What is Madness?

Introduction

Madness and lunacy are both words that have been loosely used throughout history. Although modern research allows us to discover and treat madness and lunacy more accurately this was not always the case. It is interesting to look at what people actually mean when they use the term madness and what people used to do about it.

Psychiatric hospitals, also known as mental hospitals specialise in short term temporary or permanent care of patients who require assistance, treatment or a controlled environment. Patients are often voluntary admitted however involuntary admittance can be given if they pose a threat to themselves.

There are a number of different types of modern psychiatric hospital which include:

Crisis stabilization – dealing with suicidal, violent patients. In effect it is an emergency room for critical individuals

Open units – these are designed to make life as normal as possible. They are also designed to adapt the individual ready for discharge.

Juvenile wards – these are set aside for children with mental problems.

Long term care facilities – Modern buildings, modern security and being locally sited to help with reintegration into society once medication has stabilized the condition.

Halfway houses – these are designed for people with long term illnesses who need assistance for an extended period of time.

When lunacy was first discovered the symptoms where not definite. Because of this doctors could make up the symptoms to ‘create’ more patients. This way they could make more money when business was slow. This is known as hegemony (controlling a market)

There were many differences in the 16th– 17th centuries and the 18th– 19th centuries as science increased. Some of these differences are listed below:

16th – 17th centuries

Lunatics where left to their own devices

Very few institutions and treatments for lunacy

Lunatics where controlled by a full moon. They were also not part of society and was classed as the ‘otherness’.

18th – 19th centuries

There is a Distinction between ‘mad’ and other

Asylums increased greatly

Specialised province of medicine and treatments.

As more people became aware of lunacy more and more people began to admit themselves as the symptoms where very vague. In 1807 there were 2000 recorded lunatics however in 1844 this had rose to 20000 and in 1890 this had grown to a massive 86000.

Many mental hospitals have been opened to try and ‘contain’ and ‘treat’ lunatics, one of which was Wittingham hospital. This hospital has many accounts of patients being mistreated and abused. These included: Patients left untreated; Patients given only bread and jam, regardless of menu; given a spoon only regardless of diet; food mixed up and served as “slops”; Patients restricted in fluids during and after meals; put to bed in only vests; left queuing on the stairs waiting for a bath; certain patients locked in rooms under the stairs; Patients put out and locked out in the airing courts, regardless of weather conditions; certain patients locked in the washrooms.

The worst kind of complaints made where that people had witnessed patients being dragged by their hair. Also on one of the male wards, the main allegation was that there were incidents of the “wet towel treatment”; this involved twisting a wet towel or bed sheet round a patient’s neck until the patient lost consciousness. Finally on another male ward, it was alleged that two male nurses had poured methylated spirits into the slippers of one patient and into the dressing gown pocket of another, and set them alight. Although all these complaints were denied it does question the belief that this ‘hospital’ was actually helping patients.

The colonial American society referred to those suffering from mental illnesses as ‘lunatics’ which came from the word lunar which means moon. The reason behind this that it was believed that insanity was caused by a full moon. They also believed that lunatics were possessed by the devil and where usually removed from society. The main treatments they used were submerging patients in ice baths until they list consciousness or executing a massive shock to the brain. They also used means to expel the devil from the patient which included inducing vomiting and the notorious “bleeding” practice. The bleeding practice entailed draining the bad blood from the individual, Unfortunately this inhumane practice normally resulted in death.

Around the 19th century, Europeans introduced a new approach to the treatment of the mentally ill known as “Moral Management.” This approach was based on the belief that the environment played a vital role in the treatment of the mentally ill. Creating a more domestic feel, beds and decorations replaced chains and cement cells. It was thought that recovery would more likely occur if conditions and surroundings resembled the comfort of home.

