It has been a very exciting summer for the Center for Education youth programs. On June 25, 2021, The College of Physicians of Philadelphia officially announced the creation of the George and Judy Wohlreich Junior Fellows program. Formerly the Karabots Junior Fellows and the College Junior Fellows program, the George and Judy Wohlreich Junior Fellows is a three-year summer and after-school program for Philadelphia high school students from historically excluded communities who are interested in careers in healthcare and medicine.
In August, we were happy to welcome the latest cohort of the program. A small group of students from all across the city came together to participate in an intensive two-week summer program. This year’s theme was “Lessons of 2020,” taking a closer look at the tumultuous year and a half we have all been experiencing through the lens of health. Some of the topics addressed included how diseases behave; lessons learned, and not learned, from past pandemics such as the 1918 influenza and 1980s AIDS pandemics; the social determinants of health, the impact of the COVID-19 pandemic on historically marginalized or excluded communities, such as incarcerated people and communities of color; and what it means to be a healthcare professional during a global pandemic.
A key element of the program is putting students in contact with healthcare professionals in the field. This summer, we were fortunate to have an exciting group of guest speakers who shared their professional expertise and life experiences with our students. These experts represented such fields as pathology, microbiology, immunology, public health, pediatrics, physical therapy, hospice and palliative care, internal medicine, and emergency medicine.
We are proud of our new students’ accomplishments and excited to offer them new educational opportunities during the school year.
If you are a Philadelphia high school student who will be starting their sophomore year during this coming school year, there are still a few spots available in our cohort. For more information on eligibility check out our website or our FAQ, or contact Kevin D. Impellizeri, PhD, Assistant Director of the Center for Education. You can also fill out an application HERE.
Hello, again, loyal readers, editor Kevin here welcoming you to guest writer Isabel DuBois’ second installment in a three-part series examining the history of mental health treatment for women in the 19th century. If you haven’t read part one, I encourage you to check it out.
Disability and mental illness hold a very negative stigma and have for hundreds of years. Recent social trends of greater acceptance and understanding have caused us as a society to look back on past treatments for mental illness with dismay. What was life really like for those living with disabilities and or mental illness?
This question is surprisingly hard to answer. Much of this history has been lost or forgotten along with the lives the patients left behind upon entering the halls of a sanitarium.
Today 9% of the U.S. population, or 28.8 million Americans, will have an eating disorder in their lifetime (National Association of Anorexia Nervosa and Associated Disorders (ANDA) 2020.) Modern treatments for these disorders include psychotherapy, behavioral therapy, family-focused therapy, and medically monitored food consumption. In the modern day, it is understood that these disorders are about more than food, in fact, they have deep roots in other mental health issues and body image issues. This modern form of treatment centers around compassion and understanding and is in stark contrast to the seemingly harsh treatment options available in the past.
In 1689, English physician Richard Morton described two cases of “nervous consumption” —one in a boy and one in a girl. Due to Doctor Morton’s inability to find a physical explanation for the loss of appetite and “wasting,” he determined “this consumption to be nervous.” Although there is no record of the treatment used, these two cases are considered to be the earliest modern cases of the illness we now know as anorexia nervosa. The next reported cases of anorexia nervosa were about 200 years later in 1873 by Sir William Gull, who coined the term “anorexia nervosa” in his published case reports.
Silas Weir Mitchell (1829-1914)
In the late 1800s, American neurologist Silas Weir Mitchell developed the rest cure for the treatment of hysteria , neurasthenia and other “nervous” illnesses. The rest cure involved strictly enforced bed rest and isolation from friends and family for 6 to 8 weeks, massage and electro therapies, no creative or intellectual activity or stimulation, as well as a fatty diet, rich in milk and meat. Especially in the case of his female patients, Mitchell believed that depression was brought on by too much mental activity and not enough attention to domestic affairs. Refusal to eat would result in the patient being force-fed either by the staff or, in some cases, by Weir himself. It became widely used in the US and UK but was prescribed more often for women than men and was frequently used to treat anorexia nervosa. The treatment kept some patients alive and others out of asylums, though some patients and doctors considered the cure worse than the disease.
