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1. I found the comparisons Shorter makes between the French and Germans regarding their effectiveness and level of care toward the mentally ill to be very striking. Shorter believes their political structure was the main contributing factor to the discrepancies between the two countries. Germany, being a decentralized country, allowed for the expansion of their mental health efforts across the country, unlike in France, where due to a lack of care from the likes of the Ministry of the Interior and psychiatric leaders like Esquirol, efforts for reformation of the treatment of the mentally ill rarely escaped outside the walls of Paris. I was left wondering why. Why were the French so content in neglecting those outside their capital the proper and humane treatment that was becoming second nature in many other parts of Europe? -Joey Welch

2. Tuke’s integration of the fictitious family dynamic was brilliant. It allowed for a sense of community in asylums that had never existed beforehand. This family structure was stepping away from strictly doctor-patient relationships and instead encapsulating asylum workers and patients in a system of reforms that was less about condemnation and control and emphasized the importance of social responsibility and belonging amongst the “mad”. Through the fictitious family, the “man of reason” provided both “domination and destination” (253) for those inflicted. - Joey Welch

1. Although Reil is supposed to have had very limited contact with patients, he makes some interesting points including talking about how he feels doctors have an ability to help and make a difference here in the field of psychiatry. He does say that there are very few psychiatrists and this is one of the reasons he is promoting the idea of an institution where patients go for this specifically. Is this what begins to separate psychiatry from the practice of medicine as a specialization? The fact that few doctors are interested in it and separate facilities for patients exist? (12-14) — Ruth Curran

2. The distinction made between “nervous disorders” and “pyschiatric illness is interesting here (25). They clearly both involve issues with the mind and are altering the person’s ability to function but they are both treated differently and even by different doctors, what is the distinction here that is keeping them from being classified together? (25) —Ruth Curran

1. It is interesting to see the paradoxes listed in the reading as it was stated that Rush in particular proclaimed one thing in his textbook, yet he practiced another at his hospital. Was this common throughout psychiatric treatment when it was becoming more mainstream? And do we see similar patterns of this today?-Margie Jones

2. The contrast between the neurological and situational cause of mental illness is a complex pattern to follow in the reading. I am curious how we have reached today's seemingly even distribution of cause of mental illness.-Margie Jones

1) Shorter mentions in History of Psychiatry that in European asylums have been around since the middle ages. While obviously they have not always been referred to as asylums or in language that is more common in our time, there have been systems in place to house those with mental disorders regardless of whether or not they were helpful. I think it would be interesting to look into treatment/housing of those with mental disorders prior to the 19th century and look into how they compare to early asylums in the US.

2) Madness and Civilization briefly mentions “positivism”(?) and how it leads the patient to believe the psychiatrist has skills beyond science, comparable to divine power or magic. This made me curious about any connections between mental health and religion during this time period. - NG

1. Shorter pointed out that the US did not have much of a pre-modern madhouse phase, unlike in Europe, as well as that the US did not go through the same reform European countries did until later. What impact might these differences have had on the history of mental health care in the US moving forward? - Morgan Kelley

2. Shortner addressed a number of explanations for the increased number of asylum patients in the 19th century and concluded that the most likely reason was a genuine increase in the number of people who required care and wider changes in who was responsible for that care. One thing that he did not address that I had wondered about was how increased legitimacy of asylums as an institution and psychiatry as a field might have made that sort of care more desirable to those who might have once been weary of the new practices; could this have been a reason for the increase as well? - Morgan Kelley

1. “What do these many founders of modern psychiatry have in common? How about the Foucaldian notion that psychiatry was born in some kind of fiendish alliance between capitalism and the central state, enlisting psychiatrists in the larger game of confining deviant individuals in order to instill work discipline into an unmotivated traditional population” (Shorter,16).

How true does this quote stand in the bigger picture? -RJD

2. Confinement at home is discussed at the beginning of Shorter's book. The mentally unwell were obviously not being treated well at home, versus in institutions later on. Accounting for anomalies in treatment, was a one size fits all approach to mental health even possible? -RJD

1. I found Pinel's three syntheses to be quite introspective. The discussion of the Silence, Mirror, and Judgement put into perspective for me just how isolating it could be in an asylum. Even if the psychiatrists have good intentions, from the patients perspective, the place can be a living hell. In what ways have Pinel's three synteheses been used today, if at all, and did these ideas prove to be effective in helping the ill? - Evan

2. How could some scholars argue that mental illness itself does not exist, if the mentally ill had to be sent to the asylum for a reason? Without mental illness, there would be no reason to send the patient to the asylum, thereby avoiding the apparent risk of developing mental illness? It seems to me to be an aspect of humanity that is ubiquitous. - Evan ps. I hope my explanation after the question made sense

1. Something that was interesting to me was what Shorter said about Bedlam, one of the oldest psychiatric hospitals, was that even though it is known to have been brutal, it is mentioned that private patients must’ve been treated better in these older psychiatric hospitals. This makes me wonder exactly how much better were the private patients who could afford to pay were treated compared to the public patients? - Teresa

2. As said by Foucault, patients of the Retreat must become aware “of [their] own madness” through being punished for “any manifestation of madness.” Therefore they would feel guilty for the punishment they received and would have no one else to blame but themselves. I question how long they used this method of punishment and self realization? - Teresa

1. In Shorter’s work he states that “these private institutions offered custody, not therapy, for individuals too unmanageable for their own families at home.” I’m curious to know what people consider to be “unmanageable” when it comes to a person, especially their family member. -Jake Martin

2. In our reading Madness and Civilization, the author states “Everything at the Retreat is organized so that the insane are transformed into minors. They are regarded as children who have an overabundance of strength…They must be given immediate punishments and rewards.” This struck me as a little odd that they would be considering or classifying people as “Children” and treating them as so. -Jake Martin

Something that is discussed in the History of Psychiatry and in The Mad Among Us is the increase of elderly patients. As families became less willing to care for these individuals, they would send them to these hospitals. Since many of the hospitals were placed far away from cities, it left the patients isolated and subject to abuse. Does the treatment of the patients play into the idea that society viewed these people as burdens? - Darian James

The economics of caring for “insane” people affect everything from the buildings to the individual families. In The Mad Among Us it discusses the financial difficulties from the perspective of the hospitals, but the other economic factor is the family's financial situation. How did a community's financial situation play into their treatment of these people? - Darian James

1. Let me preface all of this by stating my anti-Foucault bias; having read Discipline and Punish, which I consider to be the pinnacle of human achievement in boredom, I think Foucault gets a fair bit wrong here. Despite his very valid and well argued critiques of asylums, and the state of mental healthcare more broadly, Foucault, in my opinion, ends up falling onto a very anti-treatment view. Foucault erroneously seems to conflate medicalization of mental disorders with ignorance or disinterest in the condition of the patient. I think this tension still exists in the popular imagination, that to be scientific, one need ignore the lived experience of a patient. While not much of a particularly rousing question, I find myself asking why? Why can’t two things be true at once? Why must a medical eye be seen so often as callous indifference? -RM

2. It’s fascinating to me to compare the portrayal of psychiatry in Shorter and Foucault. I think in many ways Shorter takes an overly rosy view of the role and impact of psychiatric care, especially early care, while as I said, I think that Foucault takes an overly dour view. Where does this fundamental disconnect come from? What aspect of psychiatry are they each reacting so strongly to? -RM

2023-471g4--week_2_day_2.txt · Last modified: 2023/09/07 07:02 by