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The treatment of those with mental illnesses has a dark history, filled with misunderstanding, cruelty, and religious influence. As the 19th century began, a new era of understanding emerged, eventually leading to significant psychological advancements from figures like Sigmund Freud, and the development of neurology. While it's essential not to ignore the painful treatments that many endured, it's equally important to appreciate how the 19th century paved the way for modern psychiatry, shining a light on those few who truly sought to help those suffering from mental illness.
10. The Rise of Moral Treatment
The Enlightenment period dramatically reshaped how society, scientists, and philosophers viewed the world, and this shift also impacted the field of psychiatry. The concept of moral treatment emerged, advocating a more compassionate approach for those suffering from mental illness, moving away from the previous use of chains and abusive methods.
Dr. James W Trent of Gordon College explains that prior to moral treatment, people with psychiatric conditions were labeled as insane and subjected to inhumane treatment. Philippe Pinel, working at Bicetre Hospital in Paris, championed moral treatment for the mentally ill. Instead of resorting to physical abuse, Pinel emphasized kindness, patience, recreation, walks, and meaningful conversations. His approach stemmed from personal reflection, careful observation, and reading, not from chance or experimentation.
Moral treatment began to gain global traction. In the United States, Benjamin Rush, a physician from Philadelphia, started implementing this approach. Rush believed that the hectic pace of modern life was one of the causes of mental disorders, and by removing patients from such stressors, their minds could be healed.
While Rush did incorporate some elements of moral treatment, he also employed practices like bloodletting and created the tranquilizer chair. Although Pinel had optimistic expectations for his new approach, many still adhered to painful and restrictive methods to control those they deemed insane.
9. The Rise of Asylums
The infamous image of insane asylums is etched in many minds, with some even having heard eerie ghost stories related to these ominous institutions. In the 19th century, asylums began to see a dramatic rise in the number of patients, who were once cared for by family members or placed in almshouses and jails.
As cities grew increasingly populated, mental illness transitioned from being viewed as a divine punishment to being seen as a societal concern. In response, communities constructed more institutions to accommodate the increasing demand. For instance, in England, the number of patients grew from 10,000 in 1800 to a staggering 100,000 by 1900.
Historians have identified three primary theories to explain why the number of people in asylums surged so dramatically in just one century. The first suggests that modernization and the added stresses of life contributed. The second points to society’s increasing intolerance of disruptive behaviors. The third theory focuses on the expanding authority of physicians and alienists, or ‘mad-doctors.’ In hindsight, it appears to be a combination of all three factors.
As the number of asylums rose, disturbing stories of cruelty and abuse began to seep out from the dark, imposing buildings located on the outskirts of towns and cities. The so-called mad-doctors established numerous classifications to help the asylums 'cure' those suffering from psychiatric conditions. Men were separated from women, the curable from the incurable, and so on. Despite these regulations and the best intentions, asylums became infamous, earning the label ‘Bedlam,’ a term synonymous with ‘man’s inhumanity to man.’
8. Surge in Research
In the present day, attending university to study a specific discipline is commonplace. However, in the 19th century, the rise in asylums and emerging treatments spurred a surge in interest for psychiatric research, as many sought to understand why some individuals seemingly lost their sanity.
For example, Thomas Willis, an Oxford-educated physician who coined the term ‘neurology,’ worked tirelessly to identify the mental functions linked to specific brain regions. Willis proposed that the central and peripheral nervous systems relied on ‘animal spirits,’ or chemical intermediaries, to connect the mind and the body.
Around this time, Archibald Pitcairn, a doctor at Leiden in the Netherlands, treated mentally ill patients and argued that their conditions stemmed from 'false ideas' caused by the chaotic behavior of volatile animal spirits. These spirits, according to Pitcairn, then influenced the muscles, resulting in erratic and uncontrolled movements in the limbs.
In modern times, we understand that the brain does not contain animal spirits, and they do not play a role in causing mental illness. Instead, mental health issues are often linked to chemical imbalances in the brain. In an era when X-rays were just emerging and the only way to study the brain was to physically remove it from the body, these early doctors paved the way for contemporary neurology and current treatments.
7. Nervous Disorders
Today, when someone talks about having a nervous disorder, they usually mean conditions such as high blood pressure, heart disease, or trouble breathing. However, in the 19th century, nervous disorders referred to terms like shattered nerves, nervous exhaustion, or a nervous breakdown. The symptoms did not include heart or breathing issues, but instead included feelings of emptiness, hopelessness, obsessive thoughts, sluggishness, and a general lack of motivation.
This is where the expression 'strong' or 'weak' nerves originates. The notion of nervous disorders being a 'functional illness' that only affected the 'superior' members of society came from the scientific attitudes that were prevalent at the time.
Across both sides of the Atlantic, Victorian men were plagued by hypochondria while women were swept into hysteria. This led to the creation of private 'nerve' clinics, where the wealthy could retreat to spas to recover from their nervous breakdowns. However, these trends only romanticized mental illness, diverting attention from the real suffering of those who endured severe conditions.
6. Monomania
In the 19th century, many scientists sought to understand why mental illness occurred. Doctors frequently believed that insanity was a failure of reason, causing individuals to lose their ability to rationally perceive reality.
As research into mental illness expanded, Jean Etienne Esquirol proposed another theory to explain the condition: Monomania. This term referred to a partial delirium in which patients developed a false perception and then pursued it with logical reasoning. These false perceptions could take the form of illusions, hallucinations, or false convictions. Monomania is not the absence of reason, but rather the presence of a flawed idea.
For example, patients suffering from mental illness might experience illusions and hallucinations, which would convince them of an altered reality. They would then logically act on this incorrect perception.