Charlotte Perkins Gilman (1860-1935)
The rest cure has found modern day fame through Charlotte Perkins Gilman’s 1892 feminist publication, “The Yellow Wallpaper,” in which the reader follows a young woman’s rapid descent into insanity while undergoing the rest cure treatment. Gilman’s story “The Yellow Wallpaper” was not entirely fictionalized and, although some exaggerations had been made, drew largely from Gilman’s own experiences. (Gilman, Why I Wrote The Yellow Wallpaper? 86) In 1886 early in her first marriage and after the birth of her first child, Charlotte suffered from what is now known as postpartum depression, a condition described by Perkins as causing her “utter prostration” by “unbearable inner misery” and “ceaseless tears.” Due to this she was sent to Philadelphia for treatment under “the greatest nerve specialist in the country”: Weir Mitchell. For Gilman, Mitchell’s treatment was a disaster. Having been prevented from working, she soon had a nervous breakdown and, at her worst, is reported to have been reduced to crawling into closets and under beds, clutching a rag doll. After abandoning Mitchell’s treatment Gilman managed to recover from her ordeal, but she still claimed that she felt the effects for the rest of her life. For this mistreatment she held special derision for the doctor for the rest of her days, and Mitchell is referred to by name in the book. (Gilman, The Living of Charlotte Perkins Gilman 95)
“Miss C” before and after anorexia treatment, from the medical papers of William Gull
An album of photographs presented to Mitchell by William S. Playfair, the British obstetrician responsible for introducing the rest cure to England in the early 1880s, captures patients’ physical states before and after undergoing the rest cure. These portraits show in great detail the states of patients suffering from different eating disorders. The before pictures highlight the patient’s gaunt features and tired expressions, the after pictures highlight the patients plump and healthy features. However, these images do so while denying us access to the most significant part of the transformation: the treatment process.
Sources:
“Anorexia.” Harvard Health Publishing. December 19, 2014. Accessed August 20, 2021.
Greetings, loyal readers, editor Kevin here to introduce the first of a series of three articles examining the history of mental health treatment for women in the 19th century written by Center for Education summer intern Isabel DuBois. We’re thankful for her hard work researching and preparing these pieces.
Take it away, Isabel.
Most people associate the word “asylum” with squalor and brutality—an impression strengthened by portrayals in books and films like One Flew Over the Cuckoo’s Nest and American Horror Story: Asylum—but they were originally designed to be places of sanctuary. With the 18th century came a public commitment to mental health treatment, and charity became a staple of modern life. Liberal-minded reformers called for the “insane” to be placed into care facilities instead of being jailed, and thus the asylum was born. For many years, these facilities were considered to be the pinnacle of mental health care, providing housing, food and medical care for people in need. However, around the mid-19th century, insane asylums began to decline. As patients with incurable illnesses filled them, asylums became warehouses for people who could not be maintained elsewhere. Many asylums began to face the same problems, namely overcrowding and lack of funding, as facilities originally designed to hold smaller numbers of patients began to fill up, often nearly doubling in population and placing intense strain on infrastructure. These issues led to the placement of many patients in poorhouses and to unhealthy and unsafe conditions at the asylums. Many superintendents including Dr. Edward Runge, the superintendent at the Saint Louis Asylum, tried to counteract this trend of decline, but the asylums, at that time, were able to offer little more than custodial care to their many patients.
Charles Dickens. Image courtesy of the Library of Congress
In response, celebrities of the day began speaking out about the harsh conditions in insane asylums and poorhouses. Amongst these celebrities, one of the most outspoken was Charles Dickens. His 1857 publication entitled “The Star of Bethlehem” was one of his many works criticizing the current standard of care. In it, Dickens recounts the history of the St. Mary of Bethlehem hospital in London, a facility that housed the insane and mentally ill. Dickens described the hospital as a “foul, wretched place” and called for institutional reform to make the living conditions tolerable for its patients.
An unlikely advocate for change came through the work of one young journalist, Nellie Bly, who made a name for herself in the late 1800s with a series of articles about living life as a sane woman in Bellevue Hospital’s insane ward on Blackwell’s Island. Just 23, Bly was one of a handful of female reporters in New York City. For years, rumors had swirled about conditions in one of the city’s most notorious places: the insane asylum on Blackwell’s Island. Now known as Roosevelt Island, Blackwell’s Island was home to a number of public institutions, including a penitentiary, a poorhouse, hospitals for infectious diseases like smallpox, and the asylum. These articles would later be compiled into her 1887 book entitled “Ten Days in a Mad-House.” Of the many obstacles Bly faced in going undercover and getting committed to Bellevue, the one she found most daunting was whether or not she had the ability to deceive the insanity experts. In order to avoid the trouble of the experts, she chose to be committed by way of the courts. She need not have worried, though. In a journey that took less than 3 days, she set out to prove herself insane. She wandered the halls and nearby streets, refused to sleep, ranted and yelled incoherently, and even practiced looking “crazed” in her mirror. Within days, the boarding house owners summoned the police. Bly, now claiming to be a Cuban immigrant, suffering from amnesia was sent by a perplexed judge to Bellevue Hospital. Her time at Bellevue was quick to acclimate her to the suffering to come, as hospital inmates were forced to eat spoiled food and lived in squalid conditions. When Bly was diagnosed with dementia and other psychological illnesses, she was sent by ferry to Blackwell’s Island, in the East River.
Nellie Bly. Image courtesy of the Library of Congress.
