Recovery From Schizophrenia: Psychiatry And Political Economy

MADNESS AND THE INDUSTRIAL REVOLUTION 105use of physical force or any type of restraint except for the occasional use of thestraightjacket. He specified:It is a supreme moral duty and medical obligation to respect the insaneindividual as a person. 13Similarly, Joseph Daquin, the physician in charge of the institution at Chambéryin the Savoy region (an independent duchy situated between France and Italy)published, in 1791, a treatise advocating humane care for the mentally ill. 14Around the same time, Parisian physician and philosopher Georges Cabanis, whoarranged Pinel’s appointment to the Bicêtre, proposed improved treatmentmethods for the insane. 15 Physician John Ferriar at the Manchester LunaticHospital, although administering such standard medical remedies as blood-letting,blistering and purging, 16 expressed the opinion, in 1795 (the year before theRetreat opened), that the primary goal of treatment lay in “creating a habit of selfrestraint,”not through coercion, but by “the management of hope andapprehension,…small favours, the show of confidence, and apparentdistinction.” 17For each of these independent innovations, local causes may be found.Psychiatric historian George Mora, for example, suggests that Pinel and theFrench physicians, in liberating the insane, were reflecting the spirit of freedomand equality of the French Revolution (1789–99); Chiarugi’s radical reforms werea product of the revolutionary political economic reforms of the rule of the GrandDuke Peter Leopold (1747–92); the philosophy of the York Retreat was based onthe contemporary British bourgeois ideal of the family. 18 But these individualinfluences fail to explain the simultaneous but independent origin of the samenotion within a five-year period in different parts of Europe.To call the phenomenon “a striking example of zeitgeist in the history ofpsychiatry” 19 is to say nothing about causes. To see it as a reflection of theEnlightenment’s eighteenth-century ideals of human dignity, worth and freedomis to provide a unifying concept but still only fits one ideology within the broaderframework of another. If we examine the political and economic underpinning ofEnlightenment thinking, however, we may be in a better position to understandwhy moral treatment occurred when and where it did. British historian, EricHobsbawn, has this to say about the philosophy of the Age of Reason:The Great Encyclopaedia of Diderot and d’Alembert was not merely acompendium of progressive social and political thought, but oftechnological and scientific progress. For indeed the conviction of theprogress of human knowledge, rationality, wealth, civilization, and controlover nature with which the eighteenth century was deeply imbued, the“Enlightenment,” drew its strength primarily from the evident progress ofproduction, trade, and the economic and scientific rationality believed to beassociated inevitably with both. 20