PHILIPPE PINEL AND THE SYRACUSE STATE SCHOOL: PSYCHIATRY AND THE MORAL TREATMENT IN FRANCE AND THE UNITED STATES, 1750-1850

By

Taylor McKinney

History Distinction

Syracuse University

April 2020

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Abstract

This project aims to create an interdisciplinary approach between history and anthropology in the development of cross-cultural mental health institutions in the 19th century, eventually focusing specifically on the case study of the former Syracuse State School for Idiots in Syracuse, New York. I aim to investigate the “Moral Treatment” as it was founded in France and its cross-pollination to the United States through primary historical sources, artwork, and archival materials, and how this therapeutic model was expressed in public health institutions based each respective nation’s cultural and historical context.

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TABLE OF CONTENTS

Abstract………………………………………………………………………………..2

Executive Summary……………………………………………………………………4

Chapter 1………………………………………………………………………………11

Chapter 2……………………………………………………………………………....26

Chapter 3……………………………………………………………………………....42

Conclusion……………………………………………………………………………..58

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EXECUTIVE SUMMARY

SYRACUSE STATE SCHOOL

In 1855, the Syracuse State School in Geddes, New York, opened its doors to

approximately fifty matriculated pupils for the first time. Facing east into a range of grassy hills

adjacent to Burnet Park, the newly-minted facility overlooked the profile of the city and the

nearby Onondaga Lake. The State School was composed of several floors and wings of pale but

elegant brick, large enough to eventually house over four hundred students at its peak of

operation. Students from all over New York State arrived by carriage to the graveled driveway

that looped the entrance of the building to move in. The State School was granted significant

funds for its construction and upkeep, and boasted sixty acres of land for facilities, including:

gendered dormitories, schoolrooms, kitchens, laundry, a surgical center, a barn, stable, and farm,

and satellite cottages for faculty and staff. Before urban growth subsumed the school into the

city of Syracuse proper, the Syracuse State School was built a distance from the city and

designed to be self-contained and sustaining, apart from shipments by railcar for items like

groceries and other amenities. It was not a city within a city, however, and great pains were made

to incorporate and embellish the existing countryside: importantly, the grounds were marked

with grassy open space, sodded and manicured lawns, shady trees, and campus gardens that were

cared for by a salaried staff of groundskeepers and gardeners.

While surviving postcards, prints, and photographs portray an idyllic villa in the

countryside, the Syracuse State School was a residential facility in New York State for mentally

ill or disabled children. Admittance was granted to students between the ages of seven to

fourteen who were not epileptic, insane, or greatly deformed, but were otherwise considered so

idiotic or deficient that they were not suitable for ordinary schools. As it was, the “Syracuse State

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School” was the final permutation of the facility’s name since its authorization in Albany.

Remarkably, the institution changed names several times throughout the course of its history,

each reflecting a different iteration of the “proper” terminology for this brand of mental illness,

disability, or deviance. When the state government in Albany originally issued the license, it was

called the “New York State Mental Asylum for Idiots,” or the “State Idiot Asylum” for

shorthand. In the following hundred years, its name would be rebranded several times: the

Syracuse State School for Feeble-Minded Children, the Syracuse State School for Mental

Defectives, and finally, simply the Syracuse State School. When the school first opened at the

Geddes location, administrative officials asserted that, “The idiot institution is more properly a

school than an asylum,” (NY Times), and only admitted students that were believed to be at a

teachable age and within a teachable spectrum of idiocy or deviance, which might be cured

through pedagogy as well as medical practice. While the facility was just as equipped for a sick

bay as it was for classrooms, staffing doctors and nurses as well as teachers, the tension between

whether the enrolled children were primarily “pupils” or “patients” can be seen in the evolution

of the facility’s name and the mixed utility of the campus itself.

The New York State Asylum for Idiots was authorized in Albany in 1851. Three years

later, in 1854, a new building was constructed, and in the following year, the institution relocated

to what is today Syracuse, New York. The school remained in operation until 1973, and was

eventually torn down in 1988. Burnet Park remains, and the grounds are lively with the activities

of the Rosamond Gifford Zoo. While the campus of the Syracuse State School has been erased

from the landscape, its impression remains in the archives, photographs, material culture, and

larger historical movements and conversations concerning mental illness and public health.

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METHODOLOGY

In the pages that follow, this thesis will explore the Syracuse State School by placing it in

a broader historical context. This will include examining the origins of the ideological

background of the moral medical treatment, specifically in the French tradition of post-

Revolution humanism and institutional reform in the late 18th century. After highlighting the

intellectual and cultural origins of Philippe Pinel’s “moral treatment” of the mentally ill in

France, the thesis will examine the way these new medical modalities crossed the Atlantic and

became embedded in the American therapeutic model. At the urging of religious groups,

prominent social reformers, and a new generation of physicians disillusioned with preexisting

medical epistemologies and public institutions, asylums and specialized hospitals became central

in the treatment of the insane. This will culminate in an analysis of the Syracuse State School,

one of the many specialized asylums created at the middle of the 19th century.

There is rich textual and material resources for health, sanitation, and government

institutions in the development of mental health care and treatment in Central New York. On its

own, it creates a snapshot of the lives of mentally ill patients and the practices and beliefs of their

attending physicians in the 19th century in a local historical proximity. When viewed in the larger

context of other contemporary institutions, however, we gain a better understand of the historical

and cultural changes surrounding mental illness, social activism, and the evolution of clinical and

academic traditions concerning medicine at the levels of the state, nation, and transatlantic

Western hemisphere.

Using the Syracuse State School as a frame story, we will see how it both exemplified

significant medical and pedagogical aspects of emerging public health institutions like the

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Kirkbride asylums, and also stood out as a highly specialized, new kind of facility. In order to do

that, I first will attempt to broadly outline key precipitating factors in the humane reform of

medicine and mental health practices abroad, and how these ideas became enmeshed in the

professional and social channels of physicians and reformers in the United States. Then, finally, I

will turn to the anthropological concept of embodiment, where the physical body and the

surrounding landscape are reflective of – and subject to – the social environment, and vice versa:

namely, in the form and practice of the physical world of mental health asylums.

I had two main aims when beginning this research project:

1) To remove the distance between “history” and the familiarity of our surroundings; to

place local institutions within the broader context of history, using local materials and

resources

2) To situate a research project on the history of medicine and public health institutions

within an interdisciplinary conversation, between the discipline of history and the

social sciences, namely anthropology

My primary source material will be entirely comprised of historic documents, archival

materials, and artwork: however, I consider this a historical and anthropological analysis of 20th

century mental illness and treatment – and, by extension, the resultant institutions and landscape

informed by it. While the many name changes of the Syracuse State School are important for the

institution’s specific history, the specific lexical features of each successive “new” name can be

better understood when placing the institution within the context of larger cultural and

intellectual notions of health, wellness, and treatment. These conversations, though nearly two

centuries prior, are still relevant to the field of medical anthropology, which keenly feels the

tension between the biological aspects of disease and the way that social and cultural factors

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influence the diagnosis, prognosis, treatment, and even the emic experience of the illness. The

difficulty of naming disorder in a clinical setting underscores the broad social milieu that

physicians, patients, and the community must navigate. The tension between old and new

regimes of power and medicine are also evident in construction of new public institutions to deal

with evolving concepts of community, activism, national identity, and humanity.

CHAPTER OUTLINE

In Chapter One, I will discuss the emergence of the “Moral Treatment” as a post-

revolutionary reaction to the creation of a French Republic, which idealized Enlightenment-

based humanism and changes to scientific methodology as the expression of a more evolved,

morally pure society. In this chapter, D’Alambert, Rousseau, Tocqueville are the primary

resources I will emphasize as critical in understanding the political and intellectual theater of the

late 18th century France. These changes paved the way for a new wave of thinkers, reformers,

and doctors to flood administrative posts in government, academies, teachings hospitals, and

asylums.

Chapter Two shifts our focus across the Atlantic and to the United States of America,

where religious revivalism enthusiastically stimulated the preaching, performance, and

discussion of new actions and ideas. While the Great Awakening is primarily known as a

religious movement, many historians and scholars recognize its strong social component outside

of halls of worship, and the place various religious groups and reformers occupied on the public

stage, often in relationship to reform movements around hospitals, asylums, poorhouses, and

schools. Professional circles of hospital administrators, physicians, and nurses, and the growing

literary republics in both France and the United States provided the mechanism for Phillipe

Pinel’s Moral Treatment to reach America. Much of this groundwork for understanding the

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United States as it moved into the 19th century is done through scholarly sources. The writings of

Dorothea Dix serve as the bulwark of our primary source material in understanding her own

massive contributions to public reform, as well as the general reforms of the hospital system

throughout the nation, in interrelated social and professional circles.

In Chapter Three I will discuss the physical manifestations of these new religious and

intellectual movements on the landscape, in the creation of a new wave of hospitals and asylums

for the mentally ill. In Special Collections at Syracuse University’s Bird Library, the Syracuse

State School Collection contains 0.25 linear feet of mixed archival materials dated between 1862

and 1924. While the collection is comprised mostly of paperwork and scraps of textual

ephemera, these documents comprise many of the logistic necessities of running a mental health

institution, including items like payroll for staff, grocery lists, invoices, purchase orders, and

other minutiae of daily life. This collection will form the bulk of my primary source material for

Chapter 1. This will be supplemented with primary source published material from the Assembly

of the State of New York, historic newspaper articles from the New York Times, maps, and

photographs. To better situate the Syracuse State School within the context of its contemporaries,

digital textual material written by Dr. Thomas Story Kirkbride on the construction and

organization of asylums is also included . This should help establish the Syracuse State School as

a historical case study, leaving room for discussion of the name changes over time, changing of

medical thought around mental illness and “idiocy,” and a brief architectural analysis.

The study of the Syracuse State School, a now-demolished hospital in Central New York,

may seem self-contained, and prompt the reader to ask: Why is this study important, and what

does it show us? The most simple answer is: History can offer an interpretation of how people

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used to live, and how our current society has come to be. History does not exist in a vacuum, and

rigorous historical study is not reserved for only the rich and famous; further, history is not

something that happens to people who are passive subjects, but is constructed in daily thought

and action, by everyday people. In this paper, I will highlight many important themes: the 18th

century origins of the humane treatment, the juxtaposition of medical developments steeped in a

both a secular tradition and religiously-based reform, and the cross-pollination of ideas in a

global context. However, by looking at the larger trajectory of health reforms, I hope to impart

an even more meaningful conversation to the reader: The larger narrative surrounding mental

health treatment, past and present, allows us to reflect on how a specific social, cultural, and

political context alters the way that people interact with the world, even within an allegedly-

passionless paradigm like science. Science, medicine, and other clinical practice are thought to

be entirely impartial, but the historical case work in the chapters that follow may facilitate

reflection on the ways in which our own medical systems are influenced by social factors,

ultimately flawed, and subject to future change.

