History of Mental Health Series: The First Asylums

Foreword

History of Mental Health Series is a set of articles that reviews the history of mental health from a sociological perspective: from the ancient to the modern understanding of the concept. Nowadays, mental health is one of the most widely discussed topics; however, it had a hard, alluring history of development through centuries. The following six articles explore the history of mental health and some of the most fascinating and sometimes unbelievable facts about the topic, aiming to raise awareness about mental health and its importance of one’s wellbeing.

1. History of Mental Health Series: Mental Illnesses and Demons

2. History of Mental Health Series: Is there a Healthy Mind in a Healthy Body?

3. History of Mental Health Series: The First Asylums

4. History of Mental Health Series: Chlorpromazine and the Drug Revolution 

5. History of Mental Health Series Deinstitutionalization and Community Care 

6. History of Mental Health Series: Stigmatization of Mental Health 

7. History of Mental Health Series: Mental Health in an Unequal World
   

The First Asylums

Mental illness was a burden for both sides: both the affected person and the family. Mentally affected ones were mostly seen as a shame and were abused at home. Family members tried to isolate them, locking them in one room to prevent that person from being exposed to society. Apart from this, some people were put in normal hospitals where they were left without proper attention and treatments. However, others had harsher fates, as those with no family, or families that no longer wanted them, were left to die in the street (Porter, 2002).

Mental hospitals were first created to take the burden off from the family and put mentally ill people under control. One of the first mental hospitals was established in Baghdad in 792 CE (Butcher, 2007), followed by other institutions of the kind: A hospital in Valencia, Spain, in 1406, San Hipolito in Mexico, in 1566, La Maison de Charenton in France, in 1641, and Lunatics’ Tower in Vienna, in 1784 (Butcher, 2007).

Figure 1: Patient in Bedlam

The treatments adopted by those hospitals were not designed to help the individual; instead, they were institutions to punish the person and prevent any disturbance in society by supervising their behavior inside one building. Patients were treated severely, and they had to live in deplorable conditions - sometimes locked in small dark rooms under mental and physical abuse. “A case study describes a typical scene at La Bicetre, a hospital in Paris, starting with patients shackled to the wall in dark cramped cells. Iron cuffs and collars permitted just enough movement to allow patients to feed themselves but not enough to lie down at night, so they were forced to sleep upright.” Poor hygiene and malnutrition were also issues, patients were not receiving enough food which affected their physical health too. Also, wastes was not cleaned up, meaning that patients had to live in it (Butcher, 2007).

One of the most famous asylums in history is Saint Mary of Bethlehem, also known as “Bedlam”, established in 1547 in England. Apart from the excruciating treatments and conditions, patients were regularly displayed in front of the public as freaks for a very little price (Ruggeri, n.d.). Bedlam was one of the most popular places in London and it was mentioned in various Jacobean dramas and ballads (Ruggeri, n.d.).

Figure 2: View of the Hospital of Bethlehem

Beyond family custody and regular asylums, the clergy played an important role in the development of care houses. Members of the religious movements created madhouses that provided help for mentally ill individuals. Patients were asked to pray - they thought that cleaning one from one's own sins would help the healing process. Those madhouses were designed for the wealthiest members of society as the price for receiving treatment was high.

Unhuman, nearly torturing practices at the mental establishment lasted for ages. The reforms in asylums started with the shift in perception of mental treatments. In the 18th century, various minds started to look at the mentally affected ones without shame. Michel Foucault calls this era "the great medicalization" as many hospitals adopted biological and medical approaches to mental illnesses. The medicalization of the mad was a new trend in confinement because it separated the mental patients from criminals (Foucault, 1988). One of the significant changes was initiated by Philippe Pinel, in 1792, when he started leading the La Bicetre Hospital. His innovative idea suggested that patients would improve their health if they were treated in more human and caring ways. His reforms involved the elimination of abusive and torturing practices from the hospital, better living conditions, and advocating a healthier lifestyle for the patients.

Figure 3: The York Retreat

Soon after that, in 1796, English Quaker William Tuke, head of the York Retreat house, adopted new practices very similar to Pinel reforms. Driven by the purpose to heal patients, the York Retreat in York implemented various recreational activities. The staff was treating the patients with respect and consideration. and as a result, The York Retreat became one of the most outstanding establishments, helping people in need (Porter, 2002). These reforms were followed by the non-restraint method in the asylum of Devon, England.

Changes that started in Europe soon crossed the ocean and reached the United States, where mental hospitals applied “a wide-ranging method of treatment that focused on a patient’s social, individual, and occupational needs” (Butcher, 2007) that were necessary for their recovery. Following these changes, in the 1800s, asylums started encouraging patients to get involved in physical activities, labor, and mental treatments such as rehabilitation practices and spiritual discussions (Foerschner, 2010).

In conclusion, mental health treatments have had a long development process. Families could not pay proper attention to their sick members for social and personal reasons; thus, the need for mental institutions arose. The first psychiatric institutions were designed with two main goals: isolating the mentally ill to avoid social disturbances and taking the burden off the patients' families. Until the 18th century, asylums had severe methods of caring for patients and, in addition to bad treatments, they were characterized by deplorable conditions, hungry patients, an unhygienic environment, and the constant physical and mental abuse of the mentally ill. The management model of Tuke and Pinel turned the asylum practices around by implementing caring and considerate practices. This approach was successful in the primary development stage; however, it failed soon due two reasons: practices, knowledge, and treatments were not properly transmitted from one generation of staff to the next one, and the method did not work equally efficiently for hospitals of different sizes. (Foerschner, 2010).

References:

• Alexander, F. G., & Selesnick, S. (1966). The History of Psychiatry: An Evaluation of Psychiatric Thought and Practice from Prehistoric Times to the Present. Harper and Row, Publishers.

• Butcher, J. N., Mineka, S., & Hooley, J. M. (2007). Abnormal Psychology (S. Hartman, Ed.; 13th ed.). Pearson Education, Inc.

• Foerschner, A. M. (2010). The History of Mental Illness: From “Skull Drills” to “Happy Pills”. Inquiries Journal/Student Pulse, 2(09). Retrieved from http://www.inquiriesjournal.com/articles/1673/the-history-of-mental-illness-from-skull-drills-to-happy-pills

• Foucault, M. (1988). Madness and Civilization: A History of Insanity in the Age of Reason (First Edition). Vintage.

• Goffman, E. (1961). Asylums (First Edition). Penguin Books.

• Houston, R.A. “Clergy and the Care of the Insane in Eighteenth-Century Britain.” Church History 73.1 (March 2004): 114-138. World History Collection. EBSCO. Scarborough-Phillips Library, Austin, TX. 25 September 2007.

• Porter, Roy. Madness: A Brief History. New York City: Oxford University Press, 2002.

• Ruggeri, A. (n.d.). How Bedlam Became London’s Most Iconic Symbol. BBC Culture. https://www.bbc.com/culture/article/20161213-how-bedlam-became-a-palace-for-lunatics

Image references:

• Figure 1: Wellcome Library. (1814). Bedlam Patient [Painting]. https://ychef.files.bbci.co.uk/1600x900/p04l7fdn.webp

• Figure 2: Wellcome Library, London. (n.d.). View of the hospital of Bethlehem [Painting]. https://ychef.files.bbci.co.uk/1600x900/p04l7f2y.webp

• Figure 3: The Fourth Gallery of The Retreat. (1887 [Painting]. https://ychef.files.bbci.co.uk/1600x900/p04l7fdn.webp tps://warwick.ac.uk/fac/arts/history/chm/outreach/trade_in_lunacy/research/yorkretreat/