicago: University of Chicago Press, 2008: p 173
  5. Myra Samuels Himelhoch and Arthur H. Shaffer, “Elizabeth Packard: Nineteenth-Century Crusader for the Rights of Mental Patients,” Journal of American Studies 13, no. 3, December 1979: 356-357
  6. ibid., p. 358
  7. ibid.; “19th Century Psychiatric Debates,” Diseases of the Mind: Highlights of American Psychiatry through 1900, U.S. National Library of Medicine, http://www.nlm.nih.gov/hmd/diseases/debates.html
  8. Himelhoch and Shaffer, 361
  9. Brooke Kroeger, “Nellie Bly: Daredevil, Reporter, Feminist,” NYCHS excerpts presentation: Bly in Blackwell’s Island Madhouse, Before, During & After, pp. 3-4. http://www.correctionhistory.org/rooseveltisland/bly/html/kroegerltr.html
  10. Samantha Boardman & George J. Makari, “The Lunatic Asylum on Blackwell’s Island and the New York Press,” American Journal of Psychiatry 164, no. 4, April 2007: 581
  11. Jean Marie Lutes, “Into the Madhouse with Nellie Bly: Girl Stunt Reporting in Late Nineteenth-Century America,” American Quarterly 54, no. 2, June 2002: 221