Recovery From Schizophrenia: Psychiatry And Political Economy

104 THE POLITICAL ECONOMY OF SCHIZOPHRENIAstarvation; jalap, syrup of buckthorn, tartarised antimony, and ipecacuanhaadministered every spring and fall in fabulous doses to every patient,whether well or ill; spinning in whirligigs, corporal punishment, gagging,“continued intoxication”; nothing was too wildly extravagant, nothing toomonstrously cruel to be prescribed by mad-doctors.Lest we should consider that these practices were enforced through malice, hecontinues:In other respects these physicians were grave men, of mild dispositions, and—in their ample-flapped, ample-cuffed coats, with a certain gravity and airof state in the skirts; with their large buttons and gold-headed canes, theirhair-powder and ruffles—were men of benevolent aspects. 6Frank abuses aside (and psychiatrist William Parry-Jones 7 argues that these maywell have been overemphasized by historians), Dickens’ point is well taken. Weshould not assume that the eighteenth-century mad-doctors were morallydegenerate; chains and flogging were not necessarily maliciously intended. EvenGeorge III during his bouts of insanity was chained, beaten, starved andintimidated with threats. 8 The management techniques were those of animaltrainers because the insane were regarded as bestial. At the Bicêtre in Paris and theBethlem Hospital in London, the inmates were exhibited to the public, for a fee,like zoo creatures. 9 The insane were left naked in the cold and damp because theywere believed to possess inhuman resistance to the effects of the elements. 10 BothAndrew Scull and French philosopher Michel Foucault have emphasized that theintroduction of moral treatment involved a redefinition of the madman’scondition from the essence of bestiality to a degree of human rationality. 11 Nowthe lunatic becomes a fractious child. As the Swiss doctor commented in thevisitors’ book at the Retreat:In moral treatment, one does not consider the insane to be completelydeprived of reason, out of reach of the influence of fear, hope, affection andhonour. Rather one regards them, it seems, like children who have toomuch energy, and who put it to dangerous uses. 12In this redefinition lay the revolutionary impact of moral management.THE ORIGINS OF MORAL TREATMENTCuriously enough, this fundamentally new approach was not only introducedsimultaneously by Pinel and Tuke, but similar humane methods of patient carealso sprang into being independently at the same time in other parts of Europe. InFlorence, Vicenzo Chiarugi, the physician in charge of the newly open HospitalBonifacio, published regulations for patient care, in 1789, which eliminated the