Homicidal Insanity, 1800-1985

2. The Theoretical Boundaries of Dangerousness, 1800-1840

The Theoretical Boundaries of Dangerousness 1800-1840 In the United States during the last decades of the eighteenth century , the idea that lunatics should be given medical care in asylums evolved from a number of social and intellectual changes. Among the several changes that guided this transition from family and community care to medical and institutional care, the most evident was the mere fact of population: more lunatics needed to be reckoned with in the growing colonial towns. And, because transients were among the group, the usual practice offamily isolation became inapplicable. I In complex social groups working together toward common goals, even the merely disruptive are apt to be regarded as dangerous. The royal governor of Virginia, Francis Fauquier, called for a mental hospital in 1766 and again in 1767. In 1766 his briefmessage to the opening session of the House of Burgesses reflected Enlightenment beliefs about insanity as the loss of reason, the desire for order in the community, and the idea that the care ofthe insane was the responsibility of physicians. According to Norman Dain, the real impetus for the hospital project came from an editorial in the Virginia Gazette: 10 Dangerousness II A most shocking murder was perpetrated yesterday morning on the body of Mr. Charles Thompson, who lived a little distance from York, by his wife, who for some years past has been out of her senses. He got up early in the morning and walked over his plantation, and when he came home lay down, being much troubled with the headache. He had no sooner got into a doze than his wife came, and with a broadaxe broke his scull to pieces, by repeated strokes. He has left a large family ofhelpless children. The woman is secured, but seems quite insensible of the horridness of the crime she has committed. (It is really shocking to see the number ofmiserable people who have lost the use oftheir reason, that are daily wandering about, for want ofa proper house to keep them confined in. Ifthere had been such aplace, this poor man would not have met with the above untimely end.)2 Undoubtedly, as in Virginia, the reform spirit also played a role elsewhere in the shift from family to medical care. Medical and social historians place the genesis of insane asylums squarely within the Enlightenment and post-Enlightenment ideology, which included the concept that even the less fortunate members of society had and could achieve their natural rights. The intellectual changes of the Enlightenment, followed by the scientific interest in emotio.nal life, supported the sentimental humanitarianism that catalyzed the institutional approach. The humanitarianism that arose during the later Colonial period was rooted in the theory of environmentalism and the idea of progress, that it was within the capacity of man to improve his individual and social conditions. 3 By the beginning of the nineteenth century, American physicians were largely apprentice-trained and gained only a minimum of theoretical knowledge. By this time, however, hospitals were growing in number and size, particularly in Europe, and the concentration oflarge numbers of patients in one place provided data for the study of medicine. Physicians were turning to clinical experience as a source ofknowledge and began questioning the value of the standard therapeutics that had been handed down virtually unchanged from physician to apprentice for generations. This change was particularly notable in France, where new techniques 12 Homicidal Insanity, 1800-1985 and new instruments, such as the stethoscope, for example, turned physical diagnosis into a clinical discipline. By 1820 the French clinical school had begun to have a direct impact upon physicians in the eastern United States, where asylums for the insane were already being established. Under the influence of French clinical empiricism, first on the Continent and then in Great Britain and the United States, physicians began to believe that insanity was a somatic disease and therefore curable. This thesis was reinforced by A. L. J. Bayle's discovery that the symptoms ofcertain types ofinsanity could be traced to a definable pathological finding: a chronic inflammation of the brain membrane . 4 The growth of medical care for the insane in the United States and Great Britain faithfully reflected Continental advances. Even before American physicians began to flock to Paris to study at the large French clinics, William Tuke in England and Benjamin Rush in Philadelphia had already begun clinical treatment of the insane. Moral treatment...