CHAPTER ONE

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Figure 1.Tony Robert-Fleury (1837-1912)Title: “Pinel, médecin en chef de la Salpêtrière en 1795”

FRAME STORY & THESIS

As a painter and art teacher, French artist Tony Robert-Fleury was most well-known for

his romantic reenactment of historic scenes. Imitating the romantic, humanistic style of the

Italian Renaissance, Robert-Fleury’s most famous paintings include scenes of the Roman looting

of Corinthe, and the dramatic portrait of Charlotte Corday prior to assassinating Jean-Paul Marat.

The above piece, Pinel a la Salpêtrière, completed in 1876, pays tribute to Philippe Pinel, who

served as chief doctor of the asylum nearly a century prior to the creation of the painting. In this

scene, the artist depicts Pinel approaching the enfeebled, mentally ill women of the sanitorium,

and commanding their iron shackles to be removed. While this specific sequence of events

cannot be traced to any written documents, bringing the historic validity of the scene into

question, comparable depictions of an enlightened Pinel “liberating” the mentally ill from their

cruel confinement and abuse reappear in other artistic media, such as the strikingly-similar mural

by Charles Louis Muller. While we cannot determine the authenticity of Pinel’s dramatic

entrance to Salpêtrière by freeing women from their chains, the enduring image of Pinel as a

great liberator and reformer is striking; and, in a sense, the images in these works of art have

become the story of Pinel himself. While the subject matter of health reform ostensibly seems

removed from artwork perpetuating and glorifying classical imagery and powerful symbols of

the French Revolution, I would argue that Pinel and his impression on historical memory

demonstrate the legacy and cultural importance of public reformers in the post-Revolution era

Western World.

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In this painting, Pinel is exalted as a paragon in the progression of mental health

institutions, and in the eyes of history, Philippe Pinel is known as the “Father of Modern

Psychiatry” for his writings, teachings, and practices as chief physician of several Parisian

medical asylums. While his contributions to the treatment of mental illness and the development

of more capable mental health facilities were significant in urban areas in France, his actions

existed within the broader context of greater scientific movements and medical advancements in

European intellectual circles, the evolution of specialized branches of medicine into a developing

professional sphere, and the reconstruction of public institutions by these new professionals as

they interacted with each other both locally and globally. The survival of many of these texts,

their significance in their historical context, interpretation by historians, and surviving myths and

artwork offer insight into the evolving conversation around mental illness from both a social

welfare perspective and a nosology and medical perspective at the turn of the century and into

the 1800s.

In this chapter, I will broadly examine the changing attitudes and practices surrounding

mental health reform in the late 18th-to-19th century France and its subsequent diffusion to the

Western World, primarily England and the United States, and the underlying pedagogical and

political changes that enabled these reforms.

SCIENTIFIC REVOLUTION AND ENLIGHTENMENT

The Enlightenment era of 18th century Europe, following closely the precepts of the

Scientific Revolution, was deemed the “Age of Reason” for its spirited intellectual movements

that closely lay the foundations of a modern Western civilization. Given that this was not a

discrete movement contained to France, but an exchange of ideas made easier by the circulation

of print, the Enlightenment can roughly be thought of as the hundred or so years between the

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1680s and 1790s throughout Europe, though the impact of this movement would extend well

beyond this time frame1. Many of the classic works from this time period – the most well-known

thinkers being Rosseau, Locke, and Montesquieu – greatly informed emergent political

ideologies based on personal rights and liberties. The Enlightenment was not limited to

philosophical schools of thought: many of these same intellectuals prided the earlier work of 17th

century philosophers and scientists who insisted that the world could be empirically understood

through rational inquiry and experience, spurring further interest in the development of the

natural sciences. In short, the Age of Reason framed the way that the world would be viewed and

investigated in the Western world. Enlightenment thinkers in Europe, and later the United States,

would “plant the seeds for modern liberalism, cultural humanism, science and technology, and

laissez-faire capitalism”2.

Prior to the Scientific Revolution and the Enlightenment, the predominant cosmology in

the Western word was the Great Chain of Being, a medieval Christian concept with roots even as

far back as classical Greece. In this chain, a fixed hierarchy of beings began with God, then the

angels, down to humans, animals, plants, and even abiotic things like minerals3. This imaged

hierarchy attempted to explain a system of natural unity, designed intelligently by heaven.

Significantly, however, its medieval form drew a clear distinction between material and spiritual

beings, as well as human beings existing as separate from nature. This conceptual distance, in

part, is demonstrated historically through suspicion of nature as an extension of god’s will and

wrath, and ultimately an unknowable entity to all except the divine creator. Beginning with the

Scientific Revolution, however, the lines in the Great Chain of Being become blurred as

1 Kramnick, The Portable Enlightenment Reader, p. 32 Kramnick, The Portable Enlightenment Reader3 Martin Staum, Canabis, pp. 22-23

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scientists, philosophers, and thinkers attempted to reconcile unity and diversity in nature4. This

was highly controversial. When Bacon and Newton began investigating natural phenomenon as a

rational, knowable force – something that could be concrete, investigated, and understood –

public reactions were split between seeing this understanding either as a heretical overstep of

man’s purview or as proof of God’s providence5. Still, as many early taxonomic and moral

models were based on the Great Chain of Being (from the classification of race to the

justification of racial discrimination), new ideas about the universe helped to challenge a

traditional view of the world. Enlightenment thinker Rousseau, for example, discussed a kind of

deism, where a powerful Will was responsible for the universe, but its precise intelligence and

order meant that mankind could understand the world around him as rational and

understandable6. Taken to a logical extreme, this means that man could himself understand the

world around him, and if it followed its own set of laws, then man could exert greater control

over the world around him.

Jean Le Rond d’Alambert, a French mathematician and philosopher, commented on the

flourishing intellectual culture of France over the years: “… the philosophic spirit itself took

refuge in the writings of some great men,” though they did not “[desire] to tear the blindfolds

from the eyes of their contemporaries…. [working] silently in the remote background to prepare

the light of reasoning”7. D’Alambert served as the chief editor of Diderot’s Encyclopédie, which

summarized and shared Enlightenment attitudes to a broader audience to extol the virtue and

accomplishments of the Republic of Letters8. D’Alambert credits the genius of earlier men

involved in the renaissance of letters like Francis Bacon and Isaac Newton, who “have helped to

4 Martin Staum, p. 205 Martin Staum, p. 216 Rousseau, p. 134-1357 D’Alambert, “The Human Mind Emerged from Barbarism,” pp.7-88 Kramnick, p. 7

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spread enlightenment among men” – hence the commonly-used alternative name for the Age of

Reason9. Perhaps because of their great contributions, d’Alembert offers only one avenue of

reproach to these intellectual paragons: he suggests that men like Chancellor Bacon were, if

anything, “too timid” in his pursuits10. Alongside Denis Diderot, who himself was a philosopher,

scientist, and fellow man of letters, D’Alambert helped to create an encyclopédie in the latter half

of the 18th century as a tribute to progress and a tool for the dissemination of learning in the

republic of letters11.

Locke’s theory of human beings born as a tabula rasa suggested the malleability and

potential of the human mind. Similarly, D’Alambert described mankind emerging from

barbarism as experiencing “a kind of childhood,” where natural curiosity aided the acquisition of

new ideas and betterment of the self12. On the other hand, Rousseau described men as being born

weak, and in need of aid and judgement to create a better society. To create a better society,

education was of the highest importance, and the best education was found in the immersion and

understanding of nature13. In either model, men’s minds were believed to be receptive to learning

and the development of higher faculties; and, given man’s place in society, enlightened men

could achieve an enlightened society as a whole. The concept of the plasticity of the mind, along

with the confidence in empirically analyzing the world as a rational system, informed changes in

the way that science was conducted. Just as an infant is born as a blank slate, whose mental

faculties develop due to sensation and association, proper science demands that the only true

basis for theory comes from “prolonged and profound” observation and analysis14.

9 D’Alambert, “Preliminary Discourse,” p. 6010 D’Alambert, “The Human Mind Emerged from Barbarism,” p. 911 Kramnick, p. 1712 D’Alambert, “The Human Mind Emerged from Barbarism,” p. 713 Rousseau, Emile, p. 3814 Woods and Carlson, “The Psychiatry of Phillipe Pinel,” p. 15

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Given the new horizons of science and the changes to investigative methodology, fields

like medicine and technology naturally followed. Importantly, Locke’s theory of the mind also

suggested that, if a mind could be influenced to enlightenment depending on external input, then

it stood to reason that physicians might be capable of remedying sick minds back to health and

rationality.

CHANGING MEDICAL COMMUNITIES IN FRANCE

The principles of the Scientific Revolution and Enlightenment were embraced first in the

private intellectual circles of the highly educated and privileged in France, before being

incorporated into a larger construction of French character as the nation sought a new identity

following the fall of the Old Regime15. The prerequisites of literacy, wealth, and social

connections offered these individuals greater access to writers, thinkers, speakers, and new

information and ideas in circulation, as seen in the darling of France’s literary and philosophical

movement culture: the salon. In a sense, the salon was a kind of miniature public sphere where

ideas were shared, and it established a forum for debate by a host, albeit to a limited and

audience – somewhat equivalent to contemporary English coffeehouses, though tailored to a

more select crowd. The emergence and distinction of a “public” and “private” sphere is of keen

interest to historians, sociologists, and other academics in regard to the formation of a more

democratic states, and the dialogue and tension between the two can reveal veins of social and

cultural change16.

While the methodological, epistemological, and etiological shifts in thinking proposed by

the Scientific Revolution and the Enlightenment were dramatic, they nonetheless were popular

topics of curiosity, debate, and discussion, first among intellectuals and their wealthy hosts, who

15 Tocqueville, The Old Regime and the French Revolution, p. 19516 Habermas, pp. 2-4

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then later also found allies and powerful political patrons in the Old Regime. According to

Alexis de Tocqueville, so-called “men of letters” were relatively uninvolved actors in public

affairs in England and France, confined mostly to the domain of abstraction and pure philosophy.

