“A book or a set of books giving information on many subjects or on many aspects of one subject and typically arranged alphabetically.” That venerable screed The Oxford Dictionary so defines “encyclopedia.”
The Encyclopedia of Asylum Therapeutics, 1750–1950s, meets all of those definitional standards. It is a book, although nearly verbose enough to be a set of books; it contains multiple perspectives on a single topic, in this case two centuries of the treatment of the insane; and it is alphabetically arranged, first by each primary therapeutic and then by any subentries that further elaborate upon it. Readers will find a list of references after each major therapeutic entry that is relevant to it, as well as to any and all of its subentries.
The book aspires to also capture the essence, the spirit, of “encyclopedia.” The term is from the Greek, meaning a “circle of learning” that can opened, indeed must be opened, by new knowledge. The question here is, whose knowledge? This encyclopedia is predicated on the recognition that there are multiple sources of knowledge about asylum therapeutics, and multiple ways in which knowledge has been, and is still, derived from wisdom and socially constructed from information and experience. At the same time it recognizes that certain types of knowledge, and certain sources of it, have been and are still privileged over others. Thus historical archives are filled with papers and reports authored by asylum physicians who, with various degrees of clarity and reflexivity, discuss therapeutic interventions with their patients. Had this book collected, organized, synthesized and presented only that privileged body of knowledge, a deceptively progressive metanarrative would have emerged: to cure insanity things were tried, mistakes were made, lessons were learned, different and better things were then tried, mistakes were made, more lessons were then learned, ad infinitum.
Privileged knowledge often maintains its privilege by muting, if not silencing, challenges to its hegemony. A deeper spelunking of the historical archives was necessary to recover and then synthesize these quieted bodies of knowledge. The memoirs and memories of treated asylum patients, the reports of investigating and oversight committees, local newspaper reportage, and other subaltern sources were synthesized into the encyclopedic entries of this book, thus inviting readers to read not just along the grain of the metanarrative, but against it.
That is the intent, but what is the content of this book? It is an encyclopedia of asylum therapeutics, a curious topic, perhaps, but one for which a case can be made. Therapeutics are best thought of as interventions through which abstract knowledge is made practicable. Therapeutics link medical knowledge with practitioner skill and with the personal expectations of embodied patients who experience and understand their own maladies in different ways. It is curious, then, that such an important endeavor has not been granted its due of scholarly attention. The present book seeks to redress that oversight.
And it does it in an encyclopedic form. Perhaps a case for that has to be made as well. Despite the appeal of a metanarrative of steady progress in the treatment of asylum patients, therapeutics have proceeded over history in fits, starts and turns. They often have neither a clear beginning nor a definitive end, and certainly not an even spread over the geographic landscape. The inherent urge to impose order was resisted in the compilation of this book in the hope that the discontinuities, disappearances and reappearances, and recycles of therapeutics opens the encyclopedia’s “circle of learning” to critical inquiry.
To that end also, the entries herein are narrative in form rather than consisting of a cold recitation of facts. Central to many of those narratives are individuals, more often asylum physicians than not, who loom large. Some of them may have been compassionate, others inquisitive, others simply zealous in their desire to treat insanity, but in the encyclopedic narratives, and to the extent possible, their ulterior motives have been bracketed off. This, too, is in service of opening up the “circle of learning” to critical inquiry about the various contexts—from social to professional to institutional—that influenced the practice of therapeutics, their administration, and the assessment of their effects and efficacy. The bracketing off serves another purpose as well. It goes a little way towards explaining why some therapeutics that should not have worked, seemed to have worked in aiding recovery. If society, science, institution and interaction share a system of beliefs about the nature of insanity, and if the therapeutic intervention is appreciated as a reflection of those beliefs and is expected by all parties to be effective, it very well may be. That is more than a placebo effect. It is, instead, the intimate relationship between structure and agency, contexts and individuals. The encyclopedic entries are intended to invite consideration of that relationship.
