Quakers & Mental Health

Patients at the Asylum suffered from a variety of mental health issues. Due to Isaac Bonsall's lack of medical knowledge and the subjective nature of his Day Book, it is often very difficult to form a complete picture of the ailments facing a patient from the information we have. However, there are enough hints to show the variety of types of mental illness the Asylum treated. Here are the stories of some patients who show the diversity of experiences at the Friends' Asylum.

Nathan Yarnall and Mary Roberts

Nathan Yarnall and Mary Roberts both belonged to the class of patients who caused the Asylum staff the most work—they were both incontinent. Bonsall wrote frequently about the labor involved in keeping them clean. In an effort to keep Nathan Yarnall from soiling himself, Bonsall tried to shame him by making him wear a petticoat.

Nathan Yarnall's New Clothes

"The Petticoat on Nathan [Yarnall] has had the desired effect both yesterday and today which saves us much trouble. He is ashamed of it and begs for his small Cloaths [sic.] or in the place of them Trowsers [sic.]. We tell him when he learns to behave himself well his Breeches shall be returned."
-Isaac Bonsall, December 2, 1818

"[Nathan's father, a visiting manager,] was affected with seeing his Son have a Petticoat on but did not censure us and expressed a wish as it was mortifying to Nathan it should not be continued longer than necessary.
-Isaac Bonsall, December 5, 1818

Although Bonsall's treatment prevented Nathan Yarnall from soiling himself for a little while, it did not prove to be a lasting solution. Nathan Yarnall spent about 3 years in the Asylum before dying in a fever epidemic. Bonsall was unable to cure Mary Roberts either. Bonsall did not try to shame Mary Roberts into better behavior, perhaps reasoning that the method had not worked on Nathan Yarnall Instead, Mary Roberts' husband asked to take her home with him, despite her continued illness. Bonsall expressed relief at this resolution.

Mary Roberts Leaves the Asylum

"It is a great relief to [caretaker] Ruth Peirce that Mary [Roberts] is taken away on account of her filthiness and the Wing is much more comfortable now to the other Patients."
-Isaac Bonsall, January 6, 1822

Benjamin Cox

Benjamin Cox was one of the Asylum's patients who suffered from alcohol addiction. While Benjamin Cox was in the Asylum, Bonsall tried to teach him to resist temptation and conquer his addiction. Excessive consumption of alcohol was frowned upon in Quaker circles, and people like Benjamin Cox would normally have been read out of Meeting. The Asylum gave Quakers a place where addiction was treated as an illness, not a sin.

Origin of Benjamin Cox's Insanity

"Benjamin [Cox] appears so rational that we are enclined [sic.] to think that the use of intoxicating liquor has been the main cause of his Insanity. With us he does not even partake of the family small Beer. The evening he was brought he wanted Porter, Wine, and etc. none of which were given although he said he could not live without it and that while he was at the Pennsylvania Hospital he was allowed a Bottle of Porter per Day."
-Isaac Bonsall, December 2, 1818

Benjamin Cox was one of the many patients at the Friends' Asylum who had spent time at the Pennsylvania Hospital before being sent to Friends' Asylum. Benjamin Cox told Bonsall that he was grateful for the Friends' Asylum's moral treatment, which he said worked better than the medical treatment he had received at the Pennsylvania Hospital. Benjamin Cox left the Asylum six months later, cured.

Ruth Sc.

Ruth Sc. came to the Asylum incoherent and delusional. Ruth Sc. and her sister refused to believe that she was insane, but her behavior as recorded by Bonsall in the Day Book is not rational. She frustrated Bonsall by banging loudly on her door at night, and harrassing her caretakers and fellow patients.

Ruth S.'s Behavior

"[Ruth Sc.] will not be persuaded to give up her own ideas about anything no matter how absurd they may appear to others neither will she desist from importuning us to grant things which we deem unsuitable as whatever occurs to her own mind as proper to be done She considers an indispensable duty."
-Isaac Bonsall, January 7, 1822

Ruth Sc.'s delusions often had to do with religion. Bonsall never stated exactly what was unorthodox about her beliefs, but he was mortified when he took her to Meeting for Worship, and she stood to speak.

Samuel Sykes

Samuel Sykes was one of the Asylum's violent patients, but despite the threat he posed to the community, Bonsall treated him kindly, and gave him considerable freedom. Even after Samuel announced that he was being told by the Devil he had to kill Anna Bonsall, he was not locked up.

