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Questions for Tues. September 7, 2021

1. Tomes tells us that Lasch and Katz felt that asylums were instruments of social control that fostered a “single standard of citizenship” which worked well in a rapidly industrializing society. She also explains how they felt asylum treatments were nothing more than “scientific rationalizations of middle-class morality.” (10) It seems that Foucault, Lasch, and Katz all believed asylums were not necessarily good innovations. What do you think? Where asylums an integral part of 19th century America or just a way to “warehouse” social deviants?

2. Tomes Introduction calls asylums: “institutions sanctioned by the whole society to meet certain commonly perceived needs.” (12) To what needs is she referring?

Submitted by Bonnie Akkerman I pledge…

1. Throughout Chapter 1, Tomes makes the vague argument that “optimism” was a driving force for the success of hospitals in curing/dealing with mental disorders in the 18th century. Do you believe there are any counter-arguments to this simple line of thinking? Should the previously-held idea that “insanity” was related to a deficiency of one's soul have made mental-health workers more or less optimistic?

2. Reading through Tomes' Chapter 4, it appears that the Kirkbride model revolved around a similar paradigm as the “Great Man Theory” of History, in that it recommended authority be held by an all-powerful superintendent whose individual qualities would determine the welfare of an asylum. Given that theory's divisiveness, do you see any of the critiques against it taking form in the failings of the asylums this chapter follows?

3. What do you think of the idea of a separate Men's (and Women's) section, as proposed by the Kirkbride model? Tenable today?

Submitted by Theron Gertz. I pledge…

1) According to Tomes, more than 50% of women patients were married at the time of admission, while only 31% were single and 19% were widowed (pg. 28). We have mentioned in past discussions how women were often institutionalized for expressing ideas, being too forward in their opinions, or simply because their husbands didn't want to be bothered by them. Taking this into consideration as well as the knowledge that Pennsylvania Hospital had skewed from its original design of helping the poor in favor of wealthier clientele, I'd like to discuss the implications of these statistics and the moral ambiguity that comes with the institutionalization of people who aren't necessarily in need of treatment from asylums. After all asylums were seen as places to “secure the insane” in order to “seclude” them away from proper society (pg. 35). Furthermore, I'd like to discuss the social and economic motivations associated with this in the context of the 19th century.

2) There are many things the early lay people got wrong concerning mental illnesses, however there are many things they surprisingly got right. Though they do not use the modern psychological terms we are familiar with, they did manage to explain many causes and symptoms in simple terms. I'd like to discuss what these early asylum keepers managed to get right, what they got wrong, and how we feel from a modern perspective about this.

Submitted by Lyndsey Clark. I pledge…

1. In the very beginning of Chapter 1, I noticed that Kirkbride found that without the lack of restraints or harshness towards the patients, they actually handled themselves pretty well and maintained their appearance to a decent standard (pg. 21). Regardless if whether or not they were just being good for the gingerbread, how come we don't hear about these kinds of cases? Although I do know that not every asylum is run decently, especially not throughout the time period that we are studying, was there ever anything mentioned about the good cases, if there were any?

2. What was considered “Moral treatment”?

3. I was definitely drawn to the statistics as to what a “real lunatic/inmate” was. In Chapter 1, Tomes briefly explains how in order to be qualified to be in an asylum, “lunatics had to disrupt the familial or communal order in some very serious fashion.” (pg.26). With that being said, would these actions be fabricated by family members to possibly “rid” themselves of someone? Were there any cases of such?

Submitted By: Erica Banks I pledge….

1. Tomes cites Pliny Earle as saying that Americans of his day suffered from “nervous exhaustion” due to the increased uncertainty that comes along with greater progress in society (80). Is what he called “nervous exhaustion” what we would call depression or anxiety, or a combination of the two? The “strengthening regimen” he recommends using narcotics and tonics seems to complicate the picture (83).

