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PubMed1997

Brain abnormalities in murderers indicated by positron emission tomography.

Murderers pleading not guilty by reason of insanity (NGRI) are thought to have brain dysfunction, but there have been no previous studies reporting direct measures of both cortical and subcortical brain functioning in this specific group. Positron emission tomography brain imaging using a continuous performance challenge task was conducted on 41 murderers pleading not guilty by reason of insanity and 41 age- and sex-matched controls. Murderers were characterized by reduced glucose metabolism in the prefrontal cortex, superior parietal gyrus, left angular gyrus, and the corpus callosum, while abnormal asymmetries of activity (left hemisphere lower than right) were also found in the amygdala, thalamus, and medial temporal lobe. These preliminary findings provide initial indications of a network of abnormal cortical and subcortical brain processes that may predispose to violence in murderers pleading NGRI.

Adult↗

PubMed1997

Moral architecture: the influence of the York Retreat on asylum design.

Institutional and architectural history places the asylum alongside the prison and other institutional types whose architectural characteristics emphasized confinement and control. This history obfuscates important differences in how ideas about treatment were represented in the particular design of these institutions; in other words, how the structure of a place became part of its discourse. What becomes obvious in nineteenth-century, asylum architecture is the influence of a small Yorkshire private asylum built by a Quaker, William Tuke, in 1796. The York Retreat, in form, solidified the ideas of 'moral treatment' in design and in turn assumed an exalted character in the design of late nineteenth-century asylums. Every researcher working in the field of the history of insanity acknowledges the importance of this event and its impact on the discourse of insanity for the century to follow. Few however talk about how its unique design was incorporated as part of this discourse.

England↗

PubMed1989

Regional secure units: the creation of a policy.

This paper examines the historical context of the policy decision of the (then) DHSS in July 1974 to establish Regional Secure Units with an initial provision for 1,000 places. A brief examination of the history of the detention of the criminally insane and the setting up of the county asylums is followed by an examination of the various problems faced by the authorities concerned with the care of the criminally insane and the mentally ill in general in the 1960s. The paper examines the different streams of influence and power that converged upon this solution: government, special hospitals, public inquiries, unlocking of hospital wards, criminal law, DHSS and the Home Office, judges, voluntary bodies, prisons, psychiatrists and the official government reports known as the Glancy and the Butler Reports. The paper seeks to explain the policy decision to build regional secure units as a dynamic outcome arising from the confluence of opportunities, participants and solutions: a policy formation model put forward by March and Olsen (1976).

Commitment of Persons with Psychiatric Disorders↗

PubMed1990

[The Hinckley case and some sequelae for psychiatry].

After John Warnock Hinckley jr. had fired shots at President Reagan and had severely injured three others, he was considered not guilty by reason of insanity and brought to a psychiatric hospital. The case caused an unprecedented public interest because the psychiatric testimonies were contradictory (schizophrenia vs. personality disorder). According to the known facts it is very unlikely that a German psychiatrist would have diagnosed Hinckley as schizophrenic. One of the sequels of the sentence was a lowering of the reputation of psychiatrists for their inability to arrive at clear diagnosis. Another sequel was to increase the funds for research in biological psychiatry. Still another sequel was an insanity defense reform bill. The scientific debate and public discussions continue.

Commitment of Persons with Psychiatric Disorders↗

PubMed1997

[The development of criminal psychology in the work of Eugen Bleuler].

The study refers to Eugen Bleuler's first systematic publications on "the natural born criminal" (1896) and his subsequent forensic-psychiatric expertise, written by Bleuler as Director of the psychiatric Department of Psychiatry of the University of Zurich ("Burghölzli"). It could be clearly shown that Bleuler was influenced by a deterministic understanding of human behaviour. He referred to the Anglo-American concept of "moral insanity" as a circumscribed defect of altruistic feelings despite other psychic functions being normal and tended to include this psychopathic deviation in psychiatry. Although this theoretic position remained unchanged, the elderly E. Beuler--under pragmatic points of view--accepted the traditional differentiation between mental illness in a narrower sense and "moral insanity" as a personality feature of most delinquents, falling under the responsibility of law and penal institutions. In his publications as emeritus (after 1927). Bleuler was influenced by the natural philosophic and vitalistic concept of the so-called "Minemism", which, however, still made him reject the postulate of "freedom of will".

Criminal Psychology↗

PubMed2004

Founding years of clinical neurology in Berlin until 1933.

