The Architecture and Landscape of Health by Collins Julie;

Author:Collins, Julie;
Language: eng
Format: epub
Publisher: Taylor & Francis Group
Published: 2020-06-15T00:00:00+00:00

The Enlightenment and change in understandings of mental illness

The movement from custodial asylums and madhouses towards curative or therapeutic asylums had begun with a changing understanding of what insanity was. Enlightenment thinking, marked by both scientific endeavour and progressive social conscience, considered treatment for those deemed insane as possible. Moreover, Scottish Enlightenment physician, William Cullen had developed a nosology which described diseases of the nervous system leading to mental illness, and grouped these as a separate class of diseases in his 1769 publication Synopsis Nosologiae Methodicae (Weiner 2008: 269). This classification was critical, as in part it informed the development of a medical speciality in mental illnesses, and in turn, propelled the search for medical cures. Additionally, social factors played a significant role in increasing understanding and empathy for those suffering with such illnesses. This change in thinking was revolutionary, as Smith has noted,

[w]here the madman had been conceived as something akin to a wild beast, whose excesses had to be tamed in order to ensure the safety of others, he was increasingly being seen as a distressed soul who may be susceptible to a restoration of reason.

(Smith 2008: 164)

By the eighteenth century, it was believed that patients were able to be cured rather than simply locked up. However, the methods for this cure were based on purges, vomiting, blistering, bleeding, and bathing. What was deemed cured also remained unclear, Parry-Jones noted “it seems, a ‘cure’ connoted the familiar admixture of disappearance of the signs and symptoms of mental disturbance and a degree of social remission” (Parry-Jones 1973: 663). The so-called madness of King George III in the latter part of the eighteenth century was responsible for the raising of public and parliamentary interest in England in the treatment of the insane, both socially and medically. This was significant as Dora Weiner has noted, “Humanitarianism and democracy were the decisive influences that improved the lot of the insane in the eighteenth century” (Weiner 2008: 269).

English physician William Battie was one of the governors of Bethlem Asylum in the mid eighteenth century, as well as the owner of two private institutions (Beard 2007). Yet, it was Battie’s work promoting the concept of a therapeutic asylum, and the medical specialty of psychiatry, for which he became best known. In 1751, Battie was instrumental in the founding of St Luke’s Hospital for Lunatics in London as a charitable institution for the insane. Initially operating out of a converted building near Bethlem, St Luke’s physician, Battie, tested his ideas around the management of the mentally ill on his patients (Beard 2007). His findings were reported in his 1758 book A Treatise on Madness within which he suggested that patients were curable, and that the environment in which they lived was significant in contributing to their condition and therein their rehabilitation (Battie 1758).

Critically, Battie placed the mentally ill at the centre of his theory, believing that they should not be ‘held’ solely for the protection of themselves and the public, but in order to aid their recovery (Beard 2007).

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