“The insane hospital is to the insane what the splint and bandage are to the fractured limb,” he opined. “Merely to insure quiet.”18
His laid-back approach was typical of asylums throughout America at that time, partly due to the overcrowding all were experiencing. Though moral treatment had begun with the ideal of a close doctor-patient relationship, as more and more people were admitted, that ratio became unworkable and therapy obsolete, with care instead becoming custodial in nature. It became more important to maintain order, which meant increased rules and in particular increased restraint of patients. “[A] curb must be about everyone without distinction, to be tightened at will,”19 McFarland wrote, conscious of his need to retain control of his 231 patients.
The larger the hospital populations became, the more focused their superintendents were on management. There was little time for research into treatments and cures; McFarland was not alone in rarely pursuing either. Though European psychiatrists were busy conducting experiments, Americans simply did not. Historians have noted that the professional journal of the Association of Medical Superintendents of American Institutions for the Insane （AMSAII） is “notable only for the lack of articles embodying the results of original research.”20
Yet in truth, Elizabeth and her friends had a lucky escape when it came to experimentation. Given psychiatrists’ focus on women’s sexual organs as a cause of their insanity, the treatments that existed in the era centered on these too. So ice water would be injected inside the women’s intimate orifices, leeches hungrily latched onto labia and clitoris, and caustics—powerful chemical substances that could destroy tissue—liberally applied to their genitals. At the very least, vaginal examinations with a speculum were standard; only toward the end of the decade would doctors begin to question the “impropriety”21 of such exams in emotional young women, pronouncing them a “mischievous”22 practice, “almost always unnecessary.”23
By far the worst of all the treatments, however, was that recommended by Dr. Isaac Baker Brown, the senior surgeon at the London Surgical Home. The Englishman was not the first to utilize it but became its figurehead after publishing a book on the treatment in the mid-1860s. Well before then, the practice had been adopted in America, being recommended in a U.S. textbook in 1859. To cure a woman of insanity was easy, Brown and other advocates said.
All one had to do was cut off her clitoris.
What we might today call female genital mutilation.
It was a “harmless”24 operation, Brown enthused, and a necessary one, for without it, women would be subject to increasingly severe insanity and, ultimately, death. He’d been inspired to try it after being “foiled in dealing successfully”25 with hysterical women “without being able to assign a satisfactory cause for the failure.”26 When the women did not submit to his will, he decided a physical cause must be behind their tenacity. Eventually, he determined “peripheral excitement of the pudic nerve”27 the culprit. Immediately, he put his theories into practice, carrying out countless operations in which he cut women’s clitorises “down to the base,”28 removing them either “by scissors or knife—I always prefer the scissors.”29
“The rapid improvement of the patient immediately after removal of the source of irritation is most marked,”30 he recorded happily in his case notes, and no wonder, for the women were stunned, their mouths at last stitched shut with shock. Brown reported a 70 percent success rate; the “problems” from which his patients were “cured” including a “distaste for marital intercourse,”31 “distaste for the society of her husband,”32 “sterility or a tendency to abort in the early months of pregnancy,”33 and even a twenty-year-old woman who spent too much time “in serious reading.”34 The patients requiring treatment, as described by him, were “restless and excited, or melancholy and retiring…[with a] quivering of the eyelids, and an inability to look one straight in the face… Often a great disposition for novelties is exhibited, the patient desiring to escape from home, fond of becoming a nurse in hospitals…or other pursuits of the like nature.”35 But these women after treatment, he declared triumphantly, “became in every respect a good wife.”36
If patients complained or were distressed by the procedure, they were deemed incurable or not recovering well. When a fifty-seven-year-old patient cried that he had “unsexed”37 her, her family retorted that “nothing of the sort had been done…the operation had prevented her from making herself ill.”38 （She had been fond of masturbation.） Her case was one Brown cited as a success: whereas before, her husband’s life was “most wretched, his home was now one of comfort and happiness.”39