- Explain 19th-century physical and mental health reforms in terms of background, goals, and results
Physical Health & Lifestyle Reforms
Beyond temperance, other reformers looked to ways to maintain and improve physical health in a rapidly changing world. Without professional medical organizations or standards, health reform went in many different directions and was not regulated. Although the American Medical Association was formed in 1847, it did not have much power to oversee medical practices and the result was that, too often, quack doctors prescribed regimens and medicines that did far more harm than good. For example, during the cholera outbreak in Europe between 1829-1851, it was commonly believed in the U.S. that eating red meat and drinking sweet wine would protect against the disease while eating vegetables would cause one to become susceptible to it.
Grahamism and the Health Craze
One man, Sylvester Graham, strenuously objected to the notion that meat and wine would prevent cholera, and instead preached that it was a diet of vegetables, whole grains, and water that would protect people. A Presbyterian minister, Graham began his career as a temperance reformer, lecturing against the evils of strong drink. He combined an interest in temperance with vegetarianism and sexuality into what he called a “Science of Human Life,” calling for a regimented diet of more vegetables, fruits, and grain, and no alcohol, meat, or spices.
Graham advocated for the idea that a gluttonous diet of meat and other heavy foods was as detrimental to the physical and spiritual health of individuals as alcohol was. He believed anything physically pleasurable, such as rich food, alcohol, or sex, caused the breakdown of the soul, the character, and eventually the family unit. He prescribed an austere lifestyle and diet to his followers, condemning the use of spices (which he called “stimulants”), and insisting on hard beds and cold baths. “Graham crackers” were invented by one of his followers as a healthy snack food for those who followed Graham’s regimen. While Graham happened to be correct about many of these dietary theories, he was hardly a medical professional and some of his practices were questionable at best considering the lack of nutritional supplements for vegetarians in the 19th century. Graham himself died at the age of 57 after taking an opium enema on the advice of his own doctor.
John Harvey Kellogg
Graham’s ideas influenced other health advocates like John Harvey Kellogg, who first marketed Kellogg’s Cornflakes as a breakfast cereal and anaphrodisiac. Kellogg promoted a stringent regimen similar to Graham’s involving exercise, sunlight, vegetarianism, and temperance. However, Kellogg’s primary focus was on mental health as an extension of physical health. Unlike Graham, Kellogg did hold a medical degree and in 1877 he founded the first “sanitarium,” which operated as a medical hospital, a health retreat, and a psychiatric facility.
Kellogg was a member of the Seventh-Day Adventist Church and many of his ideas about health were based on scripture or the church’s belief in the imminent Second Coming of Christ. He was progressive in the fact that he often attempted to reconcile religion and science, was one of the first proponents of germ theory, and created the first patented meat substitute, which was mostly made from peanuts. He also helped to develop light therapies, hydrotherapies, and mechanical vibrating massagers that are still used today.
However, in spite of his progressive health reforms and discoveries, Kellogg was a life-long believer in eugenics and founded the Race Betterment Foundation in 1906, using funds from the Battle Creek Food Company (a forerunner of the current Kellogg’s brand) to host eugenics conferences and create a eugenics registry. Kellogg was also a proponent of the forced sterilization of mentally ill individuals and implemented the practice at the Battle Creek Sanitarium. He promoted his eugenics agenda as a member of the Michigan Board of Health.
The eugenics movement was a popular attempt at physical health and societal reform in the 19th century which, despite its good intentions, was overtaken by racism, medical malpractice, and abuse. Eugenicists believed that the human race could be improved through the selective “breeding” of people with desirable genetic traits, good physical health, and qualities like high intelligence or good work ethic. It was generally believed that social problems like mental illness, criminal proclivities, poor health, laziness, and generally “undesirable” aspects of humanity could be cured.
In order to achieve this goal of human perfection, many U.S. institutions formed and supported eugenics programs. Because of pre-existing ideas of racial superiority, eugenicists in the U.S. primarily concerned themselves with preventing White Americans from marrying or “inter-breeding” with non-White Americans by lobbying for anti-miscegenation laws (laws that prohibit interracial marriage or intimate relationships) and restrictive immigration laws. Anti-miscegenation laws were not declared unconstitutional by the Supreme Court until 1967 with the Loving v. Virginia decision.
