HLTHAGE 2G03 Lecture Notes - Lecture 2: Mania, Moral Treatment, Rationality

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Lecture 2 From Madness to Mental Illness
January 15, 2018
Key Themes
- Transition from madness to mental illness
o And perhaps how this is being reversed
- Are mental illness rates on the rise?
o How do we account for an increase in “problematic” behaviours
- Treatment/conception of mentally ill does not necessarily fit simple story of
medical progress
- How old are mental disorders?
o Are historical symptoms the same as historical diseases?
o Have they always been with us or are the caused by changes to societal
factors
Pre-Institutional History
- Earliest recordings of madness from 2nd c. BCE potentially mania, depression,
delusions
o We cannot use our modern labels for these symptoms as our
understanding of them are much wider than they were at the time
- Hippocrates and Galen madness is caused by problems of the body and brain
- Rome falls, medicine declines revived by Islamic scholars, wards for mad
found across early Islamic world
- In medieval Europe, some cited spiritual basis for madness, others argued for
imbalance of humours
o Ex: madness is God’s punishment
- Multiple explanations co-existed and ways to deal with it
o Responses to madness ranged from monastery stays, burning at the
stake, bloodletting, whipping, etc.
- No institution existed for these people, most stayed at home with their family
- Trepanation: one method of treatment
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o Drilling a hole into the skull to treat madness
o Based on the understanding that the hole would allow for the release of
demons that caused illness as well as the physical release of pressure in
the brain
Bethlem Hospital (14th c.)
- First institution set aside for the containment of mad people
o Assigned by Henry VIII
o Not a medical facility but rather a place were people were kept
- Otherwise known of Bedlam (meaning: chaos and confusion)
- Marks rising interest in madness
o Topics of madness in pop culture (e.g. Shakespeare, songs, poems)
o Ex: Story: A Rake’s Progress by Hogarth (18th c.)
About a man who gains a lot of money then blows it all and
eventually ends up in Bedlam
- Bedlam becomes a tourist destination in London
o Significant because tourists go to places for people to see things that they
cannot usually see
o Spectators would pay a lot to see the inmates
Inmates were seen as beasts and monsters
They were tormented, teased, filled with drink
o Required special precautions to “prevent sexual contact between visitors
and women patients”
o By mid 18th century, 17 000 a year
In 1770, visitors were banned
Not for moral reasons, but because there were too much interest
and they weren’t able to control all the spectators
Vagrancy Act 1714
- Differentiation between “pauper lunatics” and “vagrants, sturdy beggars, rogues”
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o The later were seen to be at fault for their lives whereas the former are not
at fault
- Lunatics were sought out and locked up for their lunacy
o State took responsibility for these individuals
o Lunatics, unlike normal poor (poor houses), were not whipped
- No requirement for treatment, but they need to be locked up to keep them safe
- Allows the government to decide who is potentially dangerous
o Power of government vs. rights of citizens
- Where would they put them? Bedlam can only hold 150 people…
Rise of Private Madhouse
- Market is created to house lunatics
o “trade in lunacy” develops during 18 c.
- If you had a property you could built a madhouse to hold lunatics
o Places of custodial care (i.e. they were sheltered, fed, etc.) , not treatment
- Concerns over wrongful confinement
o No rigorous system to determine who could be confined or not
o In literature people were confined so others could gain access to their
fortunes
1774 Act for Regulating Madhouses
- Many of the madhouses were very inhumane
- New law required inspection and licensing of madhouses by the Royal College of
Physicians
o Only those that hold the license could maintain madhouses
o Significant because doctors are becoming involved in madness
Medicalization of madness
- Physicians were also used to determine who would be confined
o Involuntary confinement was determined after a physician reviewed their
case
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Document Summary

Lecture 2 from madness to mental illness. Transition from madness to mental illness: and perhaps how this is being reversed. Are mental illness rates on the rise: how do we account for an increase in problematic behaviours. Treatment/conception of mentally ill does not necessarily fit simple story of medical progress. How old are mental disorders: are historical symptoms the same as historical diseases, have they always been with us or are the caused by changes to societal factors. Earliest recordings of madness from 2nd c. bce potentially mania, depression, delusions: we cannot use our modern labels for these symptoms as our understanding of them are much wider than they were at the time. Hippocrates and galen madness is caused by problems of the body and brain. Rome falls, medicine declines revived by islamic scholars, wards for mad found across early islamic world.

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