It is irony, Tocqueville argues, that the exact intellectuals so critical of the Old Regime society

would find benefactors among the nobility, who themselves were neutered of authority by the

monarchy but nevertheless reaped the benefits of their Estate; and, with the aristocracy

ineffective, Tocqueville argues men of letters became a kind of moral authority in the place of

the nobility17. This model of discourse, when appropriated by the nobility, eventually made its

way into the public sphere. The dialectic between public opinion and political power showed the

changing conversation from the public sphere as a body of citizenry acting “in common” – that

is, the administration of law in regards to internal affairs, military survival of external affairs, etc.

– to the civic tasks of a society engaged in critical public debate, namely in the regulation of a

civil society18. With powerful patrons and the ability to direct opinions, Enlightenment

philosophy and new scientific ideals had practical influence on sovereign authority and the

political passions of a growing audience19.

French intellectual culture covered a broad scope of philosophy, the natural sciences,

society, and politics, but public institutions like schools, prisons, and clinics were especially

significant sites for humanistic reformers. We can see this change, specifically, in the growth of

new mental health institutions in France. The spread of Enlightenment philosophy to academies

of education and government bodies meant that new students of science and medicine were not

only questioning preexisting illness paradigms in an intellectual capacity, but also the treatments

patients in a practical sense and the role of the medical and government authorities in caring for

17 Tocqueville pp. 196-19818 Habermas, pp. 51-5219 Tocqueville, p. 198

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the infirm, reimaging the roles of physicians and patients in both a clinical and administrative

sense. Changing medical pedagogy and the influence of universities and legal regulations causes

a shift from folk models to the “professionalization of medicine”; at the turn of the 18th century,

following realignment of the guilds in France, a Parisian hierarchy began to emerge among

physicians, surgeons, and other wellness-related fields, “aimed at differentiating scientifically

oriented and socially ascendant elite surgeons from their professional inferiors”20.These

academic and professional distinctions, aided by government regulations, turned their attention

on the formalization of medical teaching and practice, from dental surgeons to the development

of psychiatric centers. Just as the natural sciences were reordered and methods of inquiry were

more standardized in the Scientific Revolution, the field of medicine became a more complex

structure with various specialties and a hierarchy of professionals, in part to better investigate

and address the scope of human morbidity.

Still, even in the flux of intellectual exchange and government regulation toward the end

of the Old Regime, Phillipe Pinel and other reform-minded individuals were not always welcome

in the highest circles of professional society in France, even if they were well-qualified. Pinel

had studied science, philosophy, and mathematics at religious colleges before receiving doctoral

degrees in medicine from the University of Toulousse and Montpellier. Despite the credentials,

the Faculty of Medicine viewed him as an intellectual outsider in the hierarchical city of Paris,

barring licensure to practice medicine and excluding him from the ranks of leading physicians21.

For the first fifteen years in the city of Paris, Pinel supported himself with intellectual pursuits:

tutoring, translating, editing, writing, public speaking, and studying22. Both the Faculty of

Medicine and Pinel gave each other a wide berth, with Paris’s physicians viewing Pinel and other

20 Jones, p. 8321 Wood and Carlson, “The Psychiatry of Philippe Pinel,” pp. 14-1622 Wood and Carlson, p. 14

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reformers as provincial outsiders, and Pinel critiquing the preexisting medical authorities as

insular, elitist, and deeply entrenched in the political and pedagogical leanings of the ancien

regime23. The swelling of intellectual culture in the 18th century certainly set the social and

pedagogical foundation for social reform, but it was only until the French Revolution that the

infrastructure of the political arena and other established institutions were altered such that

structural change was truly possible.

When the French Revolution upended the feudal regime and deposed many prominent

members of society, the new government set to reorganizing hospitals, poorhouses, prisons, and

schools24. Former positions of power were available to proponents of the new regime, in part,

due to the mass overthrow and execution of Old Regime nobility and bureaucrats; in turn, the

development of new government laws, positions, and facilities led to the growth of a post-

Revolution government in need of new blood. This left new leadership positions open for

administrators trained in Enlightenment-era thought, opening the way for institutional reform25.

Among other things, the new government of France began reorganizing Bourbon monarchy

poorhouses, schools, prisons, and asylums in their own image. Phillipe Pinel was one such

reform-minded intellectuals recruited to serve as chief physician of the Bicêtre Hospital in Paris,

and then later as director of the Salpêtrière asylum, a hospital devoted specifically to mentally-ill

women. His tenure at these hospitals would be remembered for his specific contributions to the

practice of medicine, but scholars argue that the famous painting by Tony-Robert Fleury and the

mural by Charles Muller also intimated Pinel’s contribution to a larger cultural and political

23 Eghigian, p. 9424 Eghigian, p. 9425 Eghigian, p. 94

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achievement for France: an “emblem of enlighten Reason’s triumph over a backward Old

Regime”26.

PINEL AND THE MORAL TREATMENT

Figure 2.Charles Louis Muller (1815-1892)Mural, Académie de Médecine, Paris, France

Although it took Philippe Pinel (1745-1826) fifteen years to be accepted into the

professional medical community in Paris, many of his emergent beliefs and practices as a

physician and administrator of urban hospitals is well-documented from his so-called

“apprenticeship” writings prior to licensure, published texts following his appointment to Bicêtre

and Salpêtrière, and later as a professor of the school of medicine in Paris27. The connections

made during Pinel’s apprenticeship had utility following the revolution, where fellow republican-

inclined ideologists dominated the post-Revolution government and could recommend their

colleagues to important offices and appointments28. One of Pinel’s most important publications

as an established physician was the Traité Médico-Philosophique sur L’aliénation Mentale ou la

Manie, published in France in 1801. The purpose of this text follows the precepts of rigorous

26 Eghigian, p. 9427 Woods and Carlson, p. 1428 Woods and Carlson, p. 17

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scientific investigation via a deductive methodology, and seeks to differentiate between the many

kinds of morbidity of the mind, with a special focus on individual patients and the creation of an

effective treatment plan specific to them29. Pinel recognized the shortcomings of existing disease

taxonomies and etiologies concerning mental health nosology: in his original visit to the Asylum

de Bicêtre, Pinel remarks on the symptomatic diversity of patients, exhibiting various states of

melancholy, confusion, delirium, agitation, and rage, all classified under the same general

diagnostic umbrella of “insanity”30. In treating these patients, Pinel remarked on how an

insufficient label does a disservice to treatment, and resolved the need for study and

discrimination between different kinds of insanity in order to inform his study and practice. In

the early 18th century, many viewed “psychology” as a popular branch of philosophy, but

Enlightenment-educated professionals began to apply the same rigorous methodology and

inquiry that existed in the other sciences to the diagnosis and treatment of mental illness31.

Supported by Locke’s theory of the plasticity of the human mind and the scientific spirit of all

phenomenon as understandable through study, Pinel was convinced that insanity was a disease

like any other, and was therefore vulnerable to diligent analysis and could be cured in the

majority of cases32.

The equally important contribution to this text, however, is its moral in treating patients

humanely to affect change. Pinel’s capability as a researcher was matched by his “natural

benevolence” as a humanitarian33. His sympathy for maltreated inmates of 18th century asylums

prompted his lifelong devotion to the study of their illness and improving the medical institutions

29 Pinel, A Treatise on Insanity30 Pinel, A Treatise on Insanity, 231 Grange, p. 44232 Woods and Carlson, p. 1733 Woods and Carlson, p. 16

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that provided them care. Numerous medical historians had commented on the poor conditions of

European asylums, and the primary sources from Pinel are no exception34:

Public asylums for maniacs have been regarded as places of confinement for such of its members as are become dangerous to the peace of society. The managers of those institutions, who are frequently men of little knowledge and less humanity, (a) have been permitted to exercise towards their innocent prisoners a most arbitrary system of cruelty and violence; while experience affords ample and daily proofs of the happier effects of a mild, conciliating treatment, rendered effective by steady and dispassionate firmness35.

To Pinel, maltreatment of asylum inmates, especially the women he came into contact

with in Bicêtre Hospital and Salpêtrière asylum, was a sign of barbarism, prejudice, lack of

knowledge, and instability in public institutions36. He was not without optimism, however: “In

the present enlightened age, it is to be hoped… that something more effectual may be done

towards the improvement of the healing art”37. Drawing from both Enlightenment and classical

contributions to medicine, Pinel’s model of medical practice, the Moral Treatment (as described

in Traité Médico-Philosophique sur L’aliénation Mentale ou la Manie, “this treatment

exclusively moral”38) combined humane treatment with practical methods of medical care and

asylum administration.

Pinel and his Moral Treatment approach certainly changed the way that the Bicêtre

Hospital and Salpêtrière asylum were run intellectually and administratively, but these ideas

were not confined simply to medical communities in Paris. Pinel himself mentions working with

English physicians and travelers in what the “moral treatment” entails in mental health

facilities39. His treatise’s popular English translation, A Treatise on Insanity, was published in

1806 in London, and through this text, Pinel’s reform-minded ideals, beliefs, and professional

34 Woods and Carlson, p. 1835 A Treatise on Insanity, Pinel, pp. 3-436 A Treatise on Insanity, Pinel, p. 5337 Pinel, A Treatise on Insanity, p. 638 Pinel, p. 3439 Pinel, p. 38

22

practices would have great influence over French and Anglo-American psychiatrists well into the

19th century. Humane methods of patient care and medical treatment would be picked up by other

social reformers. Florence Nightingale, for example, was an English intellectual credited with the

creation of modern nursing. Her own publication, Notes on Nursing: What it is and what it is not

(1859), became a source of curriculum at her own nursing school in London, which was the first

secular nursing school of its kind, and sold well to the general public. Originally intended for use

in the home, Nightingale’s manual describes the distinctiveness of nursing, and the kind of care

personal care and environment necessary for a recuperative environment. Her work did much to

establish the professionalization of nursing, and normalize humane treatment into mainstream

care. Nightingale would mentor Linda Richards, America’s first trained nurse, who would bring

back her schooling experiences to the United States.

In this chapter, we have looked at medical reform in the French context: the pioneering of

hospital and treatment reform by Philippe Pinel in a post-Revolution society, aiming to integrate

an Enlightenment-based, scientific, and humanistic approach to government and public

institutions. In the next chapter, we will explore how these ideas were adopted and changed

overseas in the United States along professional and intellectual pathways, before being

reimagined in the American context by social reformers and religious groups.

