Although some small, privately-run asylums existed in the colonial period, the large, state-run lunatic hospital was largely an invention of the 19th century. In previous centuries, so-called lunatics were generally maintained in their communities. Those who could afford medical care might be treated in their homes by a physician using remedies such as bleeding and purging. Lunatics without resources were supported by “outdoor” relief (as opposed to “indoor,” institutional care) in the form of benefits paid to the family supporting them by their town or village. These methods for managing insanity were adapted to the relatively small, close-knit communities of colonial America. The rise of industrialization and the resulting growth of the population frayed these social bonds. Geographic isolation and lack of job security deprived workers of their support networks, resulting in an itinerant class of unskilled laborers who had no safety net should they fall victim to disease, poverty, or madness.
By the late 18th and early 19th centuries, Americans were beginning to recognize the failure of the new country to live up to its stated ideal of equality, particularly in the crowded and poverty-stricken areas of growing urban centers. In contrast to previous generations, who viewed paupers and lunatics as part of the natural fabric of society, members of the new mercantile elite believed that deviance presented a problem that demanded a solution. Highly educated and deeply spiritual, members of this class believed in the potential for human perfectibility. Their faith was underwritten by the religious currents of the Second Great Awakening, which portrayed mankind as advancing rapidly toward the new millennium. Industrial technologies and the capital furnished by the market economy offered the tools necessary to realize their goals in a way never before possible. The result was the total institution, a uniquely modern approach to solving uniquely modern kind of dysfunction. The lunatic hospital, the almshouse, the workhouse, the penitentiary, and the boarding school were each targeted to contain and correct a certain class of deviant individuals in order to restore health and order to society.
The rationale behind the establishment of institutions was articulated primarily in humanitarian terms. The lunatic hospital developed out of a new approach to insanity known as moral treatment, which was first elaborated in France and England in the 18th century and was quickly popularized in New England. Departing from earlier beliefs that lunatics were flawed beyond the hope of redemption, moral treatment emphasized their essential humanity. The English branch of moral treatment derived from the religious principles of the Society of Friends or Quakers, which called for “the law of love and sympathy,” in contrast to the harsh confinement and heroic medical measures used by earlier generations. The proponents of moral treatment emphasized “careful attention to cleanliness, exercise, air, and substantial diet” as a means of supporting the total health of the patient. Because insanity was attributed mainly to the unhealthy lifestyle and environment of modern civilization, it was believed that a return to moderate habits and healthy surroundings would bring about a cure in all but the severe cases.
The asylum was designed not simply as a site for moral treatment, but as its important instrument. Its extensive grounds were intended to provide access to nature unspoiled by pollution and the noise of urban life. The chapel furnished a setting for the enjoyment of sacred music and exposure to positive moral influence. Patients would be a wholesome diet with food supplied from the asylum farm. Encouraged by the reported successes of their peers in Europe, American physicians were incredibly optimistic, projecting a cure rate of 90% for patients who were treated promptly in an asylum. However, asylum administrators would soon realize the difficulty of creating an ideal environment, and of marshaling the financial and human capital necessary to sustain it.
Bibliography and Further Reading
- Cherry, Charles L. 1989. A Quiet Haven: Quakers, Moral Treatment, and Asylum Reform. London and Toronto: Associated University Press.
- Deutsch, Albert. 1946. The Mentally Ill in America: A History of their Care and Treatment from Colonial Times. New York: Columbia University Press.
- Dwyer, Ellen. 1987. Homes for the Mad: Life Inside Two Nineteenth-Century Asylums. New Brunswick, NJ and London: Rutgers University Press.
- Foucault, Michel. 1977. Madness and Civilization: A History of Insanity in the Age of Reason. New York: New American Library.
- Gamwell, Lynn and Nancy Tomes. 1984. Madness in America: Cultural and Medical Perceptions of Mental Illness Before 1914. Binghamton, NY: State University of New York.
- Goffman, Erving. 1961. Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. Garden City, N.Y.: Anchor Books.
- Payne, Christopher. 2009. Asylum: Inside the Closed World of State Mental Hospitals. Cambridge, MA: Massachusetts Institute of Technology.
- Porter, Roy. 2002. Madness: A Brief History. Oxford: Oxford University Press.
- Reaume, Geoffrey. 2000. Remembrance of Patients Past: Patient Life in the Toronto Hospital for the Insane, 1870-1940. Oxford: Oxford University Press.
- Rothman, David J. 2002. The Discovery of the Asylum: Social Order and Disorder in the New Public. New York: Aldine de Gruyter.
- Scull, Andrew. 1979. Museums of Madness: The Social Organization of Insanity in Nineteenth-Century England. New York: St. Martin’s Press.
- Scull, Andrew. 1981. Madhouses, Mad-Doctors, and Madmen: The Social History of Psychiatry in the Victorian Era. Philadelphia, Pa.: University of Pennsylvania Press.
- Tomes, Nancy. 1984. A Generous Confidence: Thomas Story Kirkbride and the Art of Asylum-Keeping, 1840-1883. Cambridge: Cambridge University Press.
- Yanni, Carla. 2007. The Architecture of Madness: Insane Asylums in the United States. Minneapolis: University of Minnesota.