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

Overall impressions: Seems like Grob really loves the institutional model, even though he describes lots of evidence that it does/did not work at all the way it was intended. For example, p 13, he describes the story of Mrs. Weston, who became a ward of the town. Her neighbors voted to absorb her property and then "provide for her maintenance." The woman died soon after (the coldness of the night, being she was naked, did kill her.) if they really were providing for her, she would not have died from exposure, and presumably the town kept her property. Grob describes this as a success story. At several points throughout, he states that the patients were extremely critical of institutions, but their objections are treated as incidental. There were whole paragraphs on p81-82 that made me angry.

Ok. One relic of psychiatry that I found really interesting was the idea that mental illness was a result of lesions on the brain. The mind itself was equated with the soul, and if the mind itself can become sick, thn it could conceivably die, which negates the concept of the immortal soul. So, to entertain other ideas was blasphemous. --Stef L.

Grob describes how institutions had their time and place when they were needed. Over time, they did indeed become obsolete it seems because of the technological advancements. I thought it was interesting how psychiatry is one of the oldest forms of medical care. Who thought that institutions for the mentally ill was a good idea? Was it Kirkbride, or was it somebody else? ~ Emily Barry

I was particularly intrigued by how quickly perceptions of mental illness and methods of treatment changed in such a short amount of time. What amazed me was how smoothly the transformation occurred, and how they almost seemed to make sense. From how, during the colonial era, the care of those seen as mentally ill fell to their families, to, during the age of the asylums, families were generally the people who left the mentally ill to the institutions. I found it interesting how patients prior to institutionalization needed to approve their move. If a person was deemed insane, did they really have the capacity to determine what was right for themselves? Just as how the class had difficulty defining "mental illness", so did people in each era. Again, people outside of societal norms were marked as insane, but what defined "normal"? I would like to know more about how race and social class fell into the class of insanity. Obviously, immigrants such as the Irish or the Chinese did not fit the standard of white Protestant society, so did "normal" people automatically view them as more susceptible to mental illness? --Chelsea Chin

For some reason while I was reading the first chapter of Grob (particularly page 12, where Grob discusses Buchan's beliefs in what causes insanity in people) I began to wonder how mad children were effected. If immoral actions (drinking, violence), diet, and climate, to name a few, is what caused insanity, or rather the breaking of the equilibrium between them all, then what about insanity or madness in children? Surely people didn't really think a child was drinking alcohol and that's why he/she was insane? Today, I feel like parents and doctors are so quick to put children who may seem a bit "crazy" (not necessarily in a mental sense, but also in a behavioral) on medication for their actions. Was madness/insanity only viewed as an adult disease during the colonial times or is it simply a topic that was never really discussed or researched? --Carly W.

I find the shifts in what to do with people who have mental illness over time interesting. America started out with those effected by mental illness living in the community and, for the most part, carrying out similar lifestyles to those who don't (ie, working, taking care of themselves). Even if the person could not take proper care of himself, others would still help. Then America shifts to putting the mentally ill into hospitals that took care of any people who could take care of themselves (Grob mentions orphans, widows, chronically sick). Eventually, we shift to the isolation of the mentally ill in asylums until the call for deinstitutionalization, and as far as I know, today most people effected by mental illness (except for extreme cases) are back to living among the "normal" population, usually with help from medication or therapy of some sort. I wonder what kinds of shifts we will see in the future involving the lives of mentally ill people? Maybe there already are some that I'm just not aware of? --Carly W.

Grob states in chapter 2 that "Although indigenous circumstances shaped each of these hospitals, there were some threads common to all. In one form or another religion was an operative element."What do you think are the most important ways religion impacted the formation and practices of hospitals for the mentally ill? Do you think that the religious aspect of the institutions was equally important to the founders, staff, and patients? -Joanna Jourdan

So going through the readings I kept asking myself this what directly caused the evolution from the 18th and 17th century family and society care modals to the asylum systems that came about in the 19th Century? -Ronnie Vest

Also I asked myself in what ways does care for the mentally disabled changed in the 16th 17th and 18th centuries?-Ronnie Vest

And how did the religious ideals of black bile, yellow bile, phlegum, and blood impact the overall view of mental care in the colonial period? What brought about the separation from religious ideals and medical treatment in the later periods?-Ronnie Vest

As far as the readings themselves I think its very interesting to look at the evolution of mental care treatment. Its hard to understand what medical doctors of the Colonial period would have actually thought about mental care. It is rather fair to say medical knowledge would have been limited. Grob brings out interesting points, but I think the colonial period was still in the time of the church in its full power its only logical that doctors would equate the disturbances of mental health with evil with the lack of overall understanding of mental health.- Ronnie Vest

What caused the changes in the reasons of why people were considered to have a mental illness? Did it just occur with the passage of time as new knowledge of individuals and what effects them were studied, or did it also include social and cultural factors of how people are treated? -Morgan H. It seems that psychiatry would have to follow the creation of asylums because before it was not studied not did people really deem it necessary to do so. After the creation of asylums, many people who had a mental illness would have been in one place instead of scattered, giving doctors and works a chance to learn more about them. -Morgan H. If have a mental illness was seen as being caused by diverting from typical “normal” behavior, would all people who did not quite fit into the “normal” model be considered deviant and have problems? What if a person showed no deviations and had experienced a normal life, yet suffered some type of mental illness? -Morgan H.

