European Outlook
Around this time, Europeans began to use a method called moral management. The idea behind moral management was that the environment had a major effect on a patients' well being. Doctors realized that patients were mentally ill, not criminals. They did away with the use of shackles and straightjackets, and focused on the beautification of the living environment, using furniture and artworks that were aesthetically pleasing. Making the asylum interior resemble home was a primary goal of this movement, as it sought to calm lunatics rather than antagonize them. Moral management practiced constant surveillance to ensure order and safety among the asylum residents.
However, moral management had repercussions, as patients became difficult to control without restraints. Many European hospitals sought to develop recreational activities that would give patients social skills and help them find more constructive ways to occupy their time. With advances in biomedical science, the moral management movement began to decline in the late 1800's due to the emphasis on drugs and psychotherapy. Moreover, leaders of moral management lost prominence because they failed to train other practitioners properly. They also failed to realize that increasing the size of asylums could lead to overextension of facilities, overcrowded patient rooms and understaffed workers.
American Perspective
In America, mental conditions such as depression, mania or melancholy could cause one to be admitted to a mental institution. These places resembled private madhouses rather than hospitals. Due to poor organizational structure and lack of quality services to patients, these madhouses left few, if any, records. To manage unruly patients, physical restraints were used. These places were obviously disastrous for all those who desperately needed psychiatric attention. Americans began to protest against patient abuse, and a call for reform rang out across the country.
One man famous for his work in the advancement of moral treatment of the mentally ill was Dr. Thomas Story Kirkbride. From the mid to late 1800's, Dr. Kirkbride insisted that patients who were confined to overcrowded jails and almshouses should be housed in facilities that had environments conducive to their well being and comfort. His magnificent architectural designs for asylums offered physical comforts never seen before. They had well-ventilated rooms and beautiful landscaping, and gave patients physical and social activities to occupy their time. One of his best buildings was the Athens Asylum for the Insane, in Athens, Ohio. The doors to this state-supported facility were opened in January of 1874, and the site featured Kirkbride's trademark ornate structural design along with two patient wings extending from a central building for medical staff. Kirkbride created this functional design to keep unruly patients in the wings, while the clinical staff was housed in the middle building for administrative duty.
Although facilities built across the Kirkbride Plan had some degree of success, due to their high cost and upkeep, many of them were abandoned or destroyed by the turn of the 20th century. Also, due to extreme overcrowding by the homeless and neglected elderly people, the quality and effectiveness of patient care diminished. Former treatments such as physical restraint and electric shock began to be used again to maintain order.
Dorothea Dix
In 1802, Dorothea Dix, another crusader in the asylum reform movement, was born in Maine and grew up in a poor home with a mentally ill mother and an alcoholic father. In order to support her family, she became a schoolteacher at the age of fifteen and later wrote textbooks. Due to her bouts with tuberculosis, Dix retired from teaching to convalesce and travel. During her trips, she became outraged at the inhumane treatment and abuse she witnessed in jails, almshouses, and other makeshift asylums. Testifying to the Massachusetts legislature, she declared that patients in American asylums were 'confined to this Commonwealth in cages, closets, cellars, stalls, pens! Chained, beaten with rods, lashed into obedience.' Because of her urgent plea, the legislature funded programs to alleviate the plight of the mentally ill.
Dorothea Dix continued her mission and crusade, traveling to Europe, Asia, and other countries where she could expose these barbaric conditions and rally for proper treatment. Thanks to her tireless efforts, New Jersey broke grounds on America's first state mental hospital in 1848. Taking her work as a humanitarian very seriously, she returned to the UK, focusing on the reform of Scottish asylums. Then, following a productive tour of Europe, she returned to the US, and during the Civil War was appointed superintendent of army nurses. Consequently, Dorothea Dix became known as the most influential asylum reformer of the 1800's.
Lesson Summary
People with mental problems during the 1800's were often called lunatics. They were placed in poorly run madhouses, jails, almshouses, and were harshly treated. In Europe, a method called moral management was created to treat the mentally ill with dignity and responsive care. Similarly, in the U.S., under the direction of Dr. Thomas Story Kirkbride, asylums with beautiful designs were created to provide care in a therapeutic, home-like setting. The outspoken schoolteacher, Dorothea Dix, was another leader of the asylum reform movement, and her crusade helped to turn the tide of patient abuse. Overall, the 1800's was a time of positive change and growth for asylums, as the mentally ill began to receive humane and decent treatment in peaceful, restorative settings.