BIBLIOGRAPHY

D’Alembert, Jean Le Rond, “The Human Mind Emerged From Barbarism,” in The Portable

Enlightenment Reader, ed. Isaac Kramnick (Penguin Books, 1995).

23

D’Alembert, Jean Le Rond. Preliminary Discourse to the Encyclopedia of Diderot. Trans.

Richard N. Schwab. (Chicago: University of Chicago Press, 1963).

“Enlightenment, Romanticism, and Reform,” in From Madness to Mental Health: Psychiatric

Disorder and Its Treatment in Western Civilization, ed. Greg Eghigian (Rutgers

University Press, 2010): 94-133. https://www.jstor.org/stable/j.ctt5hj05c.10

Grange, Kathleen M. “Pinel and 18th Century Psychiatry.” Bulletin of the History of Medicine,

vol. 35 no. 5 (Sep-Oct 1961).

Jones, Colin. The Smile Revolution in Eighteenth Century Paris. (Oxford: Oxford University

Press, 2014.)

Pinel, Phillipe. A Treatise on Insanity. trans. D. D. Davis, M.D. (London: Sheffield, Printed by

W. Todd, for Messers Cadell and Davis, 1806.)

The Portable Enlightenment Reader, ed. Isaac Kramnick (Penguin Books, 1995).

Rousseau, Jean-Jacques. Emile, or On Education. Trans. Allan Bloom. (Basic Books, 1979).

Rousseau, Jean-Jacques, “Profession of Faith of a Savoyard Vicar,” in The Portable

Enlightenment Reader, ed. Isaac Kramnick (Penguin Books, 1995).

Staum, Martin S., “The Late Enlightenment: Chain of Being, Chain of Truths,” in Canabis:

Enlightenment and Medical Philosophy in the French Revolution. (Princeton: Princeton

University Press, 1980).

Tocqueville, Alexis de. The Old Regime and the French Revolution, ed. Francois Furet and

Francois Melonio. Trans. Alan S. Kahan (Chicago: University of Chicago Press, 1998).

Woods, Evelyn. A., and Carlson, Eric T. “The Psychiatry of Philippe Pinel.” Bulletin of the

History of Medicine, vol. 35 no. 1 (Jan-Feb 1961): 14-25. The Johns Hopkins University

Press. https://www.jstor.org/stable/44446761

24

CHAPTER TWO

THE MORAL TREATMENT IN THE AMERICAN CONTEXT

As discussed in the previous chapter, Philippe Pinel left a remarkable legacy as a French

physician, hospital director, and author in the humane diagnosis and treatment of the mentally ill.

His proposed changes to medical methodology, asylum administration, and patient treatment

modeled the Moral Treatment for asylum patients. His most influential writings were translated

and published abroad at the beginning of the 19th century, where they were embraced by English

and Anglo-American physicians and social reformers.

The following questions will guide our exploration of mental health reform in the United

States: Which specific aspects of French social reform and the Moral Treatment made their way

to the United States? and, What did the Moral Treatment look like in the American context?

In France, the model of medical reform was contextualized within revolutionary

ideology, post-Bourbon administrative regulations, and evolving ideas of French national

identity within an intellectual culture. As described in the previous chapter, writings from Pinel,

Diderot, and Rousseau demonstrate that French humanistic reform was an intellectual and

25

revolutionary movement implemented at the government level, as humanistic reformers and

scholars were placed in positions of power to affect structural change. It was decidedly secular,

along with other post-revolutionary reforms, with overtures to deism, a

quasi-intellectual/spiritual belief system that was hands-off from established Christian sects. The

religious and social climate of the United States was dramatically different from France at the

turn of the 19th century, but nevertheless was fertile ground for the intellectual and humanist

movements from across the ocean. Although the French Revolution moved the republic away

from a model of government tied closely to religion – in part, to distinguish itself from the

divine-mandated impunity of Old Regime monarchy – reform undergirded by appeals to human

improvement, civil unity, and the creation of a more democratic, moral society was nevertheless

culturally resonant to grassroots movers and shakers in the United States, which was undergoing

a public religious revival. Much of the important literature from the Enlightenment was

translated into English and imported into American print culture, and as medical communities

formed around new academies and institutions, professional circles developed between

practitioners that transcended local interaction.

In this chapter, I will examine 19th century urban and medical reform in the United States,

specifically looking at the ways that French-centric ideals of science and enlightenment were

adopted in the American context. Many of the personal and societal appeals to humanism and

reform were embraced as an extension of fervent, hands-on religious moralism. These appeals,

finding traction in widespread, diverse reform groups, altered the religious and intellectual

landscape of the United States. One of the most influential medical reformers of this period was

Dorothea Dix, a Unitarian who fiercely critiqued existing accommodations for the mentally ill

and rallied public and political support for a change in patient treatment. Likeminded physicians

26

like Dr. Edward Jarvis worked to alter the therapeutic model from the inside these institutions,

and architects and administrators like Dr. Thomas Story Kirkbride (discussed in the next chapter)

and Frederick Law Olmsted worked to incorporate naturalistic infrastructure in urban centers,

including hospitals and asylums. In a very tangible, literal sense, this reform ideology also

marked the landscape in the construction and improvement of existing penal and medical

buildings.

THE GREAT AWAKENING AND AMERICAN PRINT CULTURE

When discussing the Second Great Awakening, many scholars describe the phenomenon

of religious revival, mass reform, and group-based activism as a “revival” of the religious fervor

and public participation from the previous century, rather than an “awakening” in the traditional

sense. A far more collective, unified movement than its predecessor, the Second Great

Awakening was as a “sprawling, grassroots movement” that took place over several decades that

changed the social and religious landscape of the United States roughly from 1790 to 184040.

Whereas the First Great Awakening was focused on Calvinist Protestant spiritual regeneration in

a colonial setting, the Second Great Awakening solidified Methodist, Baptist, Congregationalist,

and Presbyterian denominations in the juvenile nation of the United States with a strong social

component that was not always strictly theological. During this time, popular support for items

like temperance, abolition of slavery, medical and penal reforms, and universal education gained

traction41. Most historians trace the roots of religious revivalism in 1790 to local Connecticut

churches, though reified religious intensity would occur asynchronously, in different geographic

regions and at different times, beginning in New England and then spreading outward42. Ann

40 Stokes, “The Altar at Home,” pp. 21-2241 Wakefield, pp. 5-642 Conforti, pp. 100-101

27

Douglas described this period of religious fervor, where new churches, new sects, and new

leaders could spring up “practically overnight”43.

While charismatic religion spread like wildfire through word of mouth, it was also

facilitated by narratives borne in print44. Local print in France, England, and the United States –

as well as transatlantic communication between the three – and the experiment, contestation, and

performance surrounding these publications and their underlying ideas created a platform for a

kind of radical culture45. In an essay, Citizen Lee, a British man exiled to Philadelphia, expressed

the potential for print media to be a forum to determine the “general will” of a people46. While

proposed radical reforms were controversial in the United States, especially with respect to the

nationwide debate surrounding abolitionism, print media did become a significant forum for

public debate. Even in the absence of consensus, the surviving historical newspapers, letters,

statements, texts, and pamphlets from this time period nevertheless portray a vibrant discourse.

Although the Great Awakening is primarily characterized as a significant religious

movement in American history, it notably challenged the religious orthodoxy from where it

originated in New England, upending established conventions and hierarchies within traditional

American Protestantism and serving as a backdrop to larger cultural shifts.47. Compared to

historic, structural changes in Christian religious institutions, the Second Great Awakening was

not a “clergy-inspired campaign of social control”; instead, the revival can be more meaningfully

interpreted as an institution-building process, a cultural revitalization movement, and a woman’s

awakening48. This was significantly different from the minister-led fervor of the First Great

Awakening, suggesting greater democratic involvement and participation by churchgoers. 43 Stokes, p. 2244 Mee, p. 145 Mee, p. 146 Mee, p. 6147 Stokes, p. 2148 Conforti, “The Invention of the Great Awakening” p. 99

28

Missionaries and enthusiasts were also key in recruiting Americans to these active religious

denominations. Missionaries and enthusiastic members of these growing congregations made the

movement accessible, incorporating many people, “whom the establishment could not [or did

not] reach,” into participating members of society at large in an age when church membership

provided social as well as religious standing49. In a way distinctive from the First Great

Awakening, Methodist and Baptist sects were extending church life rather than restricting it,

recruiting Christians by the thousands, versing them in the language of evangelical Christianity,

and allowing a forum for public participation covering diverse issues50.

Relying on a familiar, historically-significant and remembered method of garnering

support, Great Awakening ministers mimicked the tactics of the Revolutionary resistance by

establishing circular letters and a committee of correspondence to raise awareness for religious

events. Materials, both revived from the previous movement and new publications, were placed

into circulation51. Unsurprisingly, the rise of religious democratic print culture began during the

Second Great Awakening52. Similar to the what Tocqueville described as the Republic of Letters

of France, democratic print culture in the United States created a forum for the exchange of

ideas, especially within and between emerging groups related to reform ideology: women’s

temperance, abolitionism, public education, prison and hospital reform, among other things.

While the audience for the consumption of written materials was certainly limited to a select

number of educated persons, the spread of these ideas into the hands of the literate, and then into

the greater public via preaching, debate, and performance still effectively energized a more

widespread movement than seen previously in American history.

49 Mathews, p. 2650 Mathews, p. 2651 Conforti, 10152 Conforti, 106

29

WOMEN, REFORM, AND THE PIONEERING OF MENTAL HYGEINE IN THE U.S.

The beginnings of these reform movements in the Great Awakening preceded the labor

law reform, construction of the idea of childhood, and the government infrastructure to provide

for universal public education; this is sensible, as the former understandable lay the foundation

of the latter. Because of this, educated leaders, professionals, and pioneers necessarily initiated

many of the major reforms of the 19th century before they were incorporated into a larger

audience of support. As opposed to France, where women were eventually pushed out of the

public theater of discussion as the Revolution began to resemble an increasingly patriarchal and

paternalistic model, 19th century United States reform movements had a passionate and

contributing demographic: conscientious women.