Samuel Sykes and Anna Bonsall

"Samuel [Sykes] told my Wife that he should be obliged to Kill her. He is so strongly impressed with the belief that we have concluded She must take more care of herself when with him than She has done. He thinks her a fine woman and his expectation of destroying her does not proceed from any dislike of her."
-Isaac Bonsall, January 22, 1822

This was not the first time that Samuel had expressed his intention of killing Anna Bonsall, but it was the first time that the Bonsalls seemed to think it warranted a response. The response, however, was not directed at Samuel, but at Anna. She was the one who had to be careful, while Samuel continued to have considerable freedom. Later, Samuel Sykes proved that he could actually follow through on his violent thoughts when he set fire to the Asylum basement.

Samuel Sykes and the Fire

"After [the fire] was put out our suspicion fell on Samuel [Sykes] as the Instrument who upon being questioned about it acknowledged he had done it—that he was tempted to do it so strongly he could not resist it. He has had much liberty of late. We shall be careful in future that no opportunity shall [be] afforded him to do a similar act.
Isaac Bonsall, May 1, 1822

Again, the Bonsalls gave Samuel Sykes a remarkable amount of freedom for someone with his case history. Samuel Sykes left the Asylum after nine months there, improved, although not all the way cured.

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Abraham Sharp

Abraham Sharp was one of the Asylum's depressed patients.While in the Asylum, Abraham Sharp tried to commit suicide by hanging himself. Bonsall's response to Abraham's suicide attempt shows the darker side of moral treatment:

Abraham Sharp's Punishment

"He proposed that We should drown him [as punishment for trying to kill himself] in consequence of which and in the hope it would have a salutary effect I proposed to the Doctor and Men caretakers to have the Bathing Tub nearly filled with Cold Water and put him in under a pretence [sic.] of drowning him they did so and held him under for some time. He was glad however to get out and willing to live some longer."
-Isaac Bonsall, February 13, 1821

Bonsall evidently hoped that Abraham Sharp, seeing how painful it was to die, would want to live longer. Bonsall's efforts reveal that although moral treatment was supposed to be kinder than traditional treatment of the insane, it still used fear as a method of treatment to some degree. Abraham Sharp did not try to kill himself again, but he also did not recover. He stayed in the Asylum for about 8 months, and was discharged, still "insane," into the care of his friends.

Anne Verree

Friends' Asylum admitted Annie or Anne Verree in fourth month 1821. She appears to be the first person of color admitted to the Asylum. She was a patient at Pennsylvania Hospital for 14 years before being transferred to Friends' Asylum. This might have been because she was a Quaker, a member of the Burlington, New Jersey Monthly Meeting. Isaac Bonsall, the superintendent of the Asylum at the time, also wrote that Verree "was brought up by my wife's grandfather and grandmother" (Fourth Month, 21st, 1820). This indicates that Verree's family also could have wanted her to be under their care and closer to family.

Anne Verree had an unusual stay once she was in the Asylum. When she first arrived at the Asylum she "objected to getting out of the carriage and was very unwilling to stay" (Fourth Month, 21st, 1820). She was very hesitant to live in a new place but little is known about why she would not have wanted to be there. While in the Asylum, the superintendent noted that she was "somewhat useful," in the kitchen. It appears that she was one of very few female patients who worked in the kitchen (Second Month, 21st, 1823).

Verree's medical records are quite sparse, lacking the usual details of treatment, and show that she was only "usually noisy," once in her first three years in the Asylum (Eighth Month, 1820). It is likely that she was brought to Friends' Asylum as a place to live out the rest of her life. She originally entered the Asylum at 70 years old and stayed there until her death 12 years later. The night before she passed away the superintendent remarked that she appeared "to be sinking under the effects of old age (Twelfth Month, 26th, 1832).

The Case Against Friends Asylum: Morgan Hinchman and Asylum Exposés

Asylums in America, as enthusiastically as they were embraced in the first half of the 19th century, faced an equally energetic environment of suspicion and fear beginning in the last few decades of that same century. As optimism about the curability of mental illness fell, asylums became associated with images of unjust imprisonment and cruel treatment, thanks in large part to the frequency of exposés and frightening stories about mental institutions that seized the public’s attention and imagination. Published in 1908, Clifford W. Beers’ book A Mind That Found Itself was a bestselling account of his hospitalization for depression and paranoia in two separate institutions and the serious maltreatment he received at both a public and private asylum.[1] In 1887, Nellie Bly faked insanity in order to be admitted to New York’s Women’s Lunatic Asylum, and investigated the abuse and neglect of patients there, eventually publishing her experiences as a series of newspaper articles, “Ten Days in a Mad-House.”[2] Elizabeth Packard was committed to an asylum against her will in 1860 by her husband, after she argued with him about religion, the raising of their children, and his support of slavery -- even after she won her own release, he was still able to claim all of their shared property and custody of her children without leaving her any legal recourse. Packard successfully campaigned in several states throughout the 1860s and 1870s to establish new legal protections for those committed to psychiatric institutions as well as to expand the legal rights of married women. Her experiences and efforts for legislative reform were widely reported on, and she published many books during her lifetime that discussed the potential for unjust commitment and the stripping of legal rights entailed by the asylum system[3].

