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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” - PowerPoint PPT Presentation
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“Tragic Figure in Chains”painted by
Washington Allston,1800
Allston modeled this painting after a painting by a Britishartist of a chained lunatic.
Viewing the Mad at the Pennsylvania Asylumfrom Ebenezer Haskel, The Trial of Ebenzer Haskel (Philadelphia, 1869)
Philippe PinelTreatise on Insanity
Head of BicêtreHospital for Men,
1793
Head of SalpêtrièreHospital for Women,
1795
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.
“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.
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
Michel Foucault (1926-1984)
Histoire de la Folie (1961)
published inabridged English
translation as:
Madness and Civilization (1965)
Moral treatment in the asylum as a
form of social control
“King Lear and Fool in a Storm”
Artist: Sir John Gilbert(1817-1897)
Foucault’s Depiction of Four Principles of the “Therapeutic” Asylum
1) Silence
2) Recognition by Mirror
3) Perpetual Judgment
4) Presence of Medical Personage
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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