Welcome to #SchizoChat, our weekly forum for discussing a topic about schizo-type illnesses and related topics! I’ll be tweeting a bunch of fun facts about institutions/asylums approximately every 5 minutes for the next two hours, so keep checking in with the thread!
Please feel free to ask me any questions at any point (today or otherwise)—comment or send me a DM! #SchizoChat
As usual, please remember I am not an expert—I study animal development, not schizophrenia or medical history! I’m just a scientist with schizoaffective disorder trying to get folks talking to #EndTheStigma #SchizoChat
...so please call me out if you see anything incorrect in the #SchizoChat-- I will fix it! You wouldn't be the first to help me make this all more accurate.
I'm working on running some code at the moment, so if you don't hear from me for a bit that'll be because I'm really excited about population modeling and/or I crashed my computer trying to run models! But I'll be back to #SchizoChat!
(already a minor typo in the first tweet, good start @SchizoScientist)
If you’ve missed our previous #SchizoChat-s about treatments please check out my pinned tweet—I put all of the previous chats in that thread so you can find them all if you want!
In honor of tomorrow’s spooky holiday (my absolute favorite yay) I’m going to spend the evening talking about a topic related to Halloween—asylums, institutionalization, and a bit about their portrayal in media/costumes. #SchizoChat
I'm going to be using the words asylum, mental health hospital, and institution interchangeably. Now there are subtle differences, but throughout much of this #SchizoChat I'll be talking about historical facilities that operated in similar ways regardless of name.
I’m going to be talking almost exclusively about the history of institutionalization in a western European context. I know nothing about institutionalization outside of this tiny bubble—if you do please let me know! I want to learn more. #SchizoChat
Please remember that this is not ancient history—you or others that you know/will be interacting with online may have experienced institutionalization. Please be respectful of other peoples’ experiences and opinions! #SchizoChat
In fact, our poll results illustrate this nicely! At the time of tweeting, many folks have responded to say that either they or a family member has spent some time in an institution. #SchizoChat
As these topics are very sensitive, please be aware that I will be using language that could be triggering throughout this #SchizoChat (like insane, asylum, crazy, psychotic, etc.). I'll also be talking about some awful abuse but I'll try to warn y'all in advance.
In using these terms, I am in no way passing judgment on people with mental illness! I am merely trying to explain the way these institutions were denoted and operated in the past (when terms like "madhouse" were used frequently). #SchizoChat
Brief side note: remember that these terms (insane, crazy, psycho, others) can be truly offensive and triggering for folks diagnosed with psychotic illnesses and their loved ones. Don’t use them flippantly! #SchizoChat
And, remember that psychotic people can reject or reclaim these terms as they please. I personally identify with the terms as I think that my psychosis is pretty insane, but I still dislike them used without care in other contexts. #SchizoChat
Anyway, back to the scheduled programming…
So, what is asylum? The word simply means to offer shelter. When we say "political asylum" we mean offering shelter within an area for people in need. In the context of mental health the term is used to describe “an institution offering shelter to the mentally ill.” #SchizoChat
Hence why I'm using asylum/institution/mental hospital interchangeably for most of this #SchizoChat
As folks have pointed out in this poll, the word asylum means a lot of things to different people. While some think of political asylum or institutions, others think of haunted houses, musical groups, and famous albums! #SchizoChat
Through the vast majority of (western) recorded history, folks with mental illness were cared for by their family or by community members in private homes—there weren’t private or public institutions dedicated to caring for the mentally ill #SchizoChat
There are, of course, notable exceptions—Ahmad ibn Tulun built a public hospital in Egypt that included care centers (music based!) for mentally ill folks. In medieval Europe, monasteries and convents provided care for individuals when families could not. #SchizoChat
One particularly famous pre-19th century asylum is the Priory of Saint Mary of Bethelhem in London, England. It was founded in 1247 AD and is now better known by another name—Bedlam. #SchizoChat
