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The mentally ill have long been considered a dependent class within society. Throughout history, communities and societies have been faced with the task of containing the adverse effects of mental illness and providing relief to those experiencing mental illness. Societal perceptions and speculations regarding insanity have undergone drastic evolutions throughout the progression of time. As the circumstances and knowledge surrounding mental illness have evolved throughout time societal responses have in turn shifted to reflect those changes with treatment of the mentally ill reflecting the needs of society.
The earliest perceptions of mental illness are embodied by ancient texts which detail the supernatural causes of erratic behaviors. Doctors attributed disturbances of mood, speech, and behavior to supernatural causes. Early Christianity, for example, sanctioned centuries of the accepted notion that insanity could be attributed to interference from the Devil. In his work Madness: A Brief History, Roy W. Porter acknowledged these ancient perspectives noting that “reason was walking in harmony with God, derangement that state of mind when the soul, diabolically assailed, blasphemed against the Almighty. Madness was thus a desperate, acute phase in the trial of gods and demons and redemption of souls because it brought a sinner into a state of crisis and provided a prelude to recovery.” In ancient times people thought symptoms 1 like epileptic convulsions to be demonic possession and Hinduism even detailed a special demon responsible for epileptic convulsions. Archaeologists have discovered skulls that date back to 5000 BC containing small round holes created by flint tools. Historians speculate that people drilled these holes in the skulls to allow the spirits to escape possessed individuals. Ancient perspectives on mental illness created a society that feared the mentally ill as a threat to social order and their responses to mental illness reflected this perspective. Mental illness was met with witch-hunts and the torture of mentally ill individuals. In this era, the brutal treatment of mentally ill individuals also met the societal need of demonstrating the consequences of straying from the path of religion. It was not until the late seventeenth century that medical doctors began to denounce the supernatural beliefs in demonic possession and secularize the study of insanity. The emergence of the Greek philosophers brought forth a new perspective.
The new thought patterns viewed the human condition naturalistically. Among those thinkers was Aristotle, who defined man as a rational being within the system of nature, the rational being valued order and logic. From this notion emerged the idea of Hippocratic medicine. Hippocratic medicine aimed to aid nature in creating and preserving a healthy mind in a healthy body. The human life was then to be understood in naturalistic terms. Experts informed individuals that all emotions arise from the brain, good or bad. Hippocratic texts noted that “men ought to know that from the brain, and from the brain only, arise our pleasures, joys, laughter, and jests, as well as our sorrows, pains, griefs and tears. Through it, in particular, we think, see, hear, and distinguish the ugly from the beautiful, the bad from the good, the pleasant from the unpleasant. . . . It is the same thing which makes us mad or delirious, inspires us with dread and fear, whether by night or by day, brings sleepless- ness, inopportune mistakes, aimless anxieties, absent- mindedness, and acts that are contrary to habit.” This definition of medicine 2 excluded the supernatural, instead Hippocratic medicine explained health in terms of basic fluids within the body called humors. The balance of these fluids accounted for health and wellness both physical and mental. The recognition of mental illness as a disease of the mind and not demonic possession shifted the societal perception of mental illness, people were still not accepting of the mentally ill but slightly less deterred by them than they had been to those who they thought were possessed. Society still considered insanity to be shameful to a family with an insane member, however, it was regarded as more manageable than the insanity imposed by a supernatural being. Care for the mentally ill following the shift away from the supernatural explanations was the responsibility of the family. Family members kept the insane out of the sight of society, sometimes even looked after by a dedicated servant. Ultimately, the birth of medical science brought rational and naturalistic ways of thinking that were incorporated into subsequent Western medical tradition. The ancient shifts in understanding mental illness reveal a distinct pattern in societal responses evolving to reflect the development of knowledge. This road to acceptance paved the way for a later societies to continue developing a deeper understanding of mental illness
By the time of the American society acknowledged insanity as a legitimate medical condition. In early Colonial America, the perception of insanity was not different from that of any other disability. Mentally ill individuals could not support themselves and people regarded them as categorically the same as any other type of dependent individual. State laws in many colonies laid out guidelines for dealing with dependents stating that any individual who could not be provided for by relatives or by their own accord was to be the responsibility of the town. Thus, immediate families, relatives, or other households in the communities cared for the mentally ill. This principle applied universally to the poor and the insane with the exception of individuals who were perceived as lazy or vagabonds. In his seminal work Discovery of the Asylum: Social Order and Disorder in the New Republic, David Rothman noted that “these attitudes were intimately related to a broad range of social and religious considerations. Colonial ideas were in part a response to prevailing religious teachings, in part to secular definitions of the proper functioning of the social order, in part to English traditions, and in part to a special sense of community.” Religion proved a significant circumstance that influenced societal responses to 3 the mentally ill. Religion asserted that the presence of the mentally ill dependents presented humanity with the God given opportunity to do good. This perspective meant that the mentally ill were a necessary and safe part of the social order instead of a threat to it.