I was intrigued and also not surprised by the fact that some African Americans where denied entrance into institutions and this raised some questions about mentally ill slaves and African Americans in the south in the 18th and 19th centuries. Who admitted these people into asylums at the time if they were to be accepted? How were mentally ill slaves cared for before the creation of such asylums? –Jack Hylan

Did the idea of the mental institution carry on for too long? Why did it take such a long time to realize that institutionalization does not always work? Once the idea of institutionalizing the mentally ill, families began to dispose of their relatives rather than find an opportunity for a cure. Was the reason for the large increase in the population of institutions caused by an overall population increase or did it become the norm in society to place those deemed unfit into these asylums? –Jack Hylan

Religion had a profound influence on caring for the mentally ill and the responsibilities of the community. I found it interesting that the Enlightenment shifted the religious precedent of unchangeable fate to one of curability, and how the Second Great Awakening progressed religious institutional involvement to address and aid the mentally ill, whereas before they were simply marginalized and locked away. –Scott Campbell

Despite nineteenth century psychiatrists believing that they could cure mental disease it seems to me that they were more concerned with simply making a patient fit—even if mildly— for reintegration into society instead of removing the disorder. The reasoning of Isaac Ray, that the lower-class patients “required less attention” than their affluent counterparts, shows how the expectation was reeducation of the patient to best fill their social role (and alleviate their social/economical burden) not treat any underlying affliction. –Scott Campbell

What is the distinction between a "Cure" & "Recovery?" How much influence did social/societal mores about appropriate behavior and conduct sway the influence of how the personality and personalities of these institutions were shaped? How did they make the distinction between people who were in need of supervised care and people who were just of a different philosophy? ~Alex Young

I think it is interesting that according to the Kirkbride plan, asylums were organized around one physician who was important to the treatment of every patient. Grob states that there were supposed to be 250 patients in each asylum, and that the moral treatment of each required daily individual attention. Adhering to this plan must have been difficult for the physician because of the number of patients under his care. -Joanna Jourdan

I found it interesting that many people perceived the mentally ill patients as possessed by the devil. Since religion overpowered thinking in the early nineteenth century it was a widely thought assumption. I also doubt the early scientific movement helped with the sometimes cruel treatments that were more like experiments. However, Grob did a good job of giving different dynamics of Christian perception in his examples or cruelty on the mentally ill. While many viewed them as possessed some Christians like Reverend Louis Dwight, who visited jails and asylums, found those who had been in the same room for eight and nine years with no human contact, windows, and bed. Obviously these asylums’ priorities were not curing the ill but obtaining wealth off of their misfortunes. How could anyone belief that that type of treatment would help someone. Luckily, Reverend Dwight pushed for investigations and was appalled by the horrible treatment. It makes me wonder if these thoughts were separated by different denominations. – Courtney Collier

I was most intrigued by the part where Grob discusses Dorothea Dix and her challenges as a woman trying to help the mentally ill at that time. Her life was shaped by her religious beliefs yet she actually saw the mentally ill as human beings who could be helped and cared for with the right treatment. Even though women lacked any power at the time Dix and other women were able to sneak under the radar with social activism. This allowed Dix to give speeches and travel to spread the word of these asylums. Grob not only talked about her statistical achievements but her zeal and passion for the treatment of the mentally ill. –Courtney Collier

Like many others have noted, I was interested by the religious aspects of mental illness and it's linkage to the Great Awakening. From today's time, religion and being possessed by the Devil seems like an 'easy' approach to handling mental illness. By using religion, people assumed it could be changed if the person just became more accepting of God. I view the religious answer to mental illness as a simple way to try and answer the mental illness question. Another part of the reading I enjoyed was Grob's discussion of early psychiatry in Chapter 3. It is noted that the doctors had no concrete evidence to link behavioral problems with the brain yet doctors were quick to link the two. Once again, I found this interesting and just evident of the time period. Overall, the reading reinforced to me that society's grasp of mental illness has been slippery and changing since the very beginning. - Maggie Nunn

I was wondering who supported the care the insane and who were the one who tried to shove off the financial responsiblity? The book says their was preferential treatment based on class and race (not institutional practices). I'm curious on if a certain faith, race, class, etc pushed for the creation of "hospitals". -Kasey Moore

I was, also, wondering why the community care for these people would not have worked as the population grew. Just because the population gets bigger doesn't neccessarily mean institutions needed to be develop; especially since the ill were few in number and some people would have cared for them in the family. Is this just a sign of the bureaucratization of colonial america? -Kasey Moore