I’m going to use Bedlam as a sort of case-study, an example asylum through with to take us from the 13th century to the 21st century. #SchizoChat
Fun fact: I write these tweets out in advance on good weeks (weeks in which I'm actually prepared) and this week I had to control/replace in my script because I kept typing Beldum (the Pokemon) rather than Bedlam (the famous asylum). #SchizoChat
The Bedlam institution was at first a hospital in the medieval sense, not a medical institution but a place for the poor and needy to live, supported by charity or taxes. This came at the cost of inhabitants’ obedience to the church. #SchizoChat
This system broke down during the Hundred Years’ War (a long conflict between France and England), as the Church was associated with France (but the asylum was in England). Bedlam was eventually claimed by Henry III for the city of London in 1547. #SchizoChat
Historians dispute when Bedlam became a “house for the insane.” We have evidence that mentally ill patients were housed in the facility as early as 1403 AD. #SchizoChat
So, as western Europe was transitioning between Medieval times and the Renaissance, mentally ill folks were cared for in an asylum. We're talking the time of Joan of Arc, Richard III, Botticelli, Bosch, da Vinci, Copernicus, and Christopher Columbus. #SchizoChat
It is easy to speculate about the way these patients were treated, just as we speculate a lot about the "backwards" ways of medieval times. In reality, we have no idea how the Bedlam patients were treated in medieval times, we simply don’t have records. #SchizoChat
Side note: much of the backwards ideas we have of medieval times were actually the results of post-medieval (Renaissance) generalizations made to portray Renaissance thinkers as newly progressive compared to Medieval folks. #SchizoChat
When I was getting a degree in medieval history I was amazed at how little of our medieval stereotypes are actually true! Very little Monty Python but instead some really neat and relatable stories of medieval life. #SchizoChat
By 1460 Bedlam had fully transitioned from a medieval-style hospital for the poor and downtrodden to an institution for the confinement of the “insane.” #SchizoChat
Why was the Bedlam institution named after a word that means madness, chaos, and irrationality? It was actually the other way around—Bedlam, the nickname for the Priory of Saint Mary of Bethlehem, was the origin of the term. #SchizoChat
Why was the Bedlam institution associated with chaos? Historians think this was the result of several plays in the 1600s, around the time when two major London theaters sprung up near the institution. The stereotype spread from there. #SchizoChat
While these plays didn't necessarily lead to the link between psychosis and chaos, it's interesting to think that the word "bedlam" in our everyday usage may mostly be the result of a few plays! #SchizoChat
At this point the story starts to get pretty dark, so skip ahead a dozen tweets or so if you want to avoid the worst of it (content warning: maltreatment, torture, confinement, restraints, abuse) #SchizoChat
By this point we know Bedlam was no longer a safe place for the poor or mentally ill. It functioned much like a prison. Under poor management, “prisoners” were “likely to starve” and had to barter for basic necessities. They weren’t considered patients until 1630. #SchizoChat
These patients were mostly free to wander the local neighborhood and the building, although they were confined if deemed dangerous (in which case they were often chained up). Conditions were described as miserable and filthy. #SchizoChat
When we think of asylums in media we tend to think of descriptions like this 1630 characterization of Bedlam, which described the “cryings, screechings, roarings, brawlings, shaking of chaines, swearings, frettings, and chaffings” of patients. #SchizoChat
Side note: It’s weird having moved from the “oh no those poor people” stage of my life to the “this would have been me” stage of my life. Thanks, modern medicine and basic human decency. #SchizoChat
In 1634 the old non-medical “stewards” of Bedlam were replaced by a medical regime with a physician, a surgeon, and an apothecary just like the hospitals of the time (which by this point were treating ill people, not poor people) #SchizoChat
So before this point, the prisoners of these asylums were not being medically treated whatsoever, but merely housed to keep them off of the streets. #SchizoChat
Having a medical board was a marked improvement to the prison-like conditions, but remember, this was still the 1600s. They introduced new amazing practices, like bathing. As in, they let people take baths. #SchizoChat
