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1. What does the kind of criteria Kirkbride looks for to release patients say about the asylums ability to rehabilitate the patients? — Ruth Curran

2. Would the idea of a “cure” leave patients who were released and then returned to their symptoms feeling like failures because of not being able to continue the standards held at the hospital? — Ruth Curran


1. It’s interesting to see the use of both moral treatment and narcotics explained, how were both able to be “effective”? By subduing patients to that extent, how were they then able to keep up with a more normal routine or conversation with doctors and other patients.-Margie Jones

2. A more trivial question, but one I think still worth asking is why were the rates of constipation so high with those who were diagnosed with a mental illness? What was thought to be the correlation there?-Margie Jones

1. “During Kirkbride’s superintendency, no more than sixteen out of the more than 8,000 admitted to the Pennsylvania Hospital for the Insane brought suits alleging wrongful confinement. Yet, this small minority of court cases had a damaging effect far out of proportion to their number. Not only did they place a tremendous strain on the superintendent and his officers by forcing them to make frequent, wearying court appearences; they also created unfavorable newspaper publicity for the hospital, which undercut the therapeutic image Kirkbride had labored so long to establish.” (252) 
 I know this is borderline a block quote, but I found it very implicitly informative as to Tomes's perspective of those who chose to speak out against the asylum and Kirkbride. Tomes was dismissive of those who presented their qualms against the asylum system and Kirkbride. Tomes appears to view these previous patients as nothing more than thorns in the side of Kirkbride. I was surprised by the degree of pessimism and invalidity Tomes expressed toward the patients and their claims. - Joey Welch

2. On page 289, Tomes mentions how “the linear plan accommodated all classes in one uniform building,” and while this technically holds true. I found her counterargument against the segregated house system to be somewhat ironic. Tomes contends that the segregated housing system would push the asylum away from remaining “classless” or “mixed.” However, what I found ironic about this particular section was that in chapter five, Tomes provides us with several damning testimonial letters from patients, where they make it quite obvious they understand the warding systems function as a way to segregate and classify patients as well as punish and reward. 

1. One would expect the escapees of mental institutions to not return, however as mentioned in Chapter 5, absconders would often return to the institution. Worth mentioning was that some patients were allowed to enter the city of Philadelphia, contingent on their sober return. Does the usage of moral treatment solely attribute to the voluntary return rate, or does it depend on the mental classification of the escapee? -RJD

2. How did Kirkbride's housing system respond to overcrowding? As specific as it is, one can imagine such stratified systems such as the wings, and flooring classifications becoming quickly overwhelmed? -RJD

1. How does the way Tomes represents the involvement of the family differ from other scholars that we have read and why might these differences exist? Will families always remain as involved with the asylum and treatment/care of their relatives as they were in Kirkbride's work? - Morgan

2. Tomes identifies the greatest achievement of the mental healthcare system in place during the 19th century to be the creation of a way that those who required mental health treatment could return to a normal life. How will the options of people with more minor and/or curable mental health conditions be impacted by the shift in attention from curability to longterm care for those with chronic issues? - Morgan

1. As briefly mentioned in the last class, Kirkbride seemed to be an incredibly charismatic person. Tomes builds on this in the opening of chapter 5 when she discusses the importance of appeasing the “demands and expectations” of patients in the asylum. Tomes stated that Kirkbride was in a peculiar position because as superintendent he held a lot of power, but also due to the nature of mental institutions, a lot of patients were there and receiving aid against their will. If too many patients spoke out about their displeasure then that would make Kirkbride and the whole of the Pennsylvania hospital look bad. Furthermore, toward the end of his career, Kirkbride had gone through multiple court allegations and public shaming of his work. Furthermore, he received a lot of hate and backlash from younger doctors entering the field, accusing him of being stuck in his ways and old fashioned. Considering all of that, how is it that Kirkbride still seems to be such a charismatic person? He only had about 16 patients publicly speak out against him and he is still such a well known and cited figure, as we discovered last class. - Teresa

2. Tomes mentions how Kirkbride differed from many of his counterparts at the time because he never doubted the ability of medical measures to alter the course of insanity” (194). Do you think Kirkland’s appreciation and use of drug therapy was affected by his background as a surgeon?  - Teresa

1. I think that it is interesting to note that in the beginning of chapter five Tomes states that “although they might object to painful medical procedures, ordinary patients rarely had a vested interest in defying the physician’s diagnosis or disputing his directions for treatment,” and then states “In contrast, the asylum doctor worked with a perpetually hostile or unappreciative clientele.” To me, this almost sounds like it was the doctor’s way or the highway and that the patients in a sense were treated less than what they should’ve been. -Jake Martin

2. In reading the conclusion it really struck me when Kirbride’s second wife started talking about her husband in the hospital journal and what she had to say about his life’s work. She states “Kirbride’s real genius as a physician had manifest in his ‘power over the afflicted’; the ‘personal ministry’ he pursued with his patients had been ‘more potent perhaps, in itself than the many remedial agencies gathered within the Institution’.” To me, it sounds like his wife Eliza is basically giving him a god complex in the way that his work was throughout this particular period and his career, which I find fascinating. -Jake Martin

1. In Chapter 5 Tomes discusses patients' initial reactions to being placed in the facility. It is noted that often they felt like they had been betrayed by their families. Knowing that asylums became “dumping grounds'' for unwanted members of society, was it unreasonable for patients to feel like this? - Darian James

2. In chapter 6 Times states “that a hospital contains none but the poorest, least influential. And most incoherent members of society would inevitably degenerate into a structure no better than its almshouse predecessor.” Given what we know about the behaviors, structure, and treatments, was it inevitable that asylums would become the low quality and abuse ridden places that they did? - Darian James

1. The way that institutionalists thought of curing mental disorders during this period is always so fascinating to me. There’s a lot of time spent discussing the reward and punishment structures used in asylums, and it’s quite interesting how it connects with the way people thought about treatment. Tomes writes on 206 “Such disciplinary measures reinforced the assumption implicit in every aspect of moral treatment: that the patients themselves must decide whether or not to act in a sane fashion. The idea that it was voluntary in a way, and that people could chose to just be sane is a huge constant in how mental illness is constructed societally. -RM

2. Prestige being an important force behind the administration of asylums is not so much unexpected, but what is more surprising is the degree to which it influenced how superintendents ran their institutions. Even though they seemed to correlate elegance and “internal harmony” with successful treatment outcomes, especially as time went on, it seemed that they cared more about this personal and institutional prestige than good patient care. -RM

1. I find the relationship between the institution and the patients family to be an interesting one. The fact that families would somehow wholeheartedly commit to the asylum system seems doubtful to me, but they did anyway. In what ways could they be involved during the institutionalization of their loved one to make sure he/she was getting the care they needed? - Evan

2. Were there any instances of mass resistance among the population of an asylum or was it more often individual? - Evan