Jumana (1114363)

Historical Views Of Abnormal Behavior 

The Establishment of Early Asylums: “From the sixteenth century on, special institutions called asylums sanctuaries or places of refuge meant solely for the care of the mentally ill—grew in number. The early asylums were begun as a way of removing from society troublesome individuals who could not care for themselves. Although scientific inquiry into abnormal behavior was on the increase, most early asylums, often referred to as “madhouses,” were not pleasant places or “hospitals” but primarily residences or storage places for the insane. The unfortunate residents lived and died amid conditions of incredible filth and cruelty. The first asylum established in Europe was probably in Spain in 1409—the Valencia mental hospital founded by Father Juan Pilberto Joffre (Villasante, 2003)—although this point has been the subject of considerable discussion (Polo, 1997; Trope, 1997). Little is known about the treatment of patients in this asylum. In 1547 the monastery of St. Mary of Bethlehem in London (initially founded as a monastery in 1247; see O’Donoghue, 1914) was officially made into an asylum by Henry VIII. Its name soon was contracted to “Bedlam,” and it became widely known for its deplorable conditions and practices. The more violent patients were exhibited to the public for one penny a look, and the more harmless inmates were forced to seek charity on the streets of London. These early asylums were primarily modifications of penal institutions, and the inmates were treated more like beasts than like human beings. This treatment continued through most of the eighteenth century” (Robert, Butcher, Hooley, & Mineka, 2007)

Humanitarian Reform: “By late eighteenth century, most mental hospitals in Europe and American were in great need of reform. The humanitarian treatment of patients received great impetus from the work of Philippe Pinel (1745–1826) in France. In 1792, shortly after the first phase of the French Revolution, Pinel was in charge in Paris. In this capacity, he received the grudging permission of the Revolutionary Commune to remove the chains from some of the inmates as an experiment to test his views that mental patients should be treated with kindness and consideration as sick people, not as vicious. The monastery of St. Mary of Bethlehem in London became an asylum for the mentally ill in the reign of King Henry the VIII during the sixteenth century. The hospital, known as “Bedlam,” became infamous for its deplorable conditions and practices “(Robert, Butcher, Hooley, & Mineka, 2007).

 TUKE’S WORK IN ENGLAND : “At about the same time that Pinel was reforming, an English Quaker named William Tuke (1732–1822) established the York Retreat, a pleasant country house where mental patients lived, worked, and rested in a kindly, religious atmosphere (Narby, 1982). This retreat represented the culmination of a noble battle against the brutality, ignorance, and indifference of Tuke’s time. The Quaker retreat at York has continued to provide humane mental health treatment for over 200 years (Borthwick, Holman, et al., 2001), even though the mental hospital movement spawned by its example evolved into large mental hospitals that became crowded and often offered less-than-humane treatment in the late nineteenth and early twentieth century’s” (Robert, Butcher, Hooley, & Mineka, 2007).

RUSH AND MORAL MANAGEMENT IN AMERICA: “The success of Pinel’s and Tuke’s humanitarian experiments revolutionized the treatment of mental patients throughout the Western world. In the United States, this revolution was reflected in the work of Benjamin Rush (1745–1813), the founder of American psychiatry and also one of the signers of the Declaration of Independence. While he was associated with the Pennsylvania Hospital in 1783, Rush encouraged more humane treatment of the mentally ill; wrote the first systematic treatise on psychiatry in America, Medical Inquiries and Observations upon Diseases of the Mind (1812); and was the first American to organize a course in psychiatry. But even he did not escape entirely from the established beliefs of his time. His medical theory was tainted with astrology, and his principal remedies were bloodletting and purgatives. In addition, he invented and used a device called “the tranquilizing chair,” which was probably more torturous than tranquil for patients. The chair was thought to lessen the force of the blood on the head while the muscles were relaxed. Despite these limitations, we can consider Rush an important transitional figure between the old era and the new” (Robert, Butcher, Hooley, & Mineka, 2007).

During the early period of humanitarian reform, the use of moral management, a wide ranging method of treatment that focused on a patient’s social, individual, and occupational needs which became relatively widespread. This approach came out largely from the work of Pinel and Tuke. (Robert, Butcher, Hooley, & Mineka, 2007)

“Moral management in asylums emphasized the patients’ moral and spiritual development and the rehabilitation of their “character” rather than their physical oriental disorders, in part because very little effective treatment was available for these conditions at the time. The treatment or rehabilitation of the physical or mental disorders was usually through manual labor and spiritual discussion, along with humane treatment. Moral management achieved a high degree of effectiveness—which is all the more amazing because it was done without the benefit of the antipsychotic drugs used today and because many of the patients were probably suffering from syphilis, a then-incurable disease of the central nervous system. In the 20-year period between 1833 and 1853, Worcester State Hospital’s discharge rate for patients who had been ill less than a year before admission was 71 percent. Even for patients with a longer preadmission disorder, the discharge rate was 59 percent (Bockhoven, 1972). In London, Walford (1878) reported that during a 100-year period ending in 1876, the “cure” rate was 45.7 percent for the famed Bedlam Hospital. Despite its reported effectiveness in many cases, moral management was nearly abandoned by the latter part of the nineteenth century. The reasons were many and varied. Among the more obvious ones were ethnic prejudice against the rising immigrant population in hospitals, leading to tension between staff and patients; the failure of the movement’s leaders to train their own replacements; and the overextension of hospital facilities, which reflected the misguided belief that bigger hospitals would differ from smaller ones only in size” (Robert, Butcher, Hooley, & Mineka, 2007).

“Two other reasons for the demise of moral management are, in retrospect, truly ironic. One was the rise of the mental hygiene movement, which advocated a method of treatment that focused almost exclusively on the physical well-being of hospitalized mental patients. Although the patients’ comfort levels improved under the mental hygienists, the patients received no help for their mental problems and thus were subtly condemned to helplessness and dependency” (Robert, Butcher, Hooley, & Mineka, 2007).

 Reference: 

 Robert, Butcher, Hooley, & Mineka. (2007). Abnormal Psychology (13th edition ed.). Pearson Education and Dorling Kindersley Publishing.