Psychiatric Beginnings:

Moral Treatment and the Asylum

James Otis

Osgood’s Farm, Andover, MAwhere Otis was cared for in 1780s

William Hogarth, Scene in a Madhouse, 1733

A Depiction of the Madby 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 Britishartist of a chained lunatic.

Bedlam of the World, 1781

A visit to Bedlam1794

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

Benjamin Rush (1745-1813)

LANCETS for Blood-letting

Tranquilizing Chair

Pinel at the Salpêtriérè, painted by Robert-Fleury

Philippe PinelTreatise on Insanity

Head of BicêtreHospital for Men,

1793

Head of SalpêtrièreHospital for Women,

1795

Salpêtrière Hospital

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

1813by

Samuel Tuke,grandson ofWilliam 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 CityFrank Leslie’s Weekly, 1865

McLean Hospital, Belmont, MA

McLean Hospital

Eli Todd,Superintendent

of theHartford Retreat,

1823-1833

Pennsylvania Hospital for the Insane

Michel Foucault (1926-1984)

Histoire de la Folie (1961)

published inabridged 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(1817-1897)

Hieronymus Bosch

“Ship of Fools”

(1490-1500)

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?