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Psychiatric Beginnings: Moral Treatment and the Asylum

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).

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Psychiatric Beginnings: Moral Treatment and the Asylum

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  1. Psychiatric Beginnings: Moral Treatment and the Asylum

  2. Further Reading on Early ModernConceptions 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, 1580-1890 • Michael Mac Donald, Mystical Bedlam: Madness, Anxiety and Healing in 17th England

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

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

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

  6. William Hogarth, Scene in a Madhouse, 1733

  7. A Depiction of the Mad by Charles Bell, 1774

  8. RESTRAINING APPARATUS and SHACKLES

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

  10. Bedlam of the World, 1781

  11. A visit to Bedlam 1794

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

  13. Benjamin Rush (1745-1813) LANCETS for Blood-letting

  14. Tranquilizing Chair

  15. Pinel at the Salpêtriérè, painted by Robert-Fleury

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

  17. Salpêtrière Hospital

  18. Salpêtrière Hospital

  19. 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.

  20. Mad King George III of England 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.

  21. Retreat at York

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

  23. “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.

  24. 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

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

  26. McLean Hospital, Belmont, MA

  27. McLean Hospital

  28. Eli Todd, Superintendent of the Hartford Retreat 1823-1833

  29. Pennsylvania Hospital for the Insane

  30. Dorothea Dix (1802-1887) 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!"

  31. Michel Foucault (1926-1984) 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

  32. “King Lear and Fool in a Storm” Artist: Sir John Gilbert (1817-1897)

  33. Hieronymus Bosch “Ship of Fools” (1490-1500)

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

  35. Bentham’s Panopticon, 1787

  36. 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?

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