The Rise of Institutional Psychiatry
We offer an anecdotal view of select places in history, spotlighting an interesting progression that gives rise to the modern day practice of psychiatry.
Author’s note: While we normally use the terms ‘mental illness’ and ‘treatment center’, you will see the words ‘lunatic’, ‘madness’ and ‘asylum’ in the following post because those terms were actually used at the time.
The Lunatic Asylum
The rise of the ‘lunatic asylum’ and its gradual transformation into, and eventual replacement by, the modern psychiatric hospital, explains the rise of organized, institutional psychiatry. While there were earlier institutions that housed the ‘insane‘, the arrival at the answer of institutionalization as the correct solution to the problem of ‘madness’, was very much an event of the nineteenth century.
Image: Pinel ordering the removal of chains from patients at the Paris Asylum for insane women.
Image credit: Dr. Philippe Pinel at the Salpêtrière, 1795 by Tony Robert-Fleury.
In the Islamic world, the Bimaristans were described by European travelers, who wrote on their wonder at the care and kindness shown to ‘lunatics’. In 872, Ahmad ibn Tulun built a hospital in Cairo that provided care to the insane which included music therapy. Nonetheless, medical historian Roy Porter cautions against idealizing the role of hospitals generally in medieval Islam stating that
“They were a drop in the ocean for the vast population that they had to serve, and their true function lay in highlighting ideals of compassion and bringing together the activities of the medical profession.”
Bethlem Hospital in 1632
Image credit: Daniel Hack Tuke,
Chapters in the History of the Insane in the British Isles (London, 1882), P.60 – Project Gutenberg Ebook Edition [#31185] 2010
How did First Bethlem Hospital function?
In 1632 it was recorded that Bethlem Royal Hospital, London had “below stairs a parlor, a kitchen, two larders, a long entry throughout the house, and 21 rooms wherein the poor distracted people lie, and above the stairs eight rooms more for servants and the poor to lie in”. Inmates who were deemed dangerous or disturbing were chained, but Bethlem was an otherwise open building for its inhabitants to roam around its confines and possibly throughout the general neighborhood in which the hospital was situated.
In 1676, Bethlem expanded into newly built premises at Moorfields with a capacity for 100 inmates.
18th Century Institutional Care
The level of specialist institutional provision for the care and control of the insane remained extremely limited at the turn of the 18th century. Madness was seen principally as a domestic problem, with families and parish authorities central to regimens of care.
Various forms of outdoor relief were extended by the parish authorities to families in these circumstances including financial support, the provision of parish nurses and, where family care was not possible, lunatics might be ‘boarded out’ to other members of the local community or committed to private ‘madhouses’.
In England at the beginning of the nineteenth century there were, perhaps, a few thousand lunatics housed in a variety of disparate institutions but by the beginning of the twentieth century that figure had grown to about 100,000. That this growth should coincide with the growth of alienism, now known as psychiatry, as a medical specialism is not coincidental.
Image: Social alienation
Around the start of the 19th century, Pinel was popularizing a new understanding of mental alienation, particularly through his ‘medical-philosophical treatise’. He argued that people could be disturbed (alienated) by emotional states and social conditions, without necessarily having lost (become alienated from) their reason, as had generally been assumed. Hegel praised Pinel for his ‘moral treatment’ approach, and developed related theories.
Asylum de Bicêtre in 1793
Image credit: “Hôpital du Kremlin-Bicêtre” by Eugène Atget – Bibliothèque nationale de France.
Licensed under Public Domain via Commons
The Bicêtre is most famous as the Asylum de Bicêtre where Superintendent Philippe Pinel is credited as being the first to introduce humane methods into the treatment of the mentally ill, in 1793.
The Bicêtre is referenced in The Birth of the Asylum from Foucault‘s Madness and Civilization. In it, Pinel’s methods are classified as more devious than humane.
Monmouthshire Lunatic Asylum at Abergavenny 1850
Image: The joint counties’ lunatic asylum, erected at Abergavenny, 1850
From 1851, the Monmouthshire Lunatic Asylum, later Pen-y-Fal Hospital, a psychiatric hospital, stood on the outskirts of Abergavenny. Between 1851 and 1950, over 3,000 patients died at the hospital. A memorial plaque for the deceased has now been placed at the site.
After closure in the 1990s, its buildings and grounds were redeveloped as a luxury housing development comprising houses as well as apartments.
Eastern State Hospital
The only hospital where mentally ill patients were sometimes taken before Eastern State Hospital was built, was the Pennsylvania Hospital, a Quaker institution in Philadelphia. Until a campaign by Benjamin Rush in 1792 to establish a separate treatment wing, mentally ill patients were kept in the basement and out of the way of regular patients who needed medical assistance.
Image: Eastern State Hospital was the first psychiatric institution to be founded in the United States.
Eastern State Hospital, located in Williamsburg, Virginia, was the first public facility in the United States constructed solely for the care and treatment of the mentally ill, and remains in operation today.
A person who was mentally ill was not diagnosed by a doctor, but rather judged by 12 citizens, much like a jury, to be either a criminal, lunatic or Idiot. Most were then placed in the Public Gaol in Williamsburg. Taxpayers probably appreciated the hospital idea only if they had a family member or close friend who was mentally ill.
We thank Wikipedia.org for the information and give credit to artists and images when known.