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Psychiatric Beginnings: Moral Treatment and the Asylum

Psychiatric Beginnings: Moral Treatment and the Asylum. James Otis. Osgood’s Farm, Andover, MA where Otis was cared for in 1780s. William Hogarth, Scene in a Madhouse, 1733. A Depiction of the Mad by Charles Bell, 1774. RESTRAINING APPARATUS and SHACKLES. “Tragic Figure in Chains”

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Psychiatric Beginnings: Moral Treatment and the Asylum

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  1. Psychiatric Beginnings: Moral Treatment and the Asylum

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

  3. William Hogarth, Scene in a Madhouse, 1733

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

  5. RESTRAINING APPARATUS and SHACKLES

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

  7. Bedlam of the World, 1781

  8. A visit to Bedlam 1794

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

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

  11. Tranquilizing Chair

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

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

  14. Salpêtrière Hospital

  15. Salpêtrière Hospital

  16. 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.

  17. Retreat at York

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

  19. “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.

  20. 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

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

  22. McLean Hospital, Belmont, MA

  23. McLean Hospital

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

  25. Pennsylvania Hospital for the Insane

  26. 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

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

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

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

  30. Bentham’s Panopticon, 1787

  31. 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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