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1. Chapter three briefly discusses patients and their understanding of their illnesses and how the majority believed the causes to be psychologically motivated rather than physical. I think this is an important distinction to make, especially when prominent figures like Benjamin Rush were inclined to believe the causes of mental illness to be physical. It makes me wonder if more patients were listened to could we have developed a better understanding of the roots of mental health issues sooner? - Joey Welch

2.“Insanity is truly the great leveler of all the artificial distinctions of society.” (134) I think this perspective from Kirkbride helps emphasize that mental health issues do not discriminate by race or class. My main question then would be why were insanity/lunacy seen as almost exclusively higher class/white male/problems? - Joey Welch

1. On pages 169-170 the idea of the “1 man rule” is discussed as having been highly important to the running of the public asylum as envisioned and laid out by Kirkbride. Was this idea a significant contribution to the failure of asylums as less ideas and opinions flourished and the man in charge was involved in too many aspects? — Ruth Curran

2. The struggle of becoming a superintendent of a public asylum is discussed as having been challenging for those who wished to assume this role. Private practices are more accessible for those who wish to be in charge. What was it that made it so difficult to be a superintendent? Is it due to Very few public hosipitals and lack of funding for such? (171) — Ruth Curran

1. In the preface, Tomes mentions working with Grob. How is Tomes' approach to the history of mental health similar to and different from what we saw in last week's readings from Grob? - Morgan

2. In chapter four, Tomes goes through the different roles one might have working in an asylum. How does the designation and responsibilities of these roles reflect wider societal trends and expectations present in American society at this time – ie. views on leadership, gender roles, etc? - Morgan

1. In chapter 1, Tomes mentions how the contributors and managers of the Pennsylvania Hospital could recommend “servants and poor neighbors'' for admission into the hospital and would typically gatekeep treatment to those they deemed as “worthy.” So those who they saw as “idle and vicious” went to the far less pleasant almshouses. This idea of who is and who isn’t worthy of care makes the idea of other people funding the treatment of the poor more believable. In previous readings it was stated that the rich would fund and pay for the treatment of the poor and these readings did not seem to add any stipulations. However, in the first “voluntary hospital” in America, the financial contributors and Board of Managers chose which of the poor deserved to be treated. - Teresa

2. It is mentioned that superintendents of mental hospitals had basically complete control over the running of the institution. Kirkbride himself had so much power and influence that even after his tenure at the Pennsylvania Hospital people still referred to it as Kirkbride’s. How do you think some affluent patients and families responded to this? Especially white male patients and family members that were so used to the world working for them. - Teresa

1.The concept of “de-institutionalization” is an interesting one, was it a term that came about during the expansion of mental health services? And have we truly “de-institutionalized” ourselves, as there are many parallels that can be drawn between today’s mental health services and the early emergence of them.-Margie Jones

2.It is brought up in chapter 1 that Kirkbride’s moral treatment somewhat reflected indigenous American developments. What are the effects of this statement and using this language in a major piece? -Margie Jones

1. Following his time at Friends hospital, Kirkbride applied some of what he learned there to his residency at Pennsylvania Hospital. His admissions routine started with a purge, then to a sedative of opium, morphine or conium. He would apply leeches to the necks of violent patients, and would occasionally use restraint if needed (67). This stands in contrast to the entire theory of moral treatment, but also shows the wide spectrum of treatments Kirkbride would implement later in his career. -RJD

2. By 1841, sixteen hospitals influenced by moral treatment had opened in the US. From the text, all of the ones listed were in Northern states. What was happening in the deep south at the time? -RJD

1. In the beginning of the preface, I find it interesting how Tomes talks about two key portrayals of mental hospitals and states “one image of a medical institution infused with humanitarian values, the other of a prisonlike structure dedicated solely to confinement.” I would be curious to know how we could as a whole change or create a more positive view of Mental institutions in today's world without automatically associating them with our images of the past like the ones we assume like in Tomes preface. -Jake Martin

2. In chapter one Tomes states “From 1790 to 1830, the hospital’s cure rate remained at around 17 percent and its rate of improvement 12 percent.” Why do you think these numbers were so low when the goal of these hospitals was to help and cure people? -Jake Martin

1. Tomes spoke about various roles within asylum’s and it sparked more curiosity about the work culture within asylums at this time. Was there a uniform understanding of how it should be run, or were there more individualistic ideas overshadowed by the popular belief? - NG

2. The

In chapter 3 it discusses the rising standards of living in the 18th and 19th centuries. Tomes states that there's no conclusive proof that this led to many people, it is stated that the hospitals “resolved a deeply felt social problem.” Why does it appear that mental facilities saw a surge in patients when America became more urban? - Darian James

2. In this weeks reading the difficulty of running and funding an asylum is discussed. With employees being overworked and overcrowding coming from a financial need. How do the economics play into the mistreatment of patients? - Darian James

1. The relationship between religion and science is once again being addressed. In what ways did northern and southern iterations of protestant groups view the practice of psychology? For example, northern baptists in New England vs southern baptists in Virginia and the Carolinas. - Evan

2. What security measures were put in place to ensure the safety of visitors to asylums, perhaps visiting a relative or friend? - Evan

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