Okay. I'm going to start by giving you an overview of what we're going to be covering in this first lecture. You've already had a chance to see a bit about the asylum first through the perspective of Liz Johnson, and then through the piece that I did out at the site of the former Mimico Lunatic Asylum. From there we are going to talk about. why the asylums came to be. And what actually contributed to their, to their decline. And that will bring us up to the beginning of the twentieth century. A lot of the history that we're going to be covering in the Brief History of Madness is around the twentieth century. So you'll see that all of these topics that are, are, listed here are things that happened, basically. Between around 1900 and it's taking us all the way up to, the end of the twentieth century. And then we're going to finish up with, a look at what's happening in the contemporary scene. And we'll of course be visiting that, over the course of the course [LAUGH]. But what we will be doing, for this first lecture is really looking at a major philosophical shift that's happened in mental health care so that we can get a sense of where we were before and how it brings us to where we are now. So. Let's get started. So our first stop is the asylums. We are reviewing this history to try to understand how we can hold together these two very extreme perspectives that we have. one that suggests the asylums were places of abuse and evil. And another that suggests asylums were places of care, refuge and healing. This history is mostly based on these two sources. The book on the left is The Provincial Asylum in Ontario, a book edited by Edna Hudson. The book on the right is The Discovery of the Asylum, by David J. Rothman. Some of you may wonder why I'm not using some of the more famous contributions by people like, Irving Gaufman, and Mitcheal Fuko, Gofmans definetly going to come up, I've decided to bring him in a little later, because of the huge influence his work had on changes to psychiatric treatment, in the, mid-twentieth century. Fuko is not going to come up in the same way, although Fuko did some really intersting work on the asylum and its, discursive functions. His work is largely theoretical, and doesn't actually have much grounding, in real events or the actualy history of asylum treatment. In contrast, the sources you see here have been. And based on the superintendent and government reports that were written at the time when these asylums existed. That doesn't mean their perfect either. if your writing ends up in the archives it usually means someone thought you were important or maybe we think you're important because your writing ended up in the archives. superintendents and government officials get their writings stored, while a lot of other people don't. a very important voice that's missing from this particular history is that of patients who were living in the asylums. In recent years there's been some really good work done to bring those voices forward. And you may also be interested in checking out a BBC documentary called History of the Madhouse. We're going to put a link to it in the resources section. It gives a history of the asylums in the British context, and it combines the voices of former patients and former staff in their portrayal of that time. So prior to the nineteenth century, most people who were considered mad or insane were in the care of their families. This may have been more true in North America than in other parts of the world. For example, in your reading of the paper about Indian psychiatry, you'll see that they date formalized mental health treatment going back as far as the fourth century in some parts of the world. But in the U.S., Canada, and to some extent the U.K., families provided care. If families were unable to meet the demands of caring for their ill family members then communities supported them in the same way that they would support any other family that was dealing with poverty or illness or disability. Institutional care was an absolute last resort it was only used if there was if it, if it was just not possible to keep the person at home because of issues of safety or violence. In these situations people would be sent to institutions that were available. So what was available at the time were usually poor houses or prisons and in. Warehouses and prisons. People with mental illnesses were often kept in isolated sections where they were mechanically restrained and subjected to harsh treatment in order to keep them under control. In this sense the asylum was at least in part a rescue from a terrible situation the description of people chained to walls in rat infested cells were not exaggerations. However, Rothman's account of the asylum urges us not to see them in isolation. Asylums came to be when there was a larger movement of creating institutional solutions to emerging social problems. When they were building asylums, they were also building orphanages, alm houses and penitentiaries. To maintain order in the communities. Some of the threat that they perceived. Arriving in communities, was due to increasing geographic mobility. So there were outsiders now, within these communities, that could not be absorbed by families and could not be absorbed by the communities because they were seen as outsiders. All of these institutions had a common goal to deal with deviants, and to maintain community stability that everybody considered was under threat. There was some sense that these institutions could somehow rehabilitate these people. And in doing so set an example of how to, to maintain stability in a community. When it came to asylums, they were seen as a response to the growing sense of chaos in North American society. The social circumstances were understood to be so treacherous, that according to some of the writing that Rothman reviewed, people spoke about insanity striking at citizens with terrifying regularity. the need for asylums was also bolstered by the horrifying descriptions of the situations in the poor houses and in the prisons, for people with mental illnesses. the asylums offered refuge from both these horrifying circumstances, and also the terrors of modern life. At the time, they believed that they could cure insanity by compensating for the deficiency of the community, using, as they say, a disciplined routine that would curb uncontrolled impulses without cruelty. and again this was to set an example for the rest of society because they felt they were able to demonstrate a proper way to to run organizations that would then be mirrored in the local communities. The environment and the milieu of the asylums was the primary