In Ten Days in a Mad-house, one of the overarching themes is that those who are deemed “insane” by medical and social institutions are not afforded the same level of free will as those considered sane are. During her time at the Women’s Lunatic Asylum at Blackwell’s Island, Nellie Bly has an exchange with one of the nurses and a doctor: “‘You play the piano?’ they asked. ‘Oh, yes; ever since I was a child,” I replied. Then they insisted that I should play, and they seated me on a wooden chair before an old-fashioned square. I struck a few notes, and the untuned response sent a grinding chill through me.” Later, she states, “When they found I would not play any more, Miss McCarten came up to me saying, roughly: ‘Get away from here,’ and closed the piano with a bang.” It’s clear that the hospital staff recognize her as having some skill in playing piano, as they asked her to play, but they don’t give her the agency to choose when she plays it. Instead of asking if she’d like to play, and leaving the opportunity open for her, they instead treat her almost like a dog that can perform a trick on command. Having restricted freedom in itself is reminiscent of patriarchal influence on women, and the forced submission of the asylum patients to the will of the hospital staff is another aspect of forced assimilation to normative behavior for women in general. At the time, women often didn’t have much control over their lives. As an “insane” patient, Nellie may have been assumed to need the guidance of a sane person, even if that person isn’t necessarily male, in saying when she can do things; eating, sleeping, even playing piano.