At this time, gender roles in society were understood as a matter of complementarity,

where men and women occupied two distinct but compatible spheres. Men, who were naturally

outgoing and authoritative, operated outside the home in the public sphere; women, who were

nurturing and sometimes even more moral than men, were relegated to the domestic sphere, in

the care and keeping of the home and children. This is compatible with the Victorian-era

intellectual legacy best conceptualized in Barbara Welter’s “Cult of True Womanhood,” which

defined the proper woman – and moreover, a lady – as extolling the “four cardinal virtues” of

piety, purity, domesticity, and submissiveness53. Based on this code of conduct, a woman’s virtue

– or lack thereof – was determined by her religious devotion, sexual purity, prowess as a

homemaker, and subservience to the men in her life54. This rigid, prescriptive model typically

kept women out of political or social movements. Throughout the 19th century, however, women

slowly carved a space in the public sphere for themselves, either by rejecting these social norms

53 Welter, “The Cult of True Womanhood,” p. 15254 Dicker, History of U.S. Feminisms, pp. 21-22

30

entirely, or capitalizing on the supposed difference between men and women to the fullest: in the

argument that, precisely because women were essentially more virtuous and moral, they had a

natural aptitude to contributing to the community as an extension of their domestic acumen55.

Although this was not without controversy, women were instrumental in the creation of

institutional reform in prisons, almshouses, hospitals, schools, and much more.

In the decades leading up the Civil War, Dorothea Lynde Dix (1802-1887) was one of the

most famous young American reformers for her dedication to improving the state of domestic

mental hygiene by establishing and improving hospitals throughout the nation. A symbol of

women’s good works, Dix “single-handedly created most of the 19th century pubic institutions

east of the Mississippi River that served people with mental illness”56. While this claim seems

exaggerated on its surface, historians have been able to identify at least thirty facilities for the

specific treatment of the mentally ill that were founded or expanded directly thanks to Dorothea

Dix57. Over a hundred more hospitals would be built in the ensuing “medical revolution” in the

United States58. Unique among reformers of a New England background, Dix was able to

successfully cross the Mason-Dixon line and receive audiences in Southern states59. Whereas

regionalism divided religious denominations and group reform efforts on many fronts in the 19th

century, Dix’s crusade for the treatment of the mentally ill was prolific and successful across

traditional geographical distinctions. Of the minimum of thirty hospitals accredited to Dix, nine

of them were established in as public facilities in the South60.

Dix was born into an old trading family, whose fortunes had been dashed by trade

embargos and war displacing the family from Boston. What little is known of her childhood 55 Dicker, p. 4656 Muckenhoupt, Dorothea Dix: Advocate for Mental Health Care, p. 757 Parry, “Dorothea Dix (1802-1887),” p. 62458 USA Embassy, “Memorial to the Massachsetts Legislature”59 USA Embassy, “Memorial to the Massachusetts Legislature”60 USA Embassy, “Memorial to the Massachusetts Legislature”

31

indicates a less-than-charmed upbringing, with little to no formal education; shortly into her

teenage years, it was arranged for her to live with a relative who had married into the upper-class

Fiske family61. Rejecting the Methodist faith of her family, Dix more closely identified with

Unitarian principles. To supplement her education, Dix took advantage of her broadened social

circle through the Fiske’s and her friend Anne Heath, attending Unitarian sermons and college

lectures for self-education, and imparting a rigorous moral education to students as a young

schoolhouse teacher she created for charitable purposes62. In between her own intellectual

pursuits and fits of poor health, Dix would open several schools for young women and girls as

she moved throughout New England.

Almost every aspect of Dix’s life showed a lack of convention to social norms: rejecting

overtures of marriage, traveling, teaching, and writing for the public all demonstrated a

passionate, intellectual spirit focused on self-discipline and the purity and spiritual development

of thinking. Dix’s time abroad in England, however, dramatically influenced her trajectory as a

mental health reformer63. With her upper-class family relationships and role as a teacher to well-

to-do young women in New England, her social reality was already mired in connections to the

wealthy and influential domestically. In England, these connections only grew: traveling

overseas for health reasons, Dix stayed in the household of British politician and reformer

William Rathbone, and built friendly and professional relationships with Elizabeth Fry, a prison

reformer, and Samuel Tuke, founder of a York retreat for the mentally ill64. Although these

relationships were an extension of Dix’s own self-education and improvement as a thinker and

61 Muckenhoupt, p. 1262 Muckenhoupt, p. 1563 USA Embassy, “Memorial to the Massachusetts Legislature”64 Parry, p. 624

32

Unitarian, they also seemingly primed her for her return to the United States as a reformer

invested in humanitarian interests.

Following her year abroad, Dix returned to Boston, and later took over a Sunday School

class at the Middlesex County House of Correction in East Cambridge on the request of a

Harvard Divinity School student in 184165. This was a women’s correctional facility, and to her

horror, Dix noted that mentally ill patients were being housed in cells alongside the common

criminals66. A resolution passed by the Massachusetts General Court provided that “a suitable

and convenient apartment or receptacle for idiots and lunatics or insane persons not furiously

mad,” be provided to the public for the care of the mentally infirm, away from the prison

system67. Despite this, conditions for mental health patients remained widely varied, and the

quality of housing and care depended on each individual institution. Surprised at the cohabitation

of patients with inmates, sometimes with many persons huddled in a small room without any

source of heat, Dix complained to the next door county courthouse and convinced them to heat

the cells68.

This small act of righting wrongs trigged a lifelong career of hospital tours, cross-country

travel, and advocating for the mentally ill on the local, state, and federal levels. Following the

death of her grandmother and subsequent inheritance, Dix achieved the financial security to

devote her life to humanitarian reform, and she began to research and reach out to her

professional, religious, and social contacts to battle governments resistant to change69. Dix

insisted that the government should aid its most helpless citizens – including prisoners, the poor,

and the mentally ill – and galvanized both popular or influential support to achieve this70. 65 Muckenhoupt, p. 4266 Muckenhoupt, p. 4267 Massachusetts General Court, “Annual Report ,” p. 8968 Muckenhoupt, pp. 42-4369 Muckenhoupt, p. 4370 Muckenhoupt, p. 7

33

Already a prolific writer and orator, she critiqued the squalid conditions of many of the hospitals

she visited from both the print and the podium. The following is an excerpt of Dix’s address to

the Massachusetts State Legislature:

About two years since leisure afforded opportunity and duty prompted me to visit several prisons and almshouses in the vicinity of this metropolis. I found, near Boston, in the jails and asylums for the poor, a numerous class brought into unsuitable connection with criminals and the general mass of paupers. I refer to idiots and insane persons, dwelling in circumstances not only adverse to their own physical and moral improvement, but productive of extreme disadvantages to all other persons brought into association with them. I applied myself diligently to trace the causes of these evils, and sought to supply remedies. As one obstacle was surmounted, fresh difficulties appeared. Every new investigation has given depth to the conviction that it is only by decided, prompt, and vigorous legislation the evils to which I refer, and which I shall proceed more fully to illustrate, can be remedied. I shall be obliged to speak with great plainness, and to reveal many things revolting to the taste, and from which my woman's nature shrinks with peculiar sensitiveness. But truth is the highest consideration. I tell what I have seen--painful and shocking as the details often are--that from them you may feel more deeply the imperative obligation which lies upon you to prevent the possibility of a repetition or continuance of such outrages upon humanity…71

Dix goes on to discuss the various ways that prisons and hospitals were involved in

“legalized barbarity”72. In cities crisscrossing the United States, Dix outlines the abuses she has

witnessed firsthand: neglect of female patients, patients in cages, closets, cellars, pens, the ill

being chained and beaten, and accommodations with little to no furnishings73. Although these

descriptions are shocking, they might in part be attributed to an antiquated method of treating the

mentally ill. Known as the “heroic treatment,” this method of healthcare was meant to exhaust

and fatigue patients to suppress symptoms of insanity: the use of restraints, as well powerful

drugs like opium, morphine, laxatives, vomit-inducing ipecac helped facilitate the heroic

treatment74. It is difficult at times, however, to distinguish between expressions of the heroic

treatment or simple maltreatment and neglect in hospital conditions, which is problematic.

71 Dix, “Memorial to the Massachusetts Legislature”72 Dix, “I Tell What I Have Seen”73 USA Embassy, “Memorial to the Massachusetts Legislature”74 Muckenhoupt, p. 46

34

Realistically, the heroic treatment might also have more practically been employed as a method

for prison, almshouse, and hospital staff to more easily control these mentally ill persons.

Samuel Gridley Howe, director of Perkins Institute for the Blind, was similarly invested

in the care of the insane as a “pet interest” and was a part of Dix’s inner circle, working with

young physicians like Edward Jarvis in opposition to the heroic treatment75. Dix, Jarvis, and

others fiercely denounced this method of healing as both inhumane and thoroughly

counterproductive to recovery. Jarvis critiqued institutions employing this method as punitive

and controlling, rather than therapeutic, and moreover, “an asylum for men’s fears, and prisons

for lunatics”76. By this time, Pinel’s model of the Moral Treatment had since migrated to the

United States by way of intellectuals and physicians like Dix, Howe, and Jarvis. Jarvis himself

wrote of Pinel’s heroic unshackling of the women in France, and suggested that the moral

treatment be used in the place of the heroic treatment77. Under this model, asylums could still be

a controlled environment with necessary discipline and hard work; however, instead of

aggravating a patient’s illness and restraining or drugging them into catatonia, proponents of the

moral treatment suggested moving patients to dedicated asylums, and keeping them calm and

busy with daily routine, hobbies, jobs, and proper counseling and treatment by asylum staff78.

Dix’s tireless advocacy consistently emphasized these key messages: mental illness was a

disease that could be treated like any other, the United States was lacking in the proper

institutional framework necessary to provide for prisoners, and existing methods of disease and

patient treatment needed to be improved to a higher standard. It also highlighted the need for a

social safety net. Her career as a humanist reformer credibly made Dix a leading figure in

75 Muckenhoupt, p. 4576 Jarvis, p. 377 Jarvis, p. 678 Muckenhoupt, p. 46

35

national and international movements that challenged the idea that the mentally ill could not be

cured, and her connections in the United States and overseas insinuated herself and the nation in

an evolving debate on the moral treatment of patients79.

OLMSTED, URBAN LANDSCAPING, AND REGENERATION

Much of this paper has been concerned with the abstract: changes in thoughts, ideas,

culture, and national identity. This is necessary to understand the intellectual and cultural

foundation on which new hospitals and mental health asylums were founded. It is equally

important, however, to understand the ways in which these new ideas and cultural changes were

embodied by the populace and marked upon the topography of the United States in a very

tangible sense. The many hospitals built in the wake of the Great Awakening and tide of reform

movement popularized by democratic print culture were not just institutions of thought: they

were physical structures based on a naturalistic design, blueprinted with amenities both practical

and comfortable for patients and physicians, and embodying efforts to change the landscape of

urban centers.

