If you’ve ever wondered what people ate in the mental health establishments of the 19th and 20th century…Sorry! You’re probably still going to be wondering for a while. Because the frank answer is that it really depended on where you were, who you were, who was caring for you, who was paying for your care, and what affliction you were presenting. But oh man did the offerings run the gamut.
I was curious about the meal regimens in the asylums of yore/yore-adjace – specifically, if they were as bad as I imagined based on the reading I’d already done.
The answer, in short, was yes. And also no. And also maybe.
My mental picture of sour milk and fetid meat was heavily informed by Nellie Bly’s detailed 1877 account which I read in high school. In the work that made her famous, Ten Days in a Mad-House, Bly described the food provided at Blackwell's Island Lunatic Asylum with precision.
Placed closed together all along the table were large dressing-bowls filled with a pinkish-looking stuff which the patients called tea. By each bowl was laid a piece of bread, cut thick and buttered. A small saucer containing five prunes accompanied the bread.
I tried the bread, but the butter was so horrible that one could not eat it…I turned my attention to the prunes and found that very few of them would be sufficient. A patient near asked me to give them to her. I did so.
My bowl of tea was all that was left. I tasted, and one taste was enough. It had no sugar, and it tasted as if it had been made in copper. It was as weak as water.
Strength of tea aside, Bly’s description of meals made of inexpensive, often-spoiled ingredients sounded like the kind of thing that might have been universal across most institutions of mental health.
But reading up on the dietary offerings of other establishments revealed a wide array of board. Some places definitely did whatever they could to pinch pennies, while others, even as early as the Victorian age, viewed nutrition as an integral piece of the health of the patients.
From Boiled Beef to Barrels of Beer
In order to get to the bottom of mental ward meal plans, we can consult the myriad documentation provided by these establishments. It’s easy enough to pull up records and see what foods were included in the accounting.
Pennsylvania Hospital librarian William Gunn Malin put pen to paper in 1830 to commemorate the work of the establishment and left a robust record. In Some account of the Pennsylvania Hospital: its origin, objects, and present state, Malin detailed the daily dining for patients — providing a stark contrast to what Bly had experienced.
“Beef, veal, mutton, or pork (often two kinds) boiled or roasted with a variety of vegetables. Puddings, pies, or fruits of the season…Milk, sugar, and molasses are all freely given…The bread is of fine wheat flour. Spirituous liquors, wines and porters are only administered by when prescribed by the medical attendant.”
It’s entirely possible that this is the result of a company man trying to make the meals at the asylum sound more palatable and robust than they actually were. But Malin also went on to explain plainly that their menu was “more generous than that of many similar institutions, judging from the bills of fare, and other statements occasionally published.”
That’s likely the case, since the Penn was a Kirkbride hospital and we know he was big on humanity (though not racial equity; the dude was still in favor of segregated care, so let’s not forget that).
Other purveyors of the so-called Moral Treatment were big into providing ample sustenance for patience. In a journal article, a Dr. Rush was quoted as saying that he believed “purging, bleeding, low diet, &c., have been adopted with little discrimination,” essentially likening starvation with the practice of bleeding. He went on to explain that these tactics must “be resorted to only when there is organic disease, which requires the reducing plan. But these remedies, especially in debilitated subjects, are seldom useful in relieving mental disease. They are usually injurious, and frequently fatal.”
Truly rancid food and meager portions did run the risk of killing patients, which was not ideal for hospitals. But if an administrator could juuuuust barely sneak by? Well, they’d certainly stand to save some money.
But there were such a wide range of institutions — just as there are today — with a wide range of different theories and practices and money-grubbing tenancies. Agitator Dorothea Dix illuminated this in her speeches and other orations in the decades she spent rallying for the improved treatment of institutionalized people. Citing in her reports to the Commonwealth of Massachusetts the horrors she’d seen. Some places were just negligent, she wrote. Others were actively abusive. She included graphic details of people bound, caged, beaten, and deprived of just about anything.
She also remarked on the food a handful of times, finding it “palatable” and “wholesome” in some institutions, but not in others. From her report:
…Many persons adopt the idea that the insane are not sensible to external circumstances that to their perceptions the dungeon, chains, cold, nakedness, and harsh epithets are as acceptable as a comfortable apartment, freedom from shackles a pleasantly tempered atmosphere, decent clothing, kindly speech, and a courteous address.
They assert that coarse, ill-prepared food is as palatable as that which is wholesome and well cooked, that cold and heat, sunshine and cloud, pure air and that loaded with noisome exhalations, liberty and confinement; are all one and the same to the insane, producing like impressions and results on the deranged intellect.
Greater error of belief was never adopted; more serious mistakes, and conducting to more fatal results could not be propagated. The insane in most cases fell as acutely and distinguish as readily as the sane.
Dix highlighted one of the reasons that cheap food was so prevalent in institutions — a lot of people just didn’t think that the patients needed, wanted, or deserved decent meals. Unlike in the Kirkbride establishments, many mental health hospitals saw feeding as a necessary line-item, not something that could actually be part of the healing process.
