›We Had Very Good Times Together‹

A Mad People’s History of Life on Asylum Wards in the Early-Twentieth Century United States

  1. ›Year In and Year Out‹ –
    Work and Socialization in the Asylum
  2. ›Night-gown Brigade‹ –
    Inmate Relationships
  3. ›Our Suicide Club‹ –
    Informal Inmate Support Groups
  4. ›Associated Grapevine Press‹ –
    Clandestine Communication Channels
  5. Conclusion: Inmate Solidarity as a Survival Strategy


Since the 1980s, historians have worked to recover the ›patient’s voice‹ in the history of medicine.1 This has especially been the case in the history of madness, psychiatry, and the asylum. Historians working across the globe have recognized the need to include mad people in their histories.2 At the same time, they acknowledge the limitations inherent in the sources available to historians. In many places and for certain groups of people – recent immigrants, illiterate or poor people, racial/ethnic/religious minorities, women – first-hand accounts of madness and institutionalization are rare. When they do not have direct access to mad people, historians have relied on letters, patient publications, and material artifacts, as well as case files, annual reports, investigative committee reports, and court records to gain insight into the experiences of patients.3 The result has been a much richer but still incomplete history of patients’ encounters with the legal and medical apparatus that worked to pathologize and confine them.

In this article, I use the writing of numerous former inmates of both public and private asylums in multiple US states produced between 1890 and 1950 to tell a story about life on the asylum wards. I refer to former inmates who went into print as ›mad writers‹ and to their writing as ›mad writing‹. Mad writers published more than books. They wrote letters and diaries, as well as newspaper and magazine articles and pamphlets; some testified under oath in state-led investigations of asylums. While the writing of former inmates has its limitations, it nevertheless provides insights into the formation of an inmate culture that helped inmates survive their mental troubles and institutional life, and laid the groundwork for later twentieth-century mad people’s movements.

Unlike previous histories, which focus on individual inmates or on inmates’ interactions with physicians and family, this study centers multiple inmate voices to gain a new perspective on life on asylum wards.4 My article, which takes its cue from the multidisciplinary fields of Disability Studies and Mad Studies, foregrounds stories told by asylum inmates about asylum life.5 Former inmates who went into print are a valuable yet underutilized historical resource. Their work is often dismissed or discredited as unreliable or unrepresentative of the experiences of most asylum inmates. It has been regarded by some historians as little more than the disjointed ramblings of ›mentally ill‹ people, as nothing more than evidence of the extent of their madness or as colorful anecdotes with little import in the larger history of madness and asylums. Although accounts of asylum life produced by former inmates have their own problems and challenges, they provide much more than has been acknowledged in previous scholarship.6

Mad writers were exceptional, and also quite ordinary. They were exceptional for what they accomplished and for the support that some of them received, but in other ways their experiences were similar to those of the other inmates who occupied the asylum wards with them. Nearly all mad writers spent time in public asylums. They experienced mental troubles and distress, which could be intense and debilitating. They endured many of the same medical interventions as other asylum inmates. And they felt the shame and stigma associated with madness and with having been committed to what inmates came to call the ›bug house‹. Unlike many of their fellow ›bugs‹, mad writers documented their experiences in ways that were not accessible or open to most Americans. Writing and publishing a book, which had always been labor-intensive, became increasingly difficult by the turn of the twentieth century. Even if they produced a self-published book at their own expense, which was becoming rarer by the end of the nineteenth century, former inmates had to find the time and the resources to write. Those who published with a commercial press, which was the case with most early-twentieth-century mad writers, had the added labor of cultivating the necessary social connections to succeed in an increasingly restrictive, market-driven publishing world. Although scant, existing evidence indicates that manuscripts produced by former asylum inmates went through many drafts, and some were read by multiple people before they reached the public. In most cases, former inmates’ memoirs, which could be published years after they left the asylum, were carefully curated artifacts of memories, thoughts, emotions, and experiences, and stories filled with messages and meanings meant to circulate through growing regional and national conversations about madness and asylums.7 Their work provides insights not only into what happened on asylum wards, but also into the political economy of asylums and mad writing in the early twentieth century. Mad writers were almost equally women and men. They were white, and many were well educated. They used their race, and the social and economic advantages that many of them had, to create a public space from which they could critique the United States’ burgeoning asylum system.

The years between 1890 and 1950 were marked by a eugenically fueled rise in the incarceration of disabled and mad people in the nation’s asylums. In 1890, the United States had about 74,028 people confined in 119 public and 43 private asylums.8 By the 1940s, there were approximately 635,796 people in 237 public and 342 private institutions in the United States, with the overwhelming majority of those people (538,629) confined in public asylums.9 Material conditions inside asylums varied by state and region and among private and public institutions. Yet it is fair to argue that by the early twentieth century, most American institutions, especially public asylums, had become underfunded, overcrowded, generally wretched spaces of confinement. Faced with such overwhelmingly debilitating conditions, disabled and mad inmates frequently turned to one another for support.

Eager to counter the dehumanizing and stigmatizing effects of mass incarceration, mad writers documented the valued relationships they formed within the asylum in great detail. They used their writing to educate, to end stigma, and to gain allies in their calls for broad reforms to the asylums that held them and their inmate friends. Former inmates’ writing, which was no doubt shaped by their gender, race, and class, reveals much more than their madness or their privilege. Instead of dismissing or discounting the work of mad writers, historians need to mine it for everything it reveals.10

For many people, life in an early-twentieth-century asylum was marked by a seemingly incongruous mix of confinement, terror, restraint, solitude, isolation, and boredom, and friendship, community, and dynamism.11 One of the most well-known early-twentieth-century mad writers, Clifford Beers, spent time in three separate asylums, both private and public, and endured life on multiple wards within each institution. Lawrence M. Jayson, who was an inmate at Kings County Hospital, New York, during the 1930s, admitted that he was not in the institution as long as many other inmates, but he did ›traverse, in relatively short time, all the halls – from the worst to the choicest‹.12 He thought that his ›progress from a straitjacket to complete liberty‹ was a ›good index‹ of institutional life.13 Even Kitty Zimmerman, who spent more than twenty years in the Elgin, Illinois asylum and was ›in a poor house for five years before that‹, went home nearly every summer.14 In the decades when institutionalized populations swelled and the asylum system expanded, inmates were able to carve out spaces within which they could find some freedom and forge valued, and, in some experiences, long-lasting relationships.

While it could be overwhelmingly isolating and cruelly monotonous, the asylum was also a dynamic space in which inmates labored and socialized, and helped one another survive and heal, both from their own mental troubles and from the everyday tortures of institutional life. Inmates did not always get along; tensions flared and prejudices that existed in the outside world persisted on asylum wards. Yet inmates came together and formed bonds and communities.

1. ›Year In and Year Out‹ –
Work and Socialization in the Asylum

Inmate labor, which was necessary to maintain the broader asylum system, structured institutional life. Work facilitated relationships among inmates and shaped their cultures.15 Former inmates wrote frequently about work. While it was true, as the Cleveland Plain Dealer announced in 1922, that ›thousands‹ of asylum inmates were ›without any employment, but [sat] around in wards and cottages brooding over their misfortunes most of their waking hours‹, it was also true that thousands more inmates worked.16 Kate Lee wrote that inmates kept the ›greatest order‹ at the Elgin asylum. They ›scoured‹ everything with ›soap and ammonia‹.17 In addition to cleaning the white floors, inmates worked in the vegetable room, the kitchen, the dining room, the sink room, and the laundry.18 Most asylum inmates worked. The press reported that the men from the ›disturbed‹ halls at the Eastern Michigan Asylum in Pontiac worked once a week during the summer weeding, raking, grading, ›wheeling cinders‹, making roads, and doing ›similar light work‹.19 Lee remembered quite specifically that at noon on Thanksgiving she was taken out of the dining room as a helper, and the next day began working in the mending room, where she sewed alongside women from the back ward.20 ›Inmate Ward 8‹ wrote without any sense of exaggeration or sensationalism that inmates did ›all the work‹ in his institution.21

