Brief Analysis of pre-1940's Asylums

Brief Analysis of pre-1940s Asylums, based on the John Steinbeck novel "Of Mice and Men"

At the end of the 1937 novel “Of Mice and Men”, George kills Lennie. Though there is confusion as to why George would kill his best and only friend but the reason is quite simple: the alternatives were worse than death. If Curley’s lynch mob had killed Lennie, it would have been slow and painful. If Lennie got imprisoned, he would be humiliated and misunderstood, not to mention abused. If that didn’t happen, Lennie would get institutionalized.

Fig. 1 Front cover of the novel "Of Mice and Men" (left) and John Steinbeck (right)

It is often said that the some best literature comes from experience. It is also often said that “Of Mice and Men” is the some best literature of the 20 th century. In a 1937 interview by the New York Times, John Steinbeck reveals a little bit about the character of Lennie. He said, “I was a bindlestiff myself for quite a spell. I worked in the same country that the story is laid in. The characters are composites to a certain extent. Lennie was a real person. He’s in an insane asylum in California right now. I worked alongside him for many weeks. He didn’t kill a girl. He killed a ranch foreman. Got sore because the boss had fired his pal and stuck a pitchfork right through his stomach. I hate to tell you how many times I saw him do it. We couldn’t stop him until it was too late.”

An asylum is a place for treating the mentally ill, but the asylum wasn’t always only for treatment. In the 1800s asylums quickly became an easy way to remove difficult and unwanted people from society, including the elderly and very young. Babies with colic and seniors with Alzheimer’s disease were common in some state asylums, although the diseases were known by different names.

Fig. 2 Bedlam then and now

Fig. 3 1735 William Hogarth engraving of Bedlam

Early asylums, such as The Bethlem Royal Hospital, or Bedlam, were notorious for the inhumane treatment and living conditions patients endured. Patients were denied basic rights, since no such rights existed at that time, and they were tortured and humiliated. In the 18th century townspeople would go to Bedlam, and if you paid one penny you were allowed to look into the patients’ cells to stare and laugh at them. On the first Tuesday of the month you could do this for free, and in 1814 there were 96,000 visits to Bedlam for this reason.

Fig. 4 Lunar phases

Lunatic is a common name for the mentally ill, or at least it used to be. People were first referred to as “lunatics” in the late 1700s. This word is derived from luna, Latin for the moon, because of the belief that lunacy was affected by the moon phases.

American colonists believed that lunatics were possessed by the devil. To rid the person of demonic possession the alienist, or psychiatrist, would administer shocks to the brain, they would induce vomiting to expel the demon, and they would perform bleeding, which was draining the “bad blood” from the patient, which usually resulted in death.

After the American Civil War hundreds of soldiers with mental and emotional trauma entered asylums. These asylums became overcrowded and they fell back on old procedures such as shock therapy and opium treatment, and started using restraints again.

In the 1800s “MoralManagement” was introduced in Europe. Beds and decorations replaced cement cells and walls restraints. The hospital workers found that the patients became ungovernable, so they started to use restraints again in certain asylums.

They started activities like gardening and sewing, as well as laundry and embroidering.

Fig. 5 Patients working in the laundry room at the Texas State Lunatic Asylum in 1898.

Fig. 6 Postcard of the Keeley Institute

"Lodge" in Dwight, Illinois, in 1930.

Postcards circulated with pictures of asylums with perfect landscapes and enjoyable patient environments to lessen the taboo the mentally ill had created and to “trick” people into trusting the asylum workers with their family members.Neglect and abuse, such as declining showers for weeks or months at a time and nearly starving patients were rampant in these early asylums.

Procedures for treating the mentally ill were mainly trial and error, or were discovered by accident.

Fig. 7 The straight jacket was a popular means of restraint in the 19th

and 20th

centuries.

The left on was used in Europe between 1925 and 1935, and the middle is from 1940. On the right: men in straight jackets in an asylum around 1940.

