Recovery From Schizophrenia: Psychiatry And Political Economy

108 THE POLITICAL ECONOMY OF SCHIZOPHRENIATHE ASYLUM MOVEMENTPublic responsibility for the care of pauper lunatics could not be avoided, andindeed it became a basic requisite in shaping the new wage labor force (as AndrewScull pointed out in his book on this theme, Museums of Madness 36 ). To separatethe employable from the unemployable was essential to the rationalization of poorrelief. The able-bodied should not be encouraged to be idle, but the incapacitatedhad to be accommodated. In an effort to reduce the bill for the care of pauperlunatics in private madhouses, the British County Asylum Act of 1808recommended the establishment of public specialty hospitals for the insane. Thefirst county asylums to open were in rural districts where pauperism was severeand subsistence farming declining. 37Throughout Europe, moral treatment was intimately tied to the developmentof the new specialty establishments for lunatics. The York Retreat was one of agrowing number of private madhouses, and its methods were copied, to a limiteddegree, by the new county asylums. Bicêtre had become a central institution forthe insane alone, only one year before Pinel struck off the fetters. La Salpêtrière wasconverted to that purpose in the same year. The miscellany of the poor, who hadpreviously been confined there, was released by the revolutionary government “inorder to distribute it to the points where the labor force was rarest.” 38 Criminals,henceforth, were to be housed separately from lunatics. 39 Chiarugi’s humanemethods were introduced in a newly erected hospital for the insane in Florence.And in the United States, as the first wave of hospitals for the insane began to beopened, moral treatment was the style of management that the newsuperintendents studied and aimed to establish in their institutions.REHABILITATION AND INSTITUTIONALIZATIONOne of the attractions of moral treatment was its curative and rehabilitativeemphasis. If patients could be cured and discharged to support themselves, theywould cease to be a drain on the public purse. The proprietor of the privateWhitchurch Asylum in Herefordshire, for example, played up this point in anadvertising handbill. Arguing that patients admitted to his establishment recoveredin a matter of days, compared with months and years for a cure in the localcounty asylums, he estimated that the cost of a cure in his private licensed housewas a fraction of the cost in the public asylums. 40 Furthermore, the emphasis inmoral management on hard work and self-discipline, as Scull has pointed out,reflected the same attitudes required in shaping the new industrial labor force. 41Despite the rehabilitative emphasis in moral treatment, however, the increase inasylum care was rapid. With the growth of wage work and the existence of alarge, cheap supply of labor, the marginally functional insane were at aconsiderable disadvantage. Many of those who might have been fairly productivein working subsistence smallholdings were now unemployable. Labor mobility,