At the beginning of the 19th century, industrialization, urbanization, and immigration contributed to the explosive growth of New York City. Accompanying this growth was a burgeoning underclass of convicts, the poor, the sick, and the insane. A policy of institutionalization was adopted to manage this group. In 1828, New York City purchased an island in the East River from the Blackwell family to build a jail and an asylum. When it opened in 1839, the asylum on Blackwell’s Island was New York’s first publicly funded mental hospital and the first municipal mental hospital in the United States.
It was designed to be a state-of-the-art institution based on the theories of moral treatment. Fundamental to its success was an organized and orderly environment. Although in the past, little effort was made to differentiate between types of mental illness, according to the tenets of moral treatment, such distinctions were imperative. As Dr. John McDonald, a physician involved with the design of the new asylum, wrote, “The indiscriminate mingling of the mild and furious, clean and filthy, convalescent and idiotic, need only be witnessed to be deprecated.” He continued: “Classification is now justly considered by almost all persons of experience of the first importance in the treatment of insanity” (1). He suggested that patients be divided into four specific classes: the “noisy, destructive, and violent,” “the idiots,” “the convalescents,” and an intermediate class for “those in the first stages of convalescence and such incurables (who) are harmless and not possessed of bad habits” (2). In addition to classification, moral treatment emphasized the human rather than beast-like nature of the insane. The design for the new asylum was free of barricades and iron bars and allowed for easy access to the outdoors.
But this model asylum was never built. Because of financial constraints, only two wings were completed and almost immediately proved inadequate. Even more disturbing, convicts from the nearby penitentiary were used as guards and attendants, so that in the words of Dr. Thomas Kirkbride, the patients were “abandoned to the tender mercies of thieves and prostitutes” (3).
Thousands of the city’s poor mentally ill were admitted to the asylum between 1839 and 1895, and the press’s fascination with the institution and its inhabitants grew intense during those years. Local newspapers, including the New York Times and Harpers Weekly, provided weekly running accounts of the asylum’s most intriguing characters. Some achieved celebrity-like status, such as the elderly woman known as “Mrs. Buchanan.”
Most people have heard of Mrs. Buchanan. She is one of the incurables—a poor old lady—Scotch I imagine—who has been an inmate of the lunatic asylum for years. Her delusion has been described in the papers. She believes she is the wife of the President and discharges her conjugal duties with such success that she bears a large family to the President. Strange to say, the offspring of her lofty amours are invariably cats. I had the honor of stroking the back of President Buchanan’s eldest son who purred as though his sire had no political difficulties to disturb his repose. (4)
Newspapers were filled with grim tales of madness, mistreated patients, wretched conditions, and wrongful confinement. In 1879, an article titled “Tormenting the Insane” appeared in the New York Times describing appalling cases of neglect. In 1887, Elizabeth Cochrane Seamen, aka Nellie Bly (1866–1922), a journalist for the New York World, feigned insanity to gain admission to the asylum on Blackwell’s Island. She wrote a series of shocking articles for the newspaper and a book. She described it as a “human rat-trap” that could drive the sanest people crazy (5).
In the wake of the scathing report, administrative changes followed, but the image of the asylum as a human rat trap lingered. The half-built, overcrowded, convict-supervised asylum was a symbol for the unrealized goals and the blatant failures so extensively covered in the press. The New York City Lunatic Asylum on Blackwell’s Island closed in 1894. All that remains of it today is a domed octagonal structure that once stood as the centerpiece of the institution.
1.Board of Assistant Aldermen: Document 101, March 10, 1934: Documents of the Board of Aldermen and Board of Assistants of the City of New York. New York, the Board, 1831–1834, p 8172.Board of Assistant Aldermen: Document 101, March 10, 1934: Documents of the Board of Aldermen and Board of Assistants of the City of New York. New York, the Board, 1831–1834, p 8203.Kirkbride TS: Proceedings of the Third Meeting of the Association of Medical Superintendents of American Institutions for the Insane, Article V. New York, July 1848, p 914.A Visit to the lunatic asylum on Blackwell’s Island. Harper’s Weekly, March 19, 1859, p 1865.Nellie Bly: Ten Days in a Madhouse—Feigning Insanity in Order to Reveal Asylum Horrors. New York, Norman Munro, 1887, p 93
Address correspondence and reprint requests to Dr. Boardman, Weill Cornell Medical College, 449 East 68th St., 2nd Fl., Suite 9, New York, NY 10021; firstname.lastname@example.org (e-mail). Images courtesy of Oskar Diethelm Library, Institute for the History of Psychiatry, Weill Cornell Medical College. The authors report no competing interests.