Other inmates refused to work, which was unacceptable in most institutions. Kate Lee wrote that attendants ›wrestled‹ with people who declined to work.22 Attendants used more than just physical force to compel people to labor. ›Inmate Ward 8‹ remembered that attendants withheld tobacco rations and denied inmates outdoor activities such as playing baseball, as well as other privileges, in an effort to get them to work.23 Margaret Aikins McGarr, who initially ›dodged the issue‹ of work while she was ›busy getting data‹ on her asylum, faced mounting pressure from attendants who began to ›clamor‹ for her to work. Attendants attempted to persuade McGarr to work by telling her that there were ›advantages in having a job outside the ward‹. She would receive a ›parole card‹ and have the ›run of the grounds‹.24

Labor was not always compulsory or coerced, however. ›Inmate Ward 8‹ learned during his commitment that under state law, no asylum inmate could be compelled to work. He argued that such laws were beneficial because they protected ›helpless patients‹ from ›overbearing slave driving attendants‹.25 In his experience, however, he found that many inmates were glad to work; some of them asked to work. Among other benefits, work helped to ›kill the dead monotony‹ of institution life.26 When Jane Hillyer was moved to a cottage on institution grounds, she initially did ›nothing, absolutely‹. There were other inmates, however, who ›helped about the cottage a little, made beds or washed dishes‹. Hillyer stressed that their labor was not compulsory.27 She wrote that over time she grew ›more and more discontented with idleness‹. Like other mad writers, she appealed to her keepers to provide her with ›something useful‹ to do. She began to take reports ›back and forth‹, she relayed messages, and she went ›for drugs‹.28 Inmates like Hillyer, who often asked to work, could have considerable mobility and responsibility within the institution.

Many inmates performed the labor of attendants and other institution staff. When Margaret Wilson was admitted to a county asylum in 1931, a ›seasoned patient‹ gave her a bath, despite her demand to have a private bath.29 Wilson recalled another inmate who acted ›as an assistant to the nurses‹. She had been in the asylum ›off and on for a good many years‹. Part of her ›regular simple job‹ was to take fellow inmates on walks.30 Another inmate named Blanche had been put in a wet wrap so many times that she had become ›an expert assistant‹ in putting other people into the ›snug pack‹.31 Augusta C. Fischer carried trays of food to ›bed patients‹ at mealtimes. In the morning, Fischer assisted with ›bed pans, bed-making and trays, and took a walk to the storeroom for supplies‹.32 In the afternoon, she mended nurses’ uniforms. Fischer remembered that she was always ›so busy with a number of things‹ when she was in Washington’s Western State Hospital.33 Kate Lee recalled that the man who came to the women’s building to tune the piano was a fellow inmate.34 ›Inmate Ward 8’s‹ job was to keep a daily record of all ›important happenings‹ on the ward, including the admission of new people, visits made by doctors and supervisors, daily packages received by inmates, the transfer of people to other wards or to the infirmary, and all visitors to the ward.35 When he was in the asylum in the 1880s, E.B. Fleming learned that some inmates buried their fellow inmates when they died.36 Though gendered and influenced by class and race, the range of work performed by inmates had few material limits in the asylum.

Although they spent many hours of the day working for the institution, inmates also found the time to develop their own trade economy, which often existed outside the gaze and control of asylum staff. Lenore McCall remembered fondly that male inmates working in the institution’s carpentry shop made things for the women inmates in exchange for cakes and pies that they produced in their cooking classes.37 Other inmates recalled trading in everything from fruit to tobacco to writing utensils and paper.38 ›Inmate Ward 8‹ wrote that in his institution ›every favor‹ granted by one inmate to another inmate was ›scrupulously‹ repaid in some way, and that most inmates could not ›be comfortable‹ until they had repaid their debts to one another.39

Sometimes the inmate economy, with all of its necessary relationships, extended beyond the confines of the institution. Kate Lee remembered one woman, an artist, who spent much of her time painting in her room. Lee discovered that through an outside friend, the woman managed to sell many of her pieces, but she was forced, because of her incarceration and the stigma surrounding institutionalization, to sell her work at about half its value. Inmates had to sell the things they made outside the institution because most asylum inmates did not have the resources to buy their work, and because most physician-administrators did not allow inmates to sell their creations in the asylum.40 Undeterred by the constraints of institutional life, some inmates became savvy business people. They nurtured the relationships necessary to survive and thrive in spite of an institutional economy designed to extract and exploit their labor.

Most mad writers confessed that when asylum work extended beyond the drudgery of maintaining the institution, it improved their troubled and distressed minds. Jane Hillyer remembered that her ›morale came up with a bang‹ when the asylum physician put her in charge of the institution’s library. She found that she started to care again about her appearance, and she began to write.41 Through her work, Hillyer was ›sure to be supplied with material for thought; doubt, pain, loneliness, longing, could no longer fix themselves upon [her] with their old deadly grip‹.42 She started writing poetry, a common activity among inmates since the nineteenth century. Henry Collins Brown, who had ›been mixed up with type and presses‹ his whole life, was allowed to work in the print shop in his institution. He later wrote that he thought that the ›old familiar smells‹ of the print shop were ›highly therapeutic‹.43 When Anton Boisen was in an institution, he ›looked around for a regular job and suggested several things‹ to asylum staff, among them woodworking and photography. Physicians gave him a job doing photographic work. Boisen found that, in his experience, the doctors were ›really kind and responsive‹ to his desire to work at something that he ›could enjoy‹.44 While not all inmates had access to the same types of work, and some had their requests to work flatly denied, there were those inmates, including several mad writers, who found some freedom and joy in institutional work, especially when it enabled them to pursue interests that they had had before they entered the asylum.

Despite their sometimes positive portrayals, mad writers remained overwhelmingly critical of asylum work. Receiving fair compensation and enjoying the right to have control over earnings and spending became important issues for many early-twentieth-century mad writers. Augusta Fischer asserted that it would only be fair to pay the women in the Western State Hospital who worked in the laundry ›year in and year out‹, serving its 1,380 inmates, and to let them spend their money.45 Henry Collins Brown, who lived for three years in the Bloomingdale asylum in New York, wrote that he favored, and advocated for, an ›arrangement‹ that would require the institution to share ›the proceeds wholly or in part‹ from the sale of items made by inmates. He argued that if inmate workers were allowed to receive all or part of the money derived from the sale of the things they made, it would not only make their work more interesting, it would also ›be of the greatest possible remedial value‹ to them and to their friends and relatives, many of whom had meager financial resources.46 While early-twentieth-century mad writers did not always engage in direct political action, they did use their writing to persuade public opinion in favor of inmate rights, which they hoped would lead to structural changes in the asylum system.

Western State Hospital, Washington, ca. 1892. The hospital opened in 1871 as the Insane Asylum of Washington Territory, with fifteen male and six female inmates. The Washington legislature changed its name to the Western Washington Hospital for the Insane in 1889, and to the Western State Hospital in 1915. (Courtesy of the Washington State Department of Social and Health Services) Visual evidence from inside hospitals and asylum wards is scarce, especially for the years before conscientious objectors to World War II released their images to the American public. One of the rare exceptions is a photographic report by the German-Jewish émigré Alfred Eisenstadt (1898–1995), who visited Pilgrim State Hospital on Long Island in 1938 for a revealing LIFE magazine article. See the photo gallery via https://www.life.com/history/strangers-to-reason-life-inside-a-psychiatric-hospital-1938.
Western State Hospital, Washington, ca. 1892. The hospital opened in 1871 as the Insane Asylum of Washington Territory, with fifteen male and six female inmates.
The Washington legislature changed its name to the Western Washington Hospital for the Insane in 1889, and to the Western State Hospital in 1915.
(Courtesy of the Washington State Department of Social and Health Services)
Visual evidence from inside hospitals and asylum wards is scarce, especially for the years before conscientious objectors to World War II released their images to the American public. One of the rare exceptions is a photographic report by the German-Jewish émigré Alfred Eisenstadt (1898–1995), who visited Pilgrim State Hospital on Long Island in 1938 for a revealing LIFE magazine article. See the photo gallery via <https://www.life.com/history/strangers-to-reason-life-inside-a-psychiatric-hospital-1938/>.