2. Tomes’ statement that the rise of neurology complicated the asylum referral process by providing an alternative method to treat those who suffered from nerve-related ailments (107). Patients would often go to neurologists first before committing family members to an asylum. This suggests that American society was unsure as to whether mental illness was best treated by medical or psychological methods. At what point would neurologists and/or families decide that their mentally ill were better treated at an asylum? Alternatively, were there instances of asylum doctors referring patients to neurologists?

Submitted by Chris O'Neill

1. Due to the stigma around mental illness, especially so in the nineteenth century, are the letters/accounts of family members misleading at illustrating the symptoms and experiences of patients as they often minimized the true extent of a relative’s mental health? Tomes acknowledges this partially in chapter 3 but more so as a reluctance to admit a family member to an asylum.

2. Kirkbride is described as a diplomatic man who was able to keep the façade of the asylum up to par with patrons, why did he not employ more staff to make up for overcrowding? With one of the patients being worth over $1,000,000 this seems like a plausible solution.

-Janis Shurtleff

1. Do you think writing the history of a mental hospital is hard because there isn't much written on it or does the political discourse have more to do with it?

2. If Kirkbride's family have chosen to go to the Hicksites, how do you think he would have run his asylum? Would he even have become a doctor?

Submitted By Audrey Schroeder

1. Why do you think that the trend of universal salvation labeled something like “reading the bible too much” as a sign of insanity? Why do you think something as innocent as reading the bible too much had arisen as a warning sign? How does this blur the lines between sanity and insanity?

2. Why do you think institutions thought having just one doctor’s opinion on the sanity of a family member was satisfactory instead of two? Do you think that this is an attempt to just increase the rate of admissions and profit or a genuine attempt to decrease the work of the general practitioners as it was explained in Tomes?

Submitted by Jack Kurz

Question 1: What happened when a patient escaped from an asylum? How did doctors look for the patient and what happened if a dangerous patient got out?

Question 2: When did the courts start to play a bigger role in admitting people to asylums? Submitted by Griffin Nameroff

1. Why was institutional care not taken seriously by traditional physicians? What were some of the reasons that Kirkbride struggled with making the decision to make asylum care his medical specialty? Pg 74

2. How did social factors contribute to the change in how insanity was classified as a disease? Why did it shift from a disease of inflammation in the Rush years to a nervous disease with Kirkbride? Pg 80

Submitted by Allison Love. I pledge…

1) Tomes states, “…the superintendent's success ultimately depended on his ability to match his patrons' needs with appealing institutional measures.” (page 14) What did people like Kirkbride use to “match” the patient needs with “treatment” at the asylum?

2) Tomes mentions that some wives of the asylum superintendents served as “A Matron of the Insane”. (page 31) What other roles did women have inside asylums?

3) Noting the relationship between addiction/alcoholism and the admission to an asylum for a mental disorder, Tomes says that often families decided whether or not to have the patient admitted. (page 119) Does this still happen today?

Submitted by Carson Berrier (I pledge…)

1) Tomes mentions in chapter 3 how some of Kirkbride’s patients were illiterate and lacked the understanding to be able to describe their own conditions or understand insanity. Do you think this could have had a lasting impact on the understanding of insanity? If the lower-class patients who were often seen as vagrants or lowly were able to accurately describe their conditions, would the view on those patients have shifted? Could they have been viewed in the same light as the wealthier patients? Or would the doctors have still only gone off their own theories and not listened to the patients own descriptions?

2) Tomes outlines the events that would occur for a patient before they were admitted to Kirkbride’s asylum. These events included reasoning, meetings with a family doctor, neurologist (occasionally), spa/health resort, private institutions and then finally admittance into Kirkbride’s asylum. However, Tomes mentions most of the patients who went through those steps were wealthier and wanted to avoid the stigma of the asylum. What might the steps for lower class and lower income patients look like?

Submitted by Mallory Karnei (I pledge…)

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