Before the populations began to rise in the colonies, it was possible to care for mental ill individuals within the community but population growth presented colonists with the need to prevent the mentally ill from wandering at bay. Alongside the population growth came the widespread perception that a lack of social order with the loosening of family, church, and community values existed. Medical professionals deduced that the cause of insanity must have been the rapid change in society as civilization advanced. According to Rothman “medical superintendents explorations of insanity took them into practically every aspect of antebellum society, from economic organization to political and religious practices, from family habits to patterns of thought and education. And little of what they saw pleased them. The style of life in the new republic seemed willfully designed to produce mental illness. Everywhere they looked they found chaos and disorder, a lack of fixity and stability.” The invention of the asylum was 4 in part a response to this perception of declining social order in conjunction with the fact that there were too many mentally ill individuals to remain caring for them in private homes.
The response to the problem of caring for the mentally ill was the invention of the asylum. The belief that environmental factors were the causes of mental illness lead reformers to seek the creation of an environment in which societal chaos could subside to allow for proper healing. Asylum supporters insisted that a well organized institution could cure almost any instance of mental illness. Order proved the most important component of the asylum. To remedy the chaos of society that was though to be the cause of mental illness, staff subjected asylum patients to strict routines and simple ways of life. Rothman conveyed the goals of the asylum when he wrote that the institution “. . . would arrange and administer a disciplined routine that would curb uncontrolled impulses without cruelty or unnecessary punishment. It would re-create fixity and stability to compensate for the irregularities of the society. Thus, it would rehabilitate the casualties of the system. The hospital walls would enclose a new world for the insane, designed in the reverse image of the one they had left.” The asylum was a place of 5 refuge, where peace and stability were provided in the midst of a world that continued to change. Some asylums placed emphasis on stability through the architecture of their facilities. In her work Asylum on the Hill: History of a a Healing Landscape, Katherine Ziff revealed the intention behind the design of the Athens Lunatic Asylum. She wrote of the asylum creators hopes for “. . . the curative function of a regular, harmonious environment with a regimen that would influence patients to internalize the behaviors of a well-ordered household.” This 6 environment would allow for the imposition of order that had been lost to the changing world. Equally important to the creation of the environment were the nature of the relationships to be formed there. Ziff also noted that the ideal hospital was seen as “. . . a cohesive and closely knit family, within whose confines the superintendent would treat patients with consideration and respect in the hope of eliciting a response in kind.” By the second half of the nineteenth 7 century, the mental hospital had become the foundation upon which mental health policy rested and most states had at least one institution. Unfortunately, the rhetoric surrounding these institutions presented a great contrast to the realities of the asylum. After 1850, the balance shifted from the prospect of improving the individual and society to the convenience facto of what to do with misfits and deviants as the urban areas now held populations of unprecedented size. Chronic patients began to dominate hospitals making rehabilitation nearly impossible, thus hospitals were transformed into custodial institutions.