Money was also, of course, as issue, just as it is today. Asylums like the Pennsylvania Hospital accepted both paying and impoverished patients, which meant that they needed to be both frugal and able to compete with private hospitals and other places where more affluent folks might go for care. That meant meals that were decent, beds that were sufficient, and enough space to stroll.
Malin went out of his way to explain, though, that the relative wealth of the patients made no difference.
“No difference exists between those who pay for their board, and those who are supported on the charity of the organization.”
Additionally, to ensure equal treatment, the attendants weren’t even told who was was paying and who was being paid for.
That certainly wasn’t universal to all asylums, though; many segregated patients based on class (in addition to race and other perceived differences), providing worse rations and linens to those from lower income households. But as the Kirkbride model took over and more and more American institutions moved toward the “moral” approach, the spoiled gruel of previous days was becoming less and less rare.
As I go exploring through the documentation, I’m again reminded that no hospital administrator was going to put into writing that he pocketed the peas-and-carrots money and instead starved his patients on strict rations of stale bread. That means published reports aren’t going to tell us the whole story.
Turning to the accounts of patients, we can get an idea of what people were eating as they, themselves, wrote it down. One diary, published in 1885, describes a young woman who is worried about her fellow patient — and how some of the basic comforts of home might benefit her greatly.
If I could keep her in a nice warm room, with kind treatment and nourishing food! She could not eat that horrible, sour bakers' bread with poor butter. Sometimes her food would set in her room a long time. I guess she only eats when she is so starved she can't help it. I eat because I am determined to live until I find some one who will help me out of this castle on the hill, that I may tell the Commissioners all about it. Sometimes I term it a college, in which I am finishing my education, and I shall graduate some day—when will it be?
Then again, sometimes the bosses told on themselves. One hospital administrator in Scotland defended the “coarse” meals at his institution, admitting that he didn’t really need to feed his patients that much because “a lot of patients came from poor backgrounds and were malnourished. Just feeding them had a good and positive impact on their mental health.”
Oh, and about the liquor.
That was not especially rare, particularly in England.
A 2004 paper published explained that while “routine distribution of alcoholic beverages to mental hospital patients would be a fanciful prospect today… in the formative decades of lunatic asylums, beer was standard issue” and “a staple item in the supposedly healthy Victorian asylum diet.”
This isn’t surprising — a lot of that beer was much weaker than the punch-you-in-the-face IPAs we’re used to. Plus, at a time when drinking water wasn’t safe (ahem diapers in the well), alcohol was at least somewhat purified.
“Little water was drunk in asylums,” according to the paper. “Until 1853, male inmates drank 14 pints per week.”
In addition to being safer than water, the beer also helped asylum staffers control patients. Patient-labor was a huge part of the asylum economy, especially in the UK, that keeping them buzzed was beneficial in enforcing strict working requirements.
Stateside, the provision of alcohol wasn’t quite as common; water systems were slightly more reliable and the Puritanical roots of American colonizers meant beer wasn’t as baked into the culture. Additionally, Thomas Kirkbride was a Quaker who specialized in treatment of alcoholism — which meant he wasn’t really into the idea of happy hour at the ‘bin. Still, some doctors did still prescribe it and use it, which is likely why Pennsylvania Hospital had it available by request.
A steep decline in dietary provisions
So what went wrong in the forty years between Malin’s journals and Bly’s reporting?
Overcrowding turned previously humane establishments into human warehouses of undesirable people. The use of asylums to house criminals, people with disabilities, and people from marginalized groups (like Indigenous children) meant margins were leaner than ever and the food began to go downhill quickly.
Funding also got whittled away, which meant that by the 20th century, patients could expect pretty meager rations. Some places worked toward self-sufficiency, creating gardens and even businesses. In Oregon, at the Oregon State Institute Asylum (the one that One Flew Over the Cuckoo’s Nest is based on), a bakery, a dairy, and a large garden operated to feed the patients and provide employment to some degree.
The OSIA wasn’t exactly a paragon of food safety, though; almost 50 people died in one horrifying 1942 instance of poisoned eggs. From a Statesman article:
The story unraveled when the hospital's assistant cook stepped forward with a confession. He had sent a patient to a basement storeroom for powdered milk and the patient mistakenly brought back roach poison that was mixed in the scrambled eggs.
Similar tragedies happened elsewhere before modern food safety regulations were adopted. In 1940, at a Salvation Army shelter in Pennsylvania, 12 men died and 48 others were sickened when roach powder was mixed into pancake batter.
OSIA is now Oregon State Hospital and the people who are receiving care there are paid a living wage for their work, so that’s good? Though I’m not sure how it begins to address things like the 3,600 unclaimed URNS discovered in the hospitals basement?
Anyway, there was a very awful period there of asylums and you can guarantee that there was a lot of soapy eggs and weak tea. But it is interesting to read about the variations in care and how much of the care provided was influenced by larger political forces. Which is deeply upsetting but not surprising; when has equitable, humane treatment of human beings ever gotten the way of a slashed budget to appease the voters?
Legally, people in mental health institutions can’t be given literally inedible meals, but if the abhorrent conditions in our nation’s carceral institutions is any indication, that’s not stopping anyone from watering down the milk to make the Sysco order stretch a little further.