mode of treatment offered. Now, it's easy to think of this as simply all they had available at the time. But this also reflected the influence of work by Phillipe Pinel who was in France, where he had been replacing the punishment and imprisonment of people with mental disorders with a more humane approach to mental health care. He really saw them, he really saw asylums as capable of providing care and understanding that would cure mental illness. In North America, they actually had the opportunity to build this philosophy of treatment into the. Way that they designed mental health care insti-, institutions. Because, unlike, other parts of the world, for example, in Europe, where they were developing their mental health care system, in spaces that already existed, often places like monasteries, former army barracks, these places were made over into asylums, they actually had to build them. So they could think about what kind of a space do we need to create this opportunity for healing from mental distress. So they quite deliberately created these spaces for healing and treatment, with an emphasis on eliminating the stressors they believed created mental illness. Instead of presenting institutions as a last resort for help. They were presented as the first line, and in fact, the responsible thing that somebody would do, eh, at the first sign of any mental disease. Families were actively discouraged from having contact with their relatives once they were admitted to the asylum, so they were actually considered part of the chaos that needed to be kept out. There emotional involvment was seen as a stressor, that needed removed, perhaps, an early indication of some of the family blaming that we would see later on, in psychiatry and we'll be talking about that more in are lecture about families and mental illness, The asylums were in natural settings where patients could get a. Exposure to soothing environments and fresh air. long hallways were created to encourage exercise. Patients were, a. Segregated according to the class of their illness. And that was an innovation that actually reflected Pinel's influence on current thinking about different categories of mental illness. also very important. Asylums were located far away from city centers. Because it was the chaos of those centers that was considered to be the cause of the conditions that they were treating. Sometimes, you can imagine, this, this need may have seemed quite stark. at the Toronto Asylum, there were accounts of people from the city trying to enter the asylum space, and see the patients as if they were some kind of exhibit for them to visit. reading about this gives you another perspective on why they built and maintained such a high wall around the place. so let's talk about, Let's take a look at our sites again here. So the Provincial asylum in Toronto, which is mentioned in the introduction to this course If you look at this portrait now I hope what you're noticing is its geographic isolation. So you see that it's they, they portray it as surrounded by cheese but it's certainly it would be much later before the city came around it and at the time it was quite isolated. And it's in a natural setting. If you look at the structure here you can see they have the long hallways that were in place to facilitate opportunities for exercise. And you can see here too nice big windows so even if there was weather inclement weather it was possible to get exercise. Possible to get some kind of exposure to natural setting. There is also some writing, about the building of asylums. It talks about those long hallways also being seen as a way of, reducing tension in the site. because it, it made sure that, that, the patients were not in close proximity to each other. Or in crowded conditions that would possibly contribute to tensions and aggression among fellow patients. also of note here, when you look at this picture, is that, The different segment of the building probably corresponded to. To spaces for different categories of patients. So back then, for example, we know that people who had mental illnesses were also kept in the same institutions as people who would have had intellectual and developmental disabilities. So they certainly wouldn't have been treated or housed in the same spaces. So, so these distinctions here in terms of the different sections, and in. In fact it looks like maybe even different buildings here probably corresponded to different, categories of patients. and probably the asylum was segregated by gender as well back then. Now if we look at the Mimico Asylum which was built just a couple of years after the Provincial Asylum there we see that actually they have this cottage layout. And at the time this was actually quite an innovation. So instead of having one large building with people. Separated by hallways. I guess hallways and, and floors. They actually had different buildings for different classes of of patients. otherwise much is similar. It's still surrounded by a natural setting as I showed you earlier. And if you look at, if you took a look at the web page that was put into the earlier presentation, then you will see that what we have here is the cricket field. And apparently the asylum cricket league was a very big part of life at the time, and certainly a part of. Exercising and getting fresh air. And then, here. This next picture's also from the former Mimico site. This is the assembly hall. And you see it's still called the assembly hall. Now it's a community center. But at the time, this was a space where there were social activities, religious services. rec-, all kinds of recreational things. And this was all part of the treatment at the time. [SOUND] So, many of you will have heard the term, moral treatment, or moral therapy. Moral treatment included the things that we've already mentioned as part of isolation. Sorry. As part of asylum life. things like isolation from social stress. Rest, exercise, predictable routines. engagement in some kind of work was considered an important aspect of this treatment as well. And this is a lot of what people really remember about moral therapy. That patients were doing work like farming, domestic work, kitchen work. All this sort of thing. so looking. Back on this from the twenty-first century many people have been highly critical of the use of unpaid patient labor and they see it as very exploitative. Now there's no question that, as I indicate here, it was a bit of a win/win situation for the superintendents that ran these places. Because patients were occupied in, in their treatment, which contributed to their healing. But it also helped to lower the bottom