Medical Apartheid – Harriet A. Washington (2007)


Subtitle: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present.

Well, this read left me a bit shattered, not because it’s so graphic, but because it’s so true and it hasn’t stopped – even in this day and age. This is a well-researched look at the history of medical apartheid, which means, basically, the history of medical experimentation on African Americans from the era of slavery to the present day. It’s an incredible read about an important (and much neglected) topic and although it was one of the hardest reads I’ve had in a long time, it’s an important addition to the history of African Americans here in the U.S.

I think that most Americans are aware of the Tuskagee syphilis experiment  from 1932 to 1972 under the auspices of the U.S. Public Health Service. This was a long-term experiment to observe the natural progression of syphilis in untreated subjects, but under the inexcusable idea that the subjects (i.e. the people in the study who had syphilis) believed that they were getting medical care when in fact, quite a few weren’t – and just so medical professionals could see what happened in the lifetime of a poor syphilis patient.

These patients were severely economically disadvantaged (mostly sharecroppers) and poorly educated, and included 600 people who believed that they were receiving free medical care, meals and free burial insurance for participating in this study, a study that even gave 201 participants syphilis (who didn’t have it before), and none of whom were given penicillin (despite all the evidence that this fairly new antibiotic would cure their disease). (Sorry – that’s a rather long sentence, but I trust that you can keep up.)

(It’s insane that this happened, and continued to occur until the 1970’s. My god. I don’t even have words to put here to describe how PO’d I am at this situation. It’s beyond my vocabulary.)

And you know what’s worse? That the medical establishment has continued to abuse this population ever since slavery, and it’s happened over and over again. (And when you read this book, I hope you’ll feel as disgusted as I am.)

One more example that’s more modern: there are several examples of medical studies looking at new technology (e.g. artificial medical devices or treatment approaches) that are totally based on studies filled by African-American participants. And yet when the final device is approved and comes to market, the population who tested it for the manufacturers are actually now least likely to afford access to its benefits. Grrrrrrrr.

Back to the book: Washington has done an excellent job writing this book through the perspective of her journalistic lens, and the book’s divided into three parts: the first is about the history of medical experimentation wrt the African-American population; the second is about more recent cases of medical abuse and research, and the third examines how this history has impacted African Americans and their current views on the (mostly) white medical establishment of today.

I worked for almost a decade in public health at the local City Health Department, and when we would offer medical screenings, some folks would participate but there were times when our services were not as well attended as we had hoped, and frankly, after reading this book and learning this history, I fully comprehend any hesitation to do so. I, too, would be careful with any of my interactions with health care workers as well if I had grown up knowing this history of continued racial and medical discrimination against my friends and family.

And this book carefully covers decades and decades of continued abuse of the African American population. It wasn’t just in the “olden days” – it continued up until close to the end of the 20th century, and actually, probably continues in some places to this day if you consider who continues to populate medical studies offering “free health care if you’ll help us with our studies”.  (It’s usually the highly disenfranchised, socially and economically disadvantaged people with few options for health care. Don’t even get me started on the availability and access to effective dental care….)

The Tuskagee study is usually the most famous study that characterizes this trend, and due to the whistle blower who let the cat out of the bag on that*, there is now an Office for Human Research Protections (OHRP) and federal laws and regulations requiring Institutional Review Boards (or IRBs) that are meant to protect human subjects in studies. (The OHRP is under the U. S. Department of Health and Human Services now.)

So – as you can probably surmise, this was a powerful read for me and it just underscores how tough and amazing the African American population are: these guys survived slavery, medical discrimination, civil rights injustices and more. Just imagine how different life for African Americans could have been without this century’s continued discrimination in almost every aspect of life. Goodness me. I’d also be very very careful when dealing with the medical establishment (or the white establishment in general) if I’d grown up learning this history and yet still continuing to thrive despite the odds.