In writing about asylum work, former inmates revealed a very different set of values than those espoused by their keepers. Instead of becoming docile and disciplined, most mad writers saw work as an opportunity to realize their own notions of what constituted a livable life in captivity. For some mad writers, work meant maintaining an identity they had had before their confinement. For others, it meant an opportunity to explore the institution and take on new responsibilities. Nearly all mad writers thought of work as a valuable way to learn how the asylum functioned and how best to survive within it. As Anton Boisen wrote, he especially liked being a photographer, because it enabled him to ›study the hospital inside and out‹.47 Margaret Aikins McGarr revealed yet another way in which inmates thought about work. She wrote that she enjoyed her job in the commissary because it provided ›a grand opportunity to meet many of the patients’ visitors‹.48 McGarr and other asylum inmates, including most mad writers, valued even the most menial labor, because it afforded them the opportunity to form relationships with each other and sometimes with visitors. Asylum labor and informal labor enabled inmates to forge bonds with one another built upon a shared sense of trust and reciprocity.49

2. ›Night-gown Brigade‹ –
Inmate Relationships

Relationships among inmates did not form easily, and not all inmates got along all the time. E.B. Fleming, who was incarcerated in the North Texas Hospital for the Insane, remembered being bullied by other inmates. He also wrote that when Black and White inmates were outside, hospital staff worked to keep them separated, because sometimes they fought.50 Lawrence Jayson, who was a ›college man‹, and who felt an affinity for other ›college men‹, initially ›refused to be drawn into any conversation‹ in the Kings County asylum.51 Clifford Beers, a Yale graduate, remembered a ›feeling of superiority‹ that came over him when he entered an institution, because he considered many of his fellow inmates ›vastly inferior‹ to him.52 Margaret Wilson, a graduate of Barnard College, recalled a great variety of inmates in the county asylum who did not always get along. Racial, class, and gender prejudices that existed outside the asylum frequently continued within it. Wilson wrote that about 90 percent of the inmates in the ›Welcome Ward‹ were ›not desirable companions, to say the least‹.53

Yet Wilson, like other mad writers, gradually came to see herself as a fellow inmate. She wrote that ›month after month‹ she revised her judgments about her fellow inmates.54 She ›reckoned‹ that they were all ›obviously peculiar in some way‹ and that she ›probably‹ was also peculiar. One woman yelled an ›indecent phrase‹ over and over, ›it seemed for hours‹. Some people had delusions and others were ›obsessed with queer notions‹. With time, these peculiarities seemed to matter little among inmates. Wilson remembered that she soon became ›shock proof‹, and that she and her roommate became friends almost immediately after physician-administrators forced them to share a room.55 Jane Hillyer described a similar process of adjustment. She recounted an early memory of her asylum stay in which inmates eating in the dining room ›tore at their food, shoveled, all but growled over it‹. Their actions made her think that insanity and beauty did not ›go together‹. Yet, before long, she ›knew‹ that she was ›one of them‹.56 She wrote that in that moment of realization, she ›supposed wearily‹ that she ›was one with them, one with this motley, drab group in this room heavy and stagnant with ugliness‹.57 The negative views of insanity and asylums that writers such as Wilson and Hillyer had, views which had been dominant in American culture for decades, seemed to dissipate, or at least became less consequential as they grew accustomed to institutional life. Over time, inmates became close, and many embraced their madness, perhaps in an effort to rob it of its power over them.

For some mad writers, disgust and reluctant acceptance gave way to a strong sense of sympathy for their fellow inmates. Margaret Starr wrote in 1904 that as a ›general knowledge‹ of the ›sad condition‹ of the approximately fifty people in her hall came to her, she began to appreciate the ›fullness of the meaning‹ of Shakespeare’s contention that ›[o]ne touch of nature makes the whole world kin‹.58 She wrote that she was ›in sympathy with [her] sister patients‹.59 Lenore McCall wrote forty-three years later that within her in the asylum an ›emotion was born‹ which ›never died‹. She came to have a ›deep, understanding pity‹ for all of her ›fellow sufferers‹. She developed a ›desire to protect them no matter what their actions were‹.60

Working with and for one another in the institution provided inmates with opportunities to strengthen their relationships. When Jimmy Warde was in the Arkansas asylum’s incurable (back) ward, an attendant placed him in the care of another inmate, a disabled man who ›had been knocking around on those asylum wards, almost a free man, for ten or twelve years‹.61 Warde remembered that old Bill McVey was diagnosed as an epileptic.62 McVey was responsible for providing Warde with regular meals and baths. Warde described his caretaker: ›He wore a gray mustache, and had gray chin whiskers that stuck outward from his chin more than downward. […] Bill had a crippled leg and a crippled hand. He walked with a swinging sort of limp, and always carried his crippled hand behind his back, especially while walking. When talking to anybody, Bill had a way of making gestures with his crippled hand; and would sometimes, as if by accident, strike his listener in the face.‹63 Warde wrote that he could not have ›fallen into better hands‹ than those of ›old crazy Bill McVey‹.64 McVey may have talked ›strange and funny‹, but Warde insisted that he would pay $500 ›spot cash‹ to access the knowledge and wisdom that McVey had stored away in his head.65 Warde remained grateful to McVey for teaching him ›some things‹ that were ›a big item‹ towards his ›success in the world‹ after his release from the asylum.66 Warde and McVey ›grew to be such fast friends‹ that the young man, who had maintained contact with his family outside the asylum, called McVey ›Papa‹.67 Daily care, which was part of asylum labor, but almost always extended beyond the physical maintenance of captive bodies, created the foundation for relationships among some inmates.

As Warde’s account reveals, the inmates’ informal economy, which often relied upon unspoken notions of trust and reciprocity, enabled them to nurture supportive relationships. Lawrence Jayson remembered giving a fellow inmate named Joe cigarettes, which made Joe his ›constant companion‹.68 Jayson in turn got introduced to the hospital ›gang‹.69 He described asylum life and his group of friends as a ›great mystic fraternity‹.70 Initially filled with ›piercing anguish and shame‹ at being in an asylum, Jayson eventually adapted to the rhythms of institutional life. Soon his days were ›filled by card-playing, reading, talking, and occasional walks‹. He became able to talk easily with his new friends about ›ordinary things‹, and only became ›diffident‹ about his past.71

Inmates like Jayson and his friends looked out for one another and taught each other the unwritten rules of asylum life. Jim Curran remembered that although he and his friends ›got on one another’s nerves sometimes‹, they also ›disciplined one another‹.72 Augusta Fischer remembered that as a new inmate in the Western State Hospital in the late 1920s she was ›duly enlightened by the old patients as to [the] procedure‹ of the institution.73 Fischer’s fellow inmates told her about letter writing, for example, which had been an important and contested part of asylum life since the founding of the earliest asylums. Thanks largely to former-inmates-turned-reformers who advocated for inmate rights in the nineteenth century, physician-administrators allowed all inmates to write one letter on Sunday morning after breakfast. But asylum physicians, who had won back some of their power over inmates at the end of the nineteenth century, required that all letters had to be left unsealed for a ›thorough reading‹ by hospital staff.74 If Fischer did not have money, the state would pay postage. She remembered more seasoned inmates also telling her: ›You can’t say anything but what is complimentary to the institution, or your letter won’t be mailed.‹75 The experienced inmates provided Fischer with more than just practical knowledge about letter writing. They taught her survival skills.

Speaking with other inmates ›fired‹ Fischer’s ambition to learn all she could about the institution’s ›queer pretense of treatment‹, as well. She remembered that the ›old-timers‹ spoke about ›hydrotherapy treatments‹, as if they missed them. ›Nowadays‹, Fischer wrote, ›it’s just work and scrub or sew, and then sit still and be told to keep quiet.‹76 When Looney Lee Gary entered an asylum in the 1930s, one of his fellow inmates, Louis, warned him to keep his ›eyes open‹ and not to let the physicians keep him in the institution ›just to get [his] money‹. Gary remembered that Louis told him: ›Don’t let them keep you too long.‹77 In a private asylum, where inmates had to pay significantly more than they would in a public asylum, getting out in a timely way could make a difference in an ex-inmate’s life.

