Author Archives: Carla Joinson

Whose Responsibility?

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Children Working at a Textile Mill

For much of history, dependent persons–children, the sick, poor, elderly, and disabled–were considered the entire responsibility of the family. That family (or probably the head of household) could choose how it wanted to deal with that person and was usually free to act upon its  decision. Thus, officials had no reason to interfere if a family sent a six-year-old child off to work ten hours a day, ignored or neglected an elderly  parent, or allowed a blind relative to waste away emotionally and intellectually. The poor were often allowed to starve; towns were so anxious not to incur unnecessary expenses that they often banned newcomers who couldn’t prove they had work and could provide for themselves. Independent charities, religious groups, or individuals sometimes offered aid to these dependent groups, but society largely washed its hands of them. Thus, a family member who would not or could not work due to mental problems might be allowed to wander around the countryside as best he could. Violently disturbed members were often chained to prevent their wandering or interference with the rest of the family’s tasks.

This laissez faire treatment of the insane continued into relatively modern times. In Connecticut, for instance, Mary Weed, of Stratford, stated in 1786 “that for 20 years her husband had been so insane as to be kept ‘chained.'” Whether he was chained at home or in a jail is unknown, but one place was as likely as another. Even when towns did try to help dependent citizens, they often wound up in dismal environments. The poor and sick might find a place to stay at an almshouse or workhouse, while an unruly person–no matter what the cause for the behavior–would end up in jail. Eventually, towns were forced to expend more effort to help the helpless, which I will discuss in my next post.

The Empty Cupboard, courtesy Sheffield Libraries, Archives and Information

The Madman by Sir Charles Bell, 1806, courtesy of The Wellcome Library

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Early Portrait of Madness

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Self-Portrait of William Hogarth, circa 1757

William Hogarth, a British artist born in 1697, became well known for both his satirical and morality engravings and paintings. During the 1730s and 1740s, Hogarth became interested in social and moral causes. He used his considerable talents to illustrate the sorrowful lives of those in poverty or who became impoverished due to poor choices. He took on crime, gambling, prostitution, drinking, and greed, making his moral points through intricate scenes that needed little explanation.

One of Hogarth’s best-known works is a series of paintings called “A Rake’s Progress,” which follows a young man who inherits a fortune from his miserly father. He becomes a fashionable gentleman, drinks to excess and lives riotously, and eventually squanders his wealth. After various trials and tribulations of his own making, the no-longer-young Tom Rakewell ends up in the madhouse at Bedlam. Hogarth captures the misery of the institution during its days of poor treatment for patients.

In the Madhouse

Beer Street and Gin Lane, Hogarth

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Two Causes of Insanity

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Hippocrates

In ancient times, insanity was seen as a result of spiritual forces working against an individual. A god or demon could either inhabit a body and manifest in some way, or merely cause problems for the victim via spiritual power. Sometimes manifestations were considered benign or even holy, and the person who acted oddly was left alone. If the manifestations went against society’s expectations, then the spirit was deemed evil and attempts were made to get rid of it through ceremonies and incantations. Around 460 BC, the Greek physician Hippocrates argued that the brain was the actual organ of the mind and reasoning. Therefore, insanity could be treated just like any other physical problem. His ideas were generally accepted until the Middle Ages, when once again, authorities began to believe that the spiritual realm controlled the mind. During that time, ideas of witchcraft and demonic possession flourished.

Eventually, Europe once again caught up to ancient Greek thought and began to look at physical causes for mental illness. Because of their evolving beliefs about insanity, European healers stopped dismissing the insane as hopeless cases who should be locked away for life. Instead, they looked for ways to help alleviate what might be just a temporary condition. The insane began to live in asylums rather than prisons and poorhouses, and physicians tried to discover methods of caring for them that would lead to a return of sanity. The early nineteenth century became a very hopeful time in which many doctors believed almost all cases of insanity could be cured.

Demon Leaving the Body of an Epileptic Through His Mouth

Patients With Various Mental Disorders

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Coming Full Circle

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Treatment for insanity remained surprisingly consistent in many ways over hundreds of years (see last post). One great stride in treating the insane came when authorities stopped lumping “lunatics” in with criminals and the poor, either in prisons or almshouses. (Just as often, lunatics were chained or confined even in early hospitals.)

Sketch of an Inmate in Bethlem (Bedlam) Hospital

A more compassionate understanding about the special needs of the insane emerged, and from that, elaborate asylums for their care sprang up. Though asylums eventually deteriorated into little more than holding tanks and warehouses for the insane, their original purpose was founded on kindness.

During the 1960s and 1970s, funding for mental health care was diverted from asylums (which weren’t working well) and funneled into community-based services. Like the asylums before them, community services such as clinics and halfway houses were good ideas which unfortunately never received sufficient funds to work well. As mentally ill patients were turned out of asylums, they often found no help. A 2006 report from the Bureau of Justice shows that in 2005, “more than half of all prison and jail inmates had a mental health problem.” These people included 705,600 in State prisons, 78,800 in Federal prisons, and 479,900 in local jails. Mental health problems were defined by a recent history or symptoms of a mental health problem that occurred within 12 months of the time the survey was taken.

