Civil Commitment of Women to Mental Institutions in the Nineteenth Century: A Case Study of St. Elizabeth's Hospital, 1880-1900

Summary

St. Elizabeth's Hospital opened in the District of Columbia in 1855 to serve Army and Navy veterans and indigent persons. According to common law, people could be committed if a commission of lunacy ruled they were of unsound mind and dangerous. With the opening of public mental institutions and the advent of psychiatry, mental hospitals began to claim more of a curative and less of a custodial function. As of 1855, certification by two or more competent physicians and two or more householders that a person was insane, indigent and a resident of the District of Columbia was required to commit a person to St. Elizabeth's. For paying patients, certification was replaced by a written request from a family member or friend. The District of Columbia Supreme Court ruled in 1885 that jury trials were required for commitment, but Congress overruled this requirement in 1899.

Men and women were committed to St. Elizabeth's for different reasons. During the nineteenth century insanity was thought to arise from "predisposing influences" triggered by "exciting causes." One widely held belief was that insanity in women stemmed from their reproductive systems. When men showed the same symptoms as women, their illnesses were classified as different disorders appearing because of work pressure or other form of stress. When studies claimed that women's brains were smaller than men's, the conclusion was used to support that the claim that women engaging in social activities and pursuing education instead of putting motherhood first risked insanity. Because observation of behavior was the basis for identifying mental diseases, psychiatric theorists applied normative standards based on social values.

Melancholia (depression) accounted for the most patients, at 37% of admissions. It was closely followed by mania, which accounted for 30% of admissions, dementia (25%) and other disorders (8%). Mania was the primary disease of admission for women, while melancholia was for men. Medical conditions were the leading (36%) cause of these disorders for all patients, with alcoholism the second cause for men and unknown causes second for women. The small number (6%) of women admitted for disorders stemming from pregnancy, childbirth, menstruation, and uterine diseases undermines the theory that female insanity stemmed from reproductive troubles. All the patients admitted for disorders caused by worry and poverty were women, as were 85% of patients committed for disorders stemming from "domestic trouble." The latter two statistics were likely a result of women's domestic role and economic restrictions at the time. Women also accounted for over 70% each of admissions for disorders caused by overwork, overstudy, and "irregular life," while all the patients committed for disorders stemming from masturbation and sexual excess were men.

Commitment by relatives was not always as free from abuse as psychiatrists imagined. Several women were committed, released, and readmitted several times at the behest of their husbands, fathers, sisters, and daughters. One woman, Katherine M., was abused by her husband, who threatened to commit her for the rest of her life when she cried during his beatings. It is possible that her doctors may have advised commitment to protect her from him. On many occasions women were admitted to St. Elizabeth's before their commitment hearings. Their relatives obtained letters from psychiatrists at the hospital saying that the patient's presence at their commitment hearings was detrimental to their condition. Their absence from the hearing violated the commitment statutes and prevented them from challenging their commitment.