Sometimes, groups of inmates worked together to create and maintain their own sense of order. After Margaret Aikins McGarr was committed to the asylum and taken to her ward, she met what she called the ›night-gown brigade‹.78 This was a group of women who met secretly in the washroom, ›away from the plutocrats in the hospital uniforms‹, to create their own ›democracy‹.79 McGarr recalled that she learned a lot from the ›large colored woman‹ who presided over the washroom ›council‹ and gave out ›such information as a second offender might have to offer‹ to a new inmate.80 McGarr remembered feeling grateful for the advice that she received from the night-gown brigade and comforted by its leader, who seemed to enjoy her ›power in her relationship with the group‹.81 It seemed, at least in this one account, that race was not always a divisive force in the institution. Shared circumstances and shared space, as well as a common desire to survive the asylum, brought some inmates from visibly different backgrounds together.

Although they did not write nearly as explicitly about race or ethnicity, men also told stories about bonds forged and skills and knowledge learned in the institution. ›Inmate Ward 8‹ wrote that when he was in the asylum, his new friends ›accepted [him] as one of themselves and gave [him] their confidences‹.82 He remembered that he learned about insanity and hospital life not from physicians or attendants, but from his fellow ›bugs‹.83 When Lawrence Jayson returned to the asylum late after a visit home (and to his former workplace), one of his friends told him to be careful and advised him: ›Remember, like a cripple, you’ve got to learn to walk again. Watch your step.‹84 In an environment where rules changed often and without notice, and staff interpreted every movement, behavior, and utterance as a sign or symptom of madness or recovery, inmates relied on one another for the knowledge necessary to survive.

They also depended on one another for companionship. They played games, participated in sporting events, and swapped stories. Lenore McCall remembered that she spent many ›empty hours‹ in the asylum thinking about her new friends.85 Marian King, who eventually received her own room, remembered feeling grateful for the ›comfort and solitude‹ it provided and also for her many inmate-visitors. Among King’s visitors were a musician who played the piano ›beautifully‹, a ›social service worker‹, and a young school teacher.86 The friends read aloud and did puzzles. Yet what ›absorbed‹ the women most was each other. They were in the asylum together because they were ›different from most human beings – different with some acute and dangerous difference‹.87 King, like other mad writers, internalized ideas about the association of danger and difference with madness that had been circulating in the United States for more than a century, but she did not do so uncritically. She used her writing to situate negative and damaging perceptions of asylum inmates within a broader context of friendship, artistic expression, and meaningful employment, which enabled her to reclaim their humanity in both subtle and powerful ways.

Friendships forged on asylum wards provided much needed emotional support for some inmates. Margaret Starr wrote that she referred to the ›acts and the speeches‹ of inmates with ›feelings of love, respect and sympathy‹.88 When Starr was put in a straightjacket and held in solitary confinement for four months because she refused to stop asking to go home, the other women ›offered sympathy‹ to her.89 When Augusta Fischer was in the state asylum, she encountered a fellow inmate who lay for weeks in her room, ›singing, shouting, swearing, biting and scratching all who tried to do something for her‹.90 This did not stop her friends from trying to help her, however. Fischer wrote that the rest of the women on the ward, almost ›without exception, sympathized more with the patient than with the attendants or staff‹.91 Clarissa Lathrop described a similar sentiment among the inmates at the Utica asylum. She remembered that although a ›general air of hopelessness‹ seemed to pervade the ward, inmates evinced a ›tender sympathy‹ for one another. Lathrop observed this ›even among the very insane, who would seldom under any circumstances attack a patient, but would more often vent their wrath on some attendant who had ill treated them‹.92

The strong bonds formed among inmates meant that they often advocated for one another. Margaret Starr wrote of a woman who got well and was given permission to go home, but her sister refused to take her. After many months, the woman still had ›neither money nor home‹. Starr went to the head of the institution and asked him if she could write a check for eight dollars, which the woman ›could use to pay her board in a near city until she could get an occupation‹.93 According to Starr, the next day, the physician-administrator gave the woman a ›paying position‹ in the kitchen, which enabled her to leave the institution.94 Clarissa Lathrop, who advised new inmates ›in reference to their conduct‹, also intervened when she ›had good reason‹ to think that inmate letters were not sent or when people had been ›detained an indefinite period‹.95 She remembered that in two instances, she wrote notes to relatives of inmates, ›which resulted in their removal to their homes before it was too late‹.96 Thinking back on her time at Utica, Lathrop declared: ›When the struggling intellect is awakening once more to reason, then the patient should receive kind words of sympathy and hope, the promise of home, friends and liberty, so dear to the human heart.‹97

Perhaps the most well-known mad writer, Clifford Beers, began his advocacy work while he was still in the institution. He wrote of his fellow inmates that ›none so aroused [his] sympathy as those whose submission was due to the consciousness that they had no relatives or friends to support them in a fight for their rights‹.98 He found that these inmates usually bore their burdens with ›the fortitude which under other conditions would be sublime‹.99 As an act of solidarity with his fellow inmates, Beers used his ›usual piece of smuggled lead pencil‹ to write letters in which he described the ›cruel practices‹ he observed around him, reports which he remembered were perfunctorily accepted and ›at once forgotten or ignored‹ by physician-administrators.100 Beers also claimed to have planned a mass escape from the institution, which never materialized because a night watchman refused to unlock the door early one morning.101

When they were not advocating for one another, inmates helped each other heal. Jimmy Warde remembered that he ›prayed and talked religion‹ with many of his fellow inmates, beginning on his first afternoon in the asylum.102 He moved about the institution, helping ›some of the milder ones to get back to their reason‹.103 Warde boasted that he ›had a patient down on his knees praying to God to help him get well before [he] had been in there [the asylum] one hour‹.104 Lisa Wiley remembered that after she had been in the asylum ›for a while‹, some of her fellow inmates ›sincerely tried to help‹ her.105 According to Wiley, they made her see that she was a ›likable individual‹ and that someday she would ›snap out of it and be all right again‹. After their interventions, Wiley became attached to some of her fellow inmates.106 They ›seemed like companions in distress‹ to her, and she, in turn, tried to help them.107 The experience was quite emotional for Wiley and her new friends. She wrote that there were times when they ›joked and laughed‹ about their difficulties and other times when they ›started crying‹ about their ›hopeless conditions‹.108

Lenore McCall recalled similar experiences in her institution. She described the women with whom she frequently played cards as an ›oddly assorted quartette‹. Yet the bond that existed between them was ›a strong one, the bond of mutual misfortune‹. McCall wrote that she and her companions were ›fellow derelicts adrift in the same rickety boat on a dark, turbulent sea‹.109 McCall noticed similar relationships among the men. She remembered a group of six or seven men who had ›banded together‹ under the leadership of a ›stocky, Quaker physician‹ from Pennsylvania who had committed himself to the asylum. McCall mentioned that the doctor made a ›gallant effort to overcome [his] depression‹ by helping other people.110

3. ›Our Suicide Club‹ –
Informal Inmate Support Groups

Sometimes, friendships developed into informal support groups. As Augusta Fischer wrote: ›Even in an asylum one will find cliques.‹111 Sometimes these groups elicited the support and approval of physician-administrators, attendants, or nurses. Most groups, however, were formed away from the interference and supervision of asylum staff. Henry Collins Brown wrote about what he considered the ›most interesting and diverting group in the whole hospital – our Suicide Club‹.112 Suicide was a serious concern for nearly all mad writers, as well as many other asylum inmates. Lawrence Jayson captured the ubiquity of suicide within the institution in a powerful image that remained with him long after his departure from the asylum. He remembered that the clothing of many inmates, including his own clothes, were ›not complete‹. He wrote that, ›the oddest bits were missing from them. No shoe-laces in their shoes, no belts to hold up their trousers, their shirts without ties, open wide at the necks.‹113 Brown similarly wrote that all eyeglasses were collected at night, as well as neckties, suspenders and bathrobe belts. Physician-administrators closely monitored and removed anything they thought people might use to harm or kill themselves. Suicide was, as each mad writer noted in their own way, one of the ›major problems in all hospitals‹.114 Inmates created ›suicide clubs‹ to provide support and comfort to one another at a time when they were most vulnerable. Swapping stories in their clubs became an important part of the support that some asylum inmates provided for one another.