These are only some of the most famous of the many high-profile scandals that struck asylums and challenged the methods of moral treatment during the last decades of the 19th century. Friends Asylum also had its own experience with a high-profile scandal and legal exposé -- however, this event occurred before these had become common. In some ways, the case of Morgan Hinchman set a precedent for the later pattern of attacks against psychiatric institutions in the courts or the press, revealing some of the medical and legal weaknesses in the diagnosis of mental illness at Friends Asylum, not to mention more generally at hospitals practicing moral treatment.

Morgan Hinchman was a 30 year old farmer and a member of the North Meeting of Friends in Philadelphia, and according to doctors’ records he had been suffering from “mania” for five years prior to his entering Friends Asylum. On January 7, 1847, Hinchman was committed to the Asylum by friends and family. On July 6 of the same year, he was discharged, and in 1849 he brought a lawsuit against his wife, his sister-in-law, his family physician, the men who brought him to the Asylum, the sheriff who agreed that committing him was legal, and many of the medical staff and leadership of the Asylum itself -- accusing them all of being part of a conspiracy to seize and sell off his property[4].

The defendants seemed to have a strong case. There was no short supply of testimony as to Hinchman’s unusual, erratic behavior and beliefs -- including a history of paranoia towards his wife’s family, stealing money from a local bank, his belief that he had committed terrible sins and was sick with syphilis, and seemingly false memories about his own relatives. Family members and longtime acquaintances all testified to these and more, and Dr. Charles Evans, attending physician at the Asylum, discussed in Hinchman’s patient record how Hinchman had a history of violent passions, especially directed against his wife Margaretta. His commitment had come about because he had ceased being able to contain these outbursts to times when he was alone with Margaretta while remaining “generally kind to her in the presence of strangers,” and that soon before his commitment he had also “lately manifested insanity… by making foolish bargains, by forgetfulness, and by staying out at his work the better part of the night.” This was also borne out by correspondence among Hinchman’s own family and his wife’s family, with letters between his immediate relatives expressing concern at his worsening state and discussing the need to have Hinchman taken to an institution for the insane, as well as discussing “means of preserving Morgan’s property” against his delusions[5].

Despite what might seem to be a strong case for the defense, the court ruled in Hinchman’s favor, after a trial that lasted over a month, drawing significant media coverage and packing the courtroom with interested spectators each day. The ruling came down not to the strength of Hinchman’s case, but because Hinchman had been committed and treated for “moral insanity,” the derangement of moral faculties without necessarily lacking in reason. Moral insanity was both a medical and legal concept -- it was a legal explanation for why people were suitable for commitment if they were “perfectly rational upon several subjects, but labour under a permanent delusion as to one or more,”[6] but it was also a medical theory positing that a person's emotional and moral sensibilities could become afflicted by disease in the same way that the powers of reason became diseased in the case of insanity. The idea of moral insanity was a foreign one to the jury members in the Hinchman case, and Hinchman’s attorney David Paul Brown was able to attack the medical theory of moral insanity as being poorly defined and unsupported. According to Brown, it was “nothing more than a division formed by metaphysicians, of intellectual insanity.”[7] It was the inability of the medical staff of Friends Asylum to satisfactorily use the abstract and poorly defined theory of moral insanity to explain the symptoms Morgan Hinchman displayed that ultimately led to the jury deciding in his favor.

The case also attracted substantial attention from the press. The Public Ledger of Philadelphia published an editorial during the case discussing the widespread public sympathy for Hinchman, as well as harshly criticizing the concept of moral insanity as a vague academic term that could be used to justify depriving individuals of their rights. The newspaper stated that only total insanity should justify institutional commitment, stating that “Partial insanity is the disease of mankind, not of an individual… Upon this rule, every man in society may at sometime in his life be deemed insane.” The Quaker newspaper The Friend was sympathetic to the defendants, but still criticized the moral insanity plea.[8]

In the end, all the defendants from Friends Asylum were acquitted, but Hinchman’s family and acquaintances were still decided against and made to pay damages. The case did not overturn the precedent that had been established allowing individuals to be committed to an asylum for cases of partial insanity rather than total insanity, but it did destroy the credibility of the concept of “moral insanity”, leading to the Asylum ceasing the use of the diagnosis in 1850. It also set the stage for further lawsuits and arguments against asylums in the future to use the fear of unjust confinement as an effective strategy -- “A Modern Lettre de Cachet,” an influential article published in 1868 about the lack of sufficient legal protections for people being considered for institutionalization, explicitly mentioned how easy it was for Morgan Hinchman to be confined in 1847 at the Asylum.[9]

Case Study of Emily B.