Originally built to hold 1,000 patients, Blackwell was cramming more than 1,600 people into the asylum when Bly arrived in the fall of 1887. Like many such institutions, extensive budget cuts had led to a sharp decline in patient care. In the case of Bellevue, this left just 16 doctors on staff to care for the 1,600 patients.
Most disturbing of all, even to those most accustomed to the medical practices of the day, was the prevailing wisdom of the age regarding both the causes of mental illness and how patients should be treated. Asylums like Blackwell’s Island were considered curiosities, where thrill seekers and others could visit those thought to be “mad.” Doctors and staff with little training—and in many cases, little compassion—ordered harsh and brutal treatments that did little to heal and much to harm. Bly quickly befriended her fellow inmates, who revealed rampant psychological and physical abuse. Patients were forced to take ice-cold baths and remain in wet clothes for hours, leading to frequent illnesses. They were forced to sit still on benches, without speaking or moving, for stints lasting 12 hours or more. Some patients were tethered together with ropes and forced to pull carts around like mules. Food and sanitary conditions were horrific, with rotten meat, moldy, stale bread, and frequently contaminated water dished out. Those who complained or resisted were beaten, and Bly even spoke of the threat of sexual violence by many of the tyrannical staffers.
What shocked Bly even more than the treatments was the fact that many of the patients were, in fact, not insane at all. Rather, many were recent immigrants, mostly women, caught up in a law-enforcement system in which they were unable to communicate. Others had fallen through the cracks of a society and, with few social safety nets, ended up committed simply for being poor with no family to support them. Bly quickly realized that while many of these inmates were not suffering from mental illnesses before they arrived at the asylum, the treatments had inflicted grave psychological damage on them; stating, “I would like the expert physicians who are condemning me for my action, which has proven their ability, to take a perfectly sane and healthy woman, shut her up and make her sit from 6 A. M. until 8 P. M. on straight-back benches, do not allow her to talk or move during these hours, give her no reading and let her know nothing of the world or its doings, give her bad food and harsh treatment, and see how long it will take to make her insane. Two months would make her a mental and physical wreck.”
Bellevue Hospital. Image courtesy of the Library of Congress.
A month after Bly’s articles were published, a grand-jury panel visited the asylum to investigate. Unfortunately, the hospital and its staff had been tipped off in advance. By the time the jury members arrived, the asylum had cleaned up its act, literally. Many of the inmates who had provided Bly with details of their horrific treatment had been released or transferred. The staff denied Bly’s accounts. Fresh food and water had been brought in, and the asylum itself had been scrubbed down. Despite this effort at a cover-up, the grand jury agreed with Bly. A bill that was already under consideration, which would increase funding for mental institutions, was pushed through, adding nearly $1 million ($24 million in today’s money) to the departmental budget. Abusive staff members were fired, translators were hired to assist immigrant patients, and changes were made to the system to help prevent those who did not actually suffer from mental illness from being committed.
Thank you, Isabel, for your insights. If you are looking to learn more about the history of mental health, check out our article on Victorian Rest Cures, written by a student in the George and Judy Wohlreich Junior Fellows program. Be sure to check back next week for Isabel’s next article.
The College of Physicians of Philadelphia is officially accepting applications for the Out4STEM program. The Out4STEM program is an after-school internship that aims to provide Philadelphia’s LGBTQIA youth with healthcare and STEM-oriented instruction, mentorship, academic support, and college/career preparation in an inclusive, safe space.
The program provides an opportunity for Philadelphia high school students to learn about science, technology, engineering, mathematics (STEM), and healthcare/medicine and the career opportunities they provide. The program provides a space where they can cultivate relationships between like-minded, motivated Philadelphia LGBTQIA students and professionals.
In addition to learning about STEM fields and careers, the Out4STEM program cultivates a greater understanding of LGBTQIA history, and provides opportunities to engage with scientists, educators, activists, medical practitioners, and historians who are part of the community. The discrimination that LGBTQIA individuals face interacts with other aspects of their identity, from class to race or religion, and so discussions of the history will touch on other civil rights movements (Like the Civil Rights movement of the 1950s-1970s that tackled racial inequality, the women’s liberation movement, and the labor movement) that occurred in parallel to, or otherwise influenced, various LGBTQIA activist movements.
The program consists of after-school sessions held weekly during the 2021-22 school year. The current plan is to hold sessions in person at The College of Physicians of Philadelphia (19 South 22nd Street). However, that is subject to change based on current local, state, and federal COVID-19 protocols. We will take every measure to ensure the safety of our students, including mask wearing, social distancing, and (if necessary) virtual programming.
Interested students can fill out our online application. We will be accepting students on a rolling admission basis. Please note, there are no costs to apply or remain enrolled in the program. Students will be provided with a stipend and The College will cover transportation costs (in the form of SEPTA keycards) to and from The College of Physicians of Philadelphia (19 South 22nd Street) or any off-site field trips.
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