Psychiatric Beginnings: Moral Treatment and the Asylum.

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Presentation transcript:

Psychiatric Beginnings: Moral Treatment and the Asylum

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

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)

Benjamin Rush ( ) LANCETS for Blood-letting

Tranquilizing Chair

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.

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

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?