There is nothing that I can say to make this right, so my advice would be to read this, let it in sink in, and then look at your own communities to see how you can impact them in a positive way somehow. I’m not sure that I really like the direction of this country’s administration right now (understatement of the year), but how to change that? (1) Vote. (2) Make your part of the world more just, kind, and fair in any way that you can.

This was an amazing and thought-provoking read. I hope it is for you as well.

* Someone had to whistle-blow on this study??…

Where in the world…?

hello-600x400Well, hi. I’m here in the world, but have not been able to work on my blog with the regularity that I like due to overload at work and home. Spring tends to be the busy time at work, and then in my non-work time, I’ve been researching a trip that I’m taking with my lovely old mum and twin sister which is fun but does take up some time and energy. (It’ll be worth it in the end, for sure.)

And you know – I have been reading. I’m just about to finish up a non-fiction called “Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present” by medical scholar Harriet Washington. Goodness me. This has been a very difficult and serious read, not because the content is complex but because the content is true and almost too horrible to contemplate.

Washington’s thorough research seems to cover almost every instance of when the U. S. medical system has experimented on the African-American population over the years, with the (white) medical establishment doing everything from giving an unnecessary and unwanted HIV vaccine to healthy infants (without the parental consent) to digging up bodies to sell for dissection at medical schools, from lying to study participants about receiving treatment (the infamous Tuskagee study) to hideous other well documented incidents of other abuses to a population with no recourse to change any of this.

Obviously, this is a tough read for me (as it would be to anyone), and I’ve had to take some breaks – how can people be so horrible to each other (specifically to African-Americans)? – and at the same time, I think it’s important to know this history, and I’ve also been under a tight deadline to finish this since it’s an unrenewable inter-library loan. (And yes – I could have forked over the cash to buy my own copy, but I’m on a book-buying ban AND I’m learning that I’m better as a one-book-reader than trying to juggle several).

Long story short – it’s been an intense reading week and so not much time or energy for putting together a blog post. But trust me – one will be coming on this particular read as I think everyone who is aware of social justice in any form should learn about this issue. One must know the past to influence the future, I think.

I’ve also been reading “Hope in the Dark: Untold Histories, Wild Possibilities” by Rebecca Solnit which is a series of hard-hitting essays on how activists have changed the world for better, even when it’s tough to see the progress. (It’s been helpful to balance the terror that has been coming out of the WH lately.)

So – some hard hitting books here, and once I’m finished with the Washington book, I’m probably going to be heading for some lighter reading to balance things out. It’s astonishing to me that there are years and years of this documented medical abuse and yet no one did anything about it. No wonder that the African-American community tends to stay away from the American health care system. I would as well if I knew that history.

So – that’s where I am at right now. What’s new, Blue’s Clues?

When Breath Becomes Air – Paul Kalanithi (2016)


I had an amazing read of Paul Kalanithi’s autobiography called “When Breath Becomes Air.” Kalanithi was a young surgeon (aged 36) and in the final year of his neurosurgical residency when he received the troubling diagnosis of terminal lung cancer. He had none of the risk factors for this cancer, so it was totally out of the blue and arrived right at the time of his life when he’s just about to finish the arduous training and begin his “real” life of being a surgeon. He and his wife are both physicians so they know what the CT scans show, and when they hear that Kalanithi has about one year to live, what to do, what to do.

And so this short but powerful read is a meditation on what life means, both philosophically and in real life: Kalanithi is a philosopher as much as he is a surgeon and so this reads as more of an existential meander through those final months. It’s got the medical stuff in there, as well, but it’s more of an intellectual journey than you would expect, and though I am not well-versed in the old serious thinkers of yore, it was still an educational ride through this sad time.

As Kalanithi has received this terminal diagnosis, what does that mean for him (apart from the physical process of dying)? He mixes intellectual thought with thoughts of a more pragmatic nature (Which treatment should he have? Should he even attempt treatment at this point? What about having a child with his wife?), and so it’s a very thoughtful book best read slowly so you can digest what is being said.

