Tag Archives: alienists

Other Ways to Help the Insane

Wet Sheet Pack, 1902

Wet Sheet Pack, 1902

Alienists considered light labor a welcome change of pace for patients and a great boon to their recovery (see last post) during the Civil War era. However, they also realized that every patient needed an individual plan that might include other therapeutics than labor, or no labor at all. Most specialists hoped that a calm, supportive environment would bring a patient back to health, but did recognize that sometimes more aggressive measures were needed.

If a patient showed signs of violence, there were several courses open to attendants. Restraint might be necessary, but what kind? “The worst form is where patients are held by the attendants,” said Dr. J. Paragot in his article, “General Mental Therapeutics.”

Restraints Could Be Horrifying For Patients

Restraints Could Be Horrifying For Patients

The next worst form of restraint was a cell, because attendants had to use force to place a patient in one, and then left him/her there in a state of frustration. In Dr. Paragot’s opinion, the best form of restraint was a leather strap around the wrists. “. . . the patient may enjoy the liberty of walking in the fields. . . . the patient may be left alone, no offered active violence overpowers him, it is but a passive resistance which annihilates his efforts.”

Moral restraint, imposed through “love, kindness, and reward” could also motivate patients to change their behavior. Hydrotherapy of various sorts–including swimming in tepid pools–could be beneficial, especially if a patient had the will to change but not the ability. Air baths (rambling about in the open air) could take the place of hydrotherapy for “the higher classes” in order to avoid any type of violence to the patient. Finally, a nutritious diet often helped patients enormously, particularly when they had physical problems as well as mental issues.

Elixer of Opium Promoted Restful Sleep and Composure and Relieved Nervous Excitement

Elixer of Opium Promoted Restful Sleep and Composure and Relieved Nervous Excitement

Tonics and stimulants had their place for patients needing that kind of help, but Paragot generally urged the mildest means possible when doing anything more than counseling a patient. He recognized that hydrotherapy and various types of restraint options were often accompanied with violence toward a patient, which he found particularly negative in terms of a therapeutic outcome. If his enlightened views had prevailed, asylums might not have earned the disdain and dismay that haunt them to this day.

Ways to Treat the Insane

Leisure Time at Southwestern Lunatic Asylum, circa 1890, courtesy Southwestern Virginia Mental Health Institute

Leisure Time at Southwestern Lunatic Asylum, circa 1890, courtesy Southwestern Virginia Mental Health Institute

Around the time of the Civil War, alienists were still hammering out the best ways to treat the mentally disturbed. Asylums were much more common, and a great majority of alienists felt that removal to one would benefit most patients more than home care. What they particularly stressed was an immediate change of scenery–either to an asylum or by travel–for a patient in the first stage(s) of insanity. By getting this person away from the environment that had brought on the problem, doctors could often snap the person out of the state of mind causing the insanity.

Labor of some kind was also beneficial for the physical health and mental recovery of the insane, which led most asylums to set up gardening and workshop programs for their patients. The author (Dr. J. Parigot) of an 1864 article “General Mental Therapeutics,” did stress that labor must be voluntary. “Free-will labor has the advantage that patients instinctively choose occupations in accordance with their state of health,” Pargot noted. But he also gave the following caveat: “. . . patients ought never to be converted into machines and tools for private speculation.” He was very much against using patient labor to keep down expenses so that an asylum could be self-paying or profitable.

Interior of Shoe Shop, Willard Asylum for the Insane

Interior of Shoe Shop, Willard Asylum for the Insane

Unfortunately, therapeutic labor soon came to include drudge work and difficult farm and dairy tasks that most patients probably did not enjoy. As asylums took in more patients with less per capita state funding, they had to rely on patient labor to offset the costs of food and other goods.

Patients Picking Cotton at Alabama Insane Hospital

Patients Picking Cotton at Alabama Insane Hospital

My next post will continue to discuss therapeutics during the Civil War era.

Thoughts on Religion

Causes of Insanity Included Religious Excitement

Causes of Insanity Included Religious Excitement

Discovering the reasons for insanity proved difficult for early alienists. For many years, these mental health experts attributed the origins of insanity to what modern medicine would call laughable causes: excessive novel-reading, masturbation, smoking, religion and so on. Eventually, a few medical men began to question these sorts of factors as true causes of mental issues.

Dr. John Gray, superintendent of the State Lunatic Asylum in Utica, New York, wrote in 1885 that, “Religion, strange to say, is sometimes set down as a cause of insanity . . . . To some it means that a person is insane on the subject of religion; to others that the insanity was caused by religion.”

Dr. John Gray

Dr. John Gray

Gray recognized that the idea of “Religious Insanity” actually meant that religion caused insanity to many people. His belief, though, was that: “What people talk about when they become insane, has rarely anything to do with the real cause of the disease.” Gray gave a couple of examples concerning his theory, one being the case of a severely overworked minister who finally broke down and began raving that he was Zerubbabel and had been appointed by God to preach “to the spirits in prison” and that he had descended into hell to preach the gospel of salvation and redemption.

“This was not Religious Insanity,” said Gray, “but insanity from exhaustion, religion having nothing to do with it except to give tone and character to his delusions.” Gray found that many people who appeared insane due to exhaustion or broken health could often recover when given rest and proper medical treatment.

State Lunatic Asylum, Utica, New York, courtesy National Library of Medicine

State Lunatic Asylum, Utica, New York, courtesy National Library of Medicine

His point of view was a refreshing counterpoint to others in his field who would have labeled a patient like this insane and perhaps never expected a recovery.

Predicting Madness

Issue of the American Journal of Insanity

Issue of the American Journal of Insanity

“I am tempted sometimes to think that no person goes mad . . . who does not show more or less plainly, by his gait, manner, gestures, habits of thought, feeling and action that he is predestined to go mad.”

This quote (by a Professor Maudsley) in the October,1872 issue of the American Journal of Insanity, shows clearly that many noted psychiatrists–called alienists at the time–believed they could predict who might eventually go insane. Unfortunately, alienists had little ability to prevent this madness, beyond advising potential patients to avoid certain triggers that might bring it on. Such triggers included overwork, over-excitement, riotous living, worry, financial setbacks, grief, and so on.

Group of Prominent German Alienists

Group of Prominent German Alienists

Even more unfortunately, many alienists believed that insanity was rooted in physical causes that could be hereditary. This view had the potential to put anyone who had mental illness within the family in limbo, waiting to see if the illness would manifest. And because it was so often considered hereditary, having a family member with insanity was a barrier to marriage unless its cause could be positively attributed to an unusual circumstance like a blow to the head, sunstroke, or other purely physical cause.

This Eugenics Certificate Shows the Public's Fear of Undesirable Hereditary Traits, courtesy Robert Bogdan Collection

This Eugenics Certificate Shows the Public’s Fear of Undesirable Hereditary Traits, courtesy Robert Bogdan Collection

It is certainly sad to think that many people waited and worried their entire lives over an issue that had no potential to materialize.