Patient Abuse

On the surface, CSH seemed to be a fairly pleasant place. A closer look, however, reveals some unsavory realities. For decades, the hospital confined its "worst inmates", those who screamed incessantly or who were bellicose, to the basement or the "dungeons" of the hospital. In 1870, CSH superintendent, Dr. Everts, was so appalled by the wretched condition of the dungeons that he reported it to the Governor:

"basement dungeons (are) dark, humid and foul, unfit for life of any kind, filled with maniacs who raved and howled like tortured beasts, for want of light, and air, and food, and ordinary human associations and habiliments..."

Worse yet, he exclaimed, the normal wards were "without adequate or intelligent provision for light, heat, or ventilation" and patients were forced to sleep on "beds all straw upon forbidding skeletons of iron". Repairs to the hospital structure were rarely made due to insufficient funds causing "abundant leakages" and rotten floors. Pantries and kitchen space were infested with cockroaches.

Unfortunately, Hoosier politicians did not heed Evert's words. In 1872, Dr. Everts, a frustrated and defeated man, resigned. But the work of Dr. Evert and like-minded reformers was not completely in vain: finally, in 1880, the legislature appointed an investigating committee to review charges of staff misconduct at state penal and charitable institutions.

"Indiana Crazy House," Albert Thayer, circa 1880s (99.7 KB)

Albert Thayer, a Civil War veteran, a publisher, and a CSH patient, shared Dr. Evert's reformist zeal. After being discharged from CSH in 1884, Thayer published exposes on CSH and other state institutions. Appalled by the poor treatment that he and other patients received at CSH, Thayer convinced former CSH patients to publish their stories in a broadside entitled, "The Indiana Crazy House," and in The Rough Diamond, a Thayer publication devoted to helping workers and the poor of Indiana.

"Indiana Crazy House, " page 3 (66.8 KB)

Thayer attributed most abuses to politicians, both democrats and republicans, who provided insufficient funding for the hospital which, in turn, led to understaffing, the hiring of poorly trained help, patient abuse, and inadequate food for patients.

Albert Thayer's obituary, Indianapolis News, October 1, 1920(113 KB)
In addition, Thayer sent pre-printed letters to churches across the state asking them to speak out against "the corruptions and abuses in the Indiana Hospital for the Insane and the State Prison South." Thayer, an active member of Post 165 of the Grand Army of the Republic (G.A.R), also spurred a movement among G.A.R. members to end the poor treatment of Union veterans and their widows and orphans at state charitable institutions.

CSH Medical Attendants, early 1900s

Fortunately, in the 1880s and 90s, reform-minded superintendents and community activists successfully lobbied for more funding to improve the hospital's appearance. But patient abuse continued. Medical attendants, not physicians, continued to be the primary care takers. Due to the low wages and the long hours the hospital offered, CSH was unable to attract high-caliber, well-trained personnel. Some did care for the patients with compassion, but many treated patients horribly. Attendants were known to hit patients, lock them in closets, and restrain them in bed for long periods of time. Many would punish patients if they spoke to one another, silencing them for hours on end.

The attendants, however, were not completely to blame. Abuses occurred, in part, due to understaffing and poor training. The widely-held, nineteenth-century belief that the mentally ill could control their actions and were at fault for their deviant behavior also factored into the abuse equation. At this time, attendants, as well as many Victorians, including some physicians, strongly believed that the mentally ill could be coaxed into normal adulthood through punishment, confinement, and "moral" training.

While our understanding and treatment of mental illness progressed in the twentieth century, patient abuse was an ongoing problem. At CSH, patient abuse continued to be a problem until its closure in 1994. In fact, lurid tales of patient abuse played a major role in the dismantling of Central State Hospital.

• Index

The Causes of Insanity

In the nineteenth century, the term insanity represented a broad spectrum of mental disorders as diverse as schizophrenia to the most severe of sociopathic disorders. What did nineteenth-century physicians think was at the heart of insanity?

Most antebellum physicians agreed that insanity was a disease of the brain and that examination of the brain tissues would reveal organic or functional abnormalities. Central State Hospital's (CSH) second medical superintendent, Richard Patterson, attested to this fact in his 1849 report to the State Commissioners:

mental derangement always depends upon either functional or organic diseases of the brain, and without such disease we see no derangement of the mind. The causes of this cerebral disease may be either physical or moral.

Accordingly, Dr. Patterson and his colleagues posited that "physical causes" of insanity were either direct afflictions, such as brain hemorrhaging or lesions, or indirect diseases, such as suppression of the menses or pulmonary disease, that, in time, damaged the central nervous system and eventually the brain.

But as Dr. Patterson noted, "moral causes" also contributed to the manifestation of insanity, and in an age when scientific medicine had not yet come to fruition, physicians naturally focused on the social and cultural forces causing insanity. Thus, CSH physicians typically attributed insanity to a host of social problems as diverse as domestic abuse to "Mexican War excitement" to Millerism (a religious sect founded on the belief that God's wrath would descend upon the earth before the millennium).

