Treatment of the Insane


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    …a rod is for the back of him that is void of understanding.
    Proverbs 10:13

    According to Christians, lunatics were possessed by unclean spirits. To effect a cure it was therefore necessary to dislodge the offending spirit. This idea derived from gospel stories of exorcisms.

    And there was in their synagogue a man with an unclean spirit; and he cried out , Saying, Let us alone; what have we to do with thee, thou Jesus of Nazareth? art thou come to destroy us? I know thee who thou art, The Holy One of God. And Jesus rebuked him, saying, Hold thy peace, and come out of him.
    Mark 1:23-25

    Such beliefs had at least two unfortunate consequences. The first was that for many centuries no advance was made in understanding the nature of mental illness — although it is clear that Christians did understand the there was such a thing as insanity*. The second was that many thousands of men, women and children, already burdened with madness, were confined in chains and subjected to routine torture. The idea was that by making the environment sufficiently uncomfortable, the torturers might induce the possessing spirit to leave its human host.

    Saint Benedict beats a possessed monk, driving out the demon who possessed him.
    Fresco by Spinello Aretino (detail), Basilica San Miniato al Monte, Florence, Italy

    In some monasteries, the monks whipped their insane charges regularly every day. Although the method was spectacularly unsuccessful, no one seems to have realised the fact for many centuries. Sometimes the insane were beaten out of the parish with quarterstaffs. Sometimes they were loaded onto ships and sent off to die or become a problem for someone else. This is the origin of the various popular tales about a "ship of fools".

    A ship of fools. Those abord will almost certainly die - through accident, murder, starvation or shipwreck. This was an ideal way to kill the insane without feeling guilty. Christians could excuse themselves with the belief that if the insane they had forced aboard died, it must have been will.

    For as long as the Church controlled the insane, they endured dreadful torments. They were imprisoned, chained to a wall (or if they were lucky to a bed), flogged, starved, insulted, tortured, immersed in iced water and otherwise brutalised. It also seems safe to assume that sexual abuse would have been commonplace in view of twentieth century disclosures about monasteries, seminaries, church schools, orphanages and state mental asylums. Throughout Christendom the insane were kept in insanitary conditions in mad-houses and exposed to public ridicule. The most famous place in England for such people was the hospital of St Mary of Bethlehem ("Bedlam"), where visitors were charged a fee to see the inmates, and were allowed to provoke them and laugh at them. A few inmates came to their senses, some died of old age, some died of neglect, starvation, exposure or torture, and many died of "putrid fever" or other infectious diseases that flourished in such conditions.

    The idea that demons caused insanity as well as physical illnesses was not restricted to the Catholic Church. Here is Martin Luther on the subject:

    My opinion of lunatics is, that all idiots and insane persons are possessed by devils, though on that account they will not be damned; but I think Satan tries men in different ways, some severely, some lightly, some for a long time, some for a short one. Physicians may attribute such things to natural causes, and sometimes cure them by medicene, but they are ignorant of the power of devils.
    (personal letter written by Martin Luther to Wenzel Link, dated July 14, 1528)

    Luther goes on to say that because Jesus healeed sick people with demons, he is "forced to believe that many are made dumb, deaf, and lame by Satan's malice," and he also supposes that demons can cause other kinds of sickness and even storms or blight.

    The word bedlam, meaning uproar and confusion, is derived from the name of the Bethlem Royal Hospital.. The hospital became a modern psychiatric facility, but historically it was representative of the worst excesses of asylums in the era of lunacy reform. The position of master of Bedlam was a sinecure largely regarded by its occupants as means of profiting at the expense of the poor in their charge. The 1598 visitation by the Bridewell Governors had observed that the hospital was "filthely kept". Up until the seventeeth century the Board of Governors referred to the inmates as either "the poore" or "prisoners". An inspection by the Governors in 1631 reported that the patients were "likely to starve". Inmates left in their cells with their own excreta were, on occasion, liable to throw "filth & Excrem[en]t" into the hospital yard or onto passing staff and visitors. Affluent Londoners could go to see the unfortunate inmates, to laugh at them, abuse them, or watch them being tortured. Outings to see them were so commonplace as not to need explanation. Samuel Pepys' diary for 19 February 1669 for example notes that "All the afternoon I at the Office, while the young people went to see Bedlam".

    Nepotistic appointment practices played a significant role in allocating posts. The election of James Monro as Bethlem physician in 1728 marked the beginning of an 125-year Monro family dynasty extending through four generations of fathers and sons. In 1758 William Battie, a former Governor at Bethlem, published his Treatise on Madness which castigated Bethlem as archaic and outmoded, uncaring of its patients and founded upon a despairing medical system whose therapeutic transactions were injudicious and unnecessarily violent. Bethlem was best known for the fact that it allowed admittance for a fee to casual visitors with no connection to the hospital's inmates. This display of madness as public show has often been considered the most scandalous feature of the historical Bedlam. "Swarms of People" descended upon Bethlem during public holidays. The Governors actively sought out "people of note and quallitie" as visitors, presumably because they were prepared to pay higher fees. The practice was never officially recognised (or accounted for), and probably grew out of the ancient monastic custom of giving alms to the poor. The spectacle of Bethlem was also thought to offer moral instruction for visitors, providing a deterrent by demonstrating the dangers of immorality and vice. For proponents of lunacy reform, a Quaker-run York Retreat, founded in 1796, functioned as an exemplar of the new civilised approach. Bethlem, still embroiled in scandal over its inmate conditions, symbolised its antithesis.

    Hogarth's depiction of Bedlam from A Rake's Progress.
    The well-dressed ladies in the background are not inmates, but visitors, there to amuse themselves.