Esquirol introduced the diagnosis of monomania to explain specific paranoia disorders, such as kleptomania, nymphomania, and pyromania, all of which could be identified by a trained professional. Monomania laid the groundwork for later discoveries in the fields of obsession and psychopathy by scientists and doctors.
5. The M’Naghten Rules
On January 20, 1843, a Scottish craftsman named Daniel M’Naghten became convinced that Tories and Conservatives were plotting to murder him due to his involvement in the early workers’ movement in Great Britain. In response to this belief, M’Naghten attempted to kill the sitting Prime Minister, Robert Peel. However, he mistakenly shot and killed Peel's secretary, Edward Drummond, thinking he was the Prime Minister.
During the trial, M’Naghten pleaded not guilty by reason of 'moral insanity' in the form of monomania. This defense was successful, and M’Naghten was acquitted by reason of insanity.
This verdict outraged Queen Victoria and the public, who demanded that the case be reconsidered. As a result, the judges were asked a series of questions about the case and the verdict. Their responses became known as the M’Naghten Rules, which continue to serve as the foundation for determining legal insanity in many parts of England and the United States to this day.
4. The Opal, the Lunatic’s Literary Journal
The moral treatment movement, pioneered by Pinel in Paris, opened up new possibilities for patients in New York's Lunatic Asylum Utica, including the opportunity to create their own literary journal, titled The Opal.
The first issue of The Opal, published in 1850, was distributed exclusively to members of the asylum. However, subsequent issues were sold at asylum fairs, and by 1851, the journal was being featured in the American Journal of Insanity, the professional publication of the time. By the end of its first year, The Opal had over 900 subscribers and was circulating 330 copies. All profits from the journal went towards the asylum's library.
Moral treatment, which emphasizes kindness, patience, and recreation, was exemplified through The Opal. This journal highlighted a core aspect of the treatment: diverting the mind from illness and distress. Alongside fairs, theatrical performances, debates, and lectures, The Opal helped to redirect the minds of the mentally ill from morbid thoughts towards more rational, orderly, and refined thinking.
The Opal served as a crucial platform for patients to express their voices, offering them a sense of agency. Unfortunately, the journal ceased publication in 1860, when it succumbed to the decline of the moral treatment movement.
3. Dorothea Dix
The 19th century saw the rise of insane asylums, the expansion of research, the development of new treatments, and a shift in the study of the human mind. While some of these advances helped those in need, many more brought additional suffering to the mentally ill instead of offering comfort.
Dorothea Dix, a remarkable woman, witnessed the horrific conditions of those locked away in asylums, poorhouses, and jails. She was determined to expose the cruel treatment they endured. Taking her cause to Boston, she found powerful allies like Rev. William Ellrey Channing, a leader in Unitarianism who advocated for social reforms.
In 1841, Dix began a mission to travel across Massachusetts, investigating the appalling conditions in which people with mental illness were kept. She discovered they were confined in “cages, closets, cellars, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience.”
By January 1843, Dix presented her findings to the state, urging them to allocate more funds for better care. Her voice was the only one calling for compassion and reform, but she persisted. Eventually, her efforts led to the passing of legislation that expanded the state insane asylum in Worcester.
Dix did not stop there. She continued to champion the cause of improved treatment for the mentally ill across numerous states. At a time when individuals labeled as “insane” or “mad” were subjected to worse conditions than animals, Dorothea Dix became their advocate, fighting tirelessly for their rights.
2. Phrenology
Many of us have come across images of a human head with words inscribed across it. Some may even have one as a decorative item, but most of us wouldn't use it to predict how a stranger might behave. Back in the 19th century, however, this practice was a well-known study called Phrenology.
Phrenology involves studying the link between a person's character and the shape of their skull. Austrian physician Franz Joseph Gall, a pioneer in modern neurology, developed this theory, which suggested that the shape of the skull could influence behavior. Gall studied various individuals, including mathematicians, coachmen, and sculptors, seeking patterns in the shapes of their skulls.
However, Gall's theory faced two major issues. First, he based his conclusions on isolated instances, such as the idea that “cautiousness” could be found above the ears after feeling a prominent bump on a cautious priest's head. Second, Gall tended to focus only on examples that supported his theory, while disregarding those that contradicted it.
Although Gall's understanding of Phrenology and the workings of the brain was far from accurate, his work laid the groundwork for future neurologists to delve deeper into understanding the complex and remarkable nature of the human brain.
1. India’s Insane Asylums
Historically, Great Britain colonized many nations across the globe, and India was no exception during the 19th century. As the number of mentally ill individuals rose in Europe and the United States, similar trends were seen in India.
As asylums began to be established, the British Crown adopted treatment methods similar to those of Pinel and Esquirol for Indian asylums. However, the British colonists and local authorities, seeing themselves as superior, refused to share these facilities with the Indian population. Fueled by prejudice and bigotry, the colonists segregated the locals, sending them to overcrowded, deteriorating public institutions.
Dr. R.F. Hutchinson, Superintendent of Patna Lunatic Asylum, sent a report to the Inspector General, urging the need for more space and better sanitation in one of these institutions. He pointed out that the population had reached 138, with an additional 13 individuals added to the already overcrowded facility. Hutchinson also mentioned that the drainage system, which dumped waste onto lower ground where the Indian residents lived, made parts of the building unsuitable for occupation.
Hutchinson's report was blunt in its assessment, stating, “this evil cannot, of course, be remedied without either raising the plinth or removing the Asylum bodily to a higher site.” Hutchinson was one individual, doing his best to manage a rapidly growing population of mentally ill patients, and instead of resigning to the circumstances, he took action to improve their conditions as much as he could.