Causes of Insanity, Annual Report, 1853 [78 kb]

Many physicians suggested that these social problems were a direct result of the social, economic, and political instability wrought by Jacksonian democracy, civil war, and industrialization. As historian Charles Rothman has compellingly argued, unprecedented social and economic fluidity in the mid-nineteenth century compelled Americans, poor and rich, to aspire for more, and many physicians interpreted this climbing of the proverbial ladder as excessive and pathological behavior. Physicians were equally disturbed by the new political and social freedom engendered by Jacksonian democracy. As CSH superintendent James Athon opined:

insanity increases in the same ratio with the advancement of improvements, the accumulation of the luxuries of life, and the general spread of all those fanatical, religious and political principles which characterize the age.

Entry from Central State Hospital Admission Book, 1858 [125 kb]

Fortunately, one of Dr. Patterson's predecessors, Dr. James Athon, required his medical staff to take detailed notes on the moral causes of each patient's mental illness, which appear in over fifty volumes of admission books and prescription books. These rich, detailed, and uncomfortably honest patient histories cast aspersions on many of the social, political, economic, and religious realities of nineteenth-century America.

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Medical Treatment of Insanity

Entry from Central State Hospital Prescription Book, 1912 [44kb]

Nineteenth-century treatments for mental illness reflected physicians' understanding of the moral and physical causes of insanity. Like other nineteenth-century physicians, CSH doctors tailored treatment to address both the moral depravity and the underlying physical pathology of their patients. In hopes of altering the patients' physiological and mental state, CSH physicians administered liberal doses of narcotics, stimulants, emetics, and purgatives. A few exceptional superintendents, such as William Fletcher, demanded that the medical staff limit severe drug treatment to the worst cases and reduce the dosage of milder drugs for the masses of patients. Unfortunately, Dr. Fletcher's reforms in the early 1880s were often ignored by his successors.

While Dr. Fletcher and his nineteenth-century colleagues may have debated the merits of drug treatment, they did not debate the merits of moral therapy. CSH annual reports, prescription books, and patient histories illustrate the overwhelming support for moral therapy in both medical and political circles. Today, the notion of "moral therapy" conjures up images of wealthy philanthropists forcing their values and beliefs on the poor. In the context of Central State Hospital, this assertion rings true; moral treatment at CSH typically entailed impressing middle-class and protestant work ethics and mores on patients, most of whom were poor or struggling.

There were practical as well as ideological reasons for physicians' espousal of protestant and middle-class values. For most of the nineteenth century, physicians did not have the political or economic clout they have today. As a result, physicians attempted to curry the favor of politicians and their powerful constituents, in hopes of garnering financial support for their hospitals. To do this, physicians couched moral treatment in acceptable middle-class and upper-class terms. For CSH physicians, who were mostly middle-class and protestant, this did not require a large ideological leap.

In the early 1800s, middle-class values were synonymous with older, protestant beliefs that emphasized hard work and an orderly, religiously conservative lifestyle in an agricultural setting. Thus, in the nascent years of CSH, patients were encouraged to work on the hospital farm and were required to lead quiet, orderly lives separate from the chaotic world outside. This form of therapy also fit nicely into prevailing theories of insanity: if social, political, and economic freedoms were causing insanity, then it logically followed that severely limiting freedom in the context of the asylum would cure mentally-ill patients.

Summary of Hoosier Manufacturers/Industrialists, 1885-86 [120 kb]

By the second half the nineteenth century, however, a new, burgeoning middle-class, the nouveau riche, redefined its values to include behaviors and beliefs that were beneficial to industrial capitalism.

Hoosier Agricultural Products, 1885-86[83 kb]

And, now, the stakes were even higher: segments of the new middle-class were not only powerful and wealthy, but also embraced a reformist zeal and philanthropic spirit that far exceeded that of earlier generations. It became all that more important for CSH physicians to pander to middle-class reformers and philanthropists who were searching for a charitable outlet for their money and enthusiasm.

Central State Hospital Cannery, mid 1900s [94 kb]

To prove their commitment to the new middle class values, CSH physicians attempted to engender in their patients a certain discipline and value system that fostered an industrial work ethic. Healthier patients were required, not encouraged, to follow strict work schedules, that included producing garment piece work and other products that could be sold to outside factories. In the early twentieth century, CSH instituted an "occupational therapy" program that entailed patients working with hand/foot operated machines to create products for no compensation. A few decades later, CSH built a cannery for patients, indicating that the hospital's full integration into the industrial world had been achieved. Importantly, the work therapy program served another equally imperative function: it provided additional moneys to supplement unreliable state funding that ebbed and flowed with the changing political tides.

Regulated work, however, was not enough. A "well-regulated" diet, a highly "regimented" morning and evening schedule, the reading of wholesome books from the hospital's "selected library", and the partaking in "mild and innocent amusements" were sure cures for mental illness and a sure way of inculcating white middle-class mores. In retrospect, the living conditions at CSH may seem overly oppressive and the motives of the physicians questionable, but this highly structured environment did offer solace to many patients, particularly in a period when few other cures existed.

Holding Chair, 1800's [36 kb]

If the moral universe of CSH was not sufficient to modify behavior, detention, physical restraints, and "baths" were used. Medical attendants employed cold and hot "baths" to calm patients, to force them into submission or to punish them. Attendants confined more violent patients to their beds or to holding chairs with mechanical restraints. Still others, the worst cases, were confined to the dark, dungeon-like basements of the hospital.

Many of the more harsh treatments fell out of vogue in the 1880s and '90s as compassionate superintendents and reformers, like William Fletcher and Nellie Bly, and physicians imbued with the scientific spirit, like CSH superintendent George Edenharter, pushed for change.

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