Bryn Spielvogel Professor Eghigian History 103U 16 February 2012 To what extent did asylums during the second

half of the 19th century realize or come short of the dreams Phillipe Pinel and Johann Christian August Heinroth had had for the treatment of the mad? Enlightenment; Romanticism; reformthese are not words that generally draw the mind to 19th century asylums. However, this association is a valid one; it can be traced to some very influential figures of 18th and 19th century reform movements, particularly Philippe Pinel and Johann Christian August Heinroth. Both of these men were pioneersthey delved into the study of madness and the running of asylums with new ideology and technique. Pinel developed the idea of the moral treatment of the insane, while Heinroth created and defined a new occupation known as mad doctoring, (Eghigian 94, 105). What must be noted is the complexity of the term treatment, for both Pinel and Heinroth advocated for a few form of it. Of course treatment involves attempts at curing madness, an approach that focused on the mind for both reformists (Eghigian 97, 109). However, it goes beyond treatment of the ailment of insanity, also involving the views of, interactions with, and general handling of those deemed mad. This goes to say that reforming the medical side of treatment went hand-in-hand with reforming the ethical side of it. 19th century asylums, while not perfect in practice, reflected the dreams of Heinroth and Pinel through attempts to observe and differentiate patients, develop a power-structure within asylums, and treat their patients with appropriate manners, all with the purpose of treating mental faculties as well as possible.

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Limerick Lunatic Asylum, in classifying and attempting to understand the ailments of its mental patients, carried Pinels reforms to asylums of the late 19th century. Being required to submit annual reports of their asylums, Superintendents kept strict records of admissions, discharges, patient ailments, employment, etc. (Eghigian, 143). The most important records to note are those that list the various forms of illness, the probable recovery, the education and marital statuses of patients, their ages, their previous occupations, and the supposed causes of mental illness in those patients (Eghigian 144-152). Demonstrating the endeavor of asylums, like the one in Limerick, to differentiate between different ailments, and making a point to investigate patients backgrounds (perhaps for the purpose of isolating causes of madness), these records show that Pinels ideas were being implemented. While one might ask what categorization has to do with a moral treatment, or a treatment of intellectual faculties, it is important to realize that treatment can only be practiced effectively if a diagnosis has been declared. Pinel had difficulty of his own in this regard, explaining the issues of asylums and the probable solutions: Symptoms so different, and all comprehended under the general title of insanity, required, on my part, much study and discrimination; and to secure order in the establishment and success to my practice, I determined upon adopting such a variety of measures, both as to discipline and treatment, as my patients required. (Eghigian 95) Pinel noted that different ailments would require different treatment, in the medical and behavior senses. In doing so, he purported that the first step in developing any treatment would be classification and identification of diseases and their causes, no matter how much study this required. While Limerick Asylum must have had some trouble attaining this information about many of their patients, being unsure of the causes of 192 of 445 cases, the superintendent must have demanded much investigation since all 445 were categorized under some form of illness. In this sense, Pinels dreams were at least partly implemented by the Limerick Asylum.
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Heinroth and Pinel both stressed the importance of a strong authority figure in any asylum, and evidence for superintendents and doctors that expressed this power in the late 19th century brought the visionaries ideas to life. The monthly newspaper (The Opal) written by former or current patients of the Utica Asylum is the first to point to this success (Eghigian 134). One of the writers of The Opal expressed resentment over the common physicians practice of equivocation and deceit towards the sick, demonstrating an expectation for the truth that was likely bourn of enlightenment thinking (Eghigian, 136). However, this writer went on to discuss that while this is what he expected to find in the asylum, he instead found a different kind of doctor, saying that we can speak from experience, how much it contributed to the rest of a mind tossed upon the billows of phrenzy and despair, when we had gained the conviction that those who were placed in charge of us were men in whose slightest utterance we could have confidence; men who made it a sacred principle not to deceive their patients in any particular, (Eghigian, 137). This type of doctorso unlike the physician this patient had earlier discussed was a new kind. This writer gives the impression that this doctor not only feels some sort of compassion for the mad, but that he is also firm, authoritative, and honest. Basically encompassing the mad doctor that Heinroth advocated fora man that would, according to Heinroth , influence the patientsby the sheer strength of his being, his glance and his will, (Eghigian 110)this authority figure is shown as someone thats demeanor eased the mind of a patient, helping to establish the conciliating treatment, rendered effective by steady and dispassionate firmness that Pinel desired in asylums (Eghigian 96). However, he also noted that the great secret to manage a hospital well was utilizing a force evidently and convincingly superior than a maniacal patient (Eghigian 98). Thus, an authority was important not only in keeping clearly insane patients under control, but also in providing a sense of trust and calm for