The Encyclopedia of Asylum Therapeutics, 1750–1950s, limits its scope in time and place. The first purpose-built asylum for the insane was constructed in the fifteenth century for the purpose of containment, not treatment. By the mid-eighteenth century, though, and in reaction to changing social and ideological contexts, asylums began to earnestly carry out the dual, and perhaps somewhat contradictory, goals of containment and treatment. By the mid-twentieth century most of the therapeutic innovations those goals had spawned had given way to pharmaceutical innovations, and the steady decanting of asylum patients into the community soon followed. Within those two historical markers can be found the entries in this encyclopedia. Place is also limited. The entries tend to focus on asylum therapeutics in the Western world, about which there are rich and accessible sources of information.
The language of therapeutics has always been somewhat idiosyncratic, if not sloppy. There are terms such as “mechanical restraints” that always have had wide usage throughout history and might even be said to be universally understood. But that certainly was not so of the term “straightjacket.” As one example of mechanical restraints, it variously has been referred to as a “camisole de force,” or a “strait-waistcoat,” or a “madd-shirt,” or even a “polka,” depending of course on the time and place of its reference. The language of therapeutics had a considerable influence on the organization of this book. Herein readers will find that many of the primary entries include a variety of synonymous terms, in parentheses, that were used in different times and places to identify them. Readers will open the book to the entry on “Pious frauds,” for example, and find that they also were known as “salutary demonstrations,” “innocent ruses,” “curative ruses,” and “suggestive therapies.” While the inclusion of all of these terms might seem unnecessary, the intent here is to open the circle of learning by building a vocabulary of therapeutics that aids critical inquiry and discussion. For cross-referencing purposes only the first term of each primary entry is noted in the text in brackets. The subentries that further elaborate upon each primary entry also list various synonymous terms, although they are not cross-referenced in the text.
Finally, it is important to clarify the terminology used. “Asylum” sounds like an old-fashioned term and, in fact, it is. There is probably no other institution that has gone through so many attempts to rebrand itself—from lunatic asylum, to insane asylum, to state hospital, to mental institution, to mental hospital, to psychiatric hospital, to psychiatric campus—than the asylum. But what has remained consistent is that the institution has always been a separate place, a place intended for refuge and assistance. And because that is the very definition of asylum, it seems appropriate to use the term. A bit of rebranding has also occurred for the professionals charged with the responsibility of treating the insane. They originally were referred to as mad-doctors, a moniker that inevitably called into question the difference between the healers and those being healed, then alienists, and then much later psychiatrists. Since the historical scope of this book is inclusive of all of those titles, the term “asylum physician” is used for the sake of consistency.
And then there is the object of therapeutic interventions by asylum physicians. Insanity is the settled-upon term. Affliction, distraction and lunacy were rejected as too archaic; madness as too protean; mental illness as too modern. The challenge with using insanity as a term, as well as the specific diagnoses that are referred to, was to use them in a person-first manner: the patient labeled as insane, versus the insane patient, for example, or the patient diagnosed with schizophrenia, as opposed to the schizophrenic patient, as another example. The cumbersomeness of the language is itself sad testimony as to how much mental disorder is considered identity, how much the disorder is thought to have the patient, rather than the other way around.
There is a great deal of original source material, often quoted at length, in this book. These original materials are presented as is, and with the purpose of offering knowledges, in the plural, about asylum therapeutics that are both particular and contrasting. No attempts have been made to achieve some kind of post hoc political correctness by correcting misspellings, adding “she” to the persistent male pronouns in order to achieve gender equity, or [sic] to call attention to an inaccurate expression or an unconventional spelling. And speaking of spelling, the occasional references in the book to the essential fluids of health are spelled “humours,” with a “u,” in the British fashion, a spelling that will greatly facilitate any research endeavor that their mention might prompt.
The working title of this book was originally “To a Mind Diseased,” an homage to that great observer of the human condition, William Shakespeare. In his dark and powerful play Macbeth, insanity is the leitmotif and the desire, indeed the desperation, to remedy it is palpable. Even with its final title, Encyclopedia of Asylum Therapeutics, 1750–1950s, this book reflects on centuries of attempts to answer Macbeth’s most pressing question:
Canst thou not minister to a mind diseased,
Pluck from the memory a rooted sorrow,
Raze out the written troubles of the brain,
And with some sweet oblivious antidote
Cleanse the stuffed bosom of that perilous stuff
Which weighs upon the heart?