Ohio, 1893. Cassie Alexander is declared unstable and sent away to a state asylum—an institution built as much on silence as on stone.
Inside its locked wards, diagnosis becomes destiny. Women arrive carrying grief, defiance, trauma, or simply the misfortune of being inconvenient. Some are ill. Many are not. Their names are recorded, their histories condensed into ledgers, their resistance reinterpreted as symptoms. In a place where obedience is mistaken for wellness, even sanity can be rewritten.
As Cassie forms tenuous bonds with the women around her, she begins to see that the greatest threat within the asylum is not madness, but authority—the quiet, systematic erasure of identity under the guise of care. Survival requires more than endurance; it requires remembering who you were before someone else decided who you are.
Inspired by documented 19th-century practices, Delusional Madness is a restrained and haunting exploration of institutional power, female autonomy, and the fragile boundary between diagnosis and control.
Because history does not always scream.
Sometimes it is quietly signed away.
Ohio, 1893. Cassie Alexander is declared unstable and sent away to a state asylum—an institution built as much on silence as on stone.
Inside its locked wards, diagnosis becomes destiny. Women arrive carrying grief, defiance, trauma, or simply the misfortune of being inconvenient. Some are ill. Many are not. Their names are recorded, their histories condensed into ledgers, their resistance reinterpreted as symptoms. In a place where obedience is mistaken for wellness, even sanity can be rewritten.
As Cassie forms tenuous bonds with the women around her, she begins to see that the greatest threat within the asylum is not madness, but authority—the quiet, systematic erasure of identity under the guise of care. Survival requires more than endurance; it requires remembering who you were before someone else decided who you are.
Inspired by documented 19th-century practices, Delusional Madness is a restrained and haunting exploration of institutional power, female autonomy, and the fragile boundary between diagnosis and control.
Because history does not always scream.
Sometimes it is quietly signed away.
Chapter 1
His Word, Her Fate
“My wife is mad—unmistakably so,” Jed declared with an air of solemn regret. “I can think of no gentler way to put it. As much as I should like to soften my words, there exists no euphemism that can do justice to the gravity of my concerns. You see, Your Honor, Doctor, I fear she is not only a danger to herself but to our young children as well. I can no longer entrust her with their care, and I am haunted by the dreadful thought that she may do them harm. We must act swiftly.”
“Mr. Alexander,” the judge interjected, his voice measured, “you must make plain the grounds upon which you claim your wife to be of unsound mind. These are grave accusations. It is only right that you present this court with reasoned evidence.”
I sat in rigid silence, watching an unfathomable nightmare unfold before me—a scene so surreal I could scarcely believe it was my own. My husband answered the judge’s inquiry with a casualness more fitting for the choosing of one’s morning meal. Both judge and doctor listened, their expressions unreadable, as he proceeded to dismantle my character with ease.
“Your Honor, Doctor, it has been but four weeks since my wife bore our fifth child, and in that time, she has displayed a shocking indifference to the household. She does not sleep but rather lies abed, staring blankly at the ceiling. When she does rise, she rocks for hours in her chair, humming to herself like one lost in a trance.”
The judge regarded him keenly. “If you can, Mr. Alexander, pray tell us more. In what other ways has your wife led you to believe she is…troubled?” Jed sighed, shaking his head as though pained by the burden of truth. “It is difficult to explain, Your Honor, and yet more difficult to witness. But I assure you, my wife is in dire need of care. I am convinced she suffers from an affliction of the brain—exhaustion, perhaps. I can think of no other explanation for her peculiarities.”
I could bear it no longer. His falsehoods! His brazen, calculated lies! I did not know why he sought to tarnish my good name, but I would not sit idly by while he unraveled my dignity before these men.
“Gentlemen, please—I mean no disrespect—but I beg you to listen,” I implored. “Doctor? Judge? Will you not grant me leave to speak in my own defense? Allow me some means to prove that I am not mad? Might I do something—anything—to demonstrate that I am of sound mind?”
Neither man addressed me. Instead, they turned their gazes to Jed, as though seeking his permission for my voice to be heard. The insult was a sharp one, but I refused to be silent.
