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

I found it interesting that one of the main reasons the Pennsylvania Hospital for the Insane selected a rural site for the new hospital was because of the lack of privacy provided for the patients due to the idea that they were forms of public amusement. I had just assumed it was because of the negative stigma associated with asylums. However, it's strange to think that hospitals housing the mentally ill were created for the purpose of confining those individuals from harming the general public, and yet "even members of the city's best families routinely included visits to the Pennsylvania Hospital...on the agenda of fashionable amusements." (34) In the introduction Tomes mentions that in some hospitals visitors could pay to visit the mentally ills' cells. I guess it just plucks my nerves that people pressed for these institutions because they didn't want to carry the burden of taking care of the mentally ill, but they still wanted to have access to them like they're some sort of circus act. -Carly W.k

--Carly, the hospital tourists gave me the creeps too. I have to think that hospital staff allowed these visits because they felt like they would drum up interest and (financial) support. --Stef L.

I was fascinated by Tomes' depiction of how critics view mental institutions. Critics call them "ineffective, oppressive, and uneconomical" among other things. Maybe being institutionalized helped some patients, but not others, and that is what led to their downfall. Tomes referred to the process of de-institutionalization as "revolving door syndrome" because patients kept returning to the asylum. If they were not cured enough to be in the real world, why were they released? ~ Emily Barry

Tomes are very much different from the Foucault. Tomes also very much differs in her opinion of Kirkbride, and although she does acknowledge Kirkbrides contribution, she does ultimately think he failed to embrace the scientific qualities of his time. Tomes overall is much more approachable in her style than Foucault, who writes on a level of abstraction hard to grasp. Overall the reading was very interesting to look at the perspective of asylum through tomes eyes.-Ronnie Vest

I found Tomes more readable than previous readings but at times questioned her argument. The way she broke her argument down seemed plausible to me and her critics of Kirkbride were more believable to me. She not only gave a complete history of Kirkbride but provided the reader with points to questions such as why Kirkbride chose to employ certain policies in the hospital. - Maggie Nunn

Questions:

How did doctors like Kirkbride legitimize the Nineteenth century Asylum as a place for the treatment of the mentally ill, and further without their support would the Asylum have been founded as part of the legacy of treatment for the mentally Ill?-Ronnie Vest

Looking at PA State hospital as a model for the Nineteenth century Asylums, how successful was the Asylum in the Nineteenth Century in doing what was originally laid out in the Kirkbride plan-Ronnie Vest

Tomes mentions that people would visit the hospital for entertainment, and that they became a nuisance. Was there not a system in place other than a sign and the doors to keep such people out? I know it was a public hospital, but it seems to me that they should have been able to limit access more effectively. -Joanna Jourdan

I was surprised by the fact that the attending physicians only visited the wards of Pennsylvania State Hospital twice a week in the early days of the hospital. Also they would only focus on new patients or those of particular interest. This statement shocked me because early movements for the asylum were about treatment and trying to beat mental illness. If physicians only focused on a few patients how were they suppose to overcome such a large task? It is no longer surprising to me at least why Foucault had such a strong hatred toward early asylum activist. -Jack Hylan

What aspect of asylum work most influenced Kirkbride to agree to the superintendent position? Tomes points out three: a stable life, especially for his family, afforded by consistent pay and routine, the opportunity to specialize in a limited and “new” field which could lead to national recognition and elite clients, and the desire to have complete control over an institution where he could experiment with his own ideas of physical and moral treatment. Each seems a very different motivator, at least to me. –Scott Campbell

Scott, I definitely think that for Kirkbride, accepting the superintendent position was all about the power that came along with it. Kirkbride was offered positions with asylums previously, but "what made the difference...in 1840 was the degree of institutional power it offered." I think Kirkbride's main goal, naturally, was to be as successful as he could with the educational background that he had, and he realized that accepting the superintendent position with the Pennsylvania Hospital for the Insane would offer a gateway for that success. -Carly W.

If the passions and temperaments that were thought to cause disease included skin color as a symptom, did that predispose people of the stated complexions to be diagnosed with the disorder that was associated with that skin color? For example, I have a fair complexion, so if I walked into Nathaniel Chapman’s office with a medical issue, would he assume that I have “’an ardent temper’ and a predisposition to hemorrhages and violent inflammatory diseases?” Was it thought that all people with a certain complexion could attribute their disorders to a common cause?- Joanna Jourdan

I found the architectural description of the asylum interesting because it seemed as though Kirkbride and Holden gave serious thought to the placement of each section of the hospital. What struck me as most odd was the ornate gardens, lectures and workout options that were offered. Was this the hospital's attempt at making the space more comfortable for the residents? - Maggie Nunn

Like Scott mentioned above, Kirkbride's motivations for becoming the superintendent of the Pennsylvania Hospital of the insane vary greatly, but seem to mostly align with the idea of a notable and known reputation rather than an actual vested interest in the care of the insane. That being said, I was surprised by the amount of effort he placed into his patients and their families. He obviously took great care in persuading and assuring his clients that their relatives would be taken care of, and his concern for aspects of his patients' (and staff's) comfort, such as the hygiene of his facility, reflected attentiveness of some sort. Whether this was the result of his Quaker background or a gradual interest, I am unsure.