Emily B. was admitted in 1896 for mania; however, it was not her manic tendencies which gave staff at Friends Asylum the most cause for concern, but rather her habit of masturbation, which was considered to be indicative of nymphomania (excessive sexual desire), a condition which was considered both morally unacceptable and medically pathological in the nineteenth century.1,2 On two consecutive days, Emily “had hot astringent vaginal douche and was put to bed very loosely restrained in a camisole to prevent filthy habits.”3,4 Prior to this, Emily had been restrained only when it was feared she would injure other patients. Restraint was rare at Friends Asylum, which espoused moral treatment; the use of it in Emily B. 's case thus demonstrates the perceived severity of her masturbatory habits.5 A few months later, after regular application of restraint, vaginal douches, and more standard elements of moral treatment such as exercise and visiting with other patients, the writer of Emily’s case history noted that she still “continues masturbation unless watched and sleeps in a very loosely applied camisole to prevent self-injury.”6

Case histories of patients are generally described using neutral, medical language. Even accounts of destruction of property or violence towards others are not described using language that indicates disapproval from the writer. However, that pattern was broken several times in Emily’s case. Her masturbation is described not only as “filthy,” but also as “abusive,” indicating the disdain of the person writing her case history and demonstrating the belief that she was damaging or further sickening herself by masturbating, which is in line with nineteenth-century conceptualizations of masturbation as pathological and injurious to both physical and mental health.7 All aspects of Emily’s treatment, from the restraints used on her to the language of her case history, demonstrate the highly concerning nature of her actions in the eyes of the Asylum staff.

1. Case History of Emily B, Case Histories, 1893-1899, Box 20, Folder 4, Friends Hospital Records, Quaker and Special Collections, Haverford College, Haverford, Pennsylvania.

2. Diane Mason, The Secret Vice: Masturbation in Victorian Fiction and Medical Culture, (Manchester; New York: Manchester University Press) 2008.

3. Case History of Emily B.

4. Note: camisole was another way to refer to a straitjacket.

5. Abby Corcoran, “A Mild and Appropriate System of Treatment: Moral Treatment and the Curability of Mental Illness at Friends Asylum,” Quakers and Mental Health Project, http://qmh.haverford.edu/.

6. Case History of Emily B.

7. Mason, The Secret Vice.

Hannah Jones Case Study

Hannah Jones was admitted to the Friends Asylum on the Fifth Month 27th, 1817, and she was the second patient admitted to the Asylum. Isaac Bonsall wrote extensively about her stay at Friends Asylum in his daybook, most likely because her behavior was the most noteworthy compared to other patients in the Asylum at the time, being one of the more “troublesome” patients compared to the others.1 She was often very violent and was confined to her room and/or physically restrained.

Jones’ illness caused her to be very noisy and violent, but she did not have a tendency to harm herself or others.2 She experienced periods of both calmness and violence.3 During the violent periods, she broke window panes, furniture, lights, and “every thing she can get hold of that will break.”4,5 When asked why she broke the window panes one night, she answered “because she was confined” to her bedchamber and she was not accustomed to confinement.6

Because of her aggressive behavior, Jones was often confined to her bedchamber and her movement restricted using hand straps or the straight waistcoat. Bed straps were used to confine her to her bed at night.7 At times, these restraints were used as punishments to deter her from causing any further damage. In addition, the staff ensured that Jones wouldn’t break anything else by physically restraining her. Occasionally, she was allowed to roam free without restraints if she had behaved well or promised not to be destructive.8 Despite the Asylum’s preference for methods of non-restraint, physical restraint was used liberally during this time compared to later years (see page on Early Usage of Physical Restraint and Seclusion).

Many methods were used to treat Jones’ illness, including blisters, shower baths, warm baths, and cupping. The results of these treatments were mixed; sometimes they seemed to have a calming effect and she became less aggressive, sometimes they had no effect.9 Starting in the Second Month of 1818, Jones had shown great improvements and seemed to have a “sane mind.”10 She was discharged on Fifth Month, 16th, 1818.

