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Nineteenth-century treatments for mental illness reflected physicians' understanding of the moral and physical causes of insanity. Like other nineteenth-century physicians, CSH doctors tailored treatment to address both the moral depravity and the underlying physical pathology of their patients. In hopes of altering the patients' physiological and mental state, CSH physicians administered liberal doses of narcotics, stimulants, emetics, and purgatives. A few exceptional superintendents, such as William Fletcher, demanded that the medical staff limit severe drug treatment to the worst cases and reduce the dosage of milder drugs for the masses of patients. Unfortunately, Dr. Fletcher's reforms in the early 1880s were often ignored by his successors.
While Dr. Fletcher and his nineteenth-century colleagues may have debated the merits of drug treatment, they did not debate the merits of moral therapy. CSH annual reports, prescription books, and patient histories illustrate the overwhelming support for moral therapy in both medical and political circles. Today, the notion of "moral therapy" conjures up images of wealthy philanthropists forcing their values and beliefs on the poor. In the context of Central State Hospital, this assertion rings true; moral treatment at CSH typically entailed impressing middle-class and protestant work ethics and mores on patients, most of whom were poor or struggling.
There were practical as well as ideological reasons for physicians' espousal of protestant and middle-class values. For most of the nineteenth century, physicians did not have the political or economic clout they have today. As a result, physicians attempted to curry the favor of politicians and their powerful constituents, in hopes of garnering financial support for their hospitals. To do this, physicians couched moral treatment in acceptable middle-class and upper-class terms. For CSH physicians, who were mostly middle-class and protestant, this did not require a large ideological leap.
In the early 1800s, middle-class values were synonymous with older, protestant beliefs that emphasized hard work and an orderly, religiously conservative lifestyle in an agricultural setting. Thus, in the nascent years of CSH, patients were encouraged to work on the hospital farm and were required to lead quiet, orderly lives separate from the chaotic world outside. This form of therapy also fit nicely into prevailing theories of insanity: if social, political, and economic freedoms were causing insanity, then it logically followed that severely limiting freedom in the context of the asylum would cure mentally-ill patients.
By the second half the nineteenth century, however, a new, burgeoning middle-class, the nouveau riche, redefined its values to include behaviors and beliefs that were beneficial to industrial capitalism.
And, now, the stakes were even higher: segments of the new middle-class were not only powerful and wealthy, but also embraced a reformist zeal and philanthropic spirit that far exceeded that of earlier generations. It became all that more important for CSH physicians to pander to middle-class reformers and philanthropists who were searching for a charitable outlet for their money and enthusiasm.
To prove their commitment to the new middle class values, CSH physicians attempted to engender in their patients a certain discipline and value system that fostered an industrial work ethic. Healthier patients were required, not encouraged, to follow strict work schedules, that included producing garment piece work and other products that could be sold to outside factories. In the early twentieth century, CSH instituted an "occupational therapy" program that entailed patients working with hand/foot operated machines to create products for no compensation. A few decades later, CSH built a cannery for patients, indicating that the hospital's full integration into the industrial world had been achieved. Importantly, the work therapy program served another equally imperative function: it provided additional moneys to supplement unreliable state funding that ebbed and flowed with the changing political tides.
Regulated work, however, was not enough. A "well-regulated" diet, a highly "regimented" morning and evening schedule, the reading of wholesome books from the hospital's "selected library", and the partaking in "mild and innocent amusements" were sure cures for mental illness and a sure way of inculcating white middle-class mores. In retrospect, the living conditions at CSH may seem overly oppressive and the motives of the physicians questionable, but this highly structured environment did offer solace to many patients, particularly in a period when few other cures existed.
Holding Chair, 1800's [36 kb]
If the moral universe of CSH was not sufficient to modify behavior, detention, physical restraints, and "baths" were used. Medical attendants employed cold and hot "baths" to calm patients, to force them into submission or to punish them. Attendants confined more violent patients to their beds or to holding chairs with mechanical restraints. Still others, the worst cases, were confined to the dark, dungeon-like basements of the hospital.
Many of the more harsh treatments fell out of vogue in the 1880s and '90s as compassionate superintendents and reformers, like William Fletcher and Nellie Bly, and physicians imbued with the scientific spirit, like CSH superintendent George Edenharter, pushed for change.