During the so-called "Gründerjhare" or "founding years" in Berlin it became necessary to build new hospitals because of the rapid growth of population. As a result, several infirmaries, asylums for the insane and institutions for epileptics were build between 1877 and 1912. The new building of the University of Neuropsychiatric Clinic ("Nervenklinik") of the Charité was opened in 1905 according to plans made by Friedrich Jolly (1844-1904), the physician who named myasthenia gravis pseudoparalytica. A "Neurological Central Station", under the direction of Oskar and Cecil Vogt, in existence since 1898, was a research center dedicated more to morphology. There the study of the structure of the cerebral cortex by Korbinian Brodmann (1868-1925) and research into basal ganglia diseases by the Vogts began. The Kaiser-Wilhelm Institute for Cerebral Research, which moved into a new building in 1931, also had its origin here. Hermann Oppenheim (1858-1919) promoted independent clinical neurology, as did his younger contemporary, Max Lewandowsky (1876-1918), who was already advising physician for neurology at the Berlin-Friedrichshain Hospital. Hug Liepmann (1863-1925), the creator of apraxia theory, worked at the asylums for the insane in Dalldorf (Berlin-Wittenau) and Berlin-Herzberge. In 1911, the first neurological unit was established in the large hospital in Berlin-Buch under the direction of Otto Maas. Not until after World War I were further neurological hospital units founded, under the direction of Paul Schuster (1867-1940), Kurt Goldstein (1878-1965), Kurt Löwenstein (died in 1953) and Friedrich Heinrich Lewy (1885-1950). These Jewish physicians, as well as C.E. Benda and Otto Maas, had to leave their posts in 1933 and emigrate. The clinical institutions and scientific achievements of these pioneers of independent clinical neurology will be presented up to the point of its violent dissolution.

Berlin↗

PubMed1998

'It begins with the goose and ends with the goose': medical, legal, and lay understandings of imbecility in Ingram v Wyatt, 1824-1832.

A number of historians have recently suggested that we need to get out of the asylum if we are to fully understand attitudes to insanity in the nineteenth century. Arguing that accounts of the medicalization of madness have ignored the importance of non-medical attitudes to lunacy and idiocy, recent studies have stressed the need to explore family attitudes and responses in more detail. Unfortunately, efforts to escape the asylum have to some extent been hampered by a persistent reliance on institutional records. This institutional dependence is understandable: certificates of insanity, reception orders, case-books, and asylum registers, together with published documents, constitute the major record of historical constructions of the lunatic and idiotic mind. However, there may be more resourceful ways of exploring both medical and non-medical attitudes to idiocy. In this paper, I want to use the records from a contested will case, Ingram v Wyatt, to demonstrate that records from the ecclesiastical courts can provide access to a domain where the definitions and meanings of idiocy and imbecility were routinely considered by lawyers, lay witnesses, judges, and doctors. I shall argue that such cases constitute a fruitful site for excavating lay, professional legal, and medical attitudes to imbecility, for exploring the complex relationship between medical and non-medical understandings of capacity, and for situating those understandings within the context of professional developments in law and medicine and contemporary concerns about inheritance.

History, 19th Century↗

PubMed2001

Legal madness in the nineteenth century.

Legal sources remain under-exploited in the history of madness, and the legal character of some documents is sometimes unrecognized. This article examines the inter-relations between legal and medical histories of madness, and discusses use and availability of nineteenth-century legal source material relating to criminal insanity, mental incapacity, and the confinement of the insane.

Forensic Medicine↗

PubMed2001

A quiet revolution in Brighton: Dr Helen Boyle's pioneering approach to mental health care, 1899-1939.

At the close of the nineteenth century, the English lunacy laws in relation to pauper cases made no concessions for acute, temporary, or recoverable cases. They were all located in the asylum along with severe and chronic cases. Dr Helen Boyle worked among London's poor in the 1890s and observed the deterioration of cases of nervous disorder and borderline insanity due to their lack of treatment. The early treatment of borderline cases was the aim of Boyle's charitable hospital, founded in 1905, for nervous disorders in women and girls. Boyle's interest in mental disorder included the mentally defective and she was a founder member of the Guardianship Society which sought to keep those defined as such within the community. The history of the care and treatment of the 'insane' has concentrated largely on the public and private asylums. London-based facilities such as the Tavis-tock clinic and the Maudsley Hospital, which both treated rate-aided patients in the inter-war period, have been given a great deal of attention because of wealthy benefactors and the involvement of high profile individuals. Boyle's unique in-patient facility in Brighton preceded the Maudsley by almost 20 years and as such fills an important gap in mental health history. Boyle's work challenged the lunacy laws and set out to establish a holistic system of care for recoverable conditions outside the asylum system. This essay concentrates on the work of Dr Helen Boyle in Brighton but also highlights other facilities that were available for rate-aided patients, which have been neglected in the historiography of mental health care.