Jones was readmitted as a patient a year later on Fifth Month, 6th, 1819, and she seemed to be even more troublesome than before. On one occasion, she “got her Person and the room in more dirty trim than we ever knew her to do at any time before.”11 Her condition did not improve. After a year, her health deteriorated and she died at the Friends Asylum on Eleventh Month, 21st, 1820, surrounded by her family.

1. Superintendent Daybook Vol. 1, 1817-1820 Item 61, Fifth Month, 28th, 1817, Friends Hospital Records, Quaker and Special Collections, Haverford College, Haverford, PA.

2. Medical Register, 1817 - 1820, p. 4.

3. Medical Register, 1817 - 1820, p. 4.

4. Superintendent Daybook Vol. 1, 1817-1820, Fifth Month, 28th, 1817.

5. Medical Register, 1817 - 1820, Seventh Month, 22nd, 1817.

6. Superintendent Daybook Vol. 1, 1817-1820, Fifth Month, 28th, 1817.

7. Superintendent Daybook Vol. 1, 1817-1820, Fifth Month, 30th, 1817.

8. Superintendent Daybook Vol. 1, 1817-1820, Sixth Month, 6th, 1817.

9. Medical Register, 1817 - 1820, Eighth Month, 6th, 1817.

10. Superintendent Daybook Vol. 1, 1817-1820, Second Month, 19th, 1818.

11. Superintendent Daybook Vol. 1, 1817-1820, Sixth Month, 6th, 1819.

Unusual Deaths in Friends Asylum in the Late 1800s

While most of the patients admitted to Friends Asylum were eventually discharged or moved to a different mental institution, a number died within its walls. Causes of death ranged widely: “exhaustion due to organic brain disease,” tuberculosis, and “general paresis” are only a few of many.1

The majority of deaths at the Asylum were due to illness; a small number of patients, however, died from accidental injuries. For example, Sarah M. Elkins, a patient admitted to Gurney Cottage[1] in 1887, met with an “unfortunate accident in falling from the second-story porch;” she initially appeared only to have fractured an arm but died several days later.2 In this case, as in others, the Asylum was careful to deny any blame for her death, claiming that her death “would have occurred at any rate before long” due to her preexisting brain disease.3 A second, darker, accidental death occurred in 1894, when Ebenezer Dickey was involved in an altercation with another patient, Frank Savage, and ended up “receiving injuries of the head so severe in character that he died in twenty-five minutes after the assault.”4 While the details of this incident were reported in full by the superintendent to the Board of Managers, the only hint of it in the published Annual Report is a death attributed to “traumatic cerebral hemorrhage” in a table listing causes of death for the year.5

Friends Asylum closely monitored patients who exhibited suicidal tendencies. Tragically, deaths by suicide still occurred with some regularity.6 After a six year period from 1889 to 1895 in which four patients died by suicide, the Asylum received a letter from the Committee on Lunacy calling for greater care in preventing suicide in patients with melancholia.7 Reports from the superintendent and the Board of Managers were quick to assert that all possible precautions had been taken to prevent self-harm, but in at least one instance the attendant in charge of a patient who died by suicide was fired, potentially indicating some responsibility.8 Like the death of Ebenezer Dickey, some suicides were not made public. Some are categorized as suicides in the Annual Reports, but others are either not listed at all or described in unclear terms.9 The secrecy surrounding deaths by suicide and accidental deaths, as well as the denial of blame for these incidents, demonstrates the desire of the Asylum staff and managers to both avoid culpability for preventable deaths and portray the Asylum as a safe institution.

1. Minutes of the Board of Managers, 1870-1901, Items 5 and 6, Friends Hospital Records, Quaker and Special Collections, Haverford College, Haverford, Pennsylvania.

2. Minutes of the Board of Managers, Ninth Month 1887.

3. Ibid.

4. Minutes of the Board of Managers, Twelfth Month 1894.

5. Annual Reports, 1894, Box 2, Friends Hospital Records, Quaker and Special Collections, Haverford College, Haverford, Pennsylvania.

6. Notes: as per guidelines listed by the Movement Advancement Project on the Suicide Prevention Resource Center, the language of “died by suicide” is used as opposed to “committed suicide.” See https://www.sprc.org/resources-programs/talking-about-suicide-and-lgbt-populations for more information.

7. Minutes of the Board of Managers, Seventh Month 1895.

8. Minutes of the Board of Managers, Ninth Month 1890.

9. Annual Reports, 1870-1902, Box 2.