    The Christian Church fiercely opposed the idea that insanity might have a physical cause, since it knew for a fact that it was attributable to evil spirits, and the Bible confirmed that beating was the correct treatment:

    A whip for the horse, a bridle for the ass, and a rod for the fool's back.
    Proverbs 26:3

    Insanity was recognised and accepted if the sufferer was sufficiently powerful.
    Charles the Mad (King Charles VI of France) for example believed himself to be made of glass and murdered a number of his own knights.
    Detail of Corronation of Charles VI


    In practice, Christian mental asylums were often used as prisons. Anyone that the Church did not like, or did not approve of, could be imprisoned without trial in an asylum, and then tortured and abused at will. Victims ranged from critics of Church excesses (including political radicals and atheists) to unmarried mothers, as well as the genuinely insane.

    The insane were not only a source of public entertainment, they were also an object lesson as to where immorality could lead. In France the devout Parisian bourgeoisie enjoyed Sunday excursions to Bicêtre to watch the insane perform tricks. By flicking a whip an attendant would make them dance and perform acrobatics like monkeys at a circus. For churchmen the main problem was not to reform such institutions, but to ensure that they were used to deliver the correct moral message to the spectators.

    "Popular Mode of Curing Insanity"

    Here is the Abbé Desmonceaux writing on National Benevolence in 1789 describing his idea of an asylum that could be used to illustrate the effects of immorality:

    The sight of these shadowy places and the guilty creatures they contain is well calculated to preserve from the same acts of just reprobation the deviations of a too licentious youth; it is thus prudent of mothers and fathers to familiarize their children at an early age with these horrible and detestable places, where shame and turpitude fetter crime, where man corrupted in his essence, often loses forever the rights he had acquired in society*.

    Around 1800 traditional Christian mad houses started being replaced by lunatic asylums where, at least in some institutions, attempts were made to provide medical help and effect cures. This was a break with tradition as Church run mad houses have existed only to restrain potentially dangerous people, and attempts at cures had been limited to various tortures designed to expel the demons possessing them and responsible for their afflictions.

    The Church lost its power in France during the French Revolution, and mad-houses soon became a thing of the past. A wide range of abuses ended as a direct result of the Declaration of the Rights of Man: "No man may be arrested or detained except in the cases determined by law and according to the forms therein prescribed…The law must permit only the penalties strictly and evidently necessary.... ". By a decree of 1790 the insane who had been confined in religious houses, houses of correction and elsewhere were to be examined by a magistrate to establish whether they really were mad. Those who were not mad were to be released and those who were mad were to be transferred to hospital*. Humane treatment of the insane was pioneered in France by Philippe Pinel. He was appointed to the asylum at Bicêtre in 1793 under the new secular government. One of his first acts was to remove the chains from the inmates. He then went on to unchain the women at the insane asylum for women in Paris.

    Dr. Philippe Pinel releasing male lunatics from their chains at the Bicêtre Asylum in Paris,
    painting by Charles Louis Lucien Müller (1815-1892)


    Dr. Philippe Pinel at the Salpêtrière, 1795 by Tony Robert-Fleury.
    It shows Pinel ordering the removal of chains from patients at Pitié-Salpêtrière Hospital,
    the Paris Asylum for insane women.


    In Britain the idea of a proper hospital or asylum, as opposed to the traditional mad-house, was introduced by William Tuke, a Quaker, who founded a retreat near York in 1794. The institution was more like a farm with a great walled garden than a prison. There were no grilles or bars on the windows, and like Pinel, Tuke removed the chains from his patients.

    By the early nineteenth century Parliament was investigating the Bethlehem Hospital and its traditional practices. In 1815, for one penny it was still possible each Sunday to watch the insane perform their tricks to the insults and mocking laughter of the devout*.

    Mask for the criminally insane.
    Such masks, called torture masks, have long been used during Christian times to punish criminals.


    James (William) Norris, Bethlem Patient, 1815.
    It was thie case of Norris, exposed by a newspaper, that led to the reform of Bedlam.


    Utica Crib - An adult-size restraint bed used in a New York insane asylum, 1882
    Use of the “Utica Crib” began in the 1840s at Utica, and spread throughout the United States to other mental institutions. It was widely used to confine patients. Some cribs were made out of wood, some iron. The sides and lid were made of spindles, which allowed airflow. The Utica Crib had a lid, which could be fastened over the patient. The person restrained could not sit up, nor get out. The bottom was cushioned with layers of straw.


    Patient in restraint chair at the West Riding Pauper Lunatic Asylum, Wakefield, Yorkshire, ca. 1869, ,Photographed by Henry Clarke, Wellcome Library, London (L0019069, Library reference no.: Iconographic Collection 347834)


    Secular ideas triumphed in the nineteenth century. Abuses were suppressed as the Churches lost their influence, and soon people were asking in wonder how it could be that previously "No one blushed to put the insane in prison"*.

    This is a mental patient in a Victorian mental asylum. The Christian treatment of mental patients frequently immitated the historical treatment of offenders against the Church: they were imprisoned, chained or held in painful restraints, flogged and tortured in a variety of ways, denied ordinary comforts like heat, light, company, and food and drink, and sometimes exhibitted to public ridicule.


    Modern psychiatric hospitals evolved slowly from Victorian lunatic asylums, becoming progressively less terrifying as they became progressively more secular, more humane and more medically based, and as their religious origins retreated ever further into the past.



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    §. Inquisitors would occasionally discharge accused people as insane. One rare example was Guillaume Postel born in 1510 a scholar of Arabic who was found to be heretical but harmlessly insane for his eccentric religious beliefs.

    §. Cited by Foucault, Madness and Civilization, p 207.

    §. Foucault, Madness and Civilization, pp 236-7.

    §. Foucault, Madness and Civilization, pp 68-9.

    §. Foucault, Madness and Civilization, p 221.


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