History, 19th Century↗

PubMed1996

The New Poor Law and the County Pauper Lunatic Asylum--the Devon experience 1834-1884.

In this article we examine the impact of the policies and practices of the Guardians of the New Poor Law Unions on the management of pauper lunatics in four Devon Poor Law Unions in the critical period 1834-84. The central role of the Victorian Poor Law in provision made for the insane has only recently been recognized in the research literature. Scholars have been much more concerned with the activities of professionalizing physicians and the general project of state management than they have with the micro-politics of the local Poor Law and the magistracy who were responsible for the legal disposition of the insane. In this paper we argue that not only were the Guardians of the Poor Law Unions central in the determination of the lunatic's journey through the institutional systems provided in the mid-nineteenth century, but also that there were significant variations within the Poor Law system which made for contrasting systems of disposal of lunatics as between the Unions themselves. These variations in disposal of lunatics in Devon raise important questions of ideology, policy, and practice which, if repeated elsewhere, point to a need to refine significantly our assumptions regarding the disposal of pauper lunatics in England and Wales in the fifty years following the 1834 Poor Law Amendment Act.

History, 19th Century↗

PubMed1978

Homicide and community-based psychiatry.

The authors studied the records of all persons convicted of homicide or found not guilty by reason of insanity during the uears 1963 through 1975, 6 years before and after the opening of the community-based psychiatric facility, in Albany County, New York. Using the Fisher Exact Probability Test, a statistically significant increase was found for those found not guilty by reason of insanity (p = .041) and those with a history of mental illness found guilty (p = .036). Other factors, including age of the perpetrator, use of alcohol, and relationship to the victim, were also examined. The authors caution against sweeping indictments of community-based psychiatry and urge that the study be repeated elsewhere.

Adult↗

PubMedDate not supplied

Founding friends: families and institution building in early 19th century Philadelphia.

BACKGROUND: Nurses have always had an interest in the relationships among families, clinicians, and healthcare institutions. This case study of the Friends Asylum for the Insane in early 19th century Philadelphia examines the historical roots of these relationships. METHODS: Data sources are archival documents about the male founders of the Friends Asylum, its constituent families, and the committees responsible for the creation and the maintenance of the institution. RESULTS: Families seeking a temporary respite from day-to-day turmoil created The Friends Asylum in Philadelphia. The Friends Asylum allowed them to continue to explore the processes that ultimately gained them an enduring identity as members of the newly emerging middle-class. DISCUSSION: These data suggest that the Asylum served individuals limited in their capacity for the self-control needed for a new kind of middle-class identity and those families vulnerable to the demands made by the roots of this new identity. For individuals, it provided a place that replicated the intimate domestic ideal. And for families, it allowed the sharing of care-taking responsibilities with kin who wanted the insane out of the home, but not out of the family. CONCLUSION: In the early 19th century, families presented clinicians not just with dilemmas, but with solutions that carried substantial cultural weight. This study suggests that theoretical innovations in healthcare might draw from the transformations in normative rules about domestic, work, and social roles. It suggests that nurses remain aware of the possibility that it may not be nurses who empower patients; it may be patients who empower nurses.

Christianity↗

PubMed1990

Inebriate institutions in North America, 1840-1920.

This paper analyses two contemporaneous types of 19th-century North American inebriate institutions and attempts by their promoters to develop a public treatment system. Inebriate 'homes' or 'retreats' descended from a tradition of therapeutic temperance that originated in the Washingtonian Movement of the 1840s. They were small, urban, private and charitable, dedicated to voluntaristic and Christian principles, and were intimately connected with local temperance groups that provided support after residential treatment. Inebriate asylums took inspiration from insane asylums and were large, public, coercive and isolated in rural areas. Their promoters were steeped in the deterministic, hereditarian neurologism of Victorian psychiatry. Asylum enthusiasts dominated the public treatment movement, but developed a largely disciplinary and custodial vision that undermined their political appeal. As inebriate asylums could not easily be distinguished from insane asylums, almshouses or jails, legislators regarded them as superfluous and very few were established. Prohibition destroyed what public inebriate institutions existed. Inebriate colonies, usually connected with county jails, were the only survivors of the 19th-century treatment movement apart from private sanitaria and a few inebriate wards in city or county hospitals.

