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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University Press, 2013).
39
Parry, Manon. “Dorothea Dix (1802-1887),” In American Journal of Public Health, vol. 96 no. 4
(April 2006): 624-625.
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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
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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
43
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
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