Tag Archives: Benjamin Rush

Reasonable Rehabilitation

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Amariah Brigham was Utica Asylum's First Superintendent

Amariah Brigham was Utica Asylum’s First Superintendent

The change in attitude between the old-style treatment of the insane and the new moral treatment’s philosophy (introduced by Pinel and Tuke) cannot be emphasized enough. Though some of the worst cruelties and neglect had fallen out of favor by Benjamin Rush’s time (December 24, 1745 – April 19, 1813), the man considered the “Father of American Psychiatry” believed that any physician treating an insane person had to first dominate that individual–usually through fear. Hence, threats and coercion were considered perfectly acceptable ways to gain the necessary control and authority.

One of the pioneers in American psychiatry, Dr. Amariah Brigham (December 26, 1798 – September 8, 1849) urged a completely different style of treatment. He and others of like mind developed the (then) modern insane asylum, which was capable of putting their ideas into action. For instance, Brigham believed that mental occupation was useful in effecting a cure, and suggested engaging patients’ minds in learning. He urged every institution to have something of a school within it, containing books, maps, scientific apparatus, and so on. Patients could learn reading, writing, drawing, music, arithmetic, history, philosophy, etc. The instructors in these schools would engage with patients constantly: they would teach, of course, but would also eat with patients, join them in recreational activities, and generally become their comrades. This type of engagement was for patients who were curable.

Interior of Shoe Shop, Willard Asylum for the Insane

Interior of Shoe Shop, Willard Asylum for the Insane

Patients Making Rugs, Hammocks, etc. at Hudson River State Hospital, 1909

Patients Making Rugs, Hammocks, etc. at Hudson River State Hospital, 1909

For those who weren’t (the chronic insane), manual tasks such as farm work, basket-weaving, sewing and embroidery, painting, printing, shoe-making, etc. would go a long way toward engaging patients’ attention and re-directing their thoughts in a positive manner. The physical work would also preserve their health by keeping them active.

In either type of patient, this kind of moral management, with its regular schedule, mental diversions, and lack of coercion, could be expected to help patients much more than the fear-based management of preceding philosophies. If the public had provided enough money to implement these programs effectively, the early hopes of the new psychiatric profession might have been realized.

Empty Yourself

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Bloodletting As a Treatment for Agitation in Insanity, courtesy Burns Archives

Bloodletting As a Treatment for Agitation in Insanity, courtesy Burns Archives

Early alienists typically believed that an insane person needed to eliminate something from the body in order to get well. Copious bleeding and/or purging were popular ways to deplete a maniac’s excessive energy or excitement, but many alienists soon came to believe the procedure was too extreme. Instead, they turned their attention to the bowels.

Samuel Woodward, former superintendent of the Massachusetts State Lunatic Hospital, wrote in 1846 that it was “common for the bowels to be constipated in mania,” and advised a round of laxatives to help solve the problem. He also urged that these laxatives be gentle, but unfortunately turned to poisonous mercurial compounds to do the job. A popular concoction was “blue pill” which was generally a mixture of about one-third mercury, one-third rose oil, and small proportions of licorice, milk sugar, and possibly another quarter portion of hollyhock or marshmallow derivative. Two or three of these pills might represent close to a hundred times the level of exposure that the EPA considers safe today.

Calomel Preparation, Flavored

Calomel Preparation, Flavored

Benjamin Rush's Bilious Pills

Benjamin Rush’s Bilious Pills

Mercury poisoning usually shows up first with headache, nausea, stomach pain, and later, with sore gums and loose teeth. Eventually, symptoms move on to the brain and cause loss of memory and insomnia, and often irritability, depression, and paranoia as well. Since the alienist’s goal for his patient was a daily evacuation of the bowels, patients could take something like calomel or blue pill for quite some time. And, the psychological type of symptoms as a result of mercury poisoning might well keep the sufferer both in an asylum and taking the medicine indefinitely.

Interest in the Insane

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American Psychiatric Association Emblem

American Psychiatric Association Emblem

Insanity was not new to the 19th and 20th centuries, of course, but some of its management was. The insane had often been cared for by monks and nuns under the supervision of various religious orders. Eventually, medical men ran the facilities where the insane were housed, and were often called mad-doctors or lunatic-doctors. By the late 1800s, these physicians began to be known as alienists, which referenced the insane person’s loss of a sense of self.

In the U.S., thirteen superintendents and organizers of insane asylums banded together to form the Association of Medical Superintendents of American Institutions for the Insane in 1844. The name was changed in 1892 to the American Medico-Psychological Association, and embraced more members of the medical field. Finally, the name was changed for the last time in 1921 to the American Psychiatric Association. Its emblem has a picture of Dr. Benjamin Rush (often called “The Father of American Psychiatry”) on it. The thirteen stars represent the thirteen superintendents who founded the original organization.

Association of Medical Superintendents, courtesy National Library of Medicine

Association of Medical Superintendents, courtesy National Library of Medicine

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The First Lunatic Hospitals

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Cornerstone of Pennsylvania Hospital

Cornerstone of Pennsylvania Hospital

In 1751, Dr. Thomas Bond and Benjamin Franklin founded Pennsylvania Hospital to “care for the sick, poor, and insane who were wandering the streets of Philadelphia.” It opened in 1753, and six of its first patients were “lunaticks” who needed psychiatric care.

Dr. Benjamin Rush, often called the “Father of American Psychiatry,” became involved with the hospital about 30 years after its founding. Though he believed strongly in purging, blood letting and “twirling,” his treatment methods were considerable more humane than most practices of the time. Rush forced the hospital to stop chaining its most serious lunatic cases in unheated cells, and minimized other restraints like cuffs. He also helped stop the townspeople from coming to the hospital to watch the insane patients as a form of entertainment.

Early Methods to Treat Insanity

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Bloodletting on Male Patient courtesy National Library of Medicine

Bloodletting on Male Patient courtesy National Library of Medicine

Throughout history, insane people have typically received the short end of the medical stick. They were often feared and loathed by the community, which couldn’t understand their behavior. The best they could hope for was a little physical care, or at least to be left alone.

Bloodletting Instruments courtesy of the National Library of Medicine

Bloodletting Instruments courtesy of the National Library of Medicine

Dr. Benjamin Rush (Dec 24, 1745 – Apr 19, 1813) was America’s leading physician. He tried to improve the health of the general population and worked tirelessly to help victims of the 1793 yellow fever epidemic. He also championed the cause of the mentally afflicted and insisted that they be treated with respect. Rush was so outraged by the inhuman treatment most insane people received that he agitated for–and won–funding for an insane ward at Pennsylvania Hospital.

Indian Bloodletting (pre-colonial) courtesy of the National Library of Medicine

Indian Bloodletting (pre-colonial) courtesy of the National Library of Medicine

However…Rush believed that most disease originated with problems in the circulatory system–which could be brought back into balance by bloodletting. The first thing he did with patients suffering from “maniacal excitement” was to bleed them. Not surprisingly, this treatment was very effective at calming them down.

Though Rush’s reliance on bloodletting fell into disfavor, the idea of keeping insane people calm did not. Under a mental health care system that was mainly custodial in nature, a quiet patient made things easier for everybody. Bloodletting gave way to etherization, which means exactly what you think it does–compelling a patient to breathe ether in order to induce calm.