“My husband stands before you in this courtroom, where truth is meant to prevail, and he weaves a tapestry of lies with practiced ease. He would have you believe I am unfit to be a wife, unfit to be a mother. And yet, I ask you—what evidence has he provided? What proof exists beyond his word alone? If justice is to be served, then surely you must grant me the same courtesy of speech.”
I saw a flicker of something in the judge’s eyes—pity, perhaps, or hesitation—but the doctor merely smiled, a placating expression tinged with quiet condescension.
“Mrs. Alexander,” he said smoothly, “there is no need for such distress.
Exciting the mind in this manner is most unwise. We are here to help you.”
His words slithered through the air like oil on water.
“My name is Doctor Winifred—Dr. Frederick Winifred—and I seek only to see you properly cared for. You must understand, madam, there is no shame in suffering from an ailment of the nerves. It is quite common among ladies of your station, particularly those who have endured the strain of
childbearing. We call it neurasthenia—a form of exhaustion of the faculties,
nothing more.”
I lifted my chin, meeting his gaze with defiance. “Begging your pardon, Doctor, but I care not what you call it. You may name it what you wish—a pink cow, for all the good it does me. I tell you plainly, I am afflicted with nothing but the indignity of sitting here, forced to listen to two men who know me not attempt to paint me as some feebleminded creature.”
The doctor gave a weary sigh. “Mrs. Alexander, it is natural for a woman in your position to feel overwhelmed. Your husband has spoken of your increasing difficulty in managing even the most trivial of domestic tasks.”
“Difficulty?” I scoffed. “If you would judge me so unfit, then at least allow me the chance to present my day in its entirety and then decide for yourself.”
Doctor Winifred peered over the rim of his spectacles, intrigued despite
himself.
“Today alone, "I continued, “I kneaded and baked four loaves of
bread, gathered vegetables from the garden, scrubbed the floors until they gleamed, and bathed all five of my children. I ask you, Doctor, how could a woman who manages such tasks be deemed incapable of tending to the simplest of duties? "Before he could reply, the judge raised a hand.
“Mrs. Alexander,” he said with a sigh, “it is my duty to determine, with the counsel of a physician, what course of action shall be most beneficial to your health and well-being. It is our belief that you are in need of respite—a chance to rest and restore both mind and body.”
A chill laced through my veins. I swallowed hard, my voice scarcely more than a whisper.
“Surely, Your Honor…surely you do not speak of the asylum?”
The look he bestowed upon me was answer enough. Pity. Resignation.
An authority that would not be questioned.
I was to be cast away.
Jed had spoken, and the world had listened.
In that moment, I understood what it was to be powerless. What it was to be at the mercy of men who wielded their authority with quiet cruelty, disguising injustice as benevolence.
For what is madness but a name men fear above all else?
And what is a woman to do when that name is thrust upon her, binding her to a fate from which there is no escape?
Spoilers: Delusions of Madness by Kimberly K. Taylor is about as skin crawling, creepy, harrowing, and anxiety inducing as any Supernatural Horror book or movie. The most disturbing part of this Historical Fiction nightmare is that it is true. It depicts the lives of patients, especially women in a 19th century mental asylum and it does not skimp on any of the details. Even if you don't have dementophobia (fear of insanity-which I do), you might still have nightmares.
Proper 19th century Ohio wife and mother, Cassie Alexander is institutionalized by her husband, Jed who reports that she has gone insane. She hasn't. She and Jed are having marital problems and he is having an affair and needs to get rid of the competition before he can move onto the Second Mrs. Alexander. He convinces a judge that she needs to be institutionalized, so she is sent to a mental asylum.
When Cassie arrives, she finds a filthy degrading place filled with suffering patients, practices that damage them even more, and a sadistic or indifferent staff that tortures and abuses those under their alleged care. It doesn't take Cassie long to figure out that mental asylums are not there to treat people or help them recover. They are places to put people to forget about them.
