Psychiatric Beginnings: Moral Treatment and the Asylum

Further Reading on Early Modern Conceptions of Madness William L. Parry-Jones,The Trade in Lunacy (about private mad-houses) Michael V. DePorte Nightmares and Hobbyhorses (on literary elite responses to madness). Ida Macalpine and Richard Hunter, Three Hundred Years of Psychiatry Andrew Scull, Madhouses, Mad-Doctors and Madmen (1981) Vieda Skultans, English Madness: Ideas on Insanity, Michael Mac Donald, Mystical Bedlam: Madness, Anxiety and Healing in 17 th England

James Otis Osgood’s Farm, Andover, MA where Otis was cared for in 1780s

Bethlem Hospital at Moorfields in 1675 designed by natural philosopher Robert Hooke after the Great Fire in London in 1666

William Norris in Bethlem Hospital, from an etching by Cruikshank around 1820 Credit: CAMERON COLLECTION

William Hogarth, Scene in a Madhouse, 1733

A Depiction of the Mad by Charles Bell, 1774

RESTRAINING APPARATUS and SHACKLES

“Tragic Figure in Chains” painted by Washington Allston, 1800 Allston modeled this painting after a painting by a British artist of a chained lunatic.

Bedlam of the World, 1781

A visit to Bedlam 1794

Viewing the Mad at the Pennsylvania Asylum from Ebenezer Haskel, The Trial of Ebenzer Haskel (Philadelphia, 1869)

LANCETS for Blood-letting

Pinel at the Salpêtriérè, painted by Robert-Fleury

Philippe Pinel Treatise on Insanity Head of Bicêtre Hospital for Men, 1793 Head of Salpêtrière Hospital for Women, 1795

Salpêtrière Hospital

Pinel’s Innovations Case Study Method: Detailed analysis of facts of individual case. Separation of patients according to diagnosis; new category of mania without delirium. Treatment was possible, not all madness from brain lesions. Moral Treatment: Mild but firm suggestion and even coercion.

Treated with mild methods by physician Francis Willis in 1788 Diagnosed later with porphyria; attacks Brought on by high levels of arsenic taken in the healing powders he was ingesting.

Retreat at York

Description of the Retreat 1813 by Samuel Tuke, grandson of William Tuke

“If it be true, that oppression makes a wise man mad, is it to be supposed that stripes, and insults, and injuries, for which the receiver knows no cause, are calculated to make a madman wise? Or would they now exasperate his disease, and excite his resentment? Samuel Tuke, p. 144.

Tuke’s Principles 1) Strengthen the power of the patient to control the disorder. 2) Determine modes of coercion and restraint, when absolutely necessary. 3) Promote general comfort of the insane. Tuke, p. 138

“Ball of Lunatics at the Asylum” Blackwell’s Island, New York City Frank Leslie’s Weekly, 1865

McLean Hospital, Belmont, MA

McLean Hospital

Eli Todd, Superintendent of the Hartford Retreat

Pennsylvania Hospital for the Insane

Dorothea Dix Hospital, 1849, Raleigh, NC "I have come to present to you the strong claims of suffering humanity," "I come as the advocate of the helpless, forgotten, insane men and women held in cages, closets, cellars, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience!"

Michel Foucault ( ) Histoire de la Folie (1961) published in abridged English translation as: Madness and Civilization (1965) Moral treatment in the asylum as a form of social control

“King Lear and Fool in a Storm” Artist: Sir John Gilbert ( )

Hieronymus Bosch “Ship of Fools” ( )

Foucault’s Depiction of Four Principles of the “Therapeutic” Asylum 1) Silence 2) Recognition by Mirror 3) Perpetual Judgment 4) Presence of Medical Personage

Bentham’s Panopticon, 1787

Critiques of Foucault No great confinement (limited to France in 1650s) Work duties not enforced in early asylums State did not have that much power over patients—negotiations between families, communities, local officials, superintendants. Great variety in quality of asylums. Romantic notion of the mad; what about their suffering?