History of Asylums
The opening decades of the nineteenth-century brought to the United States new European ideas about the care and treatment of the mentally ill. These ideas, soon to be called “moral treatment,” promised a cure for mental illnesses to those who sought treatment in a very new kind of institution—an “asylum.” The moral treatment of the insane was built on the assumption that those suffering from mental illness could find their way to recovery and an eventual cure if treated kindly and in ways that appealed to the parts of their minds that remained rational. It repudiated the use of harsh restraints and long periods of isolation that had been used to manage the most destructive behaviors of mentally ill individuals. It depended instead on specially constructed hospitals that provided quiet, secluded, and peaceful country settings; opportunities for meaningful work and recreation; a system of privileges and rewards for rational behaviors; and gentler kinds of restraints used for shorter periods. (Alexander)
Many of the more prestigious private hospitals tried to implement some parts of moral treatment on the wards that held mentally ill patients. But the Friends Asylum, established by Philadelphia’s Quaker community in 1814, was the first institution specially built to implement the full program of moral treatment. (Alexander) The Friends Asylum remained unique in that it was run by a lay staff rather than by medical men and women. The private institutions that quickly followed, by contrast, chose physicians as administrators. But they all chose quiet and secluded sites for these new hospitals to which they would transfer their insane patients. (Porter) Massachusetts General Hospital built the McLean Hospital outside of Boston in 1811; the New York Hospital built the Bloomingdale Insane Asylum in Morningside Heights in upper Manhattan in 1816; and the Pennsylvania Hospital established the Institute of the Pennsylvania Hospital across the river from the city in 1841. (Alexander) Thomas Kirkbride, the influential medical superintendent of the Institute of the Pennsylvania Hospital, developed what quickly became known as the “Kirkbride Plan” for how hospitals devoted to moral treatment should be built and organized. This plan, the prototype for many future private and public insane asylums, called for no more than 250 patients living in a building with a central core and long, rambling wings arranged to provide sunshine and fresh air as well as privacy and comfort. (Porter)
The Colonial American society referred to those suffering from mental illnesses as ‘lunatics” which interestingly enough was derived from the root word lunar meaning, “moon.” Through astrological reasoning it was believed that insanity was caused by a full moon at the time of a baby’s birth or a baby sleeping under the light of a full moon. Colonists declared these lunatics possessed by the devil, and usually they were removed from society and locked away. (Alexander)
Around the turn of the 19th century, Europeans introduced a new approach to the treatment of the mentally ill known as “Moral Management.” This approach was based on the belief that the environment played a vital role in the treatment of the mentally ill. Creating a more domestic feel, beds, pictures and decorations replaced shackles, chains and cement cells. It was thought that recovery would more likely occur if conditions and surroundings resembled the comfort of home. (Porter) Treatment also took a benign approach. Phrenology was introduced, studying the shape of the brain to explain illnesses and render diagnosis. Animal magnetism was another popular practice, concentrating on the benefits of hypnosis and relaxation. Problems surfaced, however, with patients becoming unruly due to lack of restraints, and concern arose with how patients were to occupy their time. To combat these concerns, work programs and recreational activities were devised for patients in asylums, significantly moving to bridge the gap between society and the hospital. (Porter)
With the increasing credibility of these institutions, the populations skyrocketed. It was common for homeless people, tramps and hobos to become ‘patients’ of the asylums seasonally for shelter and food, and then "elope," or slip away when the good weather returned. Families would often submit their elderly relatives to asylums because they lacked the resources or time to deal with them appropriately. The problem with overcrowding developed because the institutions had no established criteria for accepting or rejecting patients into their care. Rapid growth in populations caused patient care to suffer. In the Athens Asylum the patient population jumped from 200 to nearly 1800, with an insignificant alteration in staffing. (Alexander) The community found that these institutions were an easy means to remove unwanted people from society. There was no effort to provide any other programs or support, because the state was paying for the asylum. (Alexander)
The severe overcrowding led to a sharp decline in patient care and once again, the revival of old procedures and medical treatments. Restraints returned. Instead of sleeping in single rooms as the Kirkbride Plan had designed, patients were sleeping in wooden cribs stacked three patients high. Ice water baths were once again used, along with shock machines and electro- convulsive therapy. And in the early 1930s the notorious lobotomy was introduced into American medical culture. (Porter)
Alexander, Franz G., and Sheldon T. Selesnick. The History of Psychiatry: An Evaluation of Psychiatric Thought and Practice from Prehistoric Times to the Present. New York City: Harper and Row, Publishers, 1966.