Highly recommend this title if you’re a fan of physician authors such as Abraham Verghese or Atul Gwande – this is the same genre but a less straight-forward read due to philosophical questions Kalanithi addresses. This one definitely makes you think. (Or it did me, at any rate.)

The Death of Ivan Ilych – Leo Tolstoy (1886)


I dug this title up as it was mentioned in my recent read of Gawande’s On Mortality book, and I’m all about following down the rabbit holes of different books and topics sometimes. Although somewhat intimidated by Russian authors (although not sure why), I picked this up with trepidation and then relaxed. It was going to be a good read.

Gawande’s reference to this Tolstoy novella meant that I knew that the plot was about a man dying, but the actual details were vague for me (which I was happy about). I opened the book one morning and then finished it that evening and it was a great read. The plot itself is pretty simple: a man works hard in his career, gets married with kids, falls off a ladder and gets slightly hurt, and then ends up dead. (And I’m not giving the game away here. This is what the story is famous for, after all.) However, it’s a lot more than that as Tolstoy (via his lead Ivan Ilych Golovin) ruminates on the process of dying and how it may affect one’s thinking.


Young Tolstoy.

Ivan Ilych has done all the “right” things in his life, he feels: he has worked hard on his career rising in the legal ranks of the municipal court, he has married well, and has a good family. So why is he so uncomfortable dying in this way? And that’s what most of this work is about – how the dying process evolves for both the participant and the family around him. It’s really quite fascinating especially after that recent read of Gawanade’s book (which also focuses on death and dying). Sounds desperately morbid (doesn’t it?) but it’s not. This dying thing happens to everyone, and as with almost anything else, the more you know the better. (At least that is how I’m approaching things).

Using the POV of Ivan Ilych himself, the story follows his thinking process as his life winds down. His pain in the side (originally triggered by that fall at home) worsens, and as it progressively gets more and more painful, he visits a few doctors trying to get his diagnosis. However, the doctors are unable to agree and give him a final diagnosis (let alone a cure) and so Ivan struggles on, unable to talk about his concerns about dying with no one, not even the medical professionals and let alone with his family.

And I find this to be so relevant with attitudes towards death today. I’ve noticed that when one has a difficult illness, people usually don’t mind acknowledging it at first when everything is mostly normal, but as time progresses and one’s prognosis worsens, many people would prefer to talk around it than actually address it face on (a la elephant in the living room). This is how Ivan Ilych’s family and friends handled the situation, and so the reader learns about the frustrations, struggles and the sheer loneliness of the person who’s doing the dying. I really don’t think that this is an untrue situation for a lot of people, but I wish it wasn’t that way.

Gawande mentioned that this novella was taught in med school in a class about death and dying, but I’m not sure how common that is across the nation. (Anyone know?) However, common or not, I think this is an excellent novella about a very common natural human process which is frequently denied or skirted around as people are uncomfortable with it (for whatever reason).

A provocative read about a pretty ordinary guy who is going through a totally natural process and who is reflecting on his life lived. Although the subject may be dark, this is extremely well written, not maudlin at all, and is a good demonstration of something that happens but most people would prefer not to talk about. It was an excellent read when paired with reading the Gawande book. Recommended.


The Secret Life of the Grown-Up Brain – Barbara Strauch (2010)


A random pick off the TBR shelves on the topic of learning/creativity type info triggered by the TEDx conference the other day, this was an enjoyable read about the myths (and truths) of the middle-aged brain. I have just turned 50 on my last birthday, and normally my age never crosses my mind. I consider chronological age to be irrelevant for the most part and an artificial limitation for some things, so I didn’t expect to be so curious about turning fifty. The age (and the birthday) have, for some reason, triggered some growing and changing that I had not expected and so this has been eye-opening in many ways. (And it’s not only me, it seems. From talks with friends, turning fifty does do something to you, although it varies how that manifests itself in life.)

Strauch is the medical and science editor for the NYT, and so knows how to write great journalistic stories, and this one seemed to be one of those books that one reads at just the right time.