As discussed in the previous chapter, Enlightenment thinking in Europe and the United

States frequently romanticized and idealized the concept of “nature.” Rousseau, in particular,

idealized nature as not only rational and understandable, but a model free from corruption – and,

the closure one’s society resembled nature, the more virtuous and just that society tended to be.

Overtures concerning a return to nature in order to revitalize the human mind and body went

beyond the intellectual, however; it also resonated with deep-seated anxieties in the Western

model of medicine concerning the impact urban dwellings had on the body. As people began to

see mental illness as similar to physical illnesses, in that it could be logically understood and

79 Parry, p. 624

36

treated, concerns about urban dwellings affecting the mental state of its residents became a

concern.

This concept of returning to nature is also reflected in Dorothea Dix’s life. She collected

seaweed samples for Benjamin Silliman, editor of the American Journal of Sciences and Arts,

which was the most prestigious academic journal in the country at the time, and contributed

writings on insect specimens and metamorphosis in the same journal80. Even as a teacher, she

kept herself busy with her writing and other activities, which had a strong interest in nature. In

her work as a schoolteacher, she emphasized a moral education alongside a strong, customized

lesson plan involving the natural sciences. In her travels, Dix was horrified by the degradation of

the local environment, as with the Danish West Indies’ colonial sugar cane plantations81. It was

the enslavement of the island’s land and resources that horrified Dix, perhaps more so than actual

slavery.

The significance of recreating a natural environment even in sprawling urban centers can

be seen in the 19th century development of public parks, memorial-style park-cemeteries,

schools, and asylums. Frederick Law Olmsted (1822-1903), an American landscape architect and

social critic in the 19th century American republic of letters, and his audience was wide,

including editors, writers, scholars, politicians, intellectual leaders, and shapers of public

opinion82. Experienced in large-scale landscaping and administration, many famous landmarks

and public parks – Walnut Hill in New Britain, Central Park in New York City, and the Niagara

Reservation in Niagara – are attributed to the projects consulted on by Olmsted and his sons.

Given the receptiveness of the public to the romanticism of the era, as well as lingering anxieties

80 Muckenhoupt, p. 3181 Muckenhoupt, p. 3182 Roper, p. 459

37

surrounding cramped cities, the beginnings of an organized conservation movement in the

United States can be found within these projects.

The benefit of replicating nature in society, both in an intellectual and physical way, are

seen in more than just public parks. As advocates stressed the need to supplant the heroic

treatment with the moral treatment and pre-existing cramped, fetid asylums were deemed

inhumane, new institutions were built with the moral treatment in mind. In order to better care

for patients, larger facilities with practical and comfortable amenities were created, incorporating

similar concepts from Olmsted’s own plans.

The Olmsted Heritage Landscapes Act was drafted in order to “help identify,

commemorate, and preserve the historic landscapes of Frederick Law Olmsted, Sr., his sons and

associates”83. Although this law was drafted long Frederick Law Olmsted’s life, it nevertheless

commemorates the beginning of a conservation movement in the United States, as well as

leaving a tangible legacy of the romantic intellectual and spiritual movements of the 19th century,

which yearned for a greater connection to the natural world for a better society, better health, and

better spiritual wellness.

In the next chapter, we will make a further effort to look at the way that these intellectual

and religious reform movements were also integrated into new ways of looking at,

understanding, and sculpting the physical world, from altering the landscape to greater

mindfulness in the construction of new buildings and institutions, especially asylums and

hospitals.

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83 Committee on Interior and Insular Affairs, p.

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(Cambridge: Cambridge University Press, 2016).

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University Press, 2013).

39

Parry, Manon. “Dorothea Dix (1802-1887),” In American Journal of Public Health, vol. 96 no. 4

(April 2006): 624-625.

Roper, Laura Wood. “Frederick Law Olmsted in the “Literary Republic”,” in The Mississippi

Valley Historical Review, vol. 39 no. 3 (1952): pp. 459-482.

Stokes, Claudia, “Revivals of Sentiment: Sentimentalism and the Second Great Awakening,” in

The Altar at Home: Sentimental Literature and Nineteenth-Century American Religion.

(The University of Pennsylvania Press, 2014).

Wakefield, John F. “The Second Great Awakening and American Educational Reform: Insights

from the Biography of John Milton Gregory.” Vitae Scholasticae, (2011): 5-27.

Welter, Barbara. “The Cult of True Womanhood, 1820-1860,” in American Quarterly vol. 18 no.

2 (Johns Hopkins University Press, 1966): pp. 151-174.

CHAPTER THREE

“IDIOCY” AND ITS INSTITUTIONS

40

While the Enlightenment discourses concerning nature, individual rights, and social

institutions are important in understanding the changing way professionals diagnosed and treated

the human body in a very academic and professional sense, it’s also important to understand the

ways that the emerging field of psychology, psychiatry, and medical theory are more implicitly

integrated into the lifeways of others unrelated to the fields of medicine, activism, and politics.

Sociologists and anthropologists interested in the field of body studies point to the development

of a “somatic society” in late modernity, where the body is an interface of political and cultural

activity in modern social systems84. While academic sources mostly analyze somatic societies as

a phenomenon of the modern era, I would argue the emergence of a body politic can be found

even earlier in the history of the United States, beginning with the passionate, spiritual

humanistic activism and medical reform of the mid 19th century that invoked an interest in the

human body: how it functioned, how it should be treated, and how it should be talked about.

In the republic of letters, the health, shape, or appearance of one’s own body was

deliberated as an extension or expression of individual, group, cultural and religious identities85.

They also intersected with religious and secular idea of purity, virtue, or even patriotism. These

concerns also worried over the state of the mind as a physical structure, and mental hygiene as

possibly expressing a positive or negative national identity. In France, everything from the

humane treatment of the mentally ill to the emergence of smiling in formal portraiture thanks to

the emergence of professional dentistry became an extension of the French national character86.

In the United States, moral concerns related to Great Awakening spirituality and social reform

saw the treatment of prisoners, patients, and children as a reflection on the conscience of the

nation. Given anxieties about mental health and growing concern for the status of the infirm, the

84 Schilling, p. 285 Schilling, p. 286 Jones, Smile Revolution

41

insufficient institutions that reformers like Dix identified showed a growing need for new public

works projects.

In this chapter, I aim to contextualize historical primary sources on Kirkbride-modeled

mental institutions from an anthropological perspective. Building off the previous two chapters

of analysis pertaining to revolution, humanism, reform, and the development of modern

psychiatry, I want to then interpret the way that these nebulous intellectual movements actually

manifested on the physical landscape of the 19th century United States through the specific case

study of the Syracuse State School. Through archival materials, I hope to interpret the ways these

buildings incorporated new medical principles, how these principles shaped the daily lives of

faculty and students, the goal of these facilities, and the tension between patient and pupil in the

treatment and nomenclature of idiocy.

ARCHITECTURAL ANALYSIS OF KIRKBRIDE INSTITUTIONS

WHEREAS, the Board of Directors of the North Carolina Insane Asylum have heard with deep regret the announcement of the death of Dr. Kirkbride, therefore be it… Resolved, That the Board desires to express and record its sense of appreciation of the eminent services rendered to humanity by Dr. Kirkbride… That the unfortunate insane have ben deprived of a great, kind, and tireless friend, and the managers of asylums of a wise benefactor and teacher.87

Prior to the creation of the United States as an independent nation, Pennsylvania was the

first of the thirteen original colonies to recognize the need for hospital care88. The Pennsylvania

Hospital in Philadelphia was one of the earliest public teaching hospitals in America. One

famous example among its notable staff was Benjamin Rush, an original signatory of the

Declaration of Independence who was also a physician, educator, and reformer noted for early

involvement in the field of psychology89.

87 Curwen, Nichols, and Callender, p. 488 Tomes, p. ix89 Tomes, p. ix

42

The Pennsylvania Hospital continued to be an intersection point for many important

reformers moving forward into the 19th century: Thomas Story Kirkbride, a young surgeon,

would be appointed superintendent of a branch of the hospital devoted specifically to the

mentally ill, and his treatment philosophy would become the standard of care in the field.

Described as good-natured and soft-spoken, Kirkbride nevertheless was a kind of “moral

entrepreneur” whose force of personality secured him forty-three years as chief physician of the

Pennsylvania Hospital90. He was also, importantly, descended from a venerable Bucks County

Quaker family. Similar to the stories of Philippe Pinel, Kirkbride accepted carriage loads of

“hopelessly insane patients” who had previously been in seclusion and deemed unable to receive

further active medical or psychological treatment91. Restraints were removed, and patients were

able to freely move through the wards, congregating in dining halls together, under the eyes of

attending physicians and nurses. Importantly, these wards lacked “tranquilizer chairs,” leather

cuffs, straightjackets, and other binding implements that were thought in older hospitals to be

necessary for the heroic treatment – or, at the very least, the physical control – of psychiatric

patients92. Protocol demanded that, in the case of patient misbehavior or violence, the patient was

to receive a stern warning and, failing that, would be confined to their rooms until they calmed

down93.

Following his death, his colleagues within the Association of Medical Superintendents of

the American Institutions for the Insane mourned his passing but touted Kirkbride’s legacy: his

publications in the field of psychiatry and asylum keeping, his reputation in the medical

90 Tomes, p. 4491 Tomes, p. 1992 Tomes, p. 1993 Tomes, p. 21

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community, and the dozens of psychiatric institutions modeled after his designs would remain,

such that “Dr. Kirkbride can never die”94.

The perspectives of social reformers like Dorothea Dix and a new generation of

physicians like Edward Jarvis revealed the absence of proper mental institutions and the

inadequacies of existing structures, which were often reliant upon prisons or almshouses. The

construction and administration of new institutions were needed. Dr. Kirkbride’s publication, On

the Construction, Organization, and General Arrangements of Hospitals for the Insane, was

largely influential in the field of asylum keeping, which was one and the same with the field of

psychiatry at the time, since the asylum was the central institution to the treatment of mental

illness. In it, Kirkbride describes the conditions necessary for thee “ample provision, not only for

the proper custody, but also for the most enlightened treatment of all of the insane within [the

state’s] borders”95. Apart from strong connections to the moral treatment as the new therapeutic

model, its most significant contribution was the architectural and organization model for mental

hospitals96. While Pinel is not mentioned by name, clear references to the moral treatment are

seen throughout the dialogue of mental health institutions. Given the glaring deficiencies of

existing institutions, Kirkbride argued that many needed to be rebuilt to entirely to new

specifications, if not modified and expanded at great expense. It was significant to get the details

right: according to Kirkbride, and other post-Enlightenment physicians in the traditions of Pinel,

most patients of the varying breeds of insanity could be cured, with Kirkbride suggesting a

success rate of 80 to 90 percent under the right conditions97.