Porter, Roy. Madness: A Brief History. New York City: Oxford University Press, 2002.
Many of the more prestigious private hospitals tried to implement some parts of moral treatment on the wards that held mentally ill patients. But the Friends Asylum, established by Philadelphia’s Quaker community in 1814, was the first institution specially built to implement the full program of moral treatment. (Alexander) The Friends Asylum remained unique in that it was run by a lay staff rather than by medical men and women. The private institutions that quickly followed, by contrast, chose physicians as administrators. But they all chose quiet and secluded sites for these new hospitals to which they would transfer their insane patients. (Porter) Massachusetts General Hospital built the McLean Hospital outside of Boston in 1811; the New York Hospital built the Bloomingdale Insane Asylum in Morningside Heights in upper Manhattan in 1816; and the Pennsylvania Hospital established the Institute of the Pennsylvania Hospital across the river from the city in 1841. (Alexander) Thomas Kirkbride, the influential medical superintendent of the Institute of the Pennsylvania Hospital, developed what quickly became known as the “Kirkbride Plan” for how hospitals devoted to moral treatment should be built and organized. This plan, the prototype for many future private and public insane asylums, called for no more than 250 patients living in a building with a central core and long, rambling wings arranged to provide sunshine and fresh air as well as privacy and comfort. (Porter)
The Colonial American society referred to those suffering from mental illnesses as ‘lunatics” which interestingly enough was derived from the root word lunar meaning, “moon.” Through astrological reasoning it was believed that insanity was caused by a full moon at the time of a baby’s birth or a baby sleeping under the light of a full moon. Colonists declared these lunatics possessed by the devil, and usually they were removed from society and locked away. (Alexander)
Around the turn of the 19th century, Europeans introduced a new approach to the treatment of the mentally ill known as “Moral Management.” This approach was based on the belief that the environment played a vital role in the treatment of the mentally ill. Creating a more domestic feel, beds, pictures and decorations replaced shackles, chains and cement cells. It was thought that recovery would more likely occur if conditions and surroundings resembled the comfort of home. (Porter) Treatment also took a benign approach. Phrenology was introduced, studying the shape of the brain to explain illnesses and render diagnosis. Animal magnetism was another popular practice, concentrating on the benefits of hypnosis and relaxation. Problems surfaced, however, with patients becoming unruly due to lack of restraints, and concern arose with how patients were to occupy their time. To combat these concerns, work programs and recreational activities were devised for patients in asylums, significantly moving to bridge the gap between society and the hospital. (Porter)
With the increasing credibility of these institutions, the populations skyrocketed. It was common for homeless people, tramps and hobos to become ‘patients’ of the asylums seasonally for shelter and food, and then "elope," or slip away when the good weather returned. Families would often submit their elderly relatives to asylums because they lacked the resources or time to deal with them appropriately. The problem with overcrowding developed because the institutions had no established criteria for accepting or rejecting patients into their care. Rapid growth in populations caused patient care to suffer. In the Athens Asylum the patient population jumped from 200 to nearly 1800, with an insignificant alteration in staffing. (Alexander) The community found that these institutions were an easy means to remove unwanted people from society. There was no effort to provide any other programs or support, because the state was paying for the asylum. (Alexander)
The severe overcrowding led to a sharp decline in patient care and once again, the revival of old procedures and medical treatments. Restraints returned. Instead of sleeping in single rooms as the Kirkbride Plan had designed, patients were sleeping in wooden cribs stacked three patients high. Ice water baths were once again used, along with shock machines and electro- convulsive therapy. And in the early 1930s the notorious lobotomy was introduced into American medical culture. (Porter)
Alexander, Franz G., and Sheldon T. Selesnick. The History of Psychiatry: An Evaluation of Psychiatric Thought and Practice from Prehistoric Times to the Present. New York City: Harper and Row, Publishers, 1966.
Porter, Roy. Madness: A Brief History. New York City: Oxford University Press, 2002.