How did families honestly expect Kirkbride to pay such individual attention to each and every patient? Between meetings with his staff, attempts to establish a reputable position, and his daily visits to his patients...Tomes, in my opinion portrays Kirkbride as a man pulled in many directions. No wonder why institutions began to fail...the superintendent could not play the role of God (in the sense of paternal caretaker and savior, which brings to mind another question: what role did the faiths of patients and their families play in their decisions to entrust another with their loved ones? Did they indeed liken the asylums as an earthly metaphor for salvation of the "insane"?), and it almost seems as if that is what was expected of each superintendent. --Chelsea Chin

I found it interesting how the superintendents attributed the rapid increase of mental illness as a result of America’s advancing civilization—industrial revolution/Jacksonian principles—causing adverse effects to people’s nervous system because of more competition, equal access to opportunity, urban stress and work schedule. Especially considering how the asylum was a byproduct of this advance that depended on the innovation produced by progress to outfit the institutions with home-like comforts, aid expansions, and pay for the services. –Scott Campbell

After reading about a few cases where parents committed their children who wanted to run off to get married or become an actress, I was wondering if it was common place for a parent to threaten a child by calling them insane. For example might a parent say, “if you even think about dating that boy, I will have you committed” similar to the threat of a parent saying “if you keep making that face, your face will freeze like that”. – Kasey Moore

On page 95 Tomes writes, “Faced with a distressing changed in a loved one’s behavior and personality, family members cast about for a reassuring explanation of its origin, and had little difficulty in finding some psychical or psychological disturbance in the individual’s recent past to serve as a plausible cause. “This made me think about Foucault’s notion that insanity is socially constructed, it seems that Tomes might agree with his theory. –Kasey Moore

Tomes mentions numerous cases in which women were considered insane including hysteria and menopause. I was wondering if pregnant women were committed either prior to being aware they are pregnant or during their pregnancy as the hormones might cause unusual behavior. In the latter case, it seems plausible they would think the embryo as trigger of insanity and consider her cured after the birth of the child. – Kasey Moore

Lastly, I appreciated when Tomes revealed that the reports made by Kirkbride were not only used as medical proof for doctors in the referral system, but as brochures to patrons. This 100% alludes to the issue of falsifying success rates in order to bring in more business. –Kasey Moore

In chapter one on page 28, Tomes gave some statistics of women patients in the asylum from 1828. Fifty percent of the women were married which makes me skeptical on whether they truly had a mental illness. I believe many husbands during that time used the asylum as a scapegoat to get rid of their wives if they were too outspoken and didn’t fulfill their “gendered roles” of society. The second highest percentage was single women which could also bring skepticism because many were seen as wild and untamed. –Courtney Collier

Kirkbride was really the most promising choice at the time to work in the asylum. He attracted not only families with the Christian ideals but also brought a new promising scientific work. His interest in surgery and good education allowed him to gain more patients to the asylum. However, Kirkbride never really strayed far from his religious upbringing with the Bible readings and rewards afterward. I wonder if Kirkbride truly did these readings out of devotion for Christ or was he just trying to gain more families and patients? - Courtney Collier

Kirkbride was obviously a well-educated man and put forth much effort to better the asylum. However, on page 92, I was surprised to find that his correspondents were not very literate which left some patients/families confused about the real condition of the illness. – Courtney Collier

“Uterine disease was cited in some women’s cases. In several instances, family members asked on admission to the hospital…to discover if ‘derangement of the womb’ had caused her mental disease.” “Menopause, or, as one correspondent described it, ‘the period of life which is so critical with most women’, was often linked with insanity to middle aged females.” These two passages stuck out to me because of the way it focuses on the sex of a person as a reason for insanity. How much of a women’s life was based on her reproduction system and the different experiences she had to go through? These women were thought to experience a mental disease based on menopause and even today women are mocked as being insane when they are on their period. Whenever a woman does something just a little off, many will exclaim that it must be her time of the month. - Morgan Hayes

The Heroic Method mentioned in chapter one sounds very intense. Was its effectiveness based solely on the fact that it weakened the patients or was anyone actually “cured” by this form of treatment? - Morgan Hayes

As Ms. Barry mentioned above, due to the "Revolving-Door Syndrome," it stands to reason what motivated the physicians to release the patients in the first place? What were their diagnostic criteria or standards? Also it is worth mentioning that before the Seneca Falls Convention in 1848, women were in fact the property of their husbands. Who were entitled, by law, to her wages and her body. With this fact in mind, I wonder how many women were institutionalized against their will by their husbands? ~ Alex Young

Some horrific treatments listed on page 30. I wonder why, with all of the curious visitors swarming the hospital, did no one speak up against them? --Stef L.

I found it telling that Tomes refers to the first patients of Pennsylvania Hospital as inmates and later as residents. A reminder to the reader that patients were not always given freedoms and were shackled most of the time. -Katie Tryon

As Tomes points out at the beginning of our reading, Kirkbride was focused on gaining notoriety with his acceptance of the supervisor position and I think she drives the point home when she writes about his reports on pages 132 and 133 that were essentially marketing to institutionalize mentally ill and meant to appeal to family members of the insane. - Katie Tryon