The successes of these institutions were highly convoluted. In his work The Mad Among Us: A History of the Care of America’s Mentally Ill, Gerald Grob noted that Asylums failed to live up to the ideas of their supporters. Unpredictable developments shaped asylums, including the nature of and interaction among patients as well as between patients and staff. Grob asserted that “without doubt the most important element in shaping the character of the asylum was the patients themselves. However lofty the intent of the organizational rules and regulations, patients’ behavior and their relationship with the medical and lay staff more than anything shaped the internal environment … the character of the asylum was shared by the turbulent relationships of the patients among themselves and with the staff.” These negative components 8 were not made public until much later, the facade of the asylum’s success would continue. The fact that superintendents were inclined to give more dramatic results in regards to the success of their programs catalyzed the facade. They reported high recovery rates, some even announcing their number of cured patients to be at one hundred percent. However, these results were far from accurate. The only criteria devised for measuring recovery was release from the institution. In many instances, a single patient would be admitted, discharged, and readmitted on several occasions and be counted as “cured” upon each release. The public accepted these statistics and no one challenged their accuracy. Psychiatrists argued that they had pinpointed the origins of mental illness and personal ambitions inflated this confidence. Personal ambitions were intensified by the fact that the committees from the state legislatures and boards of trustees used the number of recoveries achieved as a means for deciding appointments and promotions. Competition resulted in intense pressure for asylum professionals to report high rates not only to obtain their own personal success, but to give credit to the new scientific ways to glorify the new nation by achieving a successful cure for insanity. Rothman noted that “. . . professionals and laymen alike desperately wanted to credit calculations that would glorify humanitarianism. A cure for insanity was the kind of discovery that would honor the new nation.” The desperation 9 for successful institutions demonstrated the need for the treatment of the mentally ill to fulfill the needs of society. The treatment of the mentally ill at the founding of the early asylums reflected the need to restore values of a perceived ordered society and create the idea of American success.
The Second Great Awakening presented new societal needs and sparked an era of institutional reforms regarding the means of caring for the mentally ill. This era marked a shift away from Calvinist traditions. Before the Second Great Awakening Americans placed a deep emphasis on the depravity of human beings, most people believed that they could only be saved through the grace of God. The new movement emphasized the ability of humanity to change their situation for the better. It became accepted that individuals could assert free will and opened up salvation to all types of people. In his article “The State Mental Hospital in the Mid Nineteenth Century America: A Social Analysis” Gerald Grob revealed the influence of the Second Great Awakening on the institution of the asylum when he wrote that “Protestant leaders substituted the idea of a loving and benevolent God whose first concern was the happiness of his creatures. The twin themes of their liberalized theology were the doctrine of the free individual and the belief in a moral universe. When the belief in the free individual was fused with the millennial vision of a society performing a divine mission and eradicating all evidences of evil, Evangelical Protestantism was transformed into a radical social force seeking the abolition of the restraints that bound the individual and hindered his self-development. Thus, many ministers and laymen began to work actively to. Destroy the evil institutional restraints that imprisoned the individual.” The nature of these changes shaped the impending Progressive movement and 10 provided an ideological foundation for the reforms that were to come. Progressive reformers believed that the Jacksonian system had failed to consider the needs of the individual, they proposed that tailoring the asylum to each individuals specific problem would be more effective than a generalized approach. This attitude reflected the new influence of social sciences in that they believed the discovery of more information about a problem would in turn lead to its solution.
The reality of Progressive reforms was that information gathering alone, unguided by any underlying coherent theory was ineffective. Progressive reforms did not overpower the need of society to contain the mentally ill. Program administrators failed to appreciate and understand the purposes of reforms and tried to adapt the Progressive ideas to the needs of existing institutional structures. A reform would only be implemented if it was practical and consistent with the security needs of the institution. In his work Conscience and Convenience: The Asylum and its Alternatives in Progressive America, David Rothman wrote that “the quality of the ward staff, those with hands on responsibility for patient care, was appropriate only to a holding operation. First, personal shortages were endemic; while patient rolls overflowed, the employee rolls generally had vacancies. Images of a day room filled with many patients milling about aimlessly under the nominal supervision of one attendant were altogether accurate.” The 11 implementation and subsequent failure of Progressive reforms reflected both the influence of the Second Great Awakening upon society and the affect of the needs of society in protecting the security of its order by rejecting certain reforms.
