The Case of Josiah Oakes and Restraining the Insane: How a Court of Law Enforced Mental Illness Institutionalization
- Harvard Synthesis
- Sep 22
- 8 min read
By Eunice Chon
Note from the author: This close reading exercise was part of my History of Science sophomore tutorial, where we were asked to explore an archive and analyze a single source in depth. I chose the Disability History Museum because of my interest in the history of disability and mental health care. The case of Josiah Oakes stood out to me as an early example of involuntary institutionalization and revealed striking themes of gender, power, and how society has defined “insanity.”
A disability is more than a diagnosis; it is also a social experience that has long been misunderstood, alienated, and persecuted culturally, politically, and legally. In response to the widespread ignorance on disability issues that exacerbate the obstacles faced by those with disabilities, the Disability History Museum is a digital archive founded in 2000 that fosters “a deeper understanding about how changing cultural values, notions of identity, laws and policies have shaped and influenced the experience of people with disabilities, their families and their communities over time.” The non-profit organization sponsoring the Disability History Museum archive, Straight Ahead Pictures, Inc., aims to “use archival materials and oral history to foster community dialogue about contemporary social issues.” The archive selections are listed under topics that range from “Disability by Category,” “Government, Policy, and Law,” to “Science, Health, and Technology.” There are 331 search results for the keyword “Psychiatric Disability” that encompass a wide range of materials from documents, such as articles, speeches, government documents, magazines, conference papers, books, and pamphlets, to visual stills, including illustrations, postcards, ephemera, and lithographs. The materials are presented in alphabetical order rather than by the date attributed, which falls within the late 1800s and 1900s, but even if not all dates may be discovered or accurate, I would prefer for the materials to be stored in chronological order to get a sense of development on the subject across time. It did not make sense for me to see something from 1977 sandwiched in between sources from the late 19th or early 20th centuries.
The strengths of the archive include clear labelling, full text transcriptions, and a significant time range of sources that illustrate wide changes in cultural perceptions of support for mental illness. Clear labelling and full text transcriptions improve the convenience of extracting quotes from phrases or sentences that stand out. Sources in the “Psychiatric Disability” category often include pieces from medical journals, speeches from authorities such as political leaders or churches, and images that illustrate how mental illness was perceived. Pieces from medical and political authorities give insight into the power structures present and the type of rhetoric they supported. I thoroughly enjoyed looking through the images, which sometimes convey more than words can. First and foremost, photographs of patients had faces blocked out for privacy. Often, images of a “crazy woman” and photographs of female patients sitting in “idleness,” eating, or receiving “kindly care” in contrast to male patients getting “healthy exercise” or restrained by “leather straps” suggest that gender stereotypes or bias might have played a role in recognizing and treating mental illness. Finally, photographs shed indisputable evidence on the abusive conditions of these institutions, including authoritative weapons such as “rubber hoses” and unsanitary facilities.
Some limitations of this archive are the lack of empirical data and records, patient (particularly female) narratives, and written correspondences with loved ones on their experience getting treated, and hospital chart records of hospitalized patients. Empirical data might not speak much to the social experience of disability, but it helps researchers grasp the scale of an enterprise. Records with the number of patients admitted, discharged, and died were present, but they weren’t disaggregated by diagnosis, gender, age, or even who admitted them. This lack of information not only makes it difficult to understand under which grounds these patients were institutionalized and how long they were institutionalized, but also how different illnesses may have been identified and treated. Patient correspondences are used as evidence in medical journals to illustrate how mental illness could be detected in their communications, but I am surprised not to see diary entries of these patients describing their experience with mental illness or letters to loved ones about their experience in these hospitals.
Even letters from loved ones about living with someone with mental illness could provide much context about the disability experience. Having sources from authoritative figures without plenty of patient accounts puts the researcher in a difficult position to stay conscious of incomplete narratives in the context of power and whose voice is represented in the archives. While there is one autobiography from a male patient describing mistreatment in mental health facilities, there aren’t many female patient accounts. Even among mental illness patients, only men can have a voice about their experience. Finally, I expected to see many hospital chart records of physicians’ notes on prescribed treatment and notes from nurses making rounds because there must have been heavy surveillance of these patients when they were institutionalized. Specific charts would provide much information about what the field of psychiatry was looking for in diagnosing or treating mental illness, how patients were perceived, and how much or how little dignity was attributed to them, and potential evidence to contrast with patients’ own narratives, because no matter how flawed, multiple perspectives can provide a fuller picture.
“Authority To Restrain The Insane” from January 1846, published in the American Journal of Insanity, describes briefly the circumstances leading up to the case of Josiah Oakes presented to the Supreme Judicial Court of Massachusetts in Boston on January, 1845, which found that “A person who is insane, or delirious, may be confined, or restrained of his liberty, by his family, or by others, to such extent, and for such length of time, as may be necessary to prevent injury or danger to himself and others” even if an act of violence has not been committed and a judgment was made purely based on an “aberration of mind.” The journal entry reads to be a summary of the habeus corpus case to discharge Josiah Oakes from the McLean Hospital for the Insane, and while there isn’t a transcript of the court proceedings, it is a well-detailed and balanced account of the character and expert witnesses that were present, their claims on Oakes’s mental industry and conduct, and thorough arguments made by counsel. While the summary is written by a law reporter familiar with legal proceedings over medical knowledge, the publication’s intended audience is practicing psychiatrists and psychiatrists-in-training. Oakes loses the case eventually, with the court determining: “At present, we think that it would be dangerous for Mr. Oakes to be at large, and that the care which he would meet with at the hospital would be more conducive to his cure than any other course of treatment. It is, therefore the order of the court, that he be remanded to the McLean Asylum, to remain there until further action upon the subject.” What is striking about the way the source is written is that it’s not written by a medical professional and is intended to provide an objective account of the court proceedings without making individual judgments or skewing towards one side or another.