Another target of eugenicists was women who were deemed “undesirable.” The concern for eugenicists was that these Black, Native American, Hispanic, and Asian/Pacific Islander women would either inter-marry with Whites and create mixed-race children who would be physically, mentally, and morally “inferior” to White children, since it was a common belief at the time that Anglo-Saxon and Nordic genetics were superior to others. The other concern for White eugenicists was that these women would produce more and more children and that the White race would become outnumbered by non-Whites. Poverty overwhelmingly affected women of color during the 19th century, and some women’s rights advocates like Margaret Sanger, the founder of Planned Parenthood, used the language of eugenics to advocate for poor women to have easier access to birth control. While Sanger’s intentions were to alleviate poverty by giving women control over their family size, she placed her clinics in areas with high populations of racial minorities, which made many believe that her programs were racially motivated.
To this end, many White doctors also refused sterilization procedures and birth control methods to middle and upper-class White women. “Better Baby” contests were held, awarding cash prizes to babies who best fit certain physical standards, however, Black and immigrant families were banned from entering their children in the contests. This idea extended to “Fitter Family” contests, sponsored by the Red Cross, where entire (White, middle-and upper-class) families were judged on their physical attractiveness and health and could be disqualified if there was a family history of mental illness or alcoholism.
Toward the end of the 19th century, the U.S. began to pass compulsory sterilization laws in order to progress the eugenics agenda. These statutes required the medical sterilization of “unfit” populations, such as those who were institutionalized due to mental illness, or people with congenital deformities, the deaf, blind, and those with epilepsy. The sterilization programs also took place in both women’s and men’s prisons in order to eliminate the criminal mindset, which was thought to be genetic, from the population. Any type of behavior considered to be a deviation from the norm could land a woman in an institution where sterilizations were performed, including homosexuality, prostitution, extramarital affairs, or “hysteria,” which was thought to be a disease caused by female hormones that cause women to be more outspoken, stubborn, or manic. Many institutions and hospitals practiced “passive euthanasia,” allowing mentally ill patients or newborn babies with congenital defects to die of neglect or starvation.
Although this attitude of racial and genetic superiority may seem like an unfamiliar and distant thing, the Supreme Court ruling in Buck v. Bell (1927) affirmed a state’s rights to sterilized “feeble-minded” people. In his decision, Justice Oliver Wendell Holmes Jr. wrote: “Instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes.” The Buck v. Bell ruling has never been explicitly overturned. Forced sterilizations of Native American women took place up until 1976 and an estimated 25-40% of Native women in the U.S. were sterilized without their consent between 1973 and 1976 alone.
Mental Health Reform & the “Science of the Mind”
Phrenology and Psychology
During the early nineteenth century, reformers also interested themselves in the workings of the mind in an effort to better understand the effects of a rapidly changing world awash with religious revivals and democratic movements. Phrenology—the mapping of the cranium to specific human attributes—stands as an early type of science devoted to understanding how the mind worked.
Phrenologists believed that the mind contained thirty-seven “faculties,” the strengths or weaknesses of which could be determined by a close examination of the size and shape of the cranium, thus predicting a person’s personality traits. Initially developed in Europe by Franz Joseph Gall, a German doctor, phrenology first came to the United States in the 1820s. In the 1830s and 1840s, it grew in popularity as lecturers crisscrossed the republic and also became a form of popular entertainment. Phrenology readings would be held in public and people’s “results” announced to the crowd. Phrenology measurements were also used in schools to determine which children would be susceptible to behavioral problems or learning issues. One French psychiatrist, Felix Voisin, also proposed phrenology as a method for determining which individuals harbored criminal tendencies so that they could be “corrected” or rehabilitated before they had even offended, as well as for determining the length of prison sentences, giving lighter sentences to those with “better” readings.
As you can imagine, phrenology could be used to legitimate a wide variety of eugenics programs, racial discrimination, gender discrimination, and the general oppression of those deemed “less favorable.” Luckily, it fell out of favor with both the public and the scientific community during the 1840s and was already being referred to as pseudoscience by the turn of the century.
The popularity of phrenology offers us some insight into the emotional world of the antebellum United States. Its various applications speak to the desire of those living in a rapidly changing society, where older ties to community and family were being challenged, to understand one another. It appeared to offer a way to quickly recognize an otherwise unknown individual as a readily understood set of human faculties.
Link to Learning
Map the brain! Check out all thirty-seven of phrenology’s purported faculties of the mind.
Early American psychology was focused primarily on the discipline of parapsychology (or the study of the mind’s psychic abilities). The 19th century saw an explosion of interest in the metaphysical, paranormal, and psychic “arts” such as spirit channeling, seánces, telepathy, and hypnosis. Originally, psychologists studied the ability of the human mind to understand things beyond the physical realm. Eventually, psychological science moved toward attempting to understand the nature of human consciousness, memory, personality, development, and mental abnormalities. 1883 saw the opening of the first experimental psychology laboratory at Johns Hopkins University, and many other universities followed suit, including Princeton University, which opened its own famed Department of Psychology in 1924.
