471E4--Week 2 Questions/Comments--Thursday

On page 16 of Shorter’s book, a visitor to the Pennsylvania Hospital in 1787 recorded that, “We next took a view of the maniacs. Their cells were in the lower story, which is partly underground. These cells are about 10 feet square, and made as strong as a prison…. In each door is a hole, large enough to give them food, etc., which is closed with a little door secured with strong bolts.” When I read this my mind immediately went to some horror films (Silence of the Lambs in particular) that were made that dealt with the insane and the asylums they were in. Because of the way people were kept in the asylum there was not much interaction for other people to learn and understand their behavior which is where the fear comes in. Misunderstanding brings fear. All of the details of enclosure show the fear of the people towards the mentally ill. I feel that this had much influence on American society that gave people many misconceptions of mental illness. Even if they were a danger was there any other possibility for some therapeutic interaction? What about the ones who were no threat to society? Were they still chained like animals with no interaction? – Courtney Collier In the introduction to this class I had wondered when the changes in the terminology used to describe mental institutions and mental illness occurred and why and I was pleased to see Shorter include Reil's reasonings to change the name of mental institutions on page 18. - Katie Tryon Under the practice of "moral therapy", psychiatrists treated the asylum as a rest home for mentally ill. In many cases baths, serene settings and clean facilities were used at treatments. Are these forms of treatment or just VIP custodial accommodations? - Katie Tryon Following upon Katie and Courtney's comments, I was alarmed by the chilling description of some facilities. I thought the welcoming atmosphere of other facilities was intelligent and showed that thought had been put into the overall atmosphere of the facilities. By giving the facilities a more home like atmosphere, the patients probably felt more comfortable and more willingly to try treatment options. I think the two different types of facilities reflects how the changing times effected a change in mental institutions. I'm curious though if there is still a stark contrast in mental institutions today such as sterile facilities and more 'homey' welcoming ones.- Maggie Nunn

Shorter mentions in a step of advancement in institutions that patients should be separated into curable and incurable. I feel that this may be and interesting move that could be made. If a patient's disease has a cure then why put them away? ~ Emily Barry Maybe I'm misinterpreting Foucault when he says "Catholicism frequently provokes madness" (255), but is he actually arguing that religion causes people to go mad? Interesting to see considering how we've talked about religious groups helping with the mentally ill. Anyone else find this strange or is able to help me if I'm completely misreading this? --Carly W.

Carly, I think the difference here is that he is emphasizing a social morality over a religious morality. Furthermore you can't forget that extreme pious-ism can be seen as madness (demon possession, apparation, and prophets could all be sign of mental illness). "The aslym is a religous domain without religion, a domain of pure morality, of ethical uniformity" (257) He was people to function on the basic level (domestic labor) before they function at the abstract level - Kasey Moore

I was wondering the same thing Carly, but what I got from it was that he was only referring to Catholicism because it is different from the other Protestant denominations. Not sure if that helps or not but that's how I understood it.-Courtney Collier

So going through the shorter reading for this week A Few questions stuck out that I am going to share with you now-

What parameters are designed for the treatment of the mentally ill during and especially before the nineteenth?-Ronnie Vest

Also what were the main causes for the rise of the Nineteenth Century, and what led to its eventual demise as a complex for treatment of the mentally ill?- Ronnie vest

Reading the ever controversial Foucault- What gives rise to idea of the patient doctor relationship in the Nineteenth, and how did this idea developed over the Nineteenth century and into more recent times?-Ronnie Vest

In Foucault’s Madness and Civilization I noticed on page 252 there was mention how the Retreat’s goal was to treat the mentally ill like children. While this is better than constraint and isolation, that ideal could not possibly work for everyone because each patient had different issues and different degrees of illness. However, in this case I feel the intentions were good because they were trying to educate them. –Courtney Collier

In relation to Courtney's comment about the Retreat's goal to treat the mentally ill like children, I think that it was more in a sense that the Retreat was trying to educate and provide stability to the patients through an authoritative role. Shorter discusses the success of Ernst Horn who ran his asylum in a militaristic fashion that involved "tight daily schedules...and installed a general sense of limits" (15). For some people who, for a number of reasons, didn't have their lives all-together this may have brought a more firm sense and grasp on their lives than they had before. --Carly W.