Another instance of the treatment of the mentally ill being influenced by the needs of society can be found in the insanity defense. Historically, objectors have attacked insanity defenses, and made them more difficult to sustain. The original test for determining insanity in a court of law was originally based upon the doctrine of the right or wrong test which was formulated in England. Lawrence Friedman described the rule in his work Crime and Punishment in American History when he explained that the formulation “. . . stressed cognition, the act of knowing. It tied in fairly well with other dominant themes of nineteenth century thought, notably the stress on discipline and self control. If you were aware of what you were doing, and aware that it was terribly wrong, and did it anyway, then you were deliberately choosing crime or evil, and you ought to be punished.” As knowledge surrounding mental 12 illness evolved some states added the concept of “irresistible impulse” to the rule. The medical basis for this test applied the concept of moral insanity, the idea that certain conditions were so powerful that they could affect human emotion without destroying cognitive function. In other words a person could be conscious of what he is doing and the consequences of his actions but may still be unable to restrain himself. Although the concept of irresistible impulse protected the mentally ill from capital punishment in theory, the needs of society to punish criminals were many times too great. A prime example is the case of Charles Guiteau who assassinated President Andrew Garfield in 1881 at a train station as he prepared to leave for a trip. The President died from his wounds and Guiteau’s trial was an intense affair in which psychiatric thought patterns were prominently displayed. In his book The Trial of the Assassin Guiteau: Psychiatry and the Law in the Gilded Age, Charles Rosenburg presented a case study on expert disagreement and scientific controversy. Amidst the trial tests and evidence for insanity revealed the contested nature of psychiatry at the time. The abundance of psychiatric testimony presented in the trial indicated that Guiteau was insane from a present day perspective, however the circumstances were much different in Guiteau’s time. Jury deliberation only lasted about an hour and Guiteau was presented with a guilty verdict despite an abundance of evidence that he possessed deep rooted psychological issues.
The ancient understandings of mental illness, colonial responses to metal illness, and progressive era psychiatric reforms demonstrated the wide array of social contexts concerning the insane. When society was desperate for order, the mentally ill provided a means of imposing the necessary expectations. Societal responses throughout time have shifted to reflect the knowledge and circumstances surrounding mental illness. Further, the treatment of the mentally ill reflected the needs of society as much as the knowledge and circumstances were reflected. The extent to which society utilized the mentally ill as a vehicle for achieving certain objectives and explaining various phenomena revealed that the treatment of the mentally ill was influenced by the needs of society as a whole.
Bibliography
Friedman, Lawrence. Crime and Punishment in American History. New York: Basic Books, 1993.
Grob, Gerald. The Mad Among Us: A History of the Care of America’s Mentally Ill. New York: The Free Press, 1994.
Grob, Gerald. “The State Mental Hospital in Mid-Nineteenth Century America: A Social Analysis.” American Psychologist 21, no. 6 (1966): 510-523
Porter, Roy. Madness: A Brief History. New York: Oxford University Press, 2002. Rosenburg, Charles. The Trial of the Assassin Guiteau: Psychiatry and the Law in the Gilded Age. Chicago: The University of Chicago Press, 1968.
Rothman, David. Conscience and Convenience: The Asylum and Its Alternatives in Progressive America. New York: Aldine De Gruyter, 2002.
Rothman, David. Discovery of the Asylum: Social Order and Disorder in the New Republic. New York: Aldine de Gruyter, 2002.
Ziff, Katherine. Asylum on the Hill: History of a Healing Landscape. Athens: Ohio University Press, 2012.