Stories about suicide took on multiple meanings in the asylum and among mad writers who decided to share those stories with the world. Suicide stories were a way to share deep-felt emotions and concern for one another, and, at the same time, to politicize and humanize the asylum. Asylum inmates agreed that suicide was the most serious consequence of madness and that it was an all-too-common occurrence, especially in institutions. Mad writers, many of whom had attempted to end their lives, relayed numerous accounts of fellow inmates who had committed suicide. Stories like that of Mrs. Kendall who had been found ›dead, hanging on the bars in one of the corridors, where she had been cleaning‹, were part of asylum life. What made these stories tragic for some writers, like Margaret Wilson, was that some victims of suicide had family who would have ›gladly‹ taken them home, but the inmate had neither the strength nor the will, nor the desire, to ›compete‹ in the outside world.115 Mad writers knew all too well what it meant to be both institutionalized and suicidal. They worked to support and advocate for their fellow inmates in part by forming, or joining, groups and clubs in the institution and by writing about suicide in their memoirs.

Many mad writers used their work to convey the complexity and the tragedy of suicide in the hope that it might be avoided. Looney Lee Gary recalled a conversation he had with one of the nurses about his love for his eighty-year-old mother and how it hurt him to see her suffer from his ›negligence in not taking sufficient exercise‹ to overcome his mental troubles. He felt certain that his madness and the asylum would soon kill him, which he ›would not regret‹. He wrote that he would have killed himself if he thought that it would relieve his mother’s worried mind. Yet he knew that suicide would not help matters, especially given his mother’s ›religious ideas‹. Instead, Gary longed for a ›natural death‹ while in the asylum.116 He made a point of situating his intimate account of suicide within a broader conversation about madness and suicide. He wrote that at the time of the publication of his book in 1940, there were more than twenty thousand suicides each year in the United States, and it was ›conservative to say that a majority of them [were] caused by the victim having first suffered a nervous breakdown‹.117 By telling his story and raising awareness of the connections between madness, death, and the asylum, he hoped to save lives.

Unlike Gary, Margaret Wilson focused her account of suicide directly on the politics of the asylum. She explained to readers that when she entered the asylum, she felt that her commitment would bring about ›gradual devastating effects‹ and increase her ›mental agony‹.118 She recalled that at the time she saw no way out of her situation or out of the county asylum. So she thought that ›it would be wise to kill [her]self before [she] had become too weak and lost [the] nerve‹ to commit the act. Suicide, to Wilson’s institutionalized mind, would be, in effect, ›self-defense‹.119 She remembered that for weeks she pondered the ›several possibilities‹ available to her. Ultimately, she came to the conclusion that ›hanging was the only practicable method‹.120 One evening, while her ›cell-mate‹, a ›very insane‹ woman, lay in a ›semi-comatose condition‹ in the bed next to her and an attendant sat in her armchair in the room opposite their own, Wilson used a belt to hang herself from the bars on her window.121 For her, the asylum was not a place of healing. It was at best a site of indifference and neglect, and at worst, an abusive and carceral space that could be overcome only in death.

For those mad writers who shared them, intimate, painful stories of suicide became a way of critiquing the failures of modern scientific medicine and conveying the seriousness of mental troubles and distress. Lenore McCall, who attempted to kill herself while still in a general hospital, began her five-year stay in two different mental institutions with twenty-four-hour nursing and a suicide watch. Within months these measures were relaxed, though McCall never completely lost the desire to take her life.122 She later wrote that the ›empty, dismal days went by and [her] condition crystallised more and more into a complete withdrawal from contact with others‹.123 McCall mentioned that she often felt like she ›did not want to live‹.124 Jane Hillyer captured the feelings of many asylum inmates who attempted suicide when she wrote: ›Death and life seemed equally impossible to achieve in any vital way.‹125 A mad writer known only as ›Anonymous‹, who titled his book Autobiography of a Suicide, wrote that he found himself ›feeling like a haunted, hunted thing, afraid to live, and afraid to die‹.126

When Augusta Fischer made her second attempt at suicide by swallowing a bottle of iodine and ›washing it down‹ with a diluted lye solution, she had already survived the stillborn birth of her second child and the death of her son by her own hand, as well as multiple threats of suicide from her husband and repeated encounters with physicians, Christian Scientists, and other potential healers. She felt that she had been a ›disgrace‹ to her family and to her friends. Her ›bony frame‹ had gone from 135 pounds to 85 pounds.127 She had gotten in the habit of not sleeping, ›even day or night‹. ›Dark, horrible thoughts had crowded‹ into her mind.128 She wrote that ›nothing mattered at all‹. She had ›no regrets, no wishes, no plans‹ – and no prayers anymore, either. She had only that ›insistent dull pain always there‹ under her sternum, which was ›alleviated only the slightest by activities around [her] that attracted [her] attention‹.129

By sharing stories of suicide with the public, mad writers gave voice to inmates’ desire to acknowledge and grapple with the painful realities not only of institutional life, but of life itself. As the stories told by former inmates suggest, and as Henry Collins Brown wrote, the ›suicidal complex‹ was one of the ›really dangerous features of a mental sickness‹.130 When physicians admitted Brown to the hospital, they ›charged‹ him with ›suicidal mania‹ and placed him under constant observation.131 Despite having formal clinical attention, Brown, like other inmates, felt the need to connect with people who shared similar experiences. He and the other inmates who formed the ›Suicide Club‹ were well aware of the need to provide suicidal inmates, and people outside the institution who might be experiencing suicidal thoughts, with care and support that extended beyond that offered by physicians. Mad writers, like other mad people, had grown weary of ›everybody‹ urging them ›constantly‹ to ›»snap out of it«‹.132 ›We all would have liked to »snap out of it«‹, Brown wrote. Yet, for most people, relief remained a long time coming, if it came at all. The ›Suicide Club‹ created a space where its inmate-members could talk not only about their own mental troubles, but also about the effects of suicide on family and friends.133

Inmates formed other clubs as well, which were no less important than the ›Suicide Club‹. Brown and his friends also created what they called the ›Thursday Night Club‹, in part to provide inmates with lectures. Brown wrote that he acted as ›Chairman, Toastmaster, House Committee and also as Guest Speaker, when no other speaker volunteered‹. Although the club had the support of hospital staff, it only lasted a few months.134 Kate Lee and her friends formed what they called the ›society circle of A. 1‹ (= Building A, Ward 1).135 They met secretly in an alcove. Lee described some of her fellow members: a woman who had been in the institution more than a year and was expecting to go home, but ›became quite peculiar‹ and was taken to a back ward; a woman who ›sometimes heard voices‹, especially that of her ›dearly loved daughter‹, who had died two years before her mother’s commitment; a woman who went home after two months, but was returned less than three months later; and a woman born in India to missionary parents who was well educated and thought she was related to a prominent family of the same name, but this was ›said to be a delusion‹.136 Marian King and her friends formed a parole club, which initially had its own newspaper, a tradition dating back to the earliest institutions in the nineteenth century. King wrote that the newspaper survived only one issue before the physicians ›suppressed it‹.137 She remembered that prospective members of the parole club had to go through ›various tactics‹, including a secret handshake and displaying the club’s colors, which were black and blue with a yellow streak. Members were also required to know that the club flower was the poinsettia, which they called the ›lily gone wrong‹.138 These requirements were not taken seriously, but were conducted more for the group’s amusement. They called themselves ›Two Ate One Apple‹, and declared their motto to be, ›I am going home‹.139

4. ›Associated Grapevine Press‹ –
Clandestine Communication Channels

With all of the clubs, work, and other forms of socialization, news spread quickly among inmates. Henry Collins Brown recalled stories traveling through the asylum, and from one institution to another, on what he called the ›grapevine telegraph‹.140 Jim Curran similarly wrote that the ›grapevine route‹ existed in every asylum.141 ›[G]rapevine information‹ continuously flowed through Margaret Wilson’s institution.142 Wilson recalled that inmates sometimes left notes for one another scrawled in library books. She was working in the library when she found a note written by an inmate whom she did not know and who had apparently been born in Texas, married, and moved to another state. The woman confessed to readers that her ›father was a prominent man, a Mason of high order‹, and that she was ›addicted to masturbation‹.143 The author of the notes longed to see her doctor outside the institution, but never expected to see him again. Wilson remembered that toward the end of the book, the woman’s writing became ›more and more confused, adding a word of prayer‹.144 When she inquired about the woman to other inmates, Wilson discovered that she had either been transferred to another ward or had died. It seems that even the most isolated inmates found ways to communicate inside the asylum.

