PDF Summary:The Woman They Could Not Silence, by Kate Moore

In 19th-century America, women could be committed to psychiatric institutions for defying their husbands or holding unconventional beliefs. In The Woman They Could Not Silence, Kate Moore examines how legal and medical systems disempowered women, allowing husbands to institutionalize their wives without proof of mental illness. Moore explores the concept of "moral lunacy," a controversial diagnosis used to confine women who displayed emotional or behavioral nonconformity, and details the physical restraints, solitary confinement, and punishments used to control female patients.

Moore also chronicles Elizabeth Packard's resistance to these systems and her subsequent advocacy work. Packard's efforts led to the passage of 34 bills across state legislatures, reforming mental health care practices and advancing gender equality. Her work established patient rights, including uncensored mail access, and helped lay the groundwork for formal advocacy organizations.

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(Shortform note: In Madness in Civilization, Andrew Scull explores the evolution of psychiatric thought in the nineteenth century, highlighting the debates among alienists (early psychiatrists) about the nature of insanity. He notes that some alienists believed that madness was a disorder of the intellect, while others argued that it was a disorder of the will. This debate led to the development of the concept of moral lunacy, which focused on the idea that insanity could manifest as a disorder of the moral faculties.)

The diagnosis was debated within psychiatry, because its symptoms could emerge in anyone, regardless of their mental state. Critics deemed it a scientific misfortune that the notion was ever explored. However, at the time of Elizabeth's institutionalization, proponents continued to fervently support it. Psychiatrists maintained that they understood better, even if a person seemed sane in every other aspect. They acted as authorities, deciding who had passed the threshold between sanity and insanity. They often chose the second option.

(Shortform note: The diagnosis was hotly debated in the mid-nineteenth century, especially in Europe and North America. The controversy stemmed from the criminal justice system, where the concept of “partial insanity” was introduced. This concept suggested that a person could be insane in one aspect of their life but sane in others. Judges, lacking medical expertise, increasingly relied on a small group of asylum superintendents as expert witnesses to determine the threshold between sanity and insanity.)

Practices of Control and Disciplinary Regimes

Moore explains that the facility used moral therapy to manage patients. This was based on the "law of love," which promoted close connections between doctors and patients to allow doctors to positively influence the patients. The asylum’s superintendent, Dr. McFarland, believed the best method for treating insanity was to take on a commanding role in his patients' existences. He thought his judgment was more reliable for them than their conscience.

(Shortform note: In Madness in Civilization, Andrew Scull traces the evolution of psychiatry from its roots in Enlightenment philosophy and religious reform. He explains that the doctrine of “moral treatment” emerged in the late 18th and early 19th centuries, blending Enlightenment rationalism with Quaker and Protestant ideals of philanthropy and inner reform. Reformers like Philippe Pinel in France and William Tuke in England reconceptualized madness as a disturbance of the passions and the will, something to be reshaped through a carefully ordered, domesticated asylum environment.)

He desired for them to adjust their way of living to his prescription, including what they wore, what they ate, what they did, and even the thoughts they thought. McFarland believed that once he gained complete control of the patient, he could modify their thoughts. He further believed the "cure" for insanity was merely meeting the physical needs of those suffering from it. The asylum's treatment methods were common in facilities across the U.S. at that time. The overcrowding of mental institutions made it impossible to maintain strong connections between doctors and patients, so care shifted to being custodial. The focus was on keeping order, leading to more regulations and restraining patients. As the hospital populations grew, superintendents increasingly concentrated on management. Time to research cures and treatments was limited.

Total Institutions

Sociologist Erving Goffman coined the term "total institution" in his 1961 book Asylums to describe places like McFarland's hospital. Goffman argued that total institutions are characterized by officials who regulate every aspect of inmates' lives, from their daily routines to their thoughts and behaviors. He explains that these institutions prioritize organizational order over individual well-being, often leading to dehumanizing treatment. Goffman suggests that the underlying social function of total institutions is to reshape individuals' identities to serve the institution's needs. This perspective helps explain why McFarland and his contemporaries focused more on maintaining control than on developing effective treatments.

Next, we will discuss the methods of physical and punitive control used on female asylum patients.

Methods of Physical and Punitive Control

Moore describes how female patients were subjected to physical restraints and solitary confinement. Restraints included straitjackets, bands around the wrists, and hand coverings. Solitary confinement involved being locked in a cramped, uncomfortable cell that had an iron screen over the window. Women were punished for behavior that was considered unfeminine or excessively emotional, or for not stifling their natural emotions, such as sorrow, anxiety, or resistance to regulations. They faced beatings, strangulation, and punishment on a daily basis. Solitary confinement was frequently used as punishment for behaving violently, being naughty, unclean, or speaking profanely. The use of restraints was more common on women than men, and the superintendent viewed them as indispensable for all types of treatment. The mistreatment and abuse increased over time.

The Effectiveness of Physical Restraints and Solitary Confinement

Physical restraints and solitary confinement were effective ways for the superintendent to keep the women under control. When women were punished for expressing their emotions, they learned that any display of autonomy would be met with swift punishment. This led them to pre-emptively censor their own behavior to avoid further harm. Michel Foucault, a French philosopher, argues that this self-censorship is a form of internalized discipline that reinforces the power of the institution. By making women fear the consequences of their actions, the superintendent could maintain control without constant surveillance. This system of punishment and self-regulation created a cycle where women became complicit in their own oppression, making it easier for the institution to maintain order and suppress dissent.

Moore also notes that patients faced punishment for disobedience, like being emotional, swearing, or refusing to stop mentioning their children. Punishments included isolation, straitjackets, beatings, and being held underwater in bathtubs. The staff believed that patients who complained about mistreatment were insane and not to be believed.

(Shortform note: The asylum was a “total institution,” meaning that the staff had total control over the patients’ lives. The staff could define what counted as disobedience and what punishments were appropriate. This meant that any complaint about mistreatment was seen as proof that the patient was insane and not to be believed.)

Elizabeth Packard's Resistance and its Legacy

Elizabeth Packard’s resistance led to significant reforms in mental health care and gender equality, Moore argues. She achieved the approval of 34 bills in 44 different state legislatures. She advocated for gender equality and the entitlements of those with mental illness. She ensured patients could receive mail without censorship. Her legislative changes were adopted by many states, with her name frequently appearing on the related bills.

The National Association for the Protection of the Insane and the Prevention of Insanity was founded in 1880 to advocate for legislation benefiting patients and effective monitoring of asylums. Historians say campaigners like Packard founded it by galvanizing public opinion to a degree that necessitated formal action. The assertions Packard had made for years were now published in reputable medical journals. She kept facing attacks from McFarland and others who tried to discredit her, but she remained steadfast in her mission.

The Alleged Lunatics' Friend Society

Decades before Elizabeth Packard’s resistance, the Alleged Lunatics' Friend Society in Britain united former asylum patients to campaign for legal limits on wrongful confinement and for uncensored patient correspondence. Their efforts anticipated many of the aims later taken up by the National Association for the Protection of the Insane and the Prevention of Insanity. In The Most Solitary of Afflictions, Andrew Scull explains that the Society’s members, many of whom had been confined in asylums themselves, argued that the law should protect individuals from being wrongfully detained. They believed that people labeled as insane should have the right to challenge their confinement in court and that their letters should not be censored by asylum staff. The Society’s work laid the groundwork for later reforms by showing that people with mental health issues could organize and advocate for their rights.