And remember, medicine in the 1600s was intense and awful. We aren’t talking some rudimentary antipsychotic medications, we are talking bleeding (like with leeches or simply cutting patients), purging bowels, etc. #SchizoChat
In the mid-1670s the hospital was rebuilt from its aging residence in London in a new location outside of town. It took on the form we often think of when we imagine an asylum—large walls surrounding a building and a central courtyard. #SchizoChat
Around this time other public institutions started to spring up, as did private institutions for those who could pay. In 1752 the Pennsylvania Hospital in the American colonies started admitting the mentally ill. #SchizoChat
To put that in context, this was around the time the British colonies were fighting a coalition of Native and French folks in the French and Indian War. King George III (of revolution fame) had just ascended the throne. And the first mental ward was built. #SchizoChat
Back in the United Kingdom, relatives of the patients at Bedlam were encouraged to visit and bring food and other supplies. Unfortunately, non-relatives were also encouraged to come, making the hospital a sort of zoo for gawking folks on holiday. #SchizoChat
While this visitation practice was certainly cruel to the patients and their loved ones, who had to deal with people coming to view their “madness,” it also inspired many donations to help run the institution. And started to inspire compassion. #SchizoChat
By this point folks had started to get loudly uncomfortable with the way the patients were treated at Bedlam. A Quaker by the name of Edward Wakefield published a (likely sensationalized) report of the horrors of Bedlam. #SchizoChat
In this report, Wakefield detailed horrible cases of abuse and neglect, including patients restrained all day long, in chains and stocks. Many people demanded national reform. #SchizoChat
This mirrored an international change of heart—as the Enlightenment era progressed, people began to view mental illness as a medical disorder that required compassion and care. Finally. #SchizoChat
Part of this was likely the result of the King of the United Kingdom—George III, of colonial American fame, had major problems with mental illness but went into remission, convincing many that mental illness could be treated. #SchizoChat
So, remember that the next time you are listening to the Hamilton soundtrack haha #SchizoChat
William Tuke built a facility called the York Retreat following the death of a fellow Quaker in a local asylum. It was a tiny community in the country focused on rest, talk, and manual work. They minimized restraints but also medical theories/techniques. #SchizoChat
Institutions, like the Bicetre Hospital in France, banned their previous use of shackles and chains, moving instead to “humane” restraints like straightjackets. #SchizoChat
What’s a straightjacket, no one asked? It’s a jacket-like garment that restrains the arms of an individual. Although often used in magic tricks, straightjackets are of course quite controversial. #SchizoChat
The first straightjacket was described in 1772 as a more humane way of restraining a patient (to keep them from hurting themselves or others). Restraints were (and still are?) viewed as a way to help patients regain control. #SchizoChat
The results are mixed. Sure, restraints may help caretakers feel safe, but do patients feel like they are being helped? Check out this poll [at the time of tweeting, no one has said yes]:
#SchizoChat
#SchizoChat
I'm cynical, so it's hard for me to think of restraints as being used for the convenience of caretakers rather than to help the patients. Some patients say they benefited from them, feeling safe. Others describe it as torture. I guess it is a personal preference. #SchizoChat.
While not the top method of restraining patients, straightjackets still exist and are still in use today. This isn’t some old-timey movie thing, folks! Your Halloween costumes are used to treat currently ill patients. #SchizoChat
Would you dress up as other medical devices, like crutches or wheelchairs? Or medical devices that seen as equal parts helpful and torture? Really think critically about being a “crazy lunatic” with a straightjacket for Halloween. #SchizoChat
Or a sexy lunatic, an outfit that of course exists.
That's how I describe myself, and the costume looks nothing like me haha
#SchizoChat
That's how I describe myself, and the costume looks nothing like me haha
#SchizoChat
I’m on the end of patients who would very likely not benefit from psychiatric restraints. I’ve had a panic attack just thinking about it before and even writing about it has my heart rate real up. It’s not a joke, it’s not cute or funny. It’s downright terrifying. #SchizoChat
Anyway, by the mid-1800s progress was being made on both sides of the