Accounting for Insanity: The Paper Economy within the Bloomingdale Asylum
Early in his tenure as the assistant physician of the Bloomingdale Asylum for the Insane in upper Manhattan, the alienist Pliny Earle sounded a note of skepticism about the epistemological foundations of his own profession: “Science is at once lost in mazes of uncertainty and ignorance whenever it attempts to fathom mind itself.” Earle’s consciousness of the problem of consciousness was reflected in his extensive published writings on the curability of insanity, which provide an illuminating vantage point from which to gauge the powers and limitations of the new medical psychology as it was mobilized in everyday clinical interactions between doctors and patients. Reading these sources alongside surviving registers, ledgers, casebooks, and court orders from the Bloomindale Asylum, this paper is broadly concerned with the fabrication of expert knowledge: medical, legal, and historical.
Opening its doors in June of 1821, the Bloomingdale Asylum was among the earliest institutions in the United States to adopt a program that combined medical and moral treatment, one premised upon the restorative “power of judicious kindness.” Mindful of the extent to which “the state of madhouses” was attracting the attention of legislators, physicians, and social reformers both within and beyond the state of New York, Bloomingdale’s medical superintendents boasted that their rooms and grounds rivaled the finest hotels in the “beauty of their situation.” They were at least as strategic in their publication of statistical tables, which were intended to demonstrate the usefulness of the institution not only as a means of curing or at least ameliorating the condition of the insane, but also as a site for the production of medical knowledge, establishing “the existence of certain fixed laws, governing the development of insanity.”
By the time Earle arrived at Bloomingdale in 1844, asylum cure rates were already coming to be viewed as suspect and he accordingly introduced new taxonomies and bookkeeping methods for purposes of more accurately tracking admissions, discharges and readmissions, which were made the basis for his History, Description, and Statistics of the Bloomingdale Asylum for the Insane (1848). Much was lost in the translation, however, as can be seen upon closer inspection of the leather-bond volumes that tracked the movement of the asylum population. These volumes tell a more complicated story about the dilemmas of diagnosis daily faced by doctors who had to construct patient histories upon the basis of fragmentary, unreliable narratives provided by their charges and other interested parties, always under the shadow of the law