Despite these efforts to be objective, it is particularly noticeable that Oakes’s own testimony is not included in the source. His friends testified to his shrewdness and industry, though perhaps “his faculties might have been affected by age.” His sons admitted him into the hospital, and they, along with his physician, provided opinions that he was insane, testifying to “some irregularities in the conduct and conversation of Oakes.” However, there is no mention of Oakes’s story being heard, with his perspectives on the matter. I also notice that words such as “confinement,” “detention,” and “under whose immediate charge the prisoner was at the asylum,” are usually employed to describe criminals, not hospitalized patients. The consequential incident that led to his hospitalization and the basis for the order of continued restraint of Oakes’s is also described oddly (in addition to misspelling his name):
"Mr. Odes, who is sixty seven years old, became infatuated after a young woman by the
name of Sarah Jane Neal, and engaged to marry her a few days after the death of his wife.
To prevent the marriage, prosecutions were commenced against her in the police court, by
some members of the family, for lewdness of conduct."
The basis for the psychiatrist’s judgment of delusion and the court’s order for continued restraint of Oakes is the fact that he got immediately engaged to the woman with whom he was having an
affair. While his wife was on her deathbed, he would come home asking if she was dead, to the
exceedingly shocked feelings of his daughters. Perhaps this is evidence for Josiah Oakes being
a horrible person, husband, and father, but I question if today this would be considered evidence
for mental illness or even delusion. The delusion argument derived from his “refusing to believe the evidence of her bad character,” suggesting “his unlimited confidence in his own knowledge,” is appalling when he and Neal are both allegedly homewreckers. Oakes is still described to contribute as a functioning and respectable businessman: “His overseeing his business correctly, and carefully seeing that the piles were driven well, does not prove him to be sane. He was under no delusion on that subject.” What justifies her prosecution for lewd conduct while he’s a productive provider who just happens to be institutionalized for not being in the right state of mind? Not only is Oakes’s argument not presented, but supporting claims or evidence for his mistress’s “bad character” besides sleeping with a much older, married man is absent from the source.
The court’s opinion further marks how gender played a role in identifying mental illness
over criminal offense:
"Taking all the evidence together, we are of the opinion, that Mr. Oakes is under the
operation of that degree of insanity, which renders it proper that he be restrained in the
hospital ; that his insanity is temporary in its character, and that the restraint should relief
from the present disease of his mind. . . .But this species of insanity leads to ebullitions of
passion, and in these ebullitions dangerous acts are likely to be committed. If committed,
he would be excused from punishment on the ground of insanity."
He should be excused on the ground of insanity, but his young mistress must be punished for being a bad person. I initially chose this source because I was interested in justifications for legal bases for mental health institutionalizations without patient consent, and my understanding is that hopefully, modern practices lean more clinical and medically-supported, procedure hasn’t changed much since 1845. Like the court legitimizes outsider insights on Oakes’s conduct and character as well as emphasizes McLean being “a known public establishment, with a responsible board of trustees; . . . a satisfactory and useful institution,” psychiatrists seek collateral from friends and family of patients and assume legitimacy in third-person, especially authorities regardless of how well they know the patient. However, as I analyzed the source, the themes of gender differences I saw across the archive became strikingly apparent in this source.
Further exploration of the archive, reading Oakes’s autobiography, and close reading work of similar cases of patients hospitalized against their will by guardians or authorities would provide much insight into what individuals and society perceived to be mental illness, and I’d be particularly interested in the difference in rights female mental health patients had in their situations. For this hypothetical project, I would need any court case transcripts, reports, or summaries available for women trying to get themselves discharged, but I am not too optimistic about the availability of evidence of women using the court of law for justice, based on my assumptions on the prevalence of women even having that opportunity for themselves to be heard and be provided the dignity above a second- or third-class citizen. Further sources from physicians’ accounts, patient narratives, and family correspondences would provide more context to the expectations for and treatments in female psychiatry and, more importantly, how power dynamics played a role in this medicine.
References
“About: Overview.” disability history museum--About: Overview: Disability History Museum.
Accessed March 3, 2024. https://www.disabilitymuseum.org/dhm/about/about.html.
“Library: Browse Collections.” disability history museum--Library: Browse Collections.
Accessed March 3, 2024. https://www.disabilitymuseum.org/dhm/lib/browse.html.
“Library: Browse Results.” disability history museum--Results: KEYWORDS:
Psychiatric+disability. Accessed March 3, 2024.
“Library Collections: Document: Full Text.” disability history museum--Authority To Restrain
The Insane. Accessed March 3, 2024.
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