Life stories were not all that inmates shared. Margaret Aikins McGarr, who had been in the ›Psycho‹ many times, also wrote about the ›grapevine‹.145 She remembered that inmates, who confessed to one another that they felt like ›guinea pigs‹, used the grapevine to coach each other on how to act during physical and mental examinations.146 ›All day long‹, she wrote, ›we sat along the walls on benches or on the hard wooden chairs grouped for chatting purposes – trying to glean the proper, intelligent viewpoint of someone who supposedly had some intelligent information to offer us in our plight.‹147 ›Inmate Ward 8‹ ›never ceased to wonder at the remarkable way‹ news spread through his institution.148 He added that it extended ›beyond the uncanny‹ how some of the inmates learned all about others and remembered what they had learned ›in detail‹.149 Lenore McCall remembered that the news of her ›recovery‹ traveled rapidly among inmates. ›Everyone‹ stopped and congratulated her.150 Henry Collins Brown recalled that news of a staff meeting in which physician-administrators had discussed his fate reached him through the ›Associated Grapevine Press, that mysterious channel of communication which exists in all prisons and asylums‹, well before official word came from physicians.151

Grapevine news often spread informally and surreptitiously among inmates. Asylum inmates congregated and talked whenever and wherever they could, and sometimes, as with the anonymous notes in the library book, their clandestine communications persisted over time and extended beyond conversation. ›Inmate Ward 8‹ shared memories of ›frightened‹ inmates who were ›dreading‹ a new sterilization law, meeting privately on the ›exercising porch‹ to talk about it.152 Jim Curran recalled that some of the men in his institution had ›a kind of private rest room‹ beneath the main building where they went between jobs to talk and smoke their pipes. Curran remembered that they ›liked to rest, but they liked to work‹ as well.153 Clifford Beers remembered speaking with a fellow inmate only when they were both ›so situated as to escape observation‹.154 Margaret Starr went through what she described as a series of ›rather theatrical attempts‹ to communicate with a woman from the same town who was also in the asylum. Because of their connection in the outside world, physicians forbade them to speak with one another. In an effort to communicate and avoid detection, the two women exchanged notes written on ›small pieces of unbleached muslin‹ sewn into the hems of their skirts.155

Physician-administrators and other asylum staff did not accept all of the talk among inmates, but there was little they could do to stop it. When Lenore McCall entered the asylum, the admitting physician informed her that she was not to discuss her symptoms or any phase of her ›condition‹ with other ›guests‹.156 She quickly learned that this rule was ›certainly not enforced‹ in the asylum and that ›the authorities‹ were never quite aware of ›how many times it was broken‹.157 Inmates, who depended on one another for support, comfort, and companionship, frequently shared information, despite their keepers’ efforts to silence them.

Inmates certainly did not always get along, and sometimes their mental troubles prevented them from engaging in asylum life. Yet as McCall explained, inmates had ›many ways of making [their] life in the hospital even more congenial than the authorities planned it‹. She went on to write: ›Despite the fact that all of us had either emerged from serious illness or were fighting some neurosis or emotional problem our life was absolutely normal and we had very good times together.‹158 Margaret Aikins McGarr described her experience as ›months of horror‹, but also admitted that there were ›amusing, wonderful times‹ in the asylum.159 Clifford Beers, who openly resisted institutional authority, especially during the early months of his stay in three separate institutions, recalled that with time, he ›became accustomed to the rather agreeable routine‹ of institutional life and ›began to enjoy life as much as a man could with the cloud of death hanging over him‹.160 After a period of adjustment, inmates like McCall, McGarr, and Beers created and actively shaped their own culture within the asylum, which often went either unnoticed or unsuccessfully challenged by attendants, nurses, and physicians.

For some inmates, relationships forged in the institution proved lasting. When Lawrence Jayson finally left the asylum, the farewell with his friends was ›a tearful one‹.161 Jane Hillyer’s friends were similarly ›overcome by their sadness‹ when she left the asylum.162 Looney Lee Gary wrote that upon leaving the asylum, a ›neurotic sympathy floated up‹, forming a lump in his throat that ›would not go down‹, no matter how hard he swallowed.163 When one of Lenore McCall’s inmate-friends left the asylum, it affected her more than she imagined it would. She recalled feeling disoriented at the time: How could she miss a ›madhouse‹ companion when she did not miss her own family? Upon reflection, McCall discovered that it was because her fellow inmate understood what she was ›suffering‹.164 Some of the friendships McCall made toward the end of her stay endured after she went home.165 William Seabrook wondered whether he would ever find friends ›as congenial‹ as those he made during his hospitalization.166

In the experience of some mad writers, friendships created in the asylum eclipsed those they once had with family and friends outside the institution. Jayson remembered, for example, that the friends he made in the asylum were ›more welcome dinner companions than the whole galaxy of [his] relatives‹.167 He explained that his fellow inmates ›did not disguise their thoughts‹, they ›would never exchange covert glances‹, and they ›were not solicitous‹. Jayson considered himself an equal with other inmates, which was ›precisely‹ what he did not feel at home.168 After she secured her release from the Utica asylum, Clarissa Lathrop wrote to her family that she would ›never place‹ herself or her ›means‹ at their disposal for as long as she lived. She wrote that ›henceforth‹ she had ›no family, but every suffering man or woman, particularly if they had suffered the horrors of an insane asylum‹. They were her ›mother, sister and brother‹.169 For some mad people, fellow inmates became kin.

5. Conclusion: Inmate Solidarity as a Survival Strategy

Asylum life could be harrowing and relentlessly tedious. Yet the asylum was also a dynamic space where inmates worked and formed valued relationships with one another. While not all inmates got along and prejudices common in the outside world continued to shape life within the institution, nearly all mad writers described the strong ties that bound them to their fellow inmates. Inmates helped one another adapt to institutional life, they shared information and survival strategies, and they worked, played, laughed, and cried together. They offered one another much-needed emotional support and advocated for each other in times of need. Inmate work structured asylum life. Whether they performed the menial labor necessary to keep the institution open and functioning, or took on more specialized tasks, which in some cases required considerable skill and responsibility, nearly all inmates worked. Inmates sustained the institutional economy. Yet they were not merely cogs in the institutional machinery. They created their own economies both within and outside the institution. They attached their own values to the work they performed within the institution. Relationships forged through common experiences of distress and the trauma of institutional life, and founded upon both formal and informal exchanges of labor, created a widely understood sense of trust and reciprocity among inmates, which in turn enabled them to share the most intimate details of their lives with one another. Sometimes inmate friendships flowered into groups and clubs, which could be sanctioned by asylum staff, but more often existed away from the watchful eyes of attendants, nurses, and physicians. Whether they formed clandestine groups bent on preserving democracy within the institution or providing one another with support, or spent their days gossiping and playing cards, inmates made an otherwise intolerable situation bearable. They helped one another survive, and when they could not, they mourned the loss of their friends.

Although women and men worked and socialized together, their most intimate support work was often done in homosocial settings. Private rooms, segregated wards, alcoves, bathrooms, seating areas, and courtyards or walking paths were institutional spaces where women and men could gather with friends or in small groups, often separate from one another, to convalesce, talk, share information, or just pass the time. These opportunities to come together were seen, by most mad writers, as separate from and more meaningful than the more structured, and often highly regulated and supervised, socialization provided by institution administrators and staff.

Institutions in the United States expanded significantly between 1890 and 1950. Treatment modalities and diagnostic regimes shifted, with the former becoming more invasive, and in some cases more dangerous and deadly, while the latter became more complex and ›scientific‹. Two world wars and broad demographic shifts brought about by immigration, industrialization, urbanization, and internal migration transformed asylums and asylum populations. Most institutionalized people (about 85 percent) were confined in large state asylums, which could contain thousands of inmates in increasingly squalid conditions. Private asylums held considerably fewer people and could offer more amenities. Nevertheless, they could be equally terrorizing and debilitating for people experiencing mental troubles or distress. The white, mostly middle-class, former inmates who went into print in the midst of a changing institutional environment used their writing to convey the complexities of institutional life and at the same time make sense of their experiences, while also forming a community of ex-inmates and affirming the humanity of the growing inmate population. By writing about friendships forged on asylum wards, former inmates made a massive and seemingly incomprehensible, insurmountable social problem – the unchecked expansion of the asylum system – legible to a reading public who might otherwise have been unable or unwilling to discuss it. Mad writers worked, in their own way, to extend the relationships forged inside the institution into the outside world, and to break down, or at least punch gaping holes in, the thick brick walls that surrounded the nation’s asylums. Their writing created a depiction of the inner life of the asylum that could not be accessed in other ways and helped to lay the groundwork for later mad activists who came together to dismantle the asylum system.


