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Cody Roberts
Instructor Kim
English 2367.02
17 December 2014
Mental Institutions in the Guise of Charity
Charity, helping others who are less fortunate than ourselves, is a defining trait of
humanity that holds us above the solely self-serving acts of primitive animals; is it not? Take
one example of dedication to help others. Psychiatric institutions, known through history by
many names from lunatic asylums to mad-houses, are buildings set up for the sole purpose of
housing and providing specialized care to the mentally ill; many are state-run and tax payer
funded. Their very existence shows that we must care, right? And yet these institutions, with
their long history of accusations of abuse and mistreatment, might actually be a testament to a
failing in this unique aspect of our so called humanity. Let us explore the plight of mental
patients through a first-hand account.
In 1887, Elizabeth Jane Cochrane, known by her pen name, Nellie Bly, wrote a piece
called Ten Days In a Mad-House which described the ten days she spent inside the Womens
Lunatic Asylum on Blackwell's Island in New York. Though she was committed to the asylum,
Bly was not actually insane. In reality, she was a journalist who came up with a plan to pose as a
madwoman in order to gain entrance into the institution and expose the mistreatment of those
committed there. As a mental patient, she would be able to experience the mistreatment
firsthand and write and publish a narrative that would bring it to public light.

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Nellie Bly began her act by taking up lodging at the Temporary Home for Females, a
working womens boarding-house, under the name of Nellie Brown. She quickly convinced the
other residents that she was mad by refusing to sleep and claiming she was afraid because all of
the other women looked crazy. Most of the women became afraid of her, and one even had a
nightmare of Bly attacking her with a knife. Only one woman cared enough to stay with her and
looked after her until the police took her away. After seeing a judge and being pronounced
insane at the hospital, Bly was eventually sent away to Blackwells Island (Bly Ch. II-III).
Bly made it her mission to defend those defenseless women who were unjustly mistreated
in the asylum. However, at the beginning of her quest, before even reaching the asylum, she
stayed in another home for those who were poor, defenseless and living in injustice: the working
womens boarding home. She noted that the floor was bare and the wooden dining tables were
plain, with no varnish or covers. The only choice of food was bread, beef, a potato and tea or
coffee, none of which she found herself able to eat. Sitting in the parlor was cold and
uncomfortable. And yet these honest working women and their children were made to live with
this as their home. Realizing she could not endure staying there for long, Bly decided to quickly
begin her plan to act insanely in order to be taken away as soon as possible. Ironically, in pursuit
of her quest, Bly subjected the residents to worse conditions and mental torture. In feigning
insanity, she terrified many of these women, especially the woman she caused to have a
nightmare. As the woman woke from her nightmare screaming, Bly was saddened and regretful
for what she was putting them through (Bly Ch. III).
In the processes of being committed, Bly met two other sane women who were also
bound for the island asylum. One was sent by her friends for having nervous debility and the
other, older woman was committed because she did not have money to stay in the hospital that

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was treating her for a disease she had recently caught. Bly would soon meet many other sane
women who were trapped in the asylum for one reason or another. Upon arriving at the island,
Bly noticed the conditions were even worse than the boarding home. As with the home, her first
experience with the misery of life in the institution was the dinner. Yet another long, uncovered
table with long hard benches that made the patients sore from sitting on them. If anyone tried to
adjust their positions to avoid discomfort, they were scolded by the nurses and made to sit up
straight (Bly Ch. 9-10). The food was similar yet even less edible. Of the bread Bly said, I
cannot tell you of anything which is the same dirty, black color. It was hard, and in places
nothing more than dried dough. I found a spider in my slice, so I did not eat it (Ch. 11). Along
with the bread, for dinner they received a cold, boiled potato, a pinkish-looking stuff which the
patients called tea that tasted like copper, and beef so tough they could not eat it without strong
teeth to tear it (Bly Ch.10). This food was not enough to provide the proper nutrition they
needed to recover. And yet, upon complaint, the patients were told that this food was too good
for charity patients (Bly Ch. 12). Bly once again found herself unable to eat and gave her food
away most nights. In response, a fellow patient told her, "You must force the food down []
else you will be sick, and who know but what, with these surroundings, you may go crazy. To
have a good brain the stomach must be cared for" (Bly Ch. 10). The women were bathed once a
week after dinner, all in the same ice cold water, then placed in bed, soaking wet, with nothing
but a cotton slip and a wool blanket that was too short. Bly requested a night gown but was told
by the nurse You are in a public institution now, and you can't expect to get anything. This is
charity, and you should be thankful for what you get (Bly Ch. 11). A sick girl was found dead in
the morning after this charitable mistreatment (Bly Ch. 11).