94 Curwen, Nichols, and Callender, p. 695 Kirkbride, p. 196 Pérez-Fernández and López-Muñoz, p. 33897 Kirkbride, p. 2

44

Kirkbride argued for a building style that was plain but agreeable; not extravagant, but

able to completely accommodate the needs of its patients98. Many of the guidelines outlined by

Kirkbride would be integrated into new buildings throughout the United States – leaving room

for some architectural individuality that varied from institution – but these so-called “Kirkbride

buildings” were nevertheless identifiable in shared visual characteristics,99 and contributed to a

lively discussion in the field of hospital design100. Visually, these buildings could be identified

face-on by the sprawling “bat wings” style of its floor plan, connected by a central block (Figure

4)101. The first building created in this style was built in New Jersey in 1848, and the facility was

later renamed the Trenton State Hospital (Figure 5).

Figure 4: A plate from the original Kirkbride Plan, 1854

98 Kirkbride, p. 499 Pérez-Fernández and López-Muñoz, pp. 338-339100 Tomas, p. 131101 Pérez-Fernández and López-Muñoz, p. 339

45

Figure 5. Engraving of the Trenton State Hospital, undated

Apart from the distinctive bat-wings style of the Kirkbride hospital wards, On the

Construction, Organization, and General Arrangements of Hospitals for the Insane outlined

other critical elements in the construction of new public asylums. The central block would

function as administrative hub, housing the kitchens, storerooms, reception area, business office,

medical office, faculty apartments, and lecture room and chapel102. The outward wings were

gender-segregated wards. The orientation of the building was to take into account sunlight,

winds, and access to the outdoors – and the wings were lined with tall windows, especially in

patients’ rooms, to facilitate natural ventilation and to give patients “every advantage of light,

air, and scenery”103. Within the guidelines for building instructions, Kirkbride writes several

pages on the specifications of windows. The connection between healing and natural spaces is

reflected throughout Kirkbride’s manual, as he expands on the importance of the hospital

grounds: he encourages access to a veranda and awning, well-tended grounds, a farm, garden,

102 Kirkbride, p. 12103 Kirkbride, p. 13

46

outdoor sports recreation facilities, and workshops104. Moving away from the old model of

patient confinement, the importance of outdoor labor, physical exercise, and recreation were seen

as fundamental in patient comfort, happiness, and health. In France, Pinel remarked on the

calming effects manual tasks and mild stimulation had on patient calmness and concentration;

establishing a daily routine and work schedule as an early kind of occupational therapy was also

imported into American mental institutions105.

Many of the concern and guidelines in On the Construction of Hospitals seem mundane,

and the proposed changes were not altogether ideas unique to him, making Kirkbride perhaps

more properly a rationalizer rather than an innovator. As with Florence Nightingale’s Notes on

Nursing, many of Kirkbride’s concerns centered on how hospital administrations and staff could

aid in the creation of a “moral architecture”: the development of an institution with the proper

plumbing, space, ventilation, heat, and light to be both extremely functional and comfortable106.

These building conditions, as they existed and as they became aspirational, are things that the

modern reader may take for granted today, underscoring the importance of regulation in design,

hospital administration, and state oversight as a developing practice in the latter half of the 19th

century.

As state governments began to take action, spurred on by new science, medicine, and

pressure from humanitarian reformers and professionals like Dorothea Dix and Edward Jarvis,

the latter half of the 19th century was marked by a wave of asylum-building. Of the

approximately 130 to 140 hospitals built in Dix’s time, at least 70 of them were modeled after

the Kirkbride Plan, including the Syracuse State School, located in Geddes, New York107.

104 Kirkbride, pp. 61-63105 Pérez-Fernández and López-Muñoz, p. 342-432106 Tomas, pp. 130-131107 Pérez-Fernández and López-Muñoz, p. 341

47

SYRACUSE STATE SCHOOL

Figure 6. Map of the State Idiot Asylum, 1874 Figure 7. Syracuse Idiot Asylum, 1910

In 1851, The New York State Asylum for Idiots was authorized in Albany, New York, as

a hospital and school devoted to the treatment of the mentally ill children. Three years later, the

institution was moved to rural Geddes, New York, just a short mile south of the city of Syracuse

in Burnet Park. It opened at its new location, fully furnished and functional in 1855. The state

generated 73,000 dollars for the construction of the new hospital108, with another 13,000 dollars

for necessary scholastic and dormitory furnishings109. When its doors opened, the Governor,

Lieutenant Governor, and Secretary of State acted as members of the board, and hailed the

institution as a sign of the growing prominence and affluence of the Syracuse area, and the city’s

“elegance” and “social refinement” compared to other urban areas throughout the state110. Its

enrollment was quickly filled: fifty pupils transferred from the temporary location in Albany to

bring the school to capacity, with yet another fifty applications from throughout New York State

pending.108 New York Times, “The State Idiot Asylum”109 New York State Legislature, p. 348110 New York Times, “The State Idiot Asylum”

48

The New York State Asylum for Idiots was one of the many institutions created from

roughly 1850 and onward, in the wake of social reform movements and in the image of the

hospital designs proposed by Dr. Thomas Story Kirkbride. Its first superintendent was Hervey B.

Wilbur, a student of French physician and educationist Édouard Séguin, who was well known for

his work in France and the United States with cognitively-impaired children. Wilbur’s dual

academic pedigree – medicine and education – is reflected in both the patient intake and

therapeutic model of the New York State Asylum for Idiots, also known simply as the “State

Idiot Asylum”. According to the New York Times, “[the] Idiot Institution is more properly a

school than an Asylum”111. The State Commissioner in Lunacy identified the State Idiot Asylum

for a select group of the state’s youth “who are of a proper school attending age”, were “between

the ages of seven to fourteen… [and] idiotic, or so deficient in intelligence as to be incapable of

being educated at any ordinary school,” and were otherwise not “epileptic, insane or greatly

deformed”112. Therefore, a criterion for admittance was based around a student’s age,

classification of mental illness, and absence of other serious illnesses or conditions that otherwise

would make the opportunity for wellness and re-integration into society impossible.

Its curative model involved the same kind of occupational therapy as other Kirkbride

institutions, as well as a heavy educational component, and its instruction was tailored to

“prepare inmates for self-help and independence,” with the ultimate goal being discharge from

the hospital and employment in the work force113. This facility was the only one of its kind in

New York State at the time, and its dual-function as both asylum and school created a niche for

the State Idiot Asylum as a specialized medical facility for a selective group of patients, rather

than a general public hospital for all manner of infirm persons.

111 New York Times, “The State Idiot Asylum”112 New York State Legislature, p. 355113 New York State Legislature, pp. 352-353

49

Archival materials from Special Collections at the Syracuse University Library offer

contextual clues to the administration and appearance of the Syracuse State School throughout

the mid-to-late 1800s, and the daily lives of students, faculty, and staff. Business records

archived from the month of May 1869 show payroll records for the wages of servants and

attendants, listing the employees by name, time, service, and payment tendered. While this only

a fraction of their business records for the operating year, it does offer some insight into the kind

of care and services the school provided children, apart from the attending physicians and nurses.

The diversity of staff of is interesting: multiple chefs, a baker, laundresses, tenants, dining room

staff, seamstresses, hall and table girls, teachers, housekeepers, a steward, and gymnasium staff

worked inside the walls of the State Idiot Asylum, while a farmer and multiple gardeners cared

for the campus grounds114. Original student enrollment was only for fifty children when the

asylum opened; by 1888, state records suggest the institution’s success, with around four

hundred children, half girls and half boys, attending the State Idiot Asylum. In reaction, the

school experienced several architectural expansions and the faculty and staff swelled in numbers.

Although the prevailing theory of mental rehabilitation emphasized the need to remove ill

persons from their families and community – hence the prevalence of asylum-type institutions as

the primary method of formal treatment – payroll diversity and supply invoices show an effort to

make the grounds comfortable, natural, and home-like in its furnishings and self-sufficiency.

Receipts and grocery audits show a varied diet, as well as seasonal meats and sides to be served

during the holidays; one of the kitchen staff was specifically designated as a baker, to create

breads and sweets115. Other miscellaneous invoices were for freight, shoe and clothing repair, as

well as orders of tulip bulbs rom Vaughan’s Seed Store. Among all the possible business records

114 Syracuse State School Collection, Box 1, Folder Business Records115 Syracuse State School Collection, Box 1, Folder Business Records & Miscellaneous

50

to survive, the order of tulip bulbs is very specific; and, when compared wages among all types

of staff, gardeners and farmers made a maximum of three to four times the amount of the

majority of staff, except for doctors, administrators, and educators116.

Figure 8 (top): an advertisement for a new heater, for commercial or private use. Given the importance of ventilation in Kirkbride plans, and the severity of the Syracuse winter, technology like this would have been essential seasonally. (Syracuse State School Collection)

Figure 9 (bottom): an invoice from a local greenhouse and nursery for tulip bulbs. The rural location of Burnet Park and the care and maintenance of the grounds were integral to the administration of the Syracuse State School throughout its history. (Syracuse State School Collection)

The comparisons between the Syracuse State School and other Kirkbride institutions in

New England and the tri-state area underscore the common elements of Dr. Thomas Kirkbride’s

hospital planning that resonated with a new wave of asylum administrators, physicians, and

116 Syracuse State School Collection, Box 1, Folder Business Records

51

educationists. When comparing the Syracuse State School visually with, for example, the

Trenton State Hospital – a textbook example of Kirkbride’s original plans, and the first

institution based on those blueprints – they are architecturally similar. Postcards, engravings, and

photographs of the two buildings show a similar bat-wing structure originating from a central

administrative hub, the signature architectural structure of Kirkbride institutions. Importantly, we

see the presence of windows for natural light and ventilation, as well as the placement of these

institutions in rural areas or, when being subsumed by encroaching urban districts, the efforts

made to incorporate naturalistic aspects into the landscape. The Syracuse State School, for

example, was set east into the hills, and within sight of the Onondaga Lake. The money set aside

for grounds keeping staff, the erection of the Geddes location within Burnet Park, and archival

materials relating to the importance of trees, open lawns, manicured hills, and gardens all show a

dedicated effort and commitment of resources to provide a natural space for the recuperation and

recreation of students. In sum, the creation of these new institutions to naturalistic expectations

was important, because of the belief that patients could be effectively cured, but only through

these new, enlightened methods.

