Читать книгу Abnormal Psychology - William J. Ray - Страница 58

In 1330, a convent of the order of St. Mary of Bethlehem became the first institution for the mentally ill in England. The institution eventually received a royal charter and, over the years, the word Bethlehem became Bedlam, and the institution was referred to as “Old Bedlam.” The English word bedlam comes from this institution. Various reports suggested that the inmates were often chained, treated cruelly, and not given proper food or clothing. As depicted in novels of the day, people in the 1700s would go to Bedlam to see the inmates as an outing in much the same way today we might go to a zoo. In 1814, some 96,000 people visited the asylum.

In the 1800s, there was a campaign in England to change the conditions for the patients, which led to the establishment of the Committee on Madhouses in 1815. This ushered in a period of concern for the patients rather than seeing them as objects of curiosity as in the previous century. Treatment for patients during the 1800s brought new practices including the therapeutic value of work.

During this period, there was a spirit throughout the world to adopt a “moral treatment of the insane.” Three important individuals in this movement were Benjamin Rush (1745–1813) in the United States, Phillipe Pinel (1745–1826) in France, and Vincenzo Chiarugi (1759–1820) in Italy (Gerard, 1997). In the United States, Rush, who had signed the Declaration of Independence, later established a wing at the Pennsylvania Hospital in Philadelphia for the treatment of mental illness. He is often considered to be the father of American psychiatry and saw mental illness as a problem of the mind. However, he continued to practice bloodletting as the best treatment for mental illness. Rush developed a tranquilizing chair that he believed would change the flow of blood. Professionals tend to view this invention as neither helpful nor hurtful to the patient. He also wrote the first psychiatric textbook published in America.

In France, Pinel sought to change the way the insane were treated. He engaged the idea that mental illness could be studied using the methods of the natural sciences. In 1793, Pinel became the director of the Bicêtre Asylum in Paris. As director, he reviewed the commitment papers of the inmates, toured the building, and met with each patient individually. The building was in bad shape, and the patients were chained to walls. As Pinel (1806) himself described the institution, “everything presented to me the appearance of chaos and confusion.” Pinel petitioned the government and received permission to remove the chains, and he also abandoned the practice of bloodletting.

Rush believed the tranquilizing chair would benefit patients with mental illness by changing the flow of blood.

Bettmann/Contributor/Bettmann/Getty Images

Pinel began to carefully observe patients and also talk with them. In these discussions, he attempted to create a detailed case history and to better understand the development of the disorder. This led to a classification system that he published in 1789, which sorted mental diseases into five categories: melancholia, mania without delirium, mania with delirium, dementia, and idiocy. In 1795, Pinel became the chief physician at the Hospice de la Salpêtrière, where he remained for the rest of his life. Pinel is known as the father of scientific psychiatry.

Vincenzo Chiarugi was less well known outside of Italy until a paper published in the middle of the last century, which brought his name to the attention of Americans (Mora, 1959). Some 8 years earlier than Pinel, Chiarugi began removing chains from his patients. Early in his career, Chiarugi became the director of a large hospital in Florence, which included special facilities for the mentally ill. This was established with the passage of a law in 1774 in Italy that allowed mentally ill individuals to be hospitalized. As director of the hospital, Chiarugi created guidelines concerning how patients were to be treated. One of his rules specified that patients were to be treated with respect. He also directed that if restraints were required, they should be applied in a manner to protect the patient from sores and be made of leather rather than chains. He also used psychopharmacological agents such as opium for treatment.

In France, Pinel sought to change the way the insane were treated. Here, he removes the chains from a patient with mental illness.

Public domain

In addition to mental health professionals, the humane care of individuals with mental illness was moved forward by a number of other individuals. William Tuke (1732–1822) was a successful English merchant and a Quaker philanthropist. Some friends had told him of being turned away from an asylum in York, England, when they had tried to visit a fellow Quaker who had been confined there. Within a few days, the patient was reported dead. Tuke visited the asylum and found the conditions deplorable. Having retired, he decided to devote his life to creating alternative places where “the unhappy might find refuge” (Tuke, 1813).

In 1796, near the town of York, he created the Retreat for Persons Afflicted With Disorders of the Mind. This Quaker retreat, as it was called, carried with it the idea that the individuals who were there should be given respect as well as good food and exercise. There were to be no chains or manacles. The model for the retreat was a farm, and the patients performed farm duties as part of their treatment. Others visited to learn of its operation. In 1813, the Quakers of Philadelphia founded the Friends’ Asylum for the Use of Persons Deprived of the Use of Their Reason, which was the first private psychiatric hospital in the United States. Both the retreat in York and the Friends’ Hospital of Philadelphia continue to function today as places for mental health treatment.

Another individual who contributed to the American mental health movement was Dorothea Dix (1802–1887). While teaching women at the East Cambridge House of Correction in Massachusetts, Dix had her eyes opened to the terrible conditions these women faced. Dix also realized that a number of these women had some type of mental illness. From this experience, she devoted her life to crusading for the improved treatment of the mentally ill. As part of this crusade, she visited every state east of the Mississippi River and testified before local and national legislatures. It is estimated that her work led to the establishment of some 40 mental hospitals in the United States and Europe.

The Friend’s Hospital of Philadelphia was the first private psychiatric hospital in the United States and still functions today.

Friends’ Asylum for the Insane near Frankford, printed by Lehman & Duval, 1836 (litho), Lehman, George (d.1870)/Library Company of Philadelphia, PA, USA/The Bridgeman Art Library.

By the 1950s, there were a number of hospital facilities in the United States for those with mental illness. These were administered by both state governments and private organizations. This changed in the 1950s as described in LENS: Closing Mental Hospitals in America.

Lens