In the U.S., aging seems to be a culturally negative thing in general and the common assumption seems to be that aging means losses of some kind: your friends/family die/move, you get stiff, you have more medical problems, it’s harder to learn stuff, you forget everything and you’re THAT much closer to developing dementia and/or dying. Suddenly, there are all these “Over the Hill” birthday cards (black for the oncoming funereal process), and AARP sends you a membership card and the next thing you know you’ll qualify for the Senior discount at Furrs and have supper at four in the afternoon.

(I’m not saying that everyone views it like that or that that is how I approach the aging process, but it doesn’t seem to be welcomed or viewed as a time to bloom, shall we say.)

Strauch’s book authoritively turns all this on its head, which was fun to read and backs it up with research. The first half of the book covers the various research studies that have proven that the middle-aged brain does not die off and that forgetting what you watched on TV last night is not a sign of oncoming dementia for most people. It’s a little too rosy in places for me and a little bit heavy on the cheerleading, but it’s also fascinating to read about the possibility of neurogenesis (growing new brain cells) and learning to focus on the strengths of an older brain.

So yes, we can forget the reason we went to the kitchen very easily, but older brains also are much better at looking at the whole picture of something (a debate, the long-term effect of something, the overall view) and additionally, middle-aged people have been found to have better control of their emotions that people in their 20’s. (Seems true in my experience for the most part.)

Some of this ability to see the bigger picture is due to having years of experience (so it’s easier to see how things fit in long-term), but it’s also linked to education. Loads of studies show that the more education that one has the lower your risk for (or the higher your resilience to) Alzheimers, so learning is good especially as you get older. (Love that.) It’s also easier to see the connections between disparate topics as you age which refers back to seeing the bigger picture more clearly.

And yes, it’s true – middle-aged brains do tend to get more easily distracted at the start of a project (“Squirrel!”) and to forget things (such as names of people). Strauch explains that this forgetting process is more of a retrieval problem than a disappearing problem – the names are there (tip of the tongue type thing). We just have to take a little more effort to get that information than we would when we were younger — just need to access it slightly differently, it seems. And we’re more likely to forget the names of people who we don’t know that well and who we haven’t seen for ages – makes sense to me really.

As for how to engage your middle-aged brain and keep it sharp and growing, Strauch (backed up by the researchers that she interviewed) is a huge proponent of exercise (i.e. regular aerobic exercise) as this has been found time and again as the only way for your brain to have neurogenesis (i.e. grow new brain cells). There’s been an age-old argument about how your brain stops growing once you’re older and it only shrinks etc. That is really not true, and Strauch has the research conclusions to prove it.

Besides, why wouldn’t you exercise? (It’s easy for me to say this as I’ve been regularly exercising since I was about six, so it’s like brushing my teeth – it doesn’t feel right if I don’t do it almost every day. I know it’s a big effort for others, but it’s so worth it that I wonder why a lot of people don’t. It’s free, generally (walking etc.), it improves almost every facet of life, it’s pretty simple… What’s not to like?)

So – I enjoyed this book for a number of reasons, but mainly because it backs up the lifestyle choices that DH and I have chosen for ourselves – regular aerobic exercise, continually learning new things, and challenging ourselves both physically and mentally. (Not all the time, I hasten to add, but the book did help us to feel good about how we live.)

Perhaps that is why I really enjoyed the book – that it supported how I think and live. It’s always nice to be told that you’re doing the right thing.

* One thing that I have decided to stop now that I’ve turned fifty (and it’s not a particularly mature thing to do) is admitting that I really hate eating raw broccoli and don’t eat it any more. Vile weed that it is. My rebellion comes in baby steps at times. :-)

Swabbing the decks…

swab_decksSometimes one needs to just swab the decks and catch up with posts, and this is what this post is. Several reviews for books that I have read recently, but for some reason or another (and not a fault of the book at all), I haven’t put together a long review for them. These, then, are the micro-reviews of some recent reads.