line, so that running the co-, running the asylum, was fairly low cost. All of the labor was done by these patients as part of their treatment. And unpaid patient labor was in place in many of these institutions for a very long time. In some places, up until almost the 1970's. If you visit any site on the internet that talks about patient labor in the asylums and mental hospitals. You will see that there are very strong feeling on both sides. For every person who thinks it was an exploitative thing and a violation of human rights. You will find someone else who asserts that this type of work was beneficial to people. And, in fact, far more beneficial than the medications that we, we would be offering decades later. So, it was all good until it wasn't so good. This is the first, but not the last time we are going to talk about the swing from optimism and investment in mental illness treatment to pessim-, pessimism and divestment. As the asylums, were underfunded and increasingly overcrowded and understaffed. They became more and more like the prisons and port houses that they had replaced. This was true in the sense that the mechanicals, restraints and. Harsh punishments that they were, really designed to try to avoid. Became quite common, because it was. As, as they saw it. The only way that they could really deal with. The amount of. The number of people that they had. And the difficulty of keeping things, under control. Joseph Workman. Who was a superintendent at the provision of, Provincial Asylum in Toronto wrote about the. Condition of that asylum in one of his reports, commenting on how it abounded with foul air. In fact there's a very detailed description of how there was a huge cesspool running underneath the buildings that was full of human waste. And he had the patients cut out these ice blocks of excrement in the winter and then haul them out to the farmlands so they could eventually defrost in the gardens. His conclusion was that no physician having a due regard for lives and health of his patients or for his own reputation, could tolerate the continuance of that situation. As we came toward the end of the 19th century, the high hopes for the asylum had faded. The promised cures that were to come from moral treatment, simply didn't materialize. Many of the people who were reported as cures, we later found out, actually had to come back to the asylums over and over again, to return for care. Because those cures weren't sustained. After a while, the populations in the asylum shifted. Those that could get well, stayed well, and left, leaving behind the most ill. Moral treatment was very difficult to implement and sustain with this remaining unstable and extremely disabled. Population. In the minds of the public, the asylums were no longer places to send loved ones for healing or places to protect the mentally vulnerable from the stresses and difficulties of the social environment. Instead they are places to protect the community from extremely ill and sometimes violent patients. Places that have once been places of reform were now at best places for custodial care. Unfortunately, there was also for them the, the, there was also the potential for them to become places of abuse, as the people inside were essentially abandoned by society. And the geographic isolation of the asylums made it easy to keep such people out of sight and out of mind. So, a 100 years pass and we essentially seem to be right back where we started. How did that happen? It had begun with so much hope. An then in the end it was just so bad, right? So. And, and the thing you have to think about, too, is that as early as 1850, Joseph Workman is telling us that it's that bad, and yet, at least another 50 years went by before anybody did anything. The asylums were pretty much in place up until the turn of the century. So things did eventually change. But, I think it's worth reflecting on why. The asylums were able to persist as long as they did. Even when people knew they weren't working. So, one thing I think you have to take into consideration. Is that they didn't really have a lot of other options in terms of what they were going to do. Having created these spaces for moral treatment, and discover that it worked for some people but it didn't work for others, they were left behind with the people that it didn't work for. So they have the most severely ill, the most severely disabled, and in these institutions, there's a sort of industry that's developed around them. I think we have to take that into account too. It said there were people that who had made it their business to deal with the control and the containment of people like this and. Frankly I'm not sure they had any other ideas because at that point I don't think the communities were willing to take these people back because they had been told quite strongly that they were in the places where they needed to be. So although in other parts of the world there was some developments in terms of treatments. We see in the paper on the history of psychiatry in India that there were for example Ayurvedic treatments being developed there and we can imagine that in other parts of the world there were indigenous treatments available that people were using. In North America those things weren't available so they just. Kept people in these asylums because I think that was what. They thought. They had available to do. So, maybe no other options, no other ideas at the time. The other thing though I think we have to think about is that these asylums were also made, they were put in, in geographically isolated places. in the beginning because this was part of the healing environment. But eventually, I am guessing it probably became kind of convenient that these places were out of sight and out of mind. So with these asylums and the people inside them, out of site and out of mind, I think it was easy to. Not really deal with the problems that we're having there. It's possible a lot of people didn't really know about them, because certainly part of what contributed to the change was exposure of those conditions. But also, I think that there's always been, or there's a long term problem with, communities really seeing themselves as invested in the, In the well being of people who are in institutions like this. So I think that the community sort of turned an eye away from it. and it was easy to do because they were not. Among them anymore. And so part of the disengagement, part of what allowed that disengagement and ruin to happen, was that as a community and as a society people allowed it to happen. But as I said, things did change, so that's what we're going to talk about next.
