Eighteenth and Nineteenth Century Views

It was not until what could be considered the modern historical period, beginning at the end of the eighteenth century—the time of the American and French Revolutions—that major changes took place in the treatment of the mentally ill. Additionally, there was a change in attitudes toward such persons, in approaches to their treatment and in beliefs regarding the causes of their strange behaviors. The man who, because of his courage, became a symbol of this new attitude was the French physician Philippe Pinel (1745-1826), appointed physician-in-chief of the Bictre Hospital in Paris in 1792. The Bictre was one of a number of "asylums" which had developed in Europe and in Latin America over several hundred years to house the insane. Often started with the best of intentions, most of the asylums became hellish places of incarceration.

In the Bictre, patients were often chained to the walls of their cells and lacked even the most elementary amenities. Pinel insisted to a skeptical committee of the Revolution that he be permitted to remove the chains from some of the patients. In one of the great, heroic acts in human history, Pinel introduced "moral treatment" of the insane, risking grave personal consequences if his humane experiment had failed.

This change was occurring in other places at about the same time. After the death of a Quaker in Britain's York Asylum, the local Quaker community founded the York Retreat, where neither chains nor corporal punishment were allowed. In the United States, Benjamin Rush, a founder of the Ameri-

A "centrifugal bed" was used to spin mental patients in the early nineteenth century. (National Library of Medicine)

can Psychiatric Association, applied his version of moral treatment, which was not entirely humane as it involved physical restraints and fear as therapeutic agents. Toward the middle of the nineteenth century, American crusader Dorothea Lynde Dix fought for the establishment of state hospitals for the insane. As a result of her activism, thirty-two states established at least one mental hospital. Dix had been influenced by the moral model as well as by the medical sciences, which were rapidly developing in the nineteenth century. Unfortunately, the state mental hospital often lost its character as a "retreat" for the insane.

The nineteenth century was the first time in Western history (with some exceptions) that a number of scientists turned their attention to abnormal behavior. For example, the German psychiatrist Emil Kraepelin spent much of his life trying to develop a scientific classification system for psycho-pathology. Sigmund Freud attempted to develop a science of mental illness. Although many of Freud's ideas have not withstood empirical investigation, perhaps his greatest contribution was his insistence that scientific principles apply to mental illness. He believed that abnormal behavior is not caused by supernatural forces and does not arise in a chaotic, random way, but that it can be understood as serving some psychological purpose.

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