Phrenology was introduced, studying the shape of the brain to explain illnesses. Animal magnetism was another popular practice, concentrating on the benefits of hypnosis and relaxation. Problems surfaced, however, with patients becoming unruly due to lack of restraints, and concern arose with how patients were to occupy their time. To combat these concerns, work programs and recreational activities were devised for patients in asylums, significantly moving to bridge the gap between society and the hospital.

A crucial point in the history of the mental illness was the Civil War. After the Civil War in America a great number of servicemen suffered from postwar trauma. These inflicted persons were passed on to state mental hospitals and asylums, where the public displayed much interest in their care and treatment. Although, the public eye watched very closely how their ‘war boys’ were treated, institutions had no choice but to reinstate old procedures due to the serious issue of overcrowding. Restraints and shock therapy were reintroduced, along with new drug treatments such as opium.

Along with the rising need to find placement for those suffering from mental illnesses, asylums began opening all over the country.

Thomas Story Kirkbride was a designer of asylums at the time, and became well known for his popular architectural ideas. His designs and landscaping meant that the patients took part in tasks both indoors and out to benefit their living situation, much like that of a family. In accordance with European ideals at the time, patients at the Athens Asylum also engaged in recreational activities such as dancing, picnics, boating and church. All up and coming communities housed large and attractive asylums The reputation of these institutions was significantly impressive leading parents and friends of patients to have increasing confidence in their patient’s care.

With the increasing credibility of these institutions, the populations skyrocketed. It was common for homeless people, tramps and hobos to become ‘patients’ of the asylums seasonally for shelter and food, and then slip away when the good weather returned. Families would often submit their elderly relatives to asylums because they lacked the resources or time to deal with them appropriately. The problem with overcrowding developed because the institutions had no established criteria for accepting or rejecting patients into their care. Rapid growth in populations caused patient care to suffer. In the Athens Asylum the patient population jumped from 200 to nearly 1800, with an insignificant alteration in staffing. The community found that these institutions were an easy means to remove unwanted people from society. There was no effort to provide any other programs or support, because the state was paying for the asylum.

The severe overcrowding led to a sharp decline in patient care and once again, the revival of old procedures and medical treatments. Restraints returned. Instead of sleeping in single rooms as the Kirkbride Plan had designed, patients were sleeping in wooden cribs stacked three patients high. Ice water baths were once again used, along with shock machines and electro convulsive therapy.

The lobotomy was a medical procedure where the neural passages from the front of the brain are surgically separated from those in the back of the brain. The common result of this procedure was the patient forgetting their depressing or discouraging feelings or tendencies. This was a very delicate, time-consuming procedure that required great skill and training from the practicing surgeons. Because the lobotomy appeared to effectively alter the mental health of patients, great effort was invested into developing a more practical procedure with similar desired results.

Walter J. Freeman developed the transorbital lobotomy. This new medical procedure could be performed quickly and required limited aftercare for the patient.

Because this new form of lobotomy could be performed so quickly and easily, the transorbital craze swept the nation’s asylums. Freeman himself performed over 3,000 lobotomies and was labelled the travelling lobotomist. Transorbital lobotomies were performed on hundreds of Athens Asylum patients in the early 1950s.

In conclusion, madness, or lunacy, used to be a way of segregating people from society. As science progressed so did the asylums and patients began to decline as treatments also progressed. Mental hospitals throughout history have been vial and inhumane however, without the scientific evidence to back up the fact that their methods didn’t work they could have been committing these ‘treatments’ with the best intentions. Modern day hospitals are extremely high tech and efficient. The patients are looked after a lot better than ever and treatments are constantly improving. In summary, madness is not an illness that cannot be tolerated any more as modern treatments and care means that someone with lunacy can have a normal life as everyone else does.

References:

http://www.toddlertime.com/advocacy/hospitals/Asylum/history-asylum.htm accessed 22/04/2011

http://psychiatric-hospital.co.tv/ accessed 22/04/2011

http://www.whittinghamhospital.co.uk/ accessed 22/04/2011