Medical Madness: Asylums Edition
In Medical Madness, we examine some of the kooky (or downright crazy) medical practices throughout history. This week, it’s a look at insane asylums and some of the methods used to deal with the mentally ill. Admittedly, it’s a little look, because there were countless asylums and countless treatments. Nevertheless, onwards!
The concept of caring for the mentally ill began at least 1000 years ago, but asylums as we think of them -houses for the insane- began significantly later. For example, even Bedlam- the most notorious of all asylums- only became close to what we think of it as in the 14th century.
And there’s a tangent I just have to go off on. Originally, Bedlam was a priory in London for members of the Order of Bethlehem. However, in the mid fourteenth century it began to take in small numbers of the mentally ill. By the late 15th/early 16th centuries, it was recognised as a hospital, and the care was paid for by family members, the patient’s parish or other patrons.
It was divided into two sections in 1725; curable and incurable- at least an acknowledgment that not all mentally ill people suffer permanently. However, the more violent or unstable patients were chained to the walls or floors of their cells. When the asylum was relocated to Southwark, the inhabitants had to spend a significant time without glass in their windows- trust me, I live in Britain. It’s freezing, and this would have been unpleasant.
Worse even than this constant mistreatment, was the way that those ‘unfortunates’ in the hospital were treated as a for-profit freak show. For a penny, you could gain entrance to the hospital and gaze through the doors at the antics of the patients. And if you couldn’t afford that, entry was free on the first Tuesday of every month. How nice! Fun for all the family. In 1814, there were a staggering 92000 of these visits. That, my dear friends, is probably listed under “how not to run a mental institute”.
Treatment for perceived medical problems has existed for thousands of years. The earliest mental health ward was founded in Baghdad in 705AD- as under Islam, people with mental problems were described as “incapable but worthy of humane treatment”. Treatments ranged from baths and drugs to music and activities. Which actually seems pretty ahead of its time. Sadly, we did a lot of back-pedalling before we got to where we are now. Back in Europe, mental disorders were thought to stem from a lack of morals, divinity or magic. And while those in the East were engaging in constructive therapies, we were bloodletting, treppaning, whipping and purging our mentally ill back to sanity. Oh you silly, silly Europeans.
The mentally ill were often left to the family to deal with, and if this was impossible they would be admitted to poorhouses or workhouses. Finally, in the 17th century attitudes began to change slightly, with insanity no longer seen as a fault of the soul or morals. However, the victims were often treated like wild animals, and harsh treatment such as whipping, chaining, and strict dietary control were thought to supress their animal urges.
This approach changed again in the late 18th century, with an emphasis now placed on a more personal and humane approach. However, with the industrial revolution and the huge population boom, institutions became largely impersonal and ineffective. At least in the mid-19th century, it was noted that some of the causes of mental illness were physical, and drugs began to be used.
In the early 20th century, insanity was thought of as a disease; even a contagious one. However, when men returned from the WWI front line, perceptions gradually began to change (very gradually, as this came too late for many shell-shocked soldiers who were shot for cowardice). Psychoanalysis was increasingly favoured, as were treatments such as lobotomies and electro-convulsive therapy (ECT). Lithium was now used to counter mania- and is often still used today. It was only in the 1960s that a fight began against asylums and the mentally ill were largely deinstitutionalised. However, even now we have far to go to improve the treatment and perception of people with mental health problems. Many are still victims of the system.
An extra note- if you want to see some interesting media on the subject, watch The Nun’s Story with Audrey Hepburn (tame) or One Flew Over the Cuckoo’s Nest (really not tame). In fact, even little Dorothy in the diabolically bad Return to Oz gets stuck in an institute. Enjoy!