Mental asylums have become an important topic in the past year with President Trump insisting that immigrants “from prisons and mental asylums” are being sent to the US, probably confusing mental asylums (institutions for the treatment and care of the mentally ill) with asylum seekers (people fleeing persecution, war, or violence and applying for legal recognition as refugees to another country but whose claims are still pending). Last year he signed an executive order aimed at reducing homelessness and severe mental illness by encouraging the expansion of involuntary, long-term commitment into psychiatric care including reducing community health services and bringing back long-term mental institutions and insane asylums.
It's important to remember that the treatment at such centers wasn't always the best and to understand the history of how people were treated back in the day, to recognize the mistreatment for what it was, prevent such abuse from repeating itself, and remember that there are resources that can be contacted if such abuse does happen now.
Taylor pulls no punches in her descriptions of the horrid conditions that Cassie and the other inmates/prisoners suffer through. We are treated to drafty mildewed walls, filthy floors with rancid odors and waste that is barely cleaned, uncomfortable and filthy beds, rats and other vermin that inhabit some of the rooms, and the sounds of tortured sobbing and screaming. It is not a pleasant place to say the least, said Ms. Obvious.
Then there is the staff who make Nurse Ratched from One Flew Over the Cuckoo’s Nest look like Florence Nightingale. They beat and physically torture the patients and purposely use dehumanizing language to bring them down to their lowest basest level.
Dr. Gooding, the asylum's primary physician, sexually assaults the patients. One of the patients ends up pregnant and he arranges for her to have an illegal, painful, and potentially destructive abortion. Matron Harrow, the asylum director is adept at manipulating and mentally abusing her charges. She has a particular vendetta against Cassie because there is a personal link between her and Cassie's erstwhile husband. She saves the worst punishments for her.
The asylum patients are subjected to various torturous punishments disguised as treatment from the moment they enter. They are branded upon entry. If one steps out of line as Cassie does, they are sedated and deprived of food and water. They are subjected to torture disguised as treatment like dunking their heads in ice cold water, throwing them in solitary confinement, or strapping them to a chair and spinning it around to the point of disorienting them.
There are also early forms of electroconvulsive therapy and lobotomies practiced by people who do not know what they are doing.All of these are means to break a patient's spirits and remove their free will. If they are constantly monitored, ridiculed, tortured, beaten, and dehumanized, they will consent to anything.
The dehumanization is revealed in various ways in the book. Some are left screaming. Others sit in fetal positions crying. Many just lie inert, no longer giving a damn. One woman whose child has died holds nothing but air in her hands under the delusion that her baby is with her. The sad part is if help and reform comes to the asylum, these women will be too far gone to appreciate it.
In some ways, the asylum is representative of the patriarchy. Women’s sanity is determined by husbands, male family members, judges, doctors, and attendants who make medical decisions for them. Women who help the system like matrons, nurses, and Conservative women can only seize power by siding with men and condemning women who don't fit the program. The results are the women are silenced, isolated, deprived of any agency, and left utterly dependent and complacent to whatever abuse they receive.
Just like other facets of the patriarchy, it takes women to challenge it and reveal what is wrong. While most of the female patients are left dependent and animalistic by the abuse, ironically it strengthens Cassie. She argues with staff when she or others are abused. She stands up for and defends those who can no longer speak or reason. She still recognizes their humanity. She covertly takes notes on her situation and tries to send hidden messages to authority figures so something legal and permanent can be done to stop it. She's not the only one.
The book is set around the same time that Nellie Bly wrote her famous Ten Days in a Mad House expose in which she faked mental illness symptoms to be institutionalized and was sent to Bellevue Hospital and later Blackwell Island. She took notes of the poor treatment and abuse and compiled them into her book which was such a sensation that reforms in mental institutions began almost immediately. Bly and her book even get a shout out in this book as Cassie and her fellow inmates now have someone speaking out for them and telling the truth.
Cassie in the book and Bly in real life forced the public to see that the mentally ill, particularly mentally ill and institutionalized women are people with names, histories, and identities. They challenged the people in charge and on the outside to recognize their humanity and change and reform the institutions accordingly.