Happier at Home – Gretchen Rubin (2013) book271
Rubin’s second happiness-related book, this one focuses more on the home front as opposed to her more general subject of her previous book. I enjoy her blog and like how she melds in philosophy, history and other subjects with the subject of happiness – she is pretty thoughtful and I appreciate her enthusiasm for life. (It’s not bossy or OTT which I like.) So, this one is more focused on how to appreciate life at home a bit more and so each chapter has a focus on a different aspect of that ranging from de-cluttering to getting stuff done. It’s not new or cutting edge info, but I enjoyed how she organized the info and she’s a good writer. She has a big emphasis on “noticing the little things” in life, which I agree with, and so I enjoyed this read. It’s more of a reminder about things than new info, and she seems to enjoy a pretty privileged life overall – however, that doesn’t make the info that she relates invalid. She’s received criticism from just repeating a lot of what she wrote in her first book in this one, but as I haven’t read that one, I didn’t get that.

book263How to Disappear Completely: On Modern Anorexia – Kelsey Osgood (2013)
Osgood takes a close examination of eating disorders (and especially anorexia) here, with the twist of her criticism of how society tends to veer from “condemning the victims to canonizing them”. She focuses on the way that anorexia, as an illness, has evolved over time, and how certain girls (and young women) are attracted to the shiny veneer of the disease even whilst knowing about the potentially deadly consequences. It’s a complicated argument, but I agree with it. Developing anorexia can be insidious, and a portion of that patient population are totally swallowed by the “image” that anorexia has, an image which can be sustained by the numerous pro-ana websites out there which read like a how-to manual. Osgood argues that to destroy anorexia, we must remove the glamor from it: the media coverage of eating-disordered celebrities, the lists of symptoms that proliferate and offer themselves (unwittingly) as guidelines and goals for young girls searching for an identity. It’s a fascinating argument, and I mostly agree with it.

As the author writes, “To destroy anorexia, we must devalue its currency… and leave the salacious and profitable details for the medical professionals.” It’s true that western society tends to value thin-ness in people (especially females). It’s also true that it can be competitive, diagnosis-wise, within the mental health patient population itself if you’re in a rehab type environment. (“How many diagnoses do you have? Oh, I have this many…”) Osgood also makes the point that rehab places (for anorexia patients) should not be like spas. It’s true that some are not, but some of the more high-end places are like resorts with horse-riding, acupuncture, yoga and world-class chefs. Why on earth would you want to get better if you’re in a place like that? Not that health care should degrade back to workhouse standards, but I do think that within certain groups, there is a certain panache linked with how many times you’ve been to rehab and which ones and there is pride in being a particularly complex case.

This was a provocative book on many levels and may cause unrest in the therapy world. But it’s a discussion that needs to happen.

The Great Filth: Disease, Death and the Victorian Life – Stephen Halliday (2009)


” The greatest achievements of the Victorian era was…to accept that national and local government had a responsibility for the health, education and welfare of citizens, as well as for defense against foreign invasion and domestic justice…”

As you may already know, I am a Fangirl of Victorian social history, and so this was quite a good read. I especially enjoyed and appreciated the slightly different slant that Halliday used here – instead of most of it being about doctors, this covers a lot of the public health improvements in London (and elsewhere) were due to the diligent efforts of civil engineers and architects, as well as mathematicians and others.

pumpThis title covers both the famous and infamous of Victorian medicine – the discovery of the infected well water during an epidemic (Snow et al.), the acceptance and training of midwives, the realization of good hygiene between doctor and patient, the glacial acceptance of germ theory as opposed to the miasma theory – the topics were really interesting to me (especially when considered in the light of our recent visit to the Hunterian Museum in London ).