In 1890, a physiologist named William James published a two-volume work entitled The Principles of Psychology, which established some of the first basic principles of psychological thought. James had previously argued that human consciousness must serve an evolutionary purpose since at some point humans were separated from animals by our brains. In The Principles of Psychology, James presented the argument that human behavior was a combination of instinct, experience, and memory, rather than only experience and memory as some scientists had previously argued. Before the advent of experimental psychology and technology like CAT scans and MRIs, James’ version of psychology was mostly based on observation and had a philosophical tilt. However, some of his ideas, such as stream of consciousness, are still relevant in psychology today.
Cure-Alls, Quacks, and Snake Oil
Along with the health reform craze of the 19th century came a wave of products and advice that tried to take advantage of the fad. There was no equivalent of the Food and Drug Administration in the U.S., so amateur chemists and salesmen starting creating and hawking elixirs, lotions, tonics, and pills that could cure specific ailments or act as a panacea, or cure-all. These medicines often included such basic ingredients as mineral oil, tallow (fatty grease), herbs, and spices, while some also contained cocaine, opium, alcohol, and amphetamines. These concoctions were often sold as “snake oil,” because it was a commonly known fact that Chinese railway workers sometimes used traditional medicine containing water snake oil to alleviate aches and pains.
These dubious products were marketed as a cure-all by traveling salesmen who went from town to town giving public speeches about the value of their products and using titles like Doctor or Professor in order to make themselves seem professional. They often employed a person called a shill, who would stand in the crowd and call out a positive testimonial about the product as a way to bolster sales. These operations would then sell as much as they could and leave town before people could realize that they had been scammed. Today, the phrase “snake-oil salesmen” is used to refer to people who sell shady, unlicensed, untested, or ineffective products or who engage in general health fraud.
Reforming Mental Health Treatment
As early as the 18th century in Britain, mental health became a topic of public conversation. King George III, sometimes called “Mad King George,” experienced mental health struggles and went into remission in 1789, triggering the widespread public idea that “lunatics” could actually be cured. The French doctor Phillippe Pinel was the first to suggest that mental health patients who had been institutionalized should not be chained in dark rooms, but instead allowed to roam more freely and be allowed outdoors. Public asylums had existed in England since the mid-1600s, when the state realized that many families could not care for mentally ill family members alone, and imprisoning the mentally ill was not tenable. The first American mental hospital opened in Philadelphia in 1751, under the supervision of the Quaker community, who had long been involved in mental health treatment reform.
In the 1840s, a woman named Dorothea Dix was hired to teach classes to female prisoners. While at the facility, she realized that many of the women were mentally ill and were being treated as criminals, with four of the women being locked in the basement and treated worse than animals. Dix began an investigation into the facilities for the mentally ill in her home state of Massachusetts and eventually brought her findings before the state legislature.
Memorial to the Legislature of Massachusetts, 1843
An excerpt from Dorothea Dix’s report to the state legislature of Massachusetts describes the conditions in which mental health patients found themselves:
“If I inflict pain upon you, and move you to horror, it is to acquaint you with sufferings which you have the power to alleviate and make you hasten to the relief of the victims of legalized barbarity . . . . A woman in a cage. One idiotic subject chained, and one in a close stall for seventeen years. One [person] often doubly chained, hand and foot. . . . One [person] often closely confined; now losing the use of his limbs from want of exercise . . .
There she stood, clinging to or beating upon the bars of her caged apartment. . . . which afforded space only for increasing accumulations of filth, a foul spectacle. There she stood with naked arms and disheveled hair, the unwashed frame invested with fragments of unclean garments. . . . . Irritation of body, produced by utter filth and exposure, incited her to the horrid process of tearing off her skin by inches. Her face, neck, and person were thus disfigured to hideousness. She held up a fragment just rent off. To my exclamation of horror, the mistress replied: ‘Oh, we can’t help it. Half the skin is off sometimes. We can do nothing with her; and it makes no difference what she eats, for she consumes her own filth as readily as the food which is brought her.'”
Dix conducted a similar investigation in New Jersey and her lobbying in both states resulted in increased funding for mental health treatment. She repeated her work in many other states and even presented a federal bill in 1854 for the government to set aside over 12 million acres for the care of mentally ill patients. The bill was vetoed by President Franklin Pierce, but Dix did not give up her crusade. She traveled to Europe to work on reforming mental health treatment there and in 1857 she was granted an audience with Pope Pius IX, who visited an asylum with her and was horrified at the conditions. When the Civil War began, Dix was named the Superintendant of Army Nurses for the Union and was one of the only leaders who allowed her nurses to care for wounded Confederates on the battlefield.