Alcoholism↗

PubMed1988

The development of child psychiatry in 19th century Britain.

Child psychiatry was established as a separate discipline in the 1930s. The paper analyses and describes the early development of child psychiatry in Britain, with particular reference to the contributions of the medical profession. Major influences came from general psychiatry. Children were at first treated in adult asylums; the first concepts of childhood insanity were formed around 1800, with moral insanity becoming the most common diagnosis. From 1850 onwards other major contributions came from paediatrics and the care of the mentally retarded. These developments were part of wider socio-economic changes in childhood.

Child Psychiatry↗

PubMedDate not supplied

Survey of public awareness, understanding, and attitudes toward epilepsy in Henan province, China.

The awareness, understanding, and attitudes toward epilepsy in 1,278 men and women were surveyed in Henan, China in 1988. Results showed that 93% had read or heard about epilepsy; 77% knew someone who had epilepsy; 72% had seen someone who was having a seizure; 57% would object to having their children associate with persons with epilepsy in school or at play; 87% would object to having their children marry a person with epilepsy; 53% believed that epileptic persons should not be employed in jobs as other persons are; 16% believed that epilepsy was a form of insanity; 40% did not know the cause of epilepsy; 10% did not know what an epileptic attack was like; and 17% did not know what to recommend if their friends or relatives had epilepsy. The relationship between the responses and the respondents' age, sex, marital status, number of offspring, level of education, occupation, and residence was analyzed. Education reduced the respondent's prejudice against play and employment, but did not change their objection to marriage and appeared to have reinforced their linking epilepsy with insanity. As compared with the surveys conducted in Western countries, our survey showed that awareness of epilepsy in China was greater, if not the same, but the attitudes toward epilepsy were much more negative.

Adolescent↗

PubMed1984

Epilepsy and its prejudice. Teachers' knowledge and opinions: are they a response to psychopathological phenomena?

150 teachers, 75 from a group of basic schools and 75 from a group of schools on an advanced level were asked to respond to a questionnaire consisting of 194 items in order to find out about their actual state of knowledge, opinions and prejudices against epileptics. 45 stereotype statements had to be rated for 'epilepsy', 'insanity', and 'heart disease'. A ranking order of 6 disorders--'insanity', 'depression', 'epilepsy', 'heart disease', 'amputation of a leg', and 'diabetes mellitus' had to be established. Teachers' knowledge of epilepsy proved to be somewhat diffuse but in good keeping with reality and they showed an interest in more information and research. Some of their prejudices could be attributed to old ideologies while the acquaintance with epileptics enhanced their knowledge of their real needs. Teachers' confusions went along with the controversies in medical research.

Adult↗

PubMed1989

Diagnosis, guardianship, and residential care of the mentally ill in medieval and early modern England.

Histories of psychiatry concerning preindustrial Europe emphasize demonologic beliefs and physical mistreatment of the insane. Records of an English legal incompetency jurisdiction demonstrate that both government officials and laymen accepted that psychiatric disorders had biological and psychosocial origins. This jurisdiction, which developed a social welfare dimension by the seventeenth century, offered benevolent protection for the insane. Private guardians arranged for the lodging and care of their wards in private homes. While physicians played little role in the certification process, the guardians made frequent use of their skills. Furthermore, some physicians with established reputations in psychiatry accepted patients into their homes for prolonged cures.

England↗

PubMed1978

A review board for determining the dangerousness of mentally ill offenders.

Partly as the result of legislative changes made in 1975 and 1977, Texas has a workable system for dealing with mentally abnormal offenders and assessing the dangerousness of committed offenders. The author summarizes provisions of the law related to pretrial evaluation, competency to stand trial, dispositions after a ruling of incompetency, and the insanity defense. He describes the activities, during the first two years, of multidisciplinary review boards for manifest dangerousness; the boards met monthly to assess the dangerousness of patients committed to a state hospital's maximum-security unit after rulings of incompetency (without the probability of attaining competency in a foreseeable period) or of not guilty by reason of insanity. During the two years, the boards declared 171 of 364 patients to be not manifestly dangerous and thus ready for transfer or release, but they became more conservative in making judgments of not dangerous as time passed.

Adult↗