Treatment of the Mentally Ill

Treatment of the Mentally Ill

This article relates to The Anatomy of Ghosts

In Andrew Taylor's The Anatomy of Ghosts, while recovering from his ordeal, Frank Oldershaw is first held at a home for the mentally disturbed. Although the process used to treat him there seems brutal and oppressive to modern sensibilities, for the time period it was considered quite advanced and progressive.

Throughout the Middle Ages, the Renaissance, and the Enlightenment, people in mental institutions were frequently subjected to horrendous conditions. Some inmates were chained to stone floors, to the walls of their cells, to the bars of a cage, or to heavy wooden trough bedsteads. This shackling was not always restricted to periods of maniacal excitement but could continue for years, sometimes for life. Chains, handcuffs, iron girdles, collars, and straitjackets were all used. Typically viewed as wild animals that had lost their reason, inmates were subjected to numerous torturous "treatments," including whipping, beating, bloodletting, shocking, starvation, irritant chemicals, and isolation.

Perhaps the most well-known center for the mentally ill was the Hospital of Saint Mary of Bethlehem in London (founded in 1247), which quickly became infamous for its brutal and inhumane treatment of inmates. By the sixteenth century, its nickname, Bedlam, came to signify any asylum; people discharged uncured from asylums were known as "Bedlam Beggars" (commonly known as Tom O'Bedlams). For example, in King Lear Edgar disguises himself as "Poor Tom", a Bedlam beggar. It was commonly believed that these people had a license to beg, though if such licenses existed, they were not so widespread.

The system at that time generally relied on fear to govern the insane. Attendants were instructed to initially approach patients with an austere appearance and perhaps a display of strength. In many cases of violent excitement, force was viewed as the most suitable method of control.

Various forms of baths were widely used in asylums as "hydrotherapy" to quiet excited patients. One of these was the "bath of surprise," a reservoir of water into which the patient was suddenly dropped while standing on its moveable cover. Other types of baths included the "plunge bath", the "shower bath", and the "douche bath", a jet of water applied to some part of the body, typically the face. All of these were maintained below 75ºF, while the hot, warm, and tepid baths were kept at or above 85ºF. The shower bath in particular was frequently used to treat nearly every form of illness.

Conditions began to slowly improve in the late eighteenth century, when a Quaker named William Tuke founded the York Retreat in northern England. Eventually housing about thirty patients in a quiet country manor, the Retreat was a small community that engaged the patients in a combination of rest, talk, and manual work. Rejecting most previous medical theories and techniques, treatment centered on minimizing restraints and cultivating rationality and moral strength. It created a family-style ethos and had patients perform chores to give them a sense of contributing to their community. There was a daily routine of both work and leisure time. If patients behaved well, they were rewarded; if they behaved poorly, there was minimal use of restraints or fear tactics. Telling patients that treatment depended on their own conduct recognized and reinforced patients' moral autonomy. The success of the Retreat convinced many that its method of care was the ideal method of treatment for the mentally ill.

At the same time, some physicians were also beginning to show interest in the diagnostic, clinical, therapeutic, and legal aspects of the care of the insane. There was a growth in medically-run asylums, a development in medical literature on the subject, and medical-legal involvement in court cases. Some of these new public asylums followed the example of the Retreat and attempted to treat patients without using restraints. Once mental illness was viewed as a disease, and thus a treatable condition, physicians began to focus on cures rather than confinement.

Interesting Link: For more about Bethlem Hospital, see the sidebar to our review of Revelation by C.J. Sansom.

Image above: "Douche bath" in the Pennsylvania Hospital for the Insane, 1868 (Cornell Psychiatry)

Filed under Medicine, Science and Tech

This "beyond the book article" relates to The Anatomy of Ghosts. It originally ran in February 2011 and has been updated for the January 2012 paperback edition. Go to magazine.

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