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Most nights, Bly was unable to sleep. At first it was due to the nurse constantly stomping
through the halls at night and opening their doors to check on them. Later it was due to her new,
insane roommates. Some stayed up all night chattering and one walked around the room all
night talking to herself and looking for someone to kill (Bly Ch. 11, 15). Though her story in the
boarding-house of being unable to sleep because she was afraid of the other women was an act,
in the asylum it became very true.
The nurses may have been the worst part of the situation. These were women who had
volunteered to help these unfortunates in their treatment, but instead they only abused them for
sadistic thrills. The patients were frequently cold and any who asked for more clothing were told
to shut up and that they were lucky to have the charity they already received. When Bly asked
the patients to tell the doctors they were too cold, one replied that the nurses would beat them if
they did (Bly Ch. 12). Eventually Bly witnessed them beating, choking, and spitting on some of
the patients. Many patients told her that the nurses would hold them under water with a rag on
their heads until they promised not to tell the doctors what they had done. The doctors never
believed them anyway, dismissing the abuse as the delusions of the insane (Bly 13-14).
Bly's experience showed a parallel story of mistreatment of the less fortunate. She
showed the inadequate form that which is meant to be charity takes. The patients are given the
worst available. One nurse even said that because it was a public institution, they could not
expect even kindness (Bly Ch. 13). Through her whole experience, once she was thought to be
insane, almost no one she met treated her kindly, save one woman at the boarding house, the
judge, a night nurse at the asylum, and a couple of other sane women who had been committed
with her. Does charity often take this form? Is this charity made to help those less fortunate

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or just keep them out of the way? Does it improve their conditions or trap them in their stagnant
state?
Most people would like to think that humans are good, charitable people and sensitive to
the plight of others, but people as a whole do not genuinely care enough to help the less
fortunate. Many acts of charity can be more for show than solely for the purpose of helping.
Reinhold Niebuhr in his book Moral Man and Immoral Society that philanthropy combines
genuine pity with the display of power and that the latter element explains why the powerful are
more inclined to be generous than to grant social justice (Arguments against charity). He
believed charity was used as a display of power. Indeed it may be that charity is done for more
selfish reasons than might be expected. An experiment done at the University of Chicago
showed that the most effective way to collect donations was to sell lottery tickets and more
money was raised when the fund-raisers were pretty girls because the men gave more to them
(Harford). People give more when it benefits them. The lottery tickets are a chance to gain
money for themselves and the men gave more as a chance to show their power and generosity to
the pretty girls. As Tim Harford of Slate Magazine points out people also often buy charity
Christmas cards, which are then sent off to friends and family to show off that they gave to
charity (Harford). Another cause of selfish charity is the activation of reward centers in the
brain. A study published in the Journal of Neuroscience showed found that people are more
likely to give when they think it will make them feel better (Szalavitz). Another study by
Alexander Genevsky, a graduate student in psychology at Stanford, showed that people are more
likely to give when there is an identifiable victim or face to give to because it creates a greater
emotion response and reward in their brains (Szalavitz). I do not think no one genuinely cares

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about helping those who are less fortunate, but selfish reasons likely take priority of altruism.
People clearly do not just help others for the sake of helping right a wrong.
One reason for the behavior of those in the medical profession toward the mentally ill can
be found in the beginning of the asylum. Asylums were not created to help the mentally ill, but
rather to keep them off the streets where they couldnt do harm. They were prisons where the
patients were chained like animals, much like many patients on Blackwells Island were. In
1792 an experiment was conducted in Paris in which the chains were removed and the patients
were placed in clean, sunny rooms instead of dark, filthy dungeons, and treated kindly as a
person. Afterward, many hopeless cases recovered and were able to leave (Treece,
Rangarajan, and Thompson 1-2). Environment clearly impacts health, both mental and physical.
A little improvement in conditions and these people can go back to living normal lives instead of
being imprisoned. Unfortunately this did not catch on right away as almost one hundred years
later, as Bly saw, the patients on Blackwells Island were still living under the previous treatment.
It seems strange that people who chose a profession meant to help the mentally ill would
act with such apathy and, in some instances, malice toward the patients. One might think that
may be this was an isolated incident or that Bly exaggerated the nurses' words and behavior, but
these nurses do not stand alone. Doctors Colin Ross and Elliot Goldner decided to review
literature relating to attitudes toward mental illness in the nursing profession, both in general
medical settings and specifically among psychiatric nurses. Surveys showed that in the general
medical setting patients often reported being "treated with a lack of dignity and caring, if not
outright contempt by staff" and any real health complaints were written off as part of their mental
illness (Ross and Goldner 560). Bly observed this attitude at Blackwell's Island in several ways.
Reports of the nurses beating the patients were dismissed as delusions and another patient she