IDIOCY, AND OTHER MENTAL DEFECTIVES

Thus far, I have neglected discussing the disease terminology of mental health nosology

following the late 18th century wave of asylum reform in France, Britain, and the United States in

any great detail. This is for two reasons: 1) Many of the terms used to describe specific clusters

of symptoms or diseases are today recognized as being altogether nonexistent, or under another

diagnostic scheme and name according to the Diagnostic and Statistical Manual of Mental

Disorders (DSM-5), and 2) Many of these terms are pejorative in the modern understanding, and

have little to no connotation with historical context in our cultural memory. Still, the modern

52

reader may find the references to the hospital patients in these historical documents as shocking:

in the previous chapters, many primary resources from educated, esteemed, and supposedly

“enlightened” individuals like Philippe Pinel and Dorothea Dix have casually referred to the ill

as lunatics, idiots, and mental defectives, among other things. The disconnect between the

pedigree of these authors and their aim for humanitarian compassion and reform suggests that

these terms were, in the time of their usage, not insults, but matter-of-fact classifications of the

presence of illness, just like “consumption” described what today we would diagnose as

tuberculosis.

According to sociologist Chris Schilling, who has also contributed extensively to the

anthropology subdiscipline of “body studies,” the modern era has shown us an important paradox

relating to the body and the self in the context of a somatic society:

We now have the means to exert an unprecedented degree of control over bodies, yet are living in an age that has the potential to throw into radical doubt our knowledge of what bodies are and how we should control them117.

As I have argued, the roots of today’s somatic society can be traced to important

intellectual, medical, and public health conversations occurring in the middle of the 19th

century’s wave of social reform. As the body was being studied and treated by post-

Enlightenment thinkers, reformers, and educationists, the type of dialogue surrounding the

human body and the specific semantics used to describe it became important, and sometimes

those terms were subject to rapid change. The way these patients, these bodies, and these

illnesses were spoken about was important in placing familiar illnesses within a new intellectual

paradigm, including an evolving disease model.

In the early days of medical anthropology, ethnography and cross-cultural ethnology

often described the medical systems they were studying as a cultural or ethnic model in contrast

117 Schilling, p. 4

53

to the system of biomedicine seen in North America and Europe. Critical medical

anthropologists, however, have suggested this created an implicit bias in the study of medical

systems separate from the researcher’s culture of origin – that Western biomedicine, which

emphasizes heavily a clinical perspective of care, is a standard that others are to be compared to,

suggesting a degree of under-sophistication in other models. Rather than comparing “us,” or

“them,” it is important to understand that all medical models are influenced by the culture they

are contextualized in, and that “biomedicine” or “cosmopolitan medicine” are also an ethnic

model very much influenced by social and cultural factors. These biases are easy to forget in the

moment, but become clear when studying the “backwards” moments of our own history of

medicine compared to today.

The changing dialogue in the field of mental health and disease nomenclature is

paralleled by the continuous branding and re-branding of the Syracuse State School. When the

state government in Albany originally issued the license, it was called the “New York State

Mental Asylum for Idiots,” or the “State Idiot Asylum” for shorthand. In the following hundred

years, its name would be formally changed several times: to the Syracuse State School for

Feeble-Minded Children, then the Syracuse State School for Mental Defectives, and finally,

simply the Syracuse State School, for which it is most commonly referred to today. These names

show the tension in the field of medical reform and the urge to better classify and treat illnesses.

The mixed utility of the campus and the campus’ name change also offers insight into the tension

between whether the enrolled children were primarily “pupils” or “patients,” remaining anxieties

about mental illness, and the aspirational hopes that these young persons might be reintegrated

into society as “normal.”

54

Figure 10: Two different postcards from the Syracuse State School Collection, demonstrating two different official names used by the asylum in its history.

Given more time to study this topic, I would expand the scope of this paper to discuss the

history of mental health diagnosis, treatment, and nomenclature in greater detail; however, the

purpose of this paper was to discuss the development of formal and informal academic and

intellectual structures, as well as the emergence of new medical and public health systems in

Europe and the United States. Still, given the shock of the language used in this paper, it was

necessary to examine even briefly. If nothing else, I offer this takeaway from the language of

idiocy: the changing disease taxonomy and context of these words show the age-old difficulty of

human society reconciling with illness and deviance. While cultural norms may make disorder

and deviance easy for in-group cultural members to tacitly identify, it has historically been

difficult to explicitly name disorder, even in the move to make mental health diagnosis and

treatment more methodological and scientific.

BIBLIOGRAPHY

Curwen, John, Nichols, Charles H., Callender, John H. Memoir of Thomas S. Kirkbride, M.D.,

LL. D. Warren: E. Cowan & Co., Printers, 1885.

Jones, Colin. The Smile Revolution in Eighteenth Century Paris. (Oxford: Oxford University

Press, 2014.)

55

Kirkbride, Thomas Story. On the Construction, Organization, and General Arrangements of

Hospitals for the Insane. Philadelphia: 1854.

New York State Legislature, Assembly. Documents of the Assembly of the State of New York,

Volume 6.

New York Times, “The State Idiot Asylum.” New York Times: 1855.

Pérez-Fernández, Francisco, and López-Muñoz, Francisco. “The Kirkbride buildings in

contemporary culture (1850-2015): from ‘moral management’ to horror films,” in

History of Psychiatry, vol. 30 no. 3 (2019): pp. 336-351.

Schilling, Chris. The Body and Social Theory. London: Sage Publications, 2012.

Syracuse State School Collection. Assorted materials, 1862-1869. Box 1. Syracuse University

Library, Special Collections, Syracuse, New York.

Tomes, Nancy. The Art of Asylum-Keeping: Thomas Story Kirkbride and the Origins of

American Psychiatry. Philadelphia: University of Pennsylvania Press, 1994.

CONCLUSION

In the past three chapters, I have outlined the historical development of psychiatric

treatment in the 19th century, first in post-Revolution France, then in conjunction with the Second

Great Awakening in the United States, and finally in the examination of Kirkbride institutions,

including the Syracuse State School, on the local level. By placing these institutions, academies,

56

intellectual circles, and professional connections within their larger social and political contexts,

we can think critically on their cultural positionality. Using this historical framework, we can

examine 19th century mental health treatment and the “Moral Treatment,” and make connections

to modern medical anthropological research: namely, on the tension between the biological and

social aspects of disease, and the social and cultural factors influence that may influence the

diagnosis, prognosis, treatment, and experience of mental health patients.

Given our unique perspective looking back on this extensive process, the verbiage and

descriptions of the sources, and the difficulty of finding physician records of patients might make

the reader ask: What exactly makes this treatment “moral”?

It is important to point out that Pinel, Dix, Kirkbride, and the affiliated institutions were

not without criticism – both by contemporaries in their historical context, and today, where

historians and physicians look on the legacy of the development of treatment modalities and

examine their impact on the present and future course of medicine. This paper focused on the

process of institution-building, both in the evolving medical background to treating asylum

patients and the physical creation of these asylums in Europe and the United States. To that end,

I was unable to describe at-length the pushback to these ideas and changes. Some of the

evidence, including stories describing key figures like Pinel and Kirkbride as well as artwork, are

reverent and near-hagiographical in their quality. Their preservation in the historical dialogue

show that these stories are cherished, but it does blind us to critique. Therefore, while the

descriptions of these asylums and medical pioneers are fairly idyllic, it is important to point out

some contemporary and modern critiques of new medical nosology and treatment, and the new

public support system emerging as a result.

57

Here are just a few of the criticisms of this system brought into conversation by cited

sources, larger conversations in the discipline of medical anthropology, and my own personal

analysis:

Given the frail classifications and changing nature of disease nosology, etiology, and

treatment historically, we begin to have insight into the continuing, modern example of the

unreliability of psychiatric diagnosis, which of great concern to medical anthropologists and

psychiatrists cross-culturally. Even with the shaping of psychology and psychiatry as being more

methodical, we find that there are still plenty of leftovers from classical (humoral) medicine

which are insufficient. Apart from heavy sedatives, psychopharmacology was not a tool that

physicians had great access to, unlike today; and, while Thomas Kirkbride did have a version of

“talk therapy,” modern experts would consider it a rudimentary practice and certainly not the

focus of therapeutic treatment.

Especially in the case of mental health diagnosis, there are very clear tensions between clinical

and psychodynamic modalities of treatment. During the 19th century, there were very loose

commitment laws back then, heavily weighted in the family’s favor. While Pinel and Kirkbride

institutions were shining a new light on patient comfort, patient rights were in their infancy –

there were no official channels for patients to discuss or protest abuse or mistreatment. This is

not to say that these physicians were pursuing medical reform in bad faith, or intentionally

depriving their patients of what modern readers might consider their innate rights, as people and

as patients. They were pursuing the changes they felt were prudent, effective, and progressive at

the time – just as we do now. By contextualizing and analyzing these events in a sympathetic

reconstruction, I hope to offer an avenue of conversation into the way our current medical

58

systems were developed, what its strengths and weaknesses are a result of that heritage, and

where these systems are going in the future.

So, to ask again: What made this new treatment “moral,” more so than the previous

methods of the purgative, exhaustive heroic treatment? In France, what made the Moral

Treatment “moral” was its scrutiny of patient treatment symptoms into emerging disease

taxonomies, its incorporation of Enlightenment-era scientific views, and secular humanism as a

defining characteristic of French national character. In the United States, the patient treatment

that Dix and Kirkbride advocated for was “moral” in the context of Christian revivalism and

public reform, natural romanticism, and changing ideals of the relationship between the

government and its citizens. These are two very different ideas of what constitutes morality, yet

they claim to be linked – and they are not wrong, in how ideas are changed and embraced in

different ways cross-culturally. In this case, the word “moral” is substituted as a symbol for

specific ideals and characteristics that are important to each respective tradition at the time.

Given the opportunity to continue this project, a comparative study of asylum-era

psychology and modern-day psychiatry might make those connections even more striking.

59