MHAW – The 18th/19th Century Approach


To coincide with Mental Health Awareness Week 2016, the latest blog from the Manchester Medical Manuscripts Collection looks at some of the attitudes of medical professionals from the 18th & 19th centuries and the forms of treatment they employed.

Two Manchester based physicians, teaching in the city in the first half of the 19th century, make similar comments as to the physical causes of mental illnesses as well as alluding to the overarching lack of knowledge in the area. Richard Baron Howard (1807-1848) comments that insanity is owing to “an abnormal lesion of the brain but we cannot always find any structural lesion but it is admitted by all that the brain is the organ affected in all cases … we can seldom find anything sufficient to explain the symptoms” (MMM/10/2) which Samuel Bardsley (1764-1850) corroborates with the comments “All diseases of the mind are difficult to understand in as much as the physiology of the mind is so little understood. The definition of insanity is very hard to give & hardly any two authors agree to giving the same definition.” (MMM/23/1/10)

Medical descriptions of psychiatric problems at this time tend to focus largely on the physical and can be all too brief. The belief stated by many that all mental illnesses were caused by some hard to identify organic lesion of the brain meant that background information relating to the patient’s social welfare and family and personal circumstances was often completely neglected. One writer on the subject does note the contrast between the accounts of medical professionals and those of close family members, who in contrast often went into great detail about the individual’s life (Akihito Suzuki, Madness at Home, 2006, University of California Press, p.39).  Much emphasis is also placed on the hereditary factor of mental health with many physicians in this period citing it as one of the most common causes and mid-nineteenth century institutional providers of care making a point of investigating family history in their initial assessment of patients.

The theories that the medical profession formulated at this time to explain the causes of mental illness often also informed their treatments. These could be quite varied, based on a doctor’s personal experience with specific patients, and also, like the theories on the causes, be a point of contention between physicians too.  A manuscript whose author is unknown from the late 18th century offers the following view:

“The great object of cure is putting them under restraint as it very much distresses the patient, and this now used is a short waistcoat and this kept on for 2 or 3 days in this manner we will often effect a cure. The restraint by fetters and chords and their struggling with them is very hurtful, an erect posture too is favourable.  They ought not to be kept in their own houses or suffered to be seen by strangers. Fear has been often employed, and it sometimes may have done good, but oftener it has done great harm & great severity too does great harm. I think the strait waistcoat with the awe of a stranger to look over him will generally be sufficient.” (MMM/23/1/10)

Nearly 50 years later in the late 1830s Samuel Bardsley suggests firmness but not severity is beneficial and also warns against the lack of suitable care for those that need it:

“Dr B. states the unpleasantness of having to give evidence in cases of mania. This he stated to be much increased by the knowledge of the fact that there were so few keepers who were really fit for the office of attending upon the patient should you condemn them to confinement. …

“Firmness on the part of the attendants is particularly to be recommended but with this firmness a system of conciliation in manners to be combined. Severe bodily restraint is to be avoided as much as possible as it creates a degree of irritation of mind which tends to retard the recovery of the patient.” (MMM/23/1/20)

The many other common treatments included cold baths, exercise, simple diet, opiates, and bleeding (both general and topical). Purgatives were common throughout the period also, with Bardsley remarking on them as “most important remedies in the treatment of mania. It has been long known that an obstructed state of the bowels is a very common concomitant of this disease.”

Medical men at this time were also known to comment on the higher occurrence of insanity in women than in men referring to the ‘greater irritability of the female sex depending probably in part upon the addition of the uterine system’, with a diagnosis of hysteria in women being very commonplace, and to be the subject of a later posting…

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