A Time of Change
"Insanity is now known to be a physical disease, and as amenable to human remedies as any other. It is now an object to restore the lunatic to life and society, not to bury him from sight and hope."
-Edward Jarvis, 1841
"Insanity is now known to be a physical disease, and as amenable to human remedies as any other. It is now an object to restore the lunatic to life and society, not to bury him from sight and hope."
-Edward Jarvis, 1841
Around 1790 a young boy known as Crazy Amos accidentally burned down a building in Danbury, Connecticut. This action changed Crazy Amos’ standing from a harmless, mentally disordered member of the community, to a dangerous person who potentially threatened the lives of the townspeople. When those townspeople demanded that he be dealt with Amos’ father Nathaniel had him chained to the beams of the local meeting house attic. Soon after being chained up, Crazy Amos clawed his way through the second story wall and escaped into both the forests of southwestern Connecticut and history.
This reaction to and treatment of Crazy Amos was typical in eighteenth century America. Generally the family or the community was the bedrock of care for the sick and disabled. Once a person was deemed a danger to themselves or others, they would be physically restrained, often in a brutal manner. When the family was unable or unwilling to provide care, insane individuals were placed in an almshouse or prison. This practice rested not on laziness but on misconceptions about the nature of insanity. Society believed that mental instability was the result of possession by a spirit or demon and therefore incurable; the inherent sanity, or humanity, of a person had been irrevocably destroyed leading the them to be treated with abuse, neglect, and ridicule. |
In Europe mentally ill people were cared for by family or they were placed in asylums. Within the asylums the insane were locked in cells, forgotten about, and abused by cruel attendants. Bethlem Royal Hospital in London, England, colloquially referred to as “Bedleheem,” “Bedleem,” or “Bedlam,” was particularly notorious for their harsh treatment of the insane. Here patients were chained in cells and treated like animals in a zoo. The abnormality of insane behavior provided such a spectacle that the community was allowed to walk through the halls of Bethlem and other asylums to gawk at patients.
The image to the right is a satirical representation of one such visit to Bethlem. The patients are seen poking their heads through small openings in their cell doors antagonizing visitors who appear to be angered, scared, and shocked by the behavior of the insane. The patient farthest to the right even has a chamber pot on his head. The drastic appearance of the insane as gaunt, pale, and dirty provides a stark contrast from the visitors who are all dressed in respectable clothing, well-fed, and rosy-cheeked indicating a marked division between the civilized nature of sanity and the uncivilized nature of insanity. |
Near the end of the eighteenth century these practices became the subject of humanitarian reform as medical science began to regard insanity as a disease of the brain. This meant that the insane were not animals; they somehow retained their inherent humanity through their madness. Such a belief led European physicians to adopt a healing method of treatment for the insane rather than abusive custodial care. This method became known as moral treatment, or moral therapy.
The moral treatment of insanity began around 1792 when the French physician Philippe Pinel famously struck the chains off of his patients at the Asylum de Bicêtre, depicted in the above painting. By 1801 Pinel had written and published a treatise on moral therapy titled Traité Médico-Philosophique sur l'Aliénation Mentale; ou la manie which argued that a mildness of treatment was more beneficial to patients than a system of punishment that met abnormal behavior with confinement and brutality.
While Pinel was unchaining the mad in France, William Tuke was founding the York Retreat for Insane Persons Belonging to the Quaker Society of Friends in England. The impetus for Tuke's asylum grew out of the death of fellow Quaker Hannah Mills. Mills had died shortly after her admittance to an English Asylum where the Quakers believed she had been treated more like an animal than a human. Hoping to remedy the harsh reality of life for insane Quakers, the York Retreat instituted a regime of work, exercise, and amusements that fit well within Pinel's vision of mild treatment.
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Moral therapy was officially brought to America in 1812 when Benjamin Rush published a definitive American treatise on the humane treatment of insanity: Medical Inquiries and Observations upon the Diseases of the Mind. Rush prefaced this work by stating his intention to lessen "a portion of some of the greatest evils of human life." Like Pinel and Tuke, Rush believed that insanity was curable through business, amusements like chess, and kindness.
Building on the dictates of Pinel, Tuke, and Rush, American physicians were quick to reject the brutal treatment of the eighteenth century and usher in the era of moral treatment. |