Ten Days in a Mad-House (1887) by Nellie Bly is an investigative exposé detailing the horrifying conditions within the Blackwell’s Island Insane Asylum. Bly, an American journalist and a pioneer in undercover reporting, entered the asylum under the guise of mental illness, using her work to reveal abuses and systemic failures in mental health care. Originally published in New York World newspaper installments, her account is both a work of investigative journalism and a seminal piece in the genre of muckraking literature. 

Bly’s revelations contributed to the social reform movement of the Progressive Era, where issues of institutional care, gender inequity, and human rights took center stage. Her story captures themes such as the societal and systemic mistreatment of people with a mental illness, the gendered bias in mental health treatment, and the power of journalism to effect social change—elements that would later catalyze improved funding and oversight for mental health institutions.

This guide refers to the e-book version of Ten Days in a Mad-House, which is adapted from the edition published by Norman L. Munro in 1887.

Content Warning: This guide discusses violence and abusive behavior toward, and mistreatment of, women and people with disabilities and mental health conditions. Additionally, the source text uses outdated language, which is replicated only in direct quotations. The term “asylum” (including Blackwell’s name as an “Insane Asylum”) is preserved throughout, as it is historically and linguistically accurate to Bly’s time and essential to understanding the context of her investigation.

Summary

In Ten Days in a Mad-House, journalist Nellie Bly recounts her harrowing experience going undercover in the Blackwell’s Island Insane Asylum in New York City. As an investigative reporter, Bly sought to expose the appalling conditions and systemic abuse endured by the patients in this facility. Inspired by her commitment to social justice and her desire to illuminate the plight of marginalized individuals, Bly approached the publisher of the New York World, Joseph Pulitzer, proposing to feign “insanity” to gain entry to the asylum and reveal the truth of its operations.

Bly’s journey began at a boardinghouse for women, where she carefully cultivated the persona of “Nellie Brown,” a woman showing signs of severe mental distress. Her convincing performance soon captured the attention of others, leading to her admission to Bellevue Hospital for observation. There, she endured an examination by doctors who, despite lacking substantial evidence of mental illness, deemed her unfit. Bly’s unsettling realization was that mental health professionals swiftly and easily declared her “insane” based on a few exaggerated behaviors and stereotyped assumptions, highlighting society’s simplistic and often dangerous perceptions of mental illness.

After being pronounced “insane,” Bly was transferred to Blackwell’s Island. Immediately, she was struck by the grim reality that the asylum was more of a prison than a place of healing. The patients, many of whom did not appear to have mental health conditions, suffered under deplorable conditions. Bly describes her initial fear upon realizing that she was now at the mercy of a cruel system with little chance of escape. Her fears were soon confirmed as she witnessed the horrific treatment of patients by the nurses and staff. Basic necessities, such as sufficient clothing and edible food, were withheld. Bly and her fellow patients were forced to eat stale bread, rancid butter, and unseasoned broth. The meals were so inedible that many women went hungry, with their physical health deteriorating alongside their mental well-being.

The daily schedule was bleak and monotonous. For hours on end, patients were forced to sit on rigid benches without moving, speaking, or engaging in any form of mental stimulation. Nurses frequently enforced these restrictive routines with verbal abuse and physical punishment, further dehumanizing the women under their care. Bly describes in detail the hostile environment, where nurses derived pleasure from inflicting emotional and physical pain. They mocked patients, deliberately provoked their delusions, and denied them warmth or comfort.

Bly’s accounts of her fellow patients deepen her story, providing individual portraits of women whose supposed “insanity” was often merely a result of unfortunate life circumstances. Some, like Miss Tillie Mayard, entered the asylum in relatively sound mental health but were quickly worn down by the cold, hunger, and abuse. Other women suffered from grief or poverty rather than actual mental illness. A French immigrant named Josephine Despreau, who struggled to understand English and New York’s legal processes, was confined to Blackwell’s Island for reasons Bly found indefensible. Bly’s observations make it clear that many women were sent to Blackwell’s Island because society failed to provide adequate support for those experiencing poverty, grief, or trauma.

During her stay, Bly witnessed disturbing “treatments” administered under the guise of mental health care. Patients were subjected to freezing baths, rough handling, and excessive use of sedatives like laudanum, with little regard for their physical health or comfort. Bly herself was forced to take a dose of a sedative, which she tried to expel immediately afterward, fearing that it would impair her ability to observe and remember events in the asylum. Even more distressing were the instances of fatal neglect and abuse that she heard about, such as the death of a young woman who resisted a cold bath and was physically overpowered by the nurses.

After enduring 10 days at Blackwell’s Island, Bly was finally released when a lawyer, sent by the New York World, arrived to secure her freedom. The relief of leaving the asylum, however, was bittersweet. Bly found herself haunted by the fates of the women she left behind, aware that they may never experience freedom or safety again. Her departure was a deeply emotional moment as she realized the privilege of her temporary role—unlike her companions, she could return to her former life.

Following her release, Bly presented her findings to a grand jury, recounting her experiences and describing the appalling treatment of patients. Although the asylum made a show of improvements—providing fresh bread, clean basins, and warmer clothing—Bly and the jury saw through these superficial changes. Staff and doctors were evasive when questioned, and many patients mentioned in Bly’s report were mysteriously relocated, making it difficult for the jury to verify her account. Nevertheless, Bly’s report was convincing enough that the jury recommended substantial changes, and the story sparked widespread public outrage. As a result, her exposé led to a significant increase in funding for mental health care, securing $1 million in additional funds for New York City’s mental health institutions.