The 19th century saw great leaps forward in mental health treatment. Many institutions did away with restraints and corporal punishment for patients and some even began using rudimentary forms of psychiatric therapy, occupational therapy, and even art therapy. Many patients were assigned jobs around the hospital to give a sense of normalcy and purpose. However, there was still a myriad of issues to be addressed. Barbaric treatments like electroshock therapy and lobotomies continued, poor and working-class individuals received lower-quality care, and many patients were still mistreated by individual doctors and orderlies. Asylums became overcrowded because of the widespread popular culture image of mental illness and many people were deemed insane when they became socially or financially problematic for their families. Women specifically were often institutionalized for breaking social norms, displeasing their husbands, or for suffering from things like postpartum depression and failing to properly bond with their children. One female journalist, Nellie Bly, had herself committed in order to write about asylum conditions simply by faking amnesia. Her report, Ten Days in a Mad-House, exposed some of the brutal treatment of female mental patients, prompting Bly to ask “what, excepting torture, would produce insanity quicker than this treatment?”
anti-miscegenation laws: statutes or federal laws prohibiting racial or ethnic intermarriage and sometimes prohibiting interracial sexual relationships
compulsory sterilization: the involuntary or coerced sterilization procedure performed on individuals for the purposes of preventing them from producing offspring, used in the U.S. up until the mid-20th century; this could be done for a number of reasons, including intellectual or physical disability, as a condition of criminal probation or as a criminal punishment, or to prevent racial minorities from producing more children
Dorothea Dix: a 19th-century mental health reformer and nurse who championed the improvement of living conditions at asylums in the U.S. and Europe; she was responsible for investigations of the horrific conditions at mental health facilities and convinced many state legislatures to increase funding to these places; she also served as the Superintendent of Army Nurses for the Union during the Civil War
eugenics: the belief and practice of genetic purity, wherein the human population can become stronger and healthier by preventing people with “undesirable” traits from breeding; it is often racially motivated and many eugenicists pushed for bans on “race-mixing”; state-sponsored eugenics programs have included everything from registries to segregation to forced sterilizations to ethnic cleansing and genocide
germ theory: a medical theory that was proposed in the Middle East as early as 1025, but was not widely accepted in Europe until the 19th century; this theory, which is fully accepted today, holds that many diseases are caused by microorganisms (pathogens) that invade the body, which can include both bacteria, viruses, and even fungi
John Harvey Kellogg: another 19th-century physical health reformer, Kellogg promoted similar dietary restrictions as Graham, along with exercise and hydrotherapy, and was an early proponent of germ theory; he was also a dedicated eugenicist who believed in racial segregation and sterilization of the “mentally unfit”
Margaret Sanger: an early proponent of birth control and the founder of Planned Parenthood; Sanger was key in pushing the development of the first birth control pill
panacea: a cure-all, or treatment that can alleviate any and all ailments
parapsychology: the study of psychic phenomena such as hypnosis, spirit channeling, paranormal visions, and telepathy
phrenology: a pseudoscience involving measuring the bumps and size of a person’s skull in order to predict personality traits
Sanitarium: a term coined by Kellogg to refer to his health retreat model, where patients, including the mentally ill, would be treated holistically with diet, exercise, and medication
Sylvester Graham: one of the key physical health reformers of the 19th century; Graham championed the idea of a vegetarian diet, temperance, sexual restraint, and other austere lifestyle changes in order to improve longevity
- Andrew Smith, Eating History: 30 Turning Points in the Making of American Cuisine (New York: Columbia University Press, 2009), 29. ↵
- Edwin Black. “Eugenics and the Nazis -- the California Connection.” SFGATE, January 15, 2012. https://www.sfgate.com/opinion/article/Eugenics-and-the-Nazis-the-California-2549771.php. ↵
- Sally J. Torpy; Native American Women and Coerced Sterilization: On the Trail of Tears in the 1970s. American Indian Culture and Research Journal 1 January 2000; 24 (2): 1–22. doi: https://doi.org/10.17953/aicr.24.2.7646013460646042 ↵
- Dorothea Lynde Dix. Memorial. To the Legislature of Massachusetts protesting against the confinement of insane persons and idiots in almshouses and prisons. [Boston, Printed by Munroe & Francis, 1843] Web.. https://lccn.loc.gov/11006306. ↵