When Looking 'Insane' Got You Committed

The archaic medical practice of recognizing mental illness and "idiocy" based on appearance

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State Asylum for the Insane, Morristown, New Jersey (Library of Congress)

"As we progress in our study of insanity, we are constantly reminded of the physical changes that take place in the patients ... Disease of the brain makes itself known by well-marked bodily symptoms that are, in themselves, almost as important as the many variations of disordered mental action," wrote Allan Hamilton, MD, in 1883's Types of Insanity: An illustrated guide to the physical diagnosis of mental disease.

When one walks through the wards of any asylum for the insane, he will be immediately impressed with the repulsiveness of the faces about him, for the general appearance of the insane patient is in no sense prepossessing, and this is especially the case in the female. Women of beauty, as writers upon insanity have observed, rapidly lose their good looks with the establishment of mental disease, and plainness or downright homeliness is the rule among asylum patients, whether of high or low social station.

This was a time when "the insane" -- which included "idiots, imbeciles, and lunatics" -- were committed to asylums in courts of law. Hamilton outlines legislation in every state regarding the process.

The laws relating to the care of the Insane in Wisconsin are quite simple. Lunatics are committed only by the County Judge.

In other states, physicians' testimony was required. This text was meant, then, to be of earnest use in making that commitment process more accurate.

He provides several illustrated examples, which accompany colorful descriptions in the full text:

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CHRONIC MANIA ("Is clownish in his behavior, and sings at the top of his voice.")
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MANIA OF A VIOLENT TYPE ("Her hair is coarse and becomes erect when she is excited.")
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GENERAL PARESIS ("Has delusions of wealth, but is demented and stupid.")
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If a friend is keeping a hand inside his jacket, maybe he is depressed?

Hamilton was also keen on handwriting analysis:

In some cases we have but little difficulty in making a diagnosis by the letter alone, because of the striking incoherency, which the individual may restrain in conversation but which he indulges in when left to himself; and in suspected cases, where patients are on their guard, it is well to ask them to write a letter.
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One of the peculiarities of the letters of the insane consists in the use of illustrative diagrams, keys of explanation, and strangely coined words, and in forms of mental disease syrnptomatized by religious exaltation there are constant suggestions of the delusions of the individual.

This text was written with certainty and authority, 140 years ago. It doesn't go as far as to say a diagnosis could be based entirely on physical appearance, though it would have done no favors for an eccentric person who found himself in front of a judge and happened to have a hand in his coat.