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orderly patients. From The Opal, it can be seen that this idea of a power-structure was not desired by doctors or theorists alone; patients were receptive to a strong authority that could be firm yet honest, gaining their respect and thus providing them a greater peace of mind. Superintendents and doctors in the late 19th century were more than just authoritative, however; they also conveyed a genuine care for their patients. A public asylum in India boasted a superintendent that desired to attend to nearly all the needs of his patients. In discussing the two problems that needed addressing in his asylumamount of accommodations and sanitary conditionsthe superintendent, knowing that the asylum had jogged on very well in the years that are past, asked: Why interfere with either?...I think, however, that, with the improvements I am about to suggest, it will be allowed that matters would progress still more favourably: that the present rate of sickness and mortality would be still further diminished, and that the general comfort and happiness of the inmates still better maintained. (Eghigian 156) To this man, the patients of the asylum were not simply a nuisance; they were people that deserved kind treatment and comfort. His advocacy for increased accommodation to allow for even more inmates, and his interest in testing atmospheric effects on insane behavior demonstrate that rather than simply fulfilling his basic duties as superintendent, he was willing to go beyond his basic responsibilities to better the lives of the patients, (Eghigian 160). Rather than settling for mediocre accommodations, he drew up plans for more comfortable, effective ones (Eghigian 157). This reflects strongly on Pinels ideas regarding Jean-Baptiste Pussins behavior towards the mad. For Pinel, this hospital manager was the ideal model; a philanthropist, knowledgeable of his duties, exercising the vigilance of a kind and affectionate parent towards all patients (Eghigian 100). The superintendent of the Indian Asylum neglected none of these qualities. While it is perhaps true that not all authorities at asylums showed this amount of
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humanitarian concern, the treatment of patients in an ethical way contributed to a doctors ability to medically treat his patients, particularly in a mental sense. Ultimately, the purpose of a doctor attaining the respect of patients coincided with the goal of bringing the mad back to sanity, effectively using a combination of mad doctoring and the moral treatment. One of The Opals patient-writersthe one so focused on the truth of physiciansclearly expressed the importance of a doctors demeanor and honesty on a patients mind. He explained how truth could penetrate the insane mind, saying nor is it unfrequent that the recovered patient is able to call to mind, how the truthful declarations of his physician first broke in upon his delusions with persuasive power, and how from this source the first ray of light shone upon the brooding darkness, (Eghigian 137). This outlook on the goal of the doctor was one shared by Pinel and Heinroth. Both men would agree that the psyche, or intellectual state, of a mad person needs repairedthat it was the doctors goal to break delusions of the mind. Heinroth saw the intention of the mad doctor in a strikingly similar way to that of The Opal writer, explaining that it is the purpose of the doctor of the soul to bring the mentally disturbed, whose inner life is totally darkened, back to light, (Eghigian 110). The insights of the patientwriter go to show that the practice of mad doctoring must have taken off, or at the very least existed, within asylums. For Heinroth, it was only a mad doctor that could effectively use the moral treatment to bring a patient back to sanity, and for the writer of The Opals excerpt, this was precisely the treatment that succeeded for physicians in the mad house. Finally, at late 19th century asylums, the use of either coercion or personal liberties, depending on behavior, was reminiscent of Pinels dreams regarding the treatment of madness. While some of the tactics of 19th century mad doctors would fall under the ethical category, Pinel did not mean to imply that his moral treatment was always entirely right. The fact that
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restraints such as the straight Waistcoat were occasionally utilized during the late 19th century does not go to say that the moral treatment was being neglected (Eghigian 152). Rather, the fact that only 14 out of 445 people had to be restrained in an insane asylum demonstrates that the various other methods of behavior towards and treatment of patients worked quite well (Eghigian 152). Even Pinel cited an example in which he threatened the use of the severest punishment if one patient did not comply with directives (Eghigian 101). This did not go to say that punishment should be frequent, however. Liberties were also afforded to patients, and a proud writer at The Opal exclaimed the beloved and honored Superintendent, nor either of his estimable Assistants interpose any control or direction in the productions of the brains or pens of the contributors to the OPALthat is, they do not advise or supervise in the matter, (Eghigian 140). This method of allowing freedom for patients was seemingly effective, not only in encouraging more respect for the authority, but also in encouraging outlets for the minds wanderings. Pinel advocated to allow every maniac all the latitude of personal liberty consistent with safety; to proportion the degree of coercion to the demands upon it from his extravagance of behavior; to use mildness of manners or firmness as occasion may require, (Eghigian 104). In other words, he believed that every patient should be treated with latitude, and that force and firmness need only be used when a patient should act out, just as was practiced in asylums of the 19th century. Through the development of mad doctoring and the usage of the moral treatment, 19th century asylums carried on the dreams of Pinel and Heinroth to a great extent. For asylum authorities of the period, the goals of a mad doctor became focused on restoring the minds faculties through an air of honesty, concern, mildness, firmness, and irresistible authority. While not all asylums were ideal, with some, like the India asylum, being in great need of repair, they

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were no longer places of mistreatment and crueltywith the help of caring, inquisitive superintendents and willing patients, they became better suited for the treatment of madness. Without Pinel and Heinrothwithout their dreams for treatment and the resulting reforms that carried on through the centuriespsychology would likely be far behind where it is today.

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Work Cited Eghigian, Greg, ed. From Madness to Mental Health. New Jersey: Rutgers University Press, 2010. N. pag. Print.

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