471E4--Week 3 Questions/Comments--Thursday

I must admit, I was relieved to finally gain some perspective into what the patients were feeling throughout their stay at Kirkbride's asylum. That being said, she is very heavy on the Kirkbride content. Praise of Kirkbride seemed to almost always follow her evidence of patients who did not agree or expressed dissatisfaction of Kirkbride's methods. The triangle system of doctor-families-patron seemed quasi-helpful, but I cannot help wonder what happened when any of the corners argued with the other. For example, patients may have turned to their families for help, but the families, should they agree with Kirkbride, faced anger from their relatives at the same time. How did Kirkbride reconcile this? --Chelsea Chin

This is exactly what I was talking about in class on Tuesday: "Praise of Kirkbride seemed to almost always follow her evidence of patients who did not agree." Tomes reads like, "The asylum would have worked great if it weren't for those pesky patients." Overall, I feel that Tomes is extremely dismissive of patients' concerns. --Stef L.

On page 278, I thought it was clever of Tomes to mention the asylum worker’s risk of working at a mental institution. We have spent the majority of our time thus far learning of some horrible conditions for the patients in these asylums, but Tomes uses another view to show the mental and physical effects of working in an asylum. It is not surprising that many of the workers had to retire early because of the toll their bodies and minds dealt with. In this class I think it is important that we don’t assume all of the patients were like motionless zombies that were confined all of the time. Many patients were probably very violent and rude to some of the workers; we tend to forget about the hardships they faced as well. –Courtney Collier

I thought Tomes did a great job of paying tribute to Kirkbride. Even in his illness he was determined to make progress and improvements in the mental institutions for the patients. He had already made a name for himself, obviously he was driven by a strong bond and love for his patients and his field. The younger generations tried to get rid of him completely yet even after his death he found some way back through Chapin. His wife, Eliza, should have been a prime example to all of his colleagues that he had the upmost respect and concern for his patients and truly believed in their curability. I can see why Tomes gave such admiration to Kirkbride, at a time when hope was unsure he was able to make great improvements to all he came in contact with. –Courtney Collier

Kirkbride's hospital had evening entertainment for his patients during part of the year. Wouldn't this be harmful to people who had mental problems. A musical performance, may not be harmful, but something that requires attention may not be the greatest idea. -Emily Barry

Surely, being a superintendent in an asylum took its toll. Merrick Bemis, a superintendent from State Lunatic Hospital began suffering from depression. I thought it was interesting that Bemis sought out Kirkbride and asked to be admitted into the Pennsylvania Hospital instead of his own institution. ~ Emily Barry

Kirkbride’s regimen created a strict atmosphere that reflected outside gradations in social status, where upper classes benefitted from better facilities, activities, and accoutrements. Why did he not seek to promote change through a uniform, one-size-fits-all policy that treated patients—reinforcing work ethic, obedience, and acceptance—regardless of status? His incentives system strikes me as not very promising, especially for the chronically ill who would be unable to participate. Furthermore, it makes Kirkbride seem dishonest and only concerned with keeping patients happy instead of treating them because, after all, his institution’s profits depended upon a happy majority. Also, by Kirkbride mirroring outside social norms in his daily activities how is he not illustrating how easy it would be for wealthier families to care for their own in the lifestyle they were accustom? This really backs my thoughts on the asylum being a convenient choice for the rich to dump difficult, but not chronically ill, family members. –Scott Campbell

I was taken by the incentive system in which a patient would be moved to higher or lower wards as a form of punishment/reward. This too me sound like the perfect punishment for a place that tries to create a microcosm of the outsidw world in order to rehabilitate their patients. SCREAMS SOCIAL CONTROL and SOCIAL REPRODUCTION! -Kasey Moore

I was very interested in the example of the downfall of asylums, in particular that of the patient-ralated disputes. I was so proud of Elizabeth Packard for not only sueing her husband, but sueing the institution. It was definately a needed counterbalance to the all powerful superintendant and the one certificate rule. -Kasey Moore

I thought it was extremely clever of the patients to use the rule book to voice their complaints. By doing so, they not only adhered to Kirkrbide's rules but were asking for what they wanted. As I read this I laughed and almost thought the patients were manipulating the workers for their gain. Going off of Kasey's comments, I was shocked by the higher or lower wards as a way to punish or reward patients but it seems as though this was a logical tactic. I'm sure the patients looked at other patients through a cynical or aspiring lens in the fact that they wanted to shape their behavior after their peers. The different wards was a way to reinforce the concept of good behavior which seems to be a way to manage patients behavior.- Maggie Nunn

We've read so much about moral treatment that it never occurred to me to question the medicinal regime established for patients when they entered the hospital. I figured that because Kirkbride went out of his way to establish these "better" settings and new freedoms in his asylum that patients were only put on medication when cases became extreme or they needed to be calmed down, but Tomes shed some light on the subject. I had just assumed Kirkbride was a "last resort" prescriber of medication, so it surprised me to read that he gave virtually all new patients a medication plan for the first year or so, and if patients remained after that, their medication was stopped. Was this common practice? --Carly W.

