Tag Archives: Bethlem Royal Hospital

Intervention in Insanity

Eliza Josolyne, Insanity Caused by Overwork, courtesy Bethlem Royal Hospital Archives

Eliza Josolyne, Insanity Caused by Overwork

Alienists (early psychiatrists) believed in actively treating insanity. Most believed that it was beneficial to a patient to completely remove him or her from familiar surroundings; the change would allow new thought patterns and behaviors to form more easily.

Many times, asylums were the change in environment alienists selected, but some recommended travel as a way to change a patient’s surroundings and get his mind focused on new things. Of course, early intervention was paramount, since all alienists believed “acute” insanity (active, new cases) were easier to cure than chronic ones of long duration.

 

Children's Dayroom at Byberry (Philadelphia State Hospital), circa 1938, courtesy Historical Society of Pennsylvania

Children’s Dayroom at Byberry (Philadelphia State Hospital), circa 1938

 

Dr. J. Parigot believed in the value of intervention to the extreme. Writing in 1864, he made the case that marriage should be avoided when undesirable traits were found in potential parents. This belief wasn’t strictly because he felt the traits would be inherited; it was additionally founded on a belief that parents with those traits couldn’t properly raise a child. He gave an example of intemperate parents who would have to be particularly careful to educate and develop their children so that they wouldn’t degenerate into intemperance themselves. Likewise, he said, “nervous and fidgety persons are incompetent to the direction and control of petulant and sometimes mischievous children.”

Children's Ward, 1927, Byberry (Philadelphis State Hospital), courtesy Historical Society of Pennsylvania

Children’s Ward, 1927, Byberry (Philadelphis State Hospital), courtesy Historical Society of Pennsylvania

To counteract the influence of tainted parents in cases of insanity, Parigot stated that: “Children who have inherited germs of mental disease should be separated from their parents, and educated under the eye of the psychiatrist. Sometimes their locality should be changed at the time of their birth. . . .”

Fortunately, such thinking was not generally accommodated by the public.

More Study on Insanity

Some Ocular Manifestations of Hysteria, Walter Baer Weidler, 1912, courtesy Wellcome Institute Library

As Freud and other medical men tried to delve into the treatment of insanity (see last post), another group of experts had already made inroads into the blossoming field of early psychiatry. Asylum superintendents were mainly concerned with the management of asylums and how they could help patients within asylum walls. Though treatment in the early years of asylum reform recommended that patients have regular talks with knowledgeable physicians, overcrowded facilities eventually made that impossible. Superintendents had to focus on how schedules, work, and medicine–within the confines of the asylum community–could best be used for patients’ treatment and management.

Some physicians believed that insanity arose from problems within the nervous system. They were confident that study and research would develop new treatments for insanity that would be much better than the care most patients received in asylums. These new doctors were called neurologists. Eighteen neurologists in the U.S. formed the American Neurological Association in 1875, and used the Journal of Nervous and Mental Disease as its mouthpiece. They focused on scientific methods and discoveries, versus the sometimes nebulous criteria old-school alienists used as a basis for diagnosis and treatment.

In an article in the March, 1902 issue of the Journal of Nervous and Mental Disease, author F. Savary Pearce discussed a case of hysteria in a 17-year-old girl. She had stopped eating, believed that x-rays were being used upon her, and that “blood had been taken from her head and that her head had been ‘sewed up’.” The doctor caring for her isolated her from her family, force-fed her through a stomach feeding tube, and gave her static electricity treatments and massage.

She apparently improved greatly under this treatment, which was not much different (if at all) from what she would have received at an asylum. At the end of his article and after a longer discussion of hysteria and its treatment, Pearce recommended institutionalization for cases which did not clear up within about thirty days, or when patients appeared suicidal.

Woman Diagnosed as Insane Due to Anxiety, courtesy Bethlem Royal Hospital Archives

Religious Melancholia and Convalescence, from John Conolly's book, Physionomy of Insanity, 1858, courtesy Brown University

______________________________________________________________________________________