1 Anne R. Hanley/Jessica Meyer (eds), Patient Voices in Britain, 1840–1948, Manchester 2021.

2 Roy Porter is generally considered the person who urged social historians of medicine interested in asylums and psychiatry to consider the patient perspective. See: Roy Porter, Madmen. A Social History of Madhouses, Mad-doctors & Lunatics, Stroud 2004; A Social History of Madness. Stories of the Insane, London 1987; The Patient’s View. Doing Medical History from Below, in: Theory and Society 14 (1985), pp. 175-198. Inspired by the work of Porter, the journal Medical History dedicated a special issue to ›Tales from the Asylum. Patient Narratives and the (De)construction of Psychiatry‹. See: Alexandra Bacopoulos-Viau/Aude Fauvel, The Patient’s Turn: Roy Porter and Psychiatry’s Tales, Thirty Years on, in: Medical History 60 (2016), pp. 1-18. For work that incorporates the perspective of families and patients in North America, see: Ellen Dwyer, Homes for the Mad. Life Inside Two Nineteenth-Century Asylums, New Brunswick 1987; Wendy Gonaver, The Peculiar Institution and the Making of Modern Psychiatry, 1840–1880, Chapel Hill 2018; Geoffrey Reaume, Remembrance of Patients Past. Patient Life at the Toronto Hospital for the Insane, 1870–1940, Don Mills 2000; Martin Summers, Madness in the City of Magnificent Intentions. A History of Race and Mental Illness in the Nation’s Capital, New York 2019; Nancy Tomes, A Generous Confidence. Thomas Story Kirkbride and the Art of Asylum-keeping, 1840–1883, New York 1984. For work outside North America that incorporates the perspective of families and patients, see for example: Jonathan D. Ablard, Madness in Buenos Aires. Patients, Psychiatrists, and the Argentine State, 1880–1983, Calgary 2008; Catherine Coleborne, Madness in the Family. Insanity and Institutions in the Australasian Colonial World, 1860–1914, Basingstoke 2010; Akihito Suzuki, Madness at Home. The Psychiatrist, the Patient, and the Family in England, 1820–1860, Berkeley 2006. For an international perspective, see: Waltraud Ernst/Thomas Mueller (eds), Transnational Psychiatries. Social and Cultural Histories of Psychiatry in Comparative Perspective, c. 1800–2000, Newcastle upon Tyne 2010.

3 Long-time historian of asylums and madness, Catherine Coleborne, has issued an important call for increased attention not only to the ›patient perspective‹, but also to the experiences and perspectives of mad people outside the asylum. See: Catharine Coleborne, Why Talk About Madness? Bringing History into the Conversation, Cham 2020. For a mad people’s historiography, see: Geoffrey Reaume, From the Perspectives of Mad People, in: Greg Eghigian (ed.), The Routledge History of Madness and Mental Health, London 2017, pp. 277-296. For recent scholarship that engages with the experiences of patients and former patients, as well as madness as it was experienced outside the asylum, see also: Emily Baum, The Invention of Madness. State, Society, and the Insane in Modern China, Chicago 2018; Claire E. Edington, Beyond the Asylum. Mental Illness in French Colonial Vietnam, Ithaca 2019; Tiffany F. Jones, Psychiatry, Mental Institutions, and the Mad in Apartheid South Africa, New York 2012.

4 Inspired by Erving Goffman, Asylums. Essays on the Social Situation of Mental Patients and Other Inmates, Garden City 1961, and Reaume, Remembrance of Patients Past (fn 2).

5 For a fuller account of the history of mad writers, see: Michael Rembis, Writing Mad Lives in the Age of the Asylum, New York 2023 (in preparation).

6 This article also builds upon the work of Flurin Condrau, who argues that the literature on the ›patient’s perspective‹ has advanced little since scholars in the 1980s urged historians to consider it. Flurin Condrau, The Patient’s View Meets the Clinical Gaze, in: Social History of Medicine 20 (2007), pp. 525-540.

7 I use only first-person accounts written by former inmates. I do not use fiction in this study, even if it was written by former inmates. Two of the memoirs used in this study were published in the early 1950s, but both authors were institutionalized before 1950. Anton Boisen was institutionalized several times, mostly in the 1920s. His book went through multiple reprints. In this study, I use the 1962 edition, which was not substantively different from earlier editions. Anton T. Boisen, The Exploration of the Inner World. A Study of Mental Disorder and Religious Experience, New York 1962; Margaret Aikins McGarr, And lo, the Star, New York 1953; Lisa Wiley, Voices Calling, Cedar Rapids 1955.

8 Insanity on the Increase, in: Baltimore American, 12 August 1906; Insanity Goes marching on, in: Morning Oregonian, 20 December 1906.

9 Albert Deutsch, The Shame of the States, New York 1948, pp. 30-31.

10 Coleborne, Why Talk About Madness? (fn 3); Sally Swartz, Asylum Case Records: Fact and Fiction, in: Rethinking History 22 (2018), pp. 289-301.

11 Although there could be significant differences among specific institutions, and among public and private institutions, the average annual release rate was between forty and sixty percent throughout the first half of the twentieth century. See: Gerald N. Grob, Mental Illness and American Society, 1875–1940, Princeton 1983, pp. 77, 196, 306-307.

12 Lawrence M. Jayson, Mania, New York 1937, Preface.

13 Ibid.

14 Cf. Kate Lee, A Year at Elgin Insane Asylum, New York 1902, p. 126.

15 For a contemporary medical perspective on work in a public asylum, see: C. Floyd Haviland, Occupation for the Insane, in: American Journal of Insanity 119 (1913), pp. 483-495.

16 Fred Charles, Medievalism Used in Care of Insane, in: Plain Dealer, 20 May 1922.

17 Lee, A Year at Elgin (fn 14), p. 76.

18 Ibid., pp. 33, 85.

19 Employment of Insane in the Eastern Michigan Asylum at Pontiac, in: Medical News 59, issue 15, 10 October 1891, p. 430. 248 of the institution’s 518 male inmates worked ›out of doors and in different outside departments‹ of the institution. Other male inmates worked in indoor occupations and ›hall work‹. This same report noted that women inmates worked primarily in the kitchen, the ironing-room, and the wash-room.

20 Lee tells the readers that once a week, straightjackets came to the mending room for repairs. On one of these days, a woman from the back ward expressed ›such a strong dislike‹ for the straightjackets that the supervisor, a ›short and rather stout, pleasant-spoken gray-haired lady‹, excused the woman from repairing them. Lee, A Year at Elgin (fn 14), pp. 84-85, 93-94.

21 ›Inmate Ward 8‹, Behind the Door of Delusion, New York 1932, p. 14.

22 Lee, A Year at Elgin (fn 14), p. 108.

23 ›Inmate Ward 8‹, Behind the Door of Delusion (fn 21), pp. 202-203.

24 McGarr, And lo, the Star (fn 7), p. 61.

25 ›Inmate Ward 8‹, Behind the Door of Delusion (fn 21), pp. 202-203.

26 Ibid.

27 Jane Hillyer, Reluctantly Told, New York 1935, p. 110.

28 Ibid., p. 134.

29 Margaret Isabel Wilson, Borderland Minds, Boston 1940, p. 35.

30 Ibid., p. 45.

31 Ibid., p. 48.

32 Augusta C. Fischer, Searchlight. An Autobiography, Seattle 1937, pp. 170-171.

33 Ibid.

34 Lee, A Year at Elgin (fn 14), p. 57.

35 ›Inmate Ward 8‹, Behind the Door of Delusion (fn 21), p. 48.

