Today’s mental health care system is far from ideal and there’s a lot of room for reform. However, it’s sometimes good to take a step back and look at how much things have improved over the last couple of centuries. It’s also good to honor those people whose work has resulted in more humane conditions, higher standards of care and increased rights for mental health patients. Nellie Bly is one of those people. A film about her work, 10 Days in a Madhouse, comes out this month.
Bly was famous in her time, but these days she is known mainly in the fields of journalism and women’s studies. She was a pioneer female journalist and women’s rights activist. She was also one of the first undercover investigative reporters. Bly wrote about women’s political issues, interviewed Susan B. Anthony and served as a role model for women in her varied endeavors (including running a business, inventing a stacking garbage can and traveling around the world by herself in 72 days). She entered the journalism field after writing a response to a sexist article, “What Girls Are Good For,” by a man who believed the working woman was a “monstrosity.”
Although she is generally not known as such, Bly was also one of the first mental health activists. In her time, many people with serious mental illnesses were locked up in asylums, often for life, and that was the extent of their “treatment.” Other services were available only to the wealthy. For one of her earlier newspaper assignments, Bly got herself admitted to an asylum for women and reported on the conditions there.
Bly was born in 1864. Her birth name was Elizabeth Jane Cochran (she was given the pen name “Nellie Bly” because it was considered improper at the time for women to be employed). In 1887, at the age of 23, an editor at the New York World asked her to go undercover as a patient at Blackwell’s Island Insane Asylum. The editor wanted her to investigate rumors of inhumane conditions in the asylum. When she asked how they would get her out, if she even managed to get in, the editor replied, “I do not know,” but assured her they would. From what I can tell from Bly’s account, she had no contact with the newspaper (or anyone else) once she set out on her assignment — and it’s quite conceivable that things could have ended badly.
Bly was scared but forged ahead. She spent one night teaching herself to act “crazy” based on what she had read. Over the next few days she managed to convince a houseful of women at a boarding home, a judge and a number of medical professionals that she was in need of institutionalization. Once she was admitted to the asylum, she spent 10 days observing and recording the horrific conditions there.
Here are a few of the things Bly witnessed during her time at Blackwell’s Island:
- Nurses physically abused patients, choking, beating and spitting on them. They intentionally provoked the violent patients for their own amusement.
- The food was nearly inedible and some of it was rotten.
- Patients were bathed with no privacy in ice cold water once a week. They took turns in the same bathwater.
- It was almost intolerably cold in the building. Patients weren’t given sufficient clothing to stay warm.
- No fire safety precautions were in place. All of the patients’ doors were locked from the inside and windows were barred.
- Patients weren’t allowed to read or engage in entertainment of any kind. They had nothing to sit on but uncomfortable benches or willow chairs.
- Patients were held against their will, with no rights to a hearing. Some didn’t speak English and there were no interpreters.
After 10 days, a lawyer from The World came and got Bly out. Shortly thereafter, the newspaper published her exposé on what she had observed in the asylum. Bly concluded that the place was a “human rat-trap” and wrote:
What, excepting torture, would produce insanity quicker than this treatment? Here is a class of women sent to be cured. I would like the expert physicians who are condemning me for my action, which has proven their ability, to take a perfectly sane and healthy woman, shut her up and make her sit from 6 a.m. until 8 p.m. on straight-back benches, do not allow her to talk or move during these hours, give her no reading and let her know nothing of the world or its doings, give her bad food and harsh treatment, and see how long it will take to make her insane. Two months would make her a mental and physical wreck.
Bly’s exposé was a huge hit, and the public was outraged by what it contained. As a result of Bly’s work, a grand jury investigation ensued. Bly was called to testify, as were staff from the asylum. The jury was taken to Blackwell’s Island so they could see the conditions for themselves. But word had gotten out that the grand jury was coming, and the asylum was radically transformed by the time its members arrived. The building was clean, the food was fresh, and the patients had warm clothes.
Fortunately, the members of the grand jury weren’t fooled. As a result of Bly’s work, the city of New York was given $1 million more per year “for the benefit of the insane.” (That’s about $25 million in today’s money.) Health and safety conditions improved, and more doctors were hired to oversee nurses. Bly’s exposé was also published throughout the U.S., increasing the impact of her probe.
It’s been a long, bumpy road since Bly’s time, and our current mental health system is far from perfect. Ironically, the process of deinstitutionalization that started in the second half of the 20th century is the source of some of our most serious problems today. Although the philosophy behind deinstitutionalization — that people should be treated in the least-restrictive setting possible — is sound, due to insufficient resources hundreds of thousands of people with serious mental illnesses are homeless or incarcerated.
As in 1887, we need to fix the mental health care system and provide quality services to all who need them. But thankfully, systematic abuse and human rights violations in U.S. inpatient settings are for the most part history. Laws and regulations are in place to ensure health and safety, decent living conditions, and rights to hearings, advocates and interpreters. Unfortunately, abuse in asylums continues in many countries.
Perhaps when people look back in a hundred or so years, today’s mental health care system will seem primitive. But we have come a long way since 1887. No matter how far we have to go, as someone with a mental illness l am grateful to those who have worked to bring us out of the dark ages. I salute Nellie Bly for her courage and determination.