The madness they endured: A biocultural examination of women's experiences of structural violence within 20th-century Missouri state mental hospitals

Objective This study employs feminist disability theory and the concept of structural violence to interpret the results of skeletal and documentary analysis of fracture and disease presence (i.e., syphilis and tuberculosis) among a group of institutionalized women who lived and died within 20th-century Missouri state mental hospitals. Materials The skeletal remains and corresponding death certificates of 52 adult Euro-American women housed in the Robert J. Terry Anatomical Collection at the Smithsonian Museum Support Center. Archival and historical literature concerning state mental hospitals were also utilized. Methods Macroscopic skeletal analysis of fracture and disease combined with archival research (i.e., associated death certificates and historical documentation). Results Approximately 15% of patients demonstrated evidence of perimortem hip fractures with no surgical intervention, most of whom were labeled "psychotic". Death certificates revealed the presence of syphilis (n = 4) and death from TB (n = 5). Conclusions Nineteenth and 20th-century patriarchal conditions contributed to the institutionalization of women. Women who were impoverished, spouseless, and perceived as mentally or physically disabled were particularly vulnerable to institutionalization. Once hospitalized, patients were exposed to structurally violent conditions including neglect and abuse that resulted in avoidable harm. Significance Historical and documentary data associated with osteological collections is underutilized and can serve to both humanize these individuals and advance our understanding of their intersectional experiences. The implementation of theoretical frameworks within bioarchaeology can also assist in more holistically interpreting the complexities of past life. Limitations Small, homogenous sample size limited by macroscopic analysis. Further research Future work should increase sample size, heterogeneity, and conduct other relevant skeletal and documentary analyses.