I was intrigued by Shorter's section on the treatment of "nervous" problems by society doctors, particularly in that they were called to treat people with more serious mental illness, but failed to diagnose them with anything more than being under the influence of ill "vapors." Is this because serious illnesses extended beyond their expertise, or that they did not want to cause worry among the wealthy families that paid them?-Joanna Jourdan

I don't quite understand the difference between Tuke and Pinel use of religion as treatment in Foucault's piece. Tuke believes in the fear of God and re-educating the madman moral conscience will cure him, but Pinel believes this too (just different methods?)- Kasey Moore

I was completely fascinated by Pinel's "recognition by mirror" theory; the idea that a madman must observe madness in others before he can observe it in himself. I, also, liked how it logically connected to "perpertual judgement" and Tuke notion of self-regulation. Once you see yourself as mad, then it becomes your moral obligation to control yourself -Kasey Moore (Foucault's piece)

I found it interesting how the 39 nation-states in Germany produced the most progress in the field of psychiatry during the 19th century. It was made possible by the sheer number of academic institutions, fierce competition and a desire for recognition coupled with centralized government control. This was practically the opposite of the American experience that consolidated national control among a few in the field, required bottom up action to involve government, and focused on select foreign opinions to create a national treatment model. –Scott Campbell

I'm with Scott on the topic of Germany. I had always wondered why psychiatry had a connection with Germany, but after reading Shorter and learning that Germany had such a competitive and blossoming psychiatry field, it makes sense that there is an association between Germany as a whole and the study of the mind in general. --Chelsea Chin

Shorter mentions several divisions in the budding field of psychiatry. On one side doctors were attracted to the specialty because of self-interest, money, and status, on the other a genuine curiosity and sense of altruism. I think this fits into the idea that during the field’s early years many nervous spa-scene doctors enjoyed the former—detesting any connection to a psychiatric label—while alienists appreciated the latter. –Scott Campbell

Watch out for those madness-inducing vapors coming from your uterus! But seriously though. I had to smile at the description of Pinel's attitude in Shorter--bonhomie and frankness were critical to getting a patient to open up. Seems like common sense, but Shorter says this was revolutionary. It also never occurred to me that there might be Romantic psychiatrists, but I guess why not. Romanticism was everywhere, even psychiatry can't exist in a vacuum.---Stef L.

Considering how many figures played a key role in the shaping and development of this medical science can any one person really be attributed as "The Father of Psychiatry?" Are there any comparative statistics on how often doctors gave drugs to patients that we now know to be harmful? That may have worsened peoples mental state? ~Alex Young

Shorter's information on psychiatry outside of the United States helped me to put American psychiatry into some form of international context. Keeping in mind Shorter's acerbic introduction and his desire to retell the history of psychiatry, he gives us a good general background in order to reinterpret this history as a whole. He mentions how the rise and abuse of alcohol contributed to the rise of institutionalized patients...while substance abuse is considered a disorder today, I'm not sure if it would have been a worthy reason for a person to be institutionalized. I can't help but wonder how many other people who happened to violate one societal norm or another found themselves in an asylum.

On another note, Shorter and Foucalt both bring up examples where a kind voice or a friendly tone helped calm down psychotic patients. Honestly, in a society where the "insane" were looked down upon, wouldn't it make sense that a "kind voice" or "friendly" interaction would result in a generally more favorable reaction? If patients are unaccustomed to being treated as some form of human being rather than scum, then of course they would respond positively to a person who tries to treat them with some kindness. --Chelsea Chin

Shorter states at the beginning of chapter two that there was a belief that many people admitted to the asylum had no psychiatric illness and were confined merely because they were social misfits and outcasts, and were inconvenient rather than ill. This notion brings up many questions including the definition(s) of “mentally ill”. Did social “misfits” and “outcast” make up a large percentage of mentally ill patients and how did they skew the curability rate among hospitals? -Jack Hylan