In the 19th century Dr. Benjamin Rush developed the tranquilizer chair, where the patients had no ability to move and had a box on their head. Patients were often left in these chairs, alone in a dark room to calm themselves down.

Swinging was also popular. A chair is attached to the ceiling by chains and a patient is strapped in and swung for hours at a time to instill a fear of death and to induce vomiting.

Fig. 8 Tranquilizer chairs

Fig. 9 Swinging chair

In the early 20th century there was also chemically induced vomiting, ice baths until the patient became unconscious and being submerged into a tub full of eels.

Hydrotherapy was popular and very common until the late 1960s. The patient would be put in a bath tub and freezing water would be poured onto them continuously until the early stages of hypothermia set in.

Fig. 10 A man being taken out of an

insulin-induced coma by injections of glucose

In 1933 Manfred Sakel introduced insulin shock therapy, where a patient was brought to a near-death state or hyperglycaemic coma by means of a severe insulin overdose. Glucose or adrenaline was used to bring the patient out of the induced coma. Though this method caused little side effects, 1 to 2% of patients died due to complications. Insulin shock therapy was introduced in the US in 1934 and by 1941 over 75% of American public and private institutes were using this method to treat unruly and schizophrenic patients.

In 1917 Julius Wagner-Jauregg started using malaria fever therapy in Vienna. A patient was given an injection of malaria which induced fever, convulsions and/or coma. If the patient was schizophrenic they usually ceased their schizophrenic tendencies after the convulsions. Wagner-Jauregg also tried to induce convulsions by injecting tuberculin and typhoid, and by infecting the patient with erysipelas, but he determined that it was too dangerous.

Deep sleep therapy started to be used in the 1940s. A patient went into a drug induced coma for days or weeks at a time. This usually resulted in an opium addiction, since the drugs used to tranquilize the patients were usually opiate based.

In 1934 Metrazol induced convulsions were discovered in Budapest to treat psychoses and schizophrenia. The Metrazol was injected into a vein which caused seizures so severe that some patients woke with broken bones, and 42% had spine fractures.

In 1952 Thorazine, or chlorpromazine, was introduced on the pharmaceutical market to control the symptoms of psychotic disorders, especially schizophrenia. This greatly reduced the number of people undergoing ECT and insulin shock therapy.

Fig. 11 ECT machines, circa 1940

Fig. 12 1942 ECT

Nearly if not more popular than the transorbital lobotomy that I will tell you about next, electroconvulsive therapy consisted of a patient being strapped down to a table or gurney and having 15-20 second seizures induced by means of a massive electrical shock to the brain. This was first introduced in 1938 by Dr. Ugo Cerletti and Lucio Bini, and became widespread during the 1940s and 1950s. Cerletti and Bini used it on difficult mentally ill patients and obsessive patients, who became manageable and submissive after ECT.

The shocks were administered by a device called a psychotron, which caused the patient to lose consciousness and have convulsions for at least 15 seconds. Like many of the procedures in the 1930s and 1940s there were many risks: short and long term memory loss, muscle pain, brain damage if coupled with deep sleep therapy and oxygen deficiency. 4/100,000 people died as a result of the shocks.

Fig. 13 ECT today

Between 100,000 and 150,000 people undergo electroshock therapy every year in the US under strict medical conditions, making it one of, if not the only legal therapy used today that was used to treat psychoses in the 1930s.

The lobotomy was first performed on humans in the 1890s but was discontinued because of controversy until 1933, when 2 Yale University neurologists removed half of the brain of 2 chimpanzees with behavioral problems. The monkeys retained their intelligence and after the removal of the frontal lobe the monkeys’ demeanor became calm and submissive rather than aggressive.

Neurologist Antonio Egas Moniz and neurosurgeon Pedro Almeida Lima took this experiment

and performed the first prefrontal leucotomy on November 12th

, 1935 on a female manic

depressive patient. The patient was rendered unconscious by anesthesia and then her skull was trepanned on both sides. Absolute alcohol was injected below the prefrontal area of the brain to destroy the white matter of the brain. This procedure lasted about 30 minutes and made the patient less paranoid and anxious.

