The Asylum Movement
The Asylum Movement
Changing Perceptions. In the seventeenth and early eighteenth centuries most Americans viewed mental illness as a spiritual problem, resulting from sin, guilt, or, at its worst, demonic possession. Throughout the eighteenth century a gradual shift occurred in which people began to emphasize the physical causes of mental maladies, in accordance with the practice of Enlightenment thinkers who were beginning to combine new scientific methods with the traditional approach to understanding the human body through humoral theory.
Control. Throughout most of this period people who showed signs of madness were confined in institutions only if they became violent. For the most part the only available institutions were jails and almshouses. In America only the Pennsylvania Hospital, established in 1751, accepted mentally ill patients. Those patients received harsh treatment, generally being kept in chains in basement cells. The first hospital devoted exclusively to housing the mentally ill was established in Williamsburg, Virginia, in 1773. After the Revolution the mad were often viewed as subversive to the social order; increasingly, lunatics were confined to jails and almshouses, while more hospitals established wards to confine the insane.
Medical Treatment. As the concept of madness as a physical disease gained ground, it became common practice to try to cure such patients with traditional heroic medical therapies, including cupping, purging, and bleeding. Benjamin Rush, the leading physician of the Revolutionary and early national periods, favored those practices along with harsh discipline and physical restraint using straitjackets and chains. Rush articulated the prevailing view of mental illness in his Medical Inquiries and Observations upon the Diseases of the Mind (1812), the first important work on mental illness by an American. The practices that he advocated remained common through most of the antebellum period.
Moral Treatment. At the same time, however, a movement to reform the treatment of the mentally ill gained momentum. The asylum movement was part of a broader reform climate that addressed social problems such as crime, poverty, and alcohol abuse. It began in England when a Quaker named William Tuke established an asylum called the York Retreat and developed a method called “moral treatment” for managing the mentally ill. Tuke believed that mental illness was neither purely spiritual nor purely physical but that harmful environmental influences brought on mental disorders by affecting the individual’s emotional and spiritual state. The idea of an asylum was to provide for the victim a refuge
from the harmful environment causing his or her sickness. Asylums emphasized clean, comfortable living conditions in a tranquil, rural setting. Moral treatment entailed regular habits of exercise, work, and recreation, as well as strictly enforced rules of self-restraint and politeness. In Great Britain adherents of moral treatment condemned the use of physical restraints. In the United States, however, when voluntary cooperation did not produce the desired behavior, attendants would enforce calmness and stop offensive behavior by using such devices as straitjackets and mitts over the hands. Even so, moral treatment of the mentally ill was far more humane than previous methods.
Asylums in America. The asylum movement quickly spread through Quaker contacts to the United States. The first asylum influenced by the York Retreat was the Friends Asylum near Frankford, Pennsylvania, established in 1817. The Hartford Retreat in Connecticut appeared the same year, while the McLean Asylum for the Insane was established in Boston the following year. The popularity and reputed success (although claims were exaggerated) of these private institutions produced calls for similar public institutions. The Massachusetts State Lunatic Hospital opened in 1833, while state institutions appeared in Augusta, Maine, in 1840 and Utica, New York, in 1843.
State Hospitals. Private institutions, for the most part, were beyond the reach of the poor, and state hospitals were inadequate to meet the demand. Thus the old approach of confining the insane in penal institutions persisted even as the new asylums were coming into use. As late as the 1840s only a small minority of the mentally ill were confined to asylums; the rest were held in jails and almshouses, where they were subject to abuse and neglect. Such conditions prompted efforts in Massachusetts to enlarge the state institutions. Led by Dorothea Dix, the Massachusetts reform movement succeeded and quickly spread to other states. By the beginning of the Civil War most states had established public mental institutions, and the practice of keeping the mentally ill in jails and almshouses was in decline.
Professionalization. Meanwhile a drive was under way to professionalize the treatment of the mentally ill as a medical specialty. The Association of Medical Superintendents of American Institutions for the Insane was founded in 1844 to establish standards for treatment and qualifications for practitioners. That organization exists today as the American Psychiatric Association.
Lynn Gamwell and Nancy Tomes, Madness in America: Cultural and Medical Perceptions of Mental Illness before 1914 (Ithaca, N.Y.: Cornell University Press, 1995).