36 E.B. Fleming/Augustin Fleming, Three Years in a Mad-House. The Story of My Life at the Asylum, My Escape, and the Strange Adventures Which Followed, Chicago 1893, p. 54.

37 Lenore McCall, Between Us and the Dark, Philadelphia 1947, pp. 299-300.

38 Clifford Whittingham Beers, A Mind that Found Itself. An Autobiography, New York 1908, 3rd ed. 1913, p. 185; Elsa Krauch, A Mind Restored. The Story of Jim Curran, New York 1937, p. 118.

39 ›Inmate Ward 8‹, Behind the Door of Delusion (fn 21), pp. 183, 184.

40 Lee, A Year at Elgin (fn 14), p. 102.

41 Hillyer, Reluctantly Told (fn 27), pp. 138-147.

42 Ibid.

43 Henry Collins Brown, A Mind Mislaid, New York 1937, pp. 87, 90.

44 Boisen, The Exploration of the Inner World (fn 7), p. 6.

45 Fischer, Searchlight (fn 32), p. 196.

46 Brown, A Mind Mislaid (fn 43), pp. 98-99.

47 Boisen, The Exploration of the Inner World (fn 7), p. 6.

48 McGarr, And lo, the Star (fn 7), p. 66.

49 Physicians considered work a treatment (occupational therapy). For the history of occupational therapy in the early-twentieth-century United States, see: Lori T. Andersen/Kathlyn L. Reed, The History of Occupational Therapy. The First Century, Thorofare 2017.

50 Fleming/Fleming, Three Years in a Mad-House (fn 36), pp. 22-25. On segregation and abuse of Black patients at Saint Elizabeths in Washington D.C. during the 1920s and 1930s, see: Summers, Madness in the City of Magnificent Intentions (fn 2), pp. 217-227.

51 Jayson, Mania (fn 12), p. 22.

52 Beers, A Mind that Found Itself (fn 38), p. 64.

53 Wilson, Borderland Minds (fn 29), pp. 45-46.

54 Ibid., pp. 46-48.

55 Ibid., pp. 38, 46-48.

56 Hillyer, Reluctantly Told (fn 27), p. 92.

57 Emphasis in original. Ibid., p. 68.

58 Margaret Starr, Sane or Insane? Or, How I Regained Liberty, Baltimore 1904, p. 15.

59 Ibid.

60 McCall, Between Us and the Dark (fn 37), p. 107.

61 Jimmy Warde, Experiences as a Lunatic. A True Story, Little Rock 1902, pp. 227-228.

62 Ibid., pp. 226-227.

63 Ibid.

64 Ibid., pp. 231-232.

65 Ibid.

66 Ibid.

67 Ibid., p. 233.

68 Jayson, Mania (fn 12), pp. 52-53.

69 Ibid., p. 55.

70 Ibid., pp. 70-71.

71 Ibid., p. 84.

72 Krauch, A Mind Restored (fn 38), p. 180.

73 Fischer, Searchlight (fn 32), p. 171.

74 Ibid.

75 Ibid.

76 Ibid., pp. 188-189.

77 Loony Lee Gary, The Bridge of Eternity, New York 1940, p. 161.

78 McGarr, And lo, the Star (fn 7), p. 8.

79 Ibid.

80 Ibid.

81 Ibid.

82 ›Inmate Ward 8‹, Behind the Door of Delusion (fn 21), p. 14.

83 Ibid., pp. 28-29.

84 Jayson, Mania (fn 12), p. 179.

85 McCall, Between Us and the Dark (fn 37), p. 115.

86 Marian King, The Recovery of Myself. A Patientʼs Experience in a Hospital for Mental Illness, New Haven 1931, pp. 97-98.

87 Ibid., pp. 96-97.

88 Starr, Sane or Insane? (fn 58), VII.

89 Ibid., p. 75.

90 Fischer, Searchlight (fn 32), p. 176.

91 Ibid.

92 Clarissa Caldwell Lathrop, A Secret Institution, New York 1890, p. 148.

93 Starr, Sane or Insane? (fn 58), p. 44.

94 Unfortunately, Starr wrote that, ›About four months later she [the inmate] was again committed to the hall; although on the well list, she was not considered strong, and in consequence she was doomed to associate with lunatics, in a lunatic asylum.‹ Ibid., pp. 43-44.

95 Lathrop, A Secret Institution (fn 92), p. 280.

96 Ibid.

97 Ibid.

98 Beers, A Mind that Found Itself (fn 38), p. 161.

99 Ibid.

100 Ibid., p. 182.

101 Ibid., p. 161.

102 Warde, Experiences as a Lunatic (fn 61), p. 39.

103 Ibid.

104 Ibid.

105 Wiley, Voices Calling (fn 7), pp. 58-59.

106 Ibid.

107 Ibid.

108 Ibid.

109 McCall, Between Us and the Dark (fn 37), pp. 144-145.

110 Ibid., p. 156.

111 Fischer, Searchlight (fn 32), pp. 201-202.

112 Brown, A Mind Mislaid (fn 43), p. 107.

113 Jayson, Mania (fn 12), p. 40.

114 Brown, A Mind Mislaid (fn 43), pp. 107-110.

115 Wilson, Borderland Minds (fn 29), p. 87.

116 Gary, The Bridge of Eternity (fn 77), p. 182.

117 Ibid., VI-VII.

118 Wilson, Borderland Minds (fn 29), p. 89.

119 Ibid.

120 Ibid.

121 Ibid., p. 91.

122 McCall, Between Us and the Dark (fn 37), pp. 159-162.

123 Ibid.

124 Ibid., pp. 178-179.

125 Hillyer, Reluctantly Told (fn 27), pp. 11-12.

126 Anonymous, Autobiography of a Suicide, Lawrence 1934, p. 17.

127 Fischer, Searchlight (fn 32), pp. 150, 160-161.

128 Ibid., pp. 160-161.

129 Ibid., p. 159.

130 Brown, A Mind Mislaid (fn 43), p. 116.

131 Ibid.

132 Ibid., p. 113.

133 Ibid., p. 114.

134 Ibid., pp. 172-173.

135 Lee, A Year at Elgin (fn 14), p. 45.

136 Ibid.

137 King, The Recovery of Myself (fn 86), p. 101.

138 Ibid.

139 Ibid.

140 Brown, A Mind Mislaid (fn 43), p. 32.

141 Krauch, A Mind Restored (fn 38), p. 121.

142 Wilson, Borderland Minds (fn 29), p. 86.

143 Ibid., p. 52.

144 Ibid.

145 McGarr, And lo, the Star (fn 7), p. 51.

146 Ibid.

147 Ibid., pp. 31-32.

148 ›Inmate Ward 8‹, Behind the Door of Delusion (fn 21), p. 82.

149 Ibid., p. 140.

150 McCall, Between Us and the Dark (fn 37), p. 294.

151 Brown, A Mind Mislaid (fn 43), p. 71.

152 ›Inmate Ward 8‹, Behind the Door of Delusion (fn 21), p. 248. The historiography of sterilization in the United States is vast. On sterilization in hospitals during the early twentieth century, see: Joel T. Braslow, Mental Ills and Bodily Cures. Psychiatric Treatment in the First Half of the Twentieth Century, Berkeley 1997.

153 Krauch, A Mind Restored (fn 38), p. 182.

154 Beers, A Mind that Found Itself (fn 38), p. 69.

155 Starr, Sane or Insane? (fn 58), p. 53.

156 McCall, Between Us and the Dark (fn 37), p. 97.

157 Ibid.

158 Ibid., pp. 299-300.

159 McGarr, And lo, the Star (fn 7), p. 85.

160 Beers, A Mind that Found Itself (fn 38), p. 63.

161 Jayson, Mania (fn 12), p. 100.

162 Hillyer, Reluctantly Told (fn 27), p. 166.

163 Gary, The Bridge of Eternity (fn 77), pp. 240-241.

164 McCall, Between Us and the Dark (fn 37), pp. 154-156.

165 Ibid., pp. 299-300.

166 William Seabrook, Asylum, New York 1935, p. 256.

167 Jayson, Mania (fn 12), p. 191.

168 Ibid.

169 Lathrop, A Secret Institution (fn 92), pp. 302-303.


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