Eighteenth and Nineteenth Century Views

It was not until what could be considered the modern historical period, beginning
at the end of the eighteenth century—the time of the American
and French Revolutions—that major changes took place in the treatment of
the mentally ill. Additionally, there was a change in attitudes toward such persons, in approaches to their treatment and in beliefs regarding the
causes of their strange behaviors. The man who, because of his courage, became
a symbol of this new attitude was the French physician Philippe Pinel
(1745-1826), appointed physician-in-chief of the Bictre Hospital in Paris in
1792. The Bictre was one of a number of “asylums” which had developed in
Europe and in Latin America over several hundred years to house the insane.
Often started with the best of intentions, most of the asylums became
hellish places of incarceration.

In the Bictre, patients were often chained to the walls of their cells and
lacked even the most elementary amenities. Pinel insisted to a skeptical
committee of the Revolution that he be permitted to remove the chains
from some of the patients. In one of the great, heroic acts in human history,
Pinel introduced “moral treatment” of the insane, risking grave personal
consequences if his humane experiment had failed.
This change was occurring in other places at about the same time. After
the death of a Quaker in Britain’s York Asylum, the local Quaker community
founded the York Retreat, where neither chains nor corporal punishment
were allowed. In the United States, Benjamin Rush, a founder of the American Psychiatric Association, applied his version of moral treatment, which
was not entirely humane as it involved physical restraints and fear as therapeutic
agents. Toward the middle of the nineteenth century, American crusader
Dorothea Lynde Dix fought for the establishment of state hospitals for
the insane. As a result of her activism, thirty-two states established at least
one mental hospital. Dix had been influenced by the moral model as well as
by the medical sciences, which were rapidly developing in the nineteenth
century. Unfortunately, the state mental hospital often lost its character as a
“retreat” for the insane.

The nineteenth century was the first time in Western history (with some
exceptions) that a number of scientists turned their attention to abnormal
behavior. For example, the German psychiatrist Emil Kraepelin spent much
of his life trying to develop a scientific classification system for psychopathology.
Sigmund Freud attempted to develop a science of mental illness.
Although many of Freud’s ideas have not withstood empirical investigation,
perhaps his greatest contribution was his insistence that scientific principles
apply to mental illness. He believed that abnormal behavior is not caused by
supernatural forces and does not arise in a chaotic, random way, but that it
can be understood as serving some psychological purpose.