I also found it pretty interesting that the sex ratio within the Pennsylvania Hospital for the Insane was almost 50/50. Was that the norm for the time and how did it shift over time? --Carly W.

I completely agree with what Kasey said about social control through Kirkbride’s incentive system. I think this could have contributed severely to the high rate of chronic patients coming in and out of asylums. If you were a patient who suffered from depression how were you suppose to get any better if you were lumped in the same boat as someone with schizophrenia. –Jack Hylan

What do you think about “One cannot help but see the tragedies of mid-nineteenth century asylum practice as the inevitable price the superintendents paid for their own ambitions” (page 279). –Kasey Moore

How did the Kirkbride system of Organization alter previous menas of categorizing patients, and how effective was it as a solution for the maintaining of patient manifest?- Ronnie Vest

How did Kirkbrides Religious beliefs factor into his job? What did being a man of faith bring to the way he ran his hospital and interacted with his patients-Ronnie Vest

During a patient's final months until release they received a reduction in “medications.” However, if Kirkbride suspected lingering signs of insanity or witnessed such behavior the patient was put back in the system. I am curious as to how many patients suffered serious withdraw or were addicted to medications given, like morphine, and if Kirkbride interpreted the resulting reactions as insanity. –Scott Campbell

I found it surprising that Kirkbride was discriminating in what medicines he used to treat which conditions, and that if the patient was determined to be "chronic," the medicine was discontinued. However, his use of morphine puzzles me. I understand that it was one of the most powerful medications available, but it seems like it would be difficult to heal mental illness with the patient on narcotics. -Joanna Jourdan

On page 196, Tomes says that constipation was “a chronic disorder among the insane,” but never gives an explanation. Was this due to the medication they were taking or from a bad diet? This statement really boggled me. - Katie Tryon

Regarding constipation: Most meds then and now have constipation as a side effect. Drugs in the same family as opium are pretty notorious for it. Also, sometimes people with a lot of anxiety will hold their bowels as a way of controlling their lives (think of it like the way a person with an eating disorder is trying to regain control). Then, once a person has been deliberately holding their bowels, it can be difficult to go, even if they want to. Constipation can be life-threatening, believe it or not. That is an issue that providers worry about even now. And that's the story of constipation. You're welcome, everybody. --Stef L.

Kirkbride was telling families that a sore throat could result in very serious health issues and that one man’s death started in his stomach and traveled to the brain. Were these just lies to comfort and control families or did he actually believe this? - Katie Tryon

If Kirkbride’s successor, Chapin, was hired because he was economically minded, how did building a villa, cottage and obtaining a seaside house save money? (Page 316) - Katie Tryon

As was mentioned on pages 278-280, we seldom stop to think about what the people go through who have the difficult task of caring for those who can't care for themselves. What it was like working in a sort of pressure cooker. Sadly, some superintendents fell victim to the very mental disorders they tried to cure. I sometimes wonder, what holds one person together under that kind of pressure while another succumbs to it? Also, I wonder if the nurses, then as now, acted as a kind of buffer between the doctors and patients? If so, what effect did this have on them? ~ Alex Young

Although Tomes gives examples of patients who adored Kirkbride and patients who hated him, she doesn't address the average patient relationship with him. The average relationship Kirkbride had with his patients might not be as exciting as either extreme, but I think it should have been included to give a more complete picture of the hospital. -Joanna Jourdan

On page 194 the topic of drug therapy is discussed. It mentions that “Although Kirkbride gave greater public emphasis to amusements and employments as the more innovative aspect of asylum treatment, he believed active medical treatment to be equally essential to the proper care of insanity.” For the most part, we tend to focus on how therapy differs from today’s standards, however this sentence shows that some aspects are still similar today. Many believe that it takes a balance of therapy and medication to help a person (probably not opium however). - Morgan H.

In the section of patient complaints, it brings up one of the biggest problems, or at least a problem for me, regarding patient-doctor relationships. Most of what happens in the mental institutions comes from the point of view of the doctor, not from the people who were patients there. Kirkbride might have very easily been less than kind to some of his patients, and we may never know the full story. (It seems doubtful that he would be mean to his patients without necessary cause. And then not even mean, more like “harsh but just.”)- Morgan H.