Some of the theory behind medicine at that time is startling to the modern eye in places. Not washing one’s hands between patients? Eeuw. There was more than one cholera outbreak during the nineteenth century, one of which occurred in 1832. As medical theory at that time did not conceive of germs being in the water (as opposed to the air)*, the London Board of Health came up with the following recommendations for its citizens to prevent cholera transmission:

* Consumption of large amounts of roast beef (assuming you could afford that)
• Poorer people should eat loads of potatoes and stale bread (the mold was thought to have healing powers)
• Avoid excess fruit and vegetables (obviously not washed and cleaned at this time)
• Finally, use brandy, laudanum, ammonia, sulphuric acid for treatment/prevention and…
• Apply mix of hot bricks and boiling water to the affected areas (Yikes)

When Victorian people became ill, there were very few options with which to treat them regardless of how old you were: “Lying-In” hospitals came to the fore where pregnant women would confine themselves to wait for their oncoming birth. (Thus, the use of the word “confinement” as linked to pregnancy. Just saying anything to do with a bodily function would repel well-bred Victorians for the most part.) In fact, if you were pregnant, you sort of hoped that you wouldn’t be put into one of the maternity hospitals as the mortality rate of both mother and child were significantly higher in them than outside.) Midwives were available, but had no formal training (apart from helping at other births, perhaps), and the doctors were initially opposed to formalizing the midwife profession fearing it would take money from their side of the equation… (The more things change…)

0ld-surgery_1Anesthesia was also quite a new technique, but it also increased the infection rate of the patients involved. Before anesthesia, surgery was very painful but very quick. After using anesthesia, the surgeons could take more time and care to be accurate while wielding a scalpel but the longer exposure of open wounds to the polluted air (and environment) also meant that death rates would increase for a while. Joseph Lister was the guy who helped to introduce the necessary steps in anesthesia and hygiene that would bring this death rate down. (BTW, Queen Victoria was one of the first women in the UK to ask for anesthesia during the births of some of her children. After that, there was a big trend for it, of course, when patients could afford it.)

Joseph Bazelgette, a civil engineer, was instrumental in improving the drainage in London and its surrounding areas, and in fact, when you walk along some of the embankments next to the Thames, you are walking on top of the great Victorian drains that he designed and that made such a big difference to the public’s health at that time.

“…the principal role in preventive medicine was taken, half knowingly by civil engineers…”

So, as mentioned briefly, there was a ton of good info in this book. However… (Now, I realize that this could sound nit-picky, but it still affected my reading experience nevertheless.) Halliday used different references whenever he referred to a male or female person who had played a role in this history. Men were first mentioned with first name/last name format, and then referred after that by last name only.
Women were first mentioned first name/last name format, but then referred to after that by their first names only. (So – Louis Pasteur/Pasteur or Florence Nightingale/Florence.) This irked me quite a lot as I thought it was infantilizing the women and their achievements and I was not happy with that. At first, I thought it was an editing error, but as the read continued, it was clear that it was an editing decision. My, my, my. Published in 2009 so not that old a book, so I am curious why the book was formatted in that manner…

*The word Malaria reflects this miasma theory: “Mal” is “bad” and “aria” is “air”… Fascinating when you think about it (at least to me).

The Spare Room – Helen Garner (2008)

The Spare Room book cover

This is a short spare novel (novella?) about some big questions in life regarding friendship. Where does your responsibility end with a dying friend who comes to stay with you? Where are your boundaries? And where are hers?

Garner has written a small novel (lengthwise – 175 pp) that packs a powerful punch. Helen has Nicola, a friend, to stay at her home whilst Nicola undergoes questionable cancer treatments that are expensive, hard to take, and unproven. During Nicola’s three-week stay, Helen sees her life turned upside down by her visitor and experiences a wide range of unexpected emotions from rage to tenderness as she cares for Nicola and her body ravaged by the “treatment” that she is receiving.

Reading this review so far, I think, makes this book sound horrendously sad – there are several such moments, but there are also moments of laughter, relief and a little girl who lives next door and comes to show Helen her newest flamenco dancing. This is more a story about friendship than anything. When a terminally ill and fairly distant friend comes to stay with you as you happen to live in the same town as the clinic, how much truth is ok? How do you tell your terminally ill friend that she is being irritating and difficult? How do you support her when she is in denial of how ineffective her treatments are? Is it your job to be brutally honest or do you let her keep that glimmer of hope even if you disagree with her choices?