It seems that once again, prisons constitute the primary housing for the nation’s mentally ill.

The Updated Bethlem (Bedlam) Hospital

An Engraving of Bethlem (Bedlam) Hospital

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Treatments of Long Standing

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Asylum Patients With Various Disorders

Treatments for insanity were surprisingly consistent until the modern era. Bleeding, purging, forced vomiting, and other physical remedies were go-to procedures until the early 1800s. Purging (causing the bowels to evacuate) and vomiting continued into the nineteenth century. Physicians turned to opiates to sedate patients early in the seventeenth century, and they were still popular in the nineteenth.

Even “new” psychological treatments created in the nineteenth century had echoes of this earlier period. Alienists and asylum superintendents in the 1800s recommended a change of scenery and light amusements to divert the troubled mind, particularly for those who fell into depression or melancholy as it was popularly called. Robert Burton, an expert on melancholy who wrote almost 1,400 pages on the subject in 1620, called for those afflicted with the condition to “seek merry company, play at honest amusements, dress gaily, and haunt light and lovely places.” The two treatments are remarkably similar, even though the first was part of the newly emerging “moral treatment” pioneered in the early 1800s.

On a darker note, authorities in the 1600s often beat the insane in much the same way parents would discipline unruly children. Some of the beatings or other forceful remedies for “misbehavior” could be quite painful and dehumanizing. Moral treatment succeeded in reducing or stopping such punishment for the behaviors of the insane, and patients enjoyed much more humane treatment for several decades. Unfortunately, the more crowded insane asylums became, the more often attendants ended up resorting to these primitive methods for controlling behavior. Some of the worst ills of the asylum era ended up being physical abuse and the various restraining devises attendants used.

Robert Burton's Book on the Treatment of Melancholy

A German Book on Melancholy, Published in 1653

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A Few Protections

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Undated Woodcut, Chasing the Village Idiot

Americans were guided in their treatment of the insane by English law and tradition, which recognized that certain segments of the population had special needs. Children, idiots and lunatics “were siblings in the eyes of the law” says author Michael MacDonald, because they all lacked the capacity to reason. These people were put under wardship by the courts, who often sold these wardships to the highest bidder. People who became wards of idiots and children could then plunder their estates or force them into a marriage that was somehow advantageous to the guardian.

Surprisingly, lunatics often fared much better under the wardship system. Because the insane were actually expected to get well and take back their property or at least pass it on to heirs, courts demanded greater accountability from their guardians. King James told the courts that lunatics should be committed to [primarily] friends and family–“that can receive no benefit by their death.” Lunatics weren’t as attractive to unscrupulous guardians precisely because they were insane and therefore couldn’t enter into contracts, including the marriage contract. Though lunatics’ lives were never pleasant, at least they theoretically had a chance for a decent life after recovery.

King James

Anatomy Book From 1615

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Dr. Hummer’s Credentials

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Dr. Harry Hummer

Dr. William A. White was an undisputed leader in the field of psychiatry (see last post). He was St. Elizabeths’ superintendent for over twenty years, and implemented many innovations. St. Elizabeths endured its own cycles of overcrowding, scandals, and investigations, but it was generally considered  one of the leading institutions of its kind. It attracted some of the country’s best psychiatrists and researchers, who wanted to be affiliated with the asylum and its good reputation. Continue reading →

An Important Alienist

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Alienists Were Considered Experts

Alienists became more important as experts to draw on after psychiatry became more established.

Dr. William A. White, for many years the superintendent of the federal government’s first hospital for the insane, St. Elizabeths, was an especially important figure.

His book, Outlines of Psychiatry, became a classic in its field and was used as a textbook for many years. Continue reading →

Insanity Defense Becomes More Common

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Leopold and Loeb Enter Joliet Prison Following Their Convictions

Though President Garfield’s assassin, Guiteau, did not save his life based on an insanity defense, the plea became more common.

In 1924, Dr. William A. White, superintendent of St. Elizabeths Hospital for the Insane, testified in another sensational insanity-plea trial: that of Nathan Leopold and Richard Loeb for the kidnapping and murder of a fourteen-year-old boy named Robert Franks. Continue reading →

Alienists Gain Prominence

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Print of Assassination Attempt, which appeared in Frank Leslie’s Illustrated Newspaper, July 16, 1881, courtesy Library of Congress

Charles Julius Guiteau shot President James Garfield at the Pennsylvania railroad station in Washington, DC on July 2, 1881. He did not try to escape and was apprehended on the spot; when the president died twelve weeks later, Guiteau went on trial for his murder. The public was fascinated and the trial became something of a media circus, with Guiteau’s behavior as avidly reported as the points made by the attorneys for the prosecution and defense. Continue reading →