Fig. 14 Moniz's leucotome

Fig. 15 Path of the leucotome during a leucotomy

Later Moniz developed the leucotome, a steel rod with a loop at the end, which when closed, severed the nerves inside the loop. Moniz and Lima performed this operation on approximately 50 patients, with mixed results. The best results were found in those with mood disorders, and the operation was less effective in schizophrenics.

In September 1936 an American neurologist named WalterFreeman refined Moniz’s technique with the lobotomy, or precision method, with JamesWatts. This new name was used to emphasize that white and grey matter was being destroyed.

Fig. 16 Diagram of a human brain (left) and the first lobotomy performed in the USA (right)

The procedure consisted of trepanning the skull on both sides, inserting a blunt spatula and moving it up and down to sever the tissue of the frontal lobe and prefrontal cortex, shown here in the above diagram in yellow. However, Freeman was dissatisfied with this procedure, claiming that at 30 minutes it was too long and needed too much recuperation time afterwards. Watts disassociated himself with Freeman while Freeman developed the “ice-pick lobotomy”, more commonly known as the transorbital lobotomy.

This took about 10 minutes and was first performed on January 17 th, 1945. The patient was rendered unconscious by electroshock, when a rod resembling an ice-pick is driven with a hammer through the skull above the patient’s eyeball. The rod is them moved back and forth, and then repeated on the other side. Out of the 3,500 lobotomies done by Freeman, there were mixed results, some people could return to work and other were left in a vegetable-like state.

Fig. 17 Freeman in Washington in 1949.

Fig. 18 Freeman performing a lobotomy on a 12 year old Howard Dully using the “ice-pick” method.

Freeman liked to give performances with his lobotomies; he once operated on 25 women in a single day and often taught the procedure to untrained workers.

Rosemary Kennedy, sister of the late John F. Kennedy, underwent a lobotomy performed by Walter Freeman and James Watts in 1941, at the age of 23 and was left incapacitated for the rest of her life.

Fig. 19 Rosemary Kennedy during her lobotomy, with the path of the "ice pick" drawn with dotted lines.

On the other hand, Alys Robi, the French Canadian singer, resumed singing professionally after she had a lobotomy around 1950. Robi said, after her lobotomy, “I woke up better and later understood that I was one of the rare lobotomy success stories” ("Je me réveillai guérie et jài compris plus tard que jàvais été un des rares cas réussis de lobotomie.") The lobotomy has received its share of criticism, often being performed on prisoners against their will and on the criminally insane.

Fig. 20

It has been called “psychic mercy killing” and “euthanasia of the mind” due to the severe complications and large number of deaths caused by the procedure.

Last but not least, society’s views. Society in the 1930s was very different than that of today. African Americans were inferior, as were women. People were not accepting of that which they did not understand, and people with difficulties were regarded as useless and burdens. Governments were not really involved with asylums until the late 1940s, when they renewed their interest in the treatment of the mentally ill. In the 1930s society wasn’t really concerned with these “lunatics” because they were occupied with other things.

Fig 21 The first cars driving across the Golden Gate Bridge (left) and the Hindenburg crash (right)

There was an impending war; governments were beginning to recover from the Great Depression and the Dust Bowl was wreaking havoc in the Mid-West. When “Of Mice and Men” was published, in 1937, the unemployment rate in the USA was 14.3%, construction of the Golden Gate Bridge was completed and the German airship Hindenburg crashed in New Jersey. Society was more concerned with the individual

than with the group, and those who did care about the mentally ill proceeded with only theories and hunches to guide them in their endeavors.

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References (click to be brought to individual sites)

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ECT

Asylum history

Institution history

Lobotomy

ECT

Schizophrenic treatments

Bedlam

Lobotomy

History of 1937

Great Depression

Alys Robi

Rosemary Kennedy

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Photographs:

Various sources; URLs unavailable