This was a quick and intense read which has left me thinking and pondering what I would have done in a similar situation. The writing is succinct and without extra flourishes – perhaps reflecting how life’s priorities become pared down to the basics when you’re on the edge of dying. An unexpected ending finishes off this read. Good one.

Ten Days in the Madhouse – Nellie Bly (1887)

book239In the late 1880’s, a young journalist called Nellie Bly wanted to make her mark outside the usual writing restrictions accorded to most women journalists back then. (They were usually limited to the Society page and rarely given any hard news to cover.) Her editors at the New York paper The World agreed with her and so she got herself admitted to Blackwell Island (also called Welfare Island, and now called Roosevelt Island) which was America’s first municipal mental hospital. Bly wanted to prove her worth as a journalist and decided to do an expose on the conditions at the hospital and believed only by becoming admitted as a patient could the truth come out.

Charles Dickens had already previously covered conditions here in his American Notes (published in 1842) but they were from the perspective of an outsider and of a foreign traveler. This was the first time that an actual US journalist has been on the inside of the institution. (Blackwell Island has a fascinating history by the way: it was a penitentiary, a workhouse, a smallpox hospital…)

Nellie_BlyPrinted as a series of first-person narrative articles, the resulting coverage was explosive for that time and for Blackwell. Originally intended as a state-of-the-art mental institution “devoted to humane and moral rehabilitation of its patients”, funding had been cut and care had been reduced to bitter and sadistic staff and unsympathetic doctors who simply ascribed any patient claims to sanity (and thus release) as delusional. A very Catch-22 situation for all the female patients who were imprisoned there and with little hope of freedom in their future.

Bly took her project very seriously and prepared deeply for her role as a mental patient: she practiced “looking like a lunatic” in the mirror, she dressed in tattered clothing, and posing as a Cuban immigrant who could not remember her history, Bly checked into a temporary boarding house for poorer women. Within twenty-four hours of pretend irrational behavior, Bly was taken by police to Bellevue Hospital for an evaluation, and then from there, pronounced “delusional and undoubtedly insane”, taken to Blackwell. (Testing was minimal at the time and was subjective and very quick.)

Bly’s detailed account of her time at Blackwell as a mental patient are harrowing to read about – patients were stripped of clothing in corridors and publicly humiliated by the nursing staff, mandatory cold baths in dirty bath water, and appalling living conditions (little heat, poor nutrition, no activities).

“I looked at the pretty lawns, which I had once thought was such a comfort to the poor creatures confined on the Island, and laughed at my own notions. What enjoyment is it to them? They are not allowed on the grass – it is only to look at. I saw some patients eagerly…lift a nut or a colored leaf on the path. But they were not permitted to keep them. The nurses would always compel them to throw their little bit of God’s comfort away…”

It’s also notable that all the patients were female and mostly poor (some couldn’t speak English) and so were powerless in this system of neglect.

“I have watched patients stand and gaze longingly toward the city they in all likelihood will never enter again. It means liberty and life; it seems so near, and yet heaven is not further than hell.”

Any patient who stood up for herself (and the other patients) or who proclaimed her sanity was invariably labeled delusional and so hospital stays to Blackwell became hamster wheels of no release for nearly all the patients imprisoned there.”

Once Bly’s stay was over and she had been formerly released by the newspaper’s attorney, the story went public, and one month later, Bly was giving details of her experience to a Grand Jury who then visited the hospital themselves. Prior warnings to the staff had helped to clean up the place and the patients but Bly’s report lead to recriminations from the hospital doctors and to a fast-tracked funding increase of $1 million (enormous at the time).

This was a fascinating read, and was nicely complimented by my earlier reading of “Mad, Bad, and Sad: A History of Women and the Mind Doctors” by Lisa Appignanesi. (No post on that, but definitely not a reflection on the quality of the book or the author.) The treatment of mental health has come a long way in the past one hundred years or so, and Bly’s work helped to propel some of that change.