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met was sent to the asylum because she had a legitimate health problem which was ignored. Any
assertions by the patients that they were not insane were even labeled as proof of their illness
(Bly Ch. 7, 14, 16). Many nurses were found to believe that the mentally ill are dangerous and
violent and that if one said or did "the wrong thing" it would "set them off into some explosion
of uncontrollable behavior." Nurses also reported lacking skill to manage the symptoms of
mental patients, which the nurses linked to their fear of the patients (Ross and Goldner 560).
Another belief they held was that mental illness was caused by weakness of the patient such as
laziness or lack of self-control. Even nurses in emergency and intensive care units where they
dealt with suicidal patients think this way and are often demeaning toward the patients. Some
nurses went as far as saying "they had better or more constructive things to do with the scarce
healthcare resources of time and money, such as looking after someone who is really sick,
more deserving, who has not brought it on themselves, and that the MH/P client is merely
blocking a bed" (Ross and Goldner 561-2).
Thornicroft of the Oxford Press connects this with the attribution theory, in which if the
conditions are beyond their control, the patients receive more compassion while a negative
attitude is given toward them if the mental illness is from their own failings or choice (qtd. in
Ross and Goldner 561). I agree that casting the blame for the illness onto the sufferer in this
manner is likely to lead to mistreatment by the nurses. But these are nurses in the general
medical setting, one would expect psychiatric nurses to be much more understanding as it is their
job to work with mental illness. While they have a better attitude than the general nurses, they
still showed negativity. Studies showed the psychiatric nurses to view those with borderline
personality disorder as "nuisances," "seeking attention," and "time-wasters," similar to the view
of the general nurses (Ross and Goldner 563). How could they be expected to properly care for

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their patients if they don't even care about their patients? They cannot. There is also another
reason for their lack of concern for this type of patient, many don't even want to work with them.
Not only is there a stigma against mental patients, but against the nurses who work with them as
well. Psychiatric nurses have a low status compared to other nurses, being seen as the least
likely "to be described as skilled, logical, dynamic and respected." Few nurses were even found
to be interested in a career in this part of the nursing profession (Ross and Goldner 564). It is
hard to be motivated if your job is seen as having little value. At this point, one mightier wonder
if this is only a problem in the Western world. It is not. These attitudes are exhibited by medical
staff in Asia as well (Lauber and Rssler 157-170; Li et al. 90-103). Besides the feelings of the
nurses themselves there are also other causes for their mistreatment of the patients.
Returning to the subject of power, the early prison-like environment that existed for most
of the history of mental institution would have promoted abuse and animosity toward the
patients. In 1974 the Stanford Prison Experiment was conducted to find out if brutality was
caused by sadistic personalities or the prison environment. At Stanford University 21 male
college students (chosen from 75 volunteers) were screened for psychological normality and paid
$15 per day to take part in the experiment (McLeod). They were then assigned to be either
prisoners or guards and given uniforms to match their roles. The participants were then placed in
a mock prison to act out their roles. Within hours of beginning the experiment some guards
began to harass prisoners (McLeod). The guards insulted the prisoners and ordered them to do
random tasks such as cleaning toilets with their bare hands (McLeod). With the similar
environment found in the early asylums combined with the negative view of mental patients, it is
no surprise that nurses often acted with similar cruelty such as Bly witnessed.

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Many factors come together to create the mistreatment that those with mental disorders
have received through history which continues today. Though institutionalization is less
common today in response to the mistreatment, there is still much improvement to be done. The
view of mental disorders and the treatment of them needs to change. Greater education and
attention should be brought to the causes, symptoms, and treatment of mental illness. If the
stigma against them can be reduced and the betterment of these patients can be seen as a worthy
cause, more people will actually care to treat them properly. Considering the nature of charitable
behavior, perhaps it would help to publicize the stories of patients who have been mistreated to
use the emotionally based drive as a benefit. The CDC estimates that 26.2 percent of
Americans ages 18 and older suffer from a diagnosable mental disorder (Treece, Rangarajan,
and Thompson 1). More than one in four adults. That shows how important it is that they are
given proper treatment. We have come a long way from the asylums of old so there is hope.
Perhaps one day those with mental disorders will receive the treatment they deserve. But for
now, charity is lacking, held back by conflict with the functions of the human psychology.

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Works Cited
Arguments against charity. BBC. BBC. 23 Oct. 2013. Web. 8 October 2014.
Bly, Nellie. Ten Days In a Mad-House. New York: Ian L. Munro, 1887. Web.
Harford, Tim. Charity Is Selfish: The economic case against philanthropy. Slate Magazine.
Graham Holdings Company. 14 October 2006. Web. 8 October 2014.
Lauber, Christoph and Wulf Rssler. Stigma towards people with mental illness in developing
countries in Asia. International Review of Psychiatry, 19.2 (2007): 157-178. Academic
Search Complete. Web. 8 October 2014.
Li, Jie, Juan Li, Graham Thornicroft, and Yuanguang Huang. Levels of stigma among
community mental health staff in Guangzhou, China. BMC Psychiatry, 14.1 (2014): 90103. Academic Search Complete. Web. 8 October 2014.
McLeod, S. A. Zimbardo - Stanford Prison Experiment. Simply Psychology. 2008. Web.
12 November 2014.
Ross, C. A. and E. M. Goldner. Stigma, negative attitudes and discrimination towards mental
illness within the nursing profession: a review of the literature. Journal of Psychiatric &
Mental Health Nursing, 16.6 (2009): 558-567. Academic Search Complete. Web. 8
October 2014.
Szalavitz, Maia. The Selfish Reasons Behind Why We Give. Time Magazine.
Time Inc. 23 Oct. 2013. Web. 8 October 2014.
Treece, David, Hari Priya Rangarajan, and Jordan Thompson. Past, Present, and Future
of the Asylum. Innovation Incubator. April 2011. Web. 8 October 2014.