HLTHAGE 2G03 Lecture Notes - Lecture 2: Philippe Pinel, Moral Treatment, The Retreat

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Lecture 2- A Brief History of Mental Illness and Psychiatry
-Madness -> mental illness
-Mental illness on the rise? How old are mental disorders?
Pre-Institutional History I
-Earliest recordings from 2nd c. BCE, potentially mania, depression, and delusion
-Hippocrates and Galen -> (follow medical model) situated madness in brain
Pre-Institutional History II
-In Christian Europe, some cited spiritual basis for madness, others argued for imbalance
of humours (biological)
-“treatment” happens in monasteries. Some witches and madmen burnt at stake… others
treated through prayer, bloodletting, whipping
-dancing plague- women starts dancing and doesn’t stop and than other ppl join her- at one
point 400 ppl- mass psychological event
omany danced themselves to death
Trepanation
-physical and spiritual intervention
-practice continued in some place until nineteenth century (and beyond)
Bethlem Hospital
-est. of Bethlem Hospital in 14th c.
-Henry VIII later assigned it primarily for madness, already going by the name Bedlam
(disorganized chaos)
-Marks rising interest in madness, literary trope by 16th c. becomes oft-used topic of
ballads and songs
Hogarth’s 18th c. “A Rake’s Progress”
-Picture of women looking at madness
-A rake is someone who does illegal things (gambles sex workers ext.)
-Ppl would pay to get into Bethlem Hospital to look at the patients
Bedlam as Zoo
-Inmates tormented, teased, filled w/ drink
-Swarms of ppl came to see “freak show”
-Required special precautions to “prevent sexual contact between visitors and women
patients”
-By mid 18th century, 17000 ppl a year
Eighteenth Century
-Rise of private madhouses and small charity asylums, although care in the home is still
dominant model
-Still no such thing as psychiatrists
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Vagrancy Act 1714
-Differentiated “pauper lunatics” from “vagrants, sturdy beggars, rouges.”
-Law said judges had responsibility to catch inds who were mad and dangerous to go
abroad
-To be kept safely locked up
-First law that says government has responsibility to take ppl who MAY be dangerous and
segregate them from society- not criminals, mad ppl
-Lunatics, unlike normal poor, not to be whipped
-No requirement for treatment
-Bedlam could only hold so many ppl
Rise of Private Madhouses
-“Trade in lunacy” develops during 18th c, open to anyone
-profit driven in new service economy- becomes about money making
-places of custodial care rather than treatment
owere not therapeutic
1774 Act for Regulating Madhouses
-law required inspection and licensing of madhouses by the Royal College of Physicians
owith this law we are linking madness with medicine
The Age of Enlightenment
-advances in science and philosophy
-ppl began to look a the world as something that can be changed, improved, curable
omadness was understood as something that could be changed
-asylum could be purpose designed, not simply custodial
-here we see the transformation of madness turning into mental illness
Tukes and the York Retreat
-founded by Quakers, 1796. Lay facility
-mad free to work land
-they let mad inds do the soil
-kindness rather than harsh regimen, the guide to treatment
-leading model of “moral treatment”
Moral Treatment I- Philippe Pinel
-head French mental hospitals in 1793
-believed he could improve reasoning ability of mentally ill
-“therapeutic conversation”
omodern psychotherapy
-he freed ppl from their chains
Moral Treatment II- Rise of the Treatment Asylum
-Jean- Etienne Esquirol
-Physicians w/ special training needed to treatment mentally ill, first classes on maladies
mentales”
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Document Summary

Lecture 2- a brief history of mental illness and psychiatry. Earliest recordings from 2nd c. bce, potentially mania, depression, and delusion. Hippocrates and galen -> (follow medical model) situated madness in brain. In christian europe, some cited spiritual basis for madness, others argued for imbalance of humours (biological) Trepanation physical and spiritual intervention practice continued in some place until nineteenth century (and beyond) Bethlem hospital est. of bethlem hospital in 14th c. Henry viii later assigned it primarily for madness, already going by the name bedlam (disorganized chaos) Marks rising interest in madness, literary trope by 16th c. becomes oft-used topic of ballads and songs. A rake is someone who does illegal things (gambles sex workers ext. ) Ppl would pay to get into bethlem hospital to look at the patients. Swarms of ppl came to see freak show . Required special precautions to prevent sexual contact between visitors and women patients . By mid 18th century, 17000 ppl a year.

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