By — Manya Mittal
Abstract
Historically, psychiatric institutions have been defined as oppressive spaces designed to enforce institutional conformity and validate the epistemic authority of medical professionals. However, a re-examination of asylum archives reveals a vibrant albeit heavily policed undercurrent of patient agency. Confined patients actively subverted medical authority and penned counter-narratives of sanity using diaries and smuggled letters. They exposed the subjective nature of psychiatric diagnosis by weaponising the administrative apparatus meant to contain them, repurposing literacy as a tool of self-expression. This article explores the mechanics of patient resistance within historical asylums, demonstrating how text and behavioral subversion functioned as profound assertions of sanity against a push of institutional erasure.
Introduction
The rise of the modern asylum system across Europe and North America during the late-eighteenth and nineteenth centuries were heralded as a success of humanitarian reform and medical science. Propagated by the principles of “moral treatment”, these institutions promised to replace the chains of the past with psychological introspection, behavioral conditioning and care. Andrew Scull states that the advent of moral treatment resulted in something more and something less than the triumph of humanism and of therapy, a recognition that kindness, reason, and tactful manipulation were more effective in dealing with the inmates of asylums than fear, brutal coercion and restraint, and medical therapy. Tuke’swhole system crucially depends upon “treating the patient as much in the manner of a rational being as the state of his mind will possibly allow.” Moral treatment held that if treated like rational beings, the insane would behave in kind to foster the return of reason and self-control.
In practice, however, these asylums quickly cemented themselves into institutions of social control. Within its walls, medical superintendents held unassailable authority. They insisted on the importance of internalisation of norms and the conception of how this was to be done. Every aspect of a patient’s behaviour was translated into symptoms of underlying pathology by the medical gaze. According to Foucault’s theories, disease came to be seen as a process of change and dissolution that occurred in, and which could be seen in, the body. The body became open to the “gaze” of the physician. The new method relied on the ability of the physician to translate pathological symptoms of a patient into a language of recognizable signs.
Compliance was read as evidence of ongoing illness or recovery depending on convenience, while protest, anger, or disagreement were reinterpreted as symptoms of “moral insanity” or hysterical delusion. To argue against one’s confinement was to prove one’s madness.
Pathologizing Protests
One must first understand the pervasive nature of the epistemic trap (an institutional construct where the asylum administration held a total monopoly on defining truth and rationality) set by the asylum administration to understand the magnitude of patient subversion. Medical records demonstrate that alienists viewed insights as the primary benchmark of mental restoration, specifically, the patient’s agreement with their psychiatric diagnosis. John Haslam argued that the practitioner’s own mind must be the criterion, by which he infers the insanity of any other person. Doctors often adopted a subjective standard of sanity, declaring persons sane or insane according to the “rightness” of their opinions and thoughts. If they discovered any feeling which they consider disproportionate to its cause- any singularity of mood or manner, which they believed to be morbid, they pronounce the patient to be of unsound mind, and then infer, as a necessary consequence, that he ought to be confined. Every aspect of a patient’s daily demeanor was subjected to intense clinical scrutiny and decoded as evidence of underlying mental pathology. Every detail of the patient’s daily routine was controlled by the superintendent.
Consequently, any attempt to appeal to reason outside the asylum walls was intercepted and reframed. Letters addressed to magistrates, politicians or family members detailing physical abuse, administrative neglect, or wrongful incarceration were frequently withheld by medical authorities. Dr. Thomas Kirkbride claimed that a “one man rule” was necessary to control every facet of the asylum.
Faced with systemic silencing, patients realized that conventional compliance or polite requests were futile. Reclaiming sanity required radical methods of communication and subversion. Inmates had to invent alternative channels to bypass the institutional censors, creating an underground communication network.
Smuggled Letters To The Public
One of the most potent weapons in the patient’s arsenal was the illicit letter. Denied access to standard postal routes, patients bribed sympathetic attendants, enlisted newly arrived or discharged patients as couriers and hid written appeals in the seams of clothing, laundry baskets or food trays. Arlene S. would make her way to the reception room of her locked ward where visitors were admitted and speak to them under the door to take an interest in her and try to help.
These letters served a dual purpose: they were cries of help for physical liberation and profound epistemological counter-narratives. When Elizabeth Packard was committed to the Illinois State Hospital in the 1860s by her husband due to theological disagreements, she recognized that her medical incarceration was an effort to silence her independent voice. Elizabeth believed that her husband, blinded by religious bigotry and notions of male dominance, chose to send her to an asylum as a substitute for the disgrace of divorce. While locked away, she carefully manufactured writing materials from scraps of paper and smuggled letters to outside reformers and legal allies. Her privileges were denied to her, including the use of writing materials and the right to send and receive private communications through the mail. Upon her eventual release, she published these documents alongside her institutional experiences in works like Marital Power or The Rights of Women Defended. These were a powerful adjunct to her oral arguments for tightening the commitment laws. Her main theme was that insane asylums pretended to be therapeutic institutions but were in fact prisons where patient rights were trampled upon by officers endowed with irresponsible powers.
By making their cases public, patients ruptured the impermeable seal of the asylum, forcing the outside world to confront the violent contradictions hidden behind the institution’s philanthropic facade. The popular press turned the grievances of patients into sensational readings.
Clandestine Diaries
While letters looked outside the medical institution for legal and public liberation, diaries turned inward, serving as private sanctuaries for preservation. Keeping a diary inside an asylum was a dangerous act of defiance. If discovered, notebooks were confiscated, mocked by staff or interpreted as evidence of obsessive- compulsive fixations/paranoia. Despite these risks, many inmates maintained secret journals on scraps of writing paper, margins of books or discarded sheets. These diaries acted as an anchor for the fragmented self, providing a space where the patient could maintain narrative control over their own identities.
While inmates were promised the hope of cure, safety, entertainment and medical care in a comfortable environment attended by a staff with saintlike virtues, in texts, patients audited their daily experiences, critiqued the cruelty of the staff and analysed the psychological toll of institutionalisation. They recorded instances of physical abuse being disguised as treatments, including lobotomies, intramuscular injections of salvarsan, insulin and metrazol shocks. By documenting the irrational behaviours of the keepers, patients constructed yet another scathing counter-narratives in addition to letters. The compilation of accounts by Dale Peterson, Jeffrey Geller, and Maxine Heller provide a clear record of how some inmates experience terrible trauma while confined. Patients had to deal with prejudice towards them on the basis of their physical and mental disabilities. Patients were kept in locked, overcrowded and unsanitary wards unable to avoid a staff member who harassed or abused them.
These writings challenged the medical view that mental distress was purely biological or degenerative. Patients often contextualized their breakdowns within broader socio-economic realities, domestic abuse, grief, poverty or political oppression. By attributing their suffering to external injustices rather than internal brain pathology, they rejected the foundational premise of asylum psychiatry. According to Elaine Showalter (whose research focused on psychiatric resistance by women), women still faced mental shipwreck in pregnancy and childbirth. Puerperal insanity, ranging and short-term symptoms of postpartum depression to incurable psychosis and suicide, accounted for about ten percent of female asylum admissions, and was widely accepted as a legitimate criminal defence, especially in cases of infanticide. Such social causes of the disorder such as poverty, inadequate obstetrical care, and the stigma on bearing illegitimate children were sometimes cited as contributing factors, but doctors, lawyers, and judges preferred to deal with the depression and violence of puerperal mania as an isolated, individual, and biologically determined phenomenon.
Conclusion
The collective effect of the letters and the diaries was the creation of a rich, complex archive. While historical psychiatry sought to reduce human suffering to neat statistical tables and diagnostic charts, the writings of asylum patients restored the messy, resilient reality of mental distress suffered by the people.
These historical acts of subversion laid the groundwork for modern disability studies and the consumer/survivor/ex-patient movement. They remind us that sanity and insanity are not fixed, biological absolutes that can be reduced to measurable numbers but categories deeply embedded in power dynamics, social control and the right to narrate one’s own existence. In the darkest corners of the historical asylum, the pen proved that the human mind, even under siege, retains an irrepressible capacity to define its own truth.
About The Author:
My name is Manya Mittal, and I am a second-year student in Jindal Global Law School. Writing articles on history, art and cultural topics gives me the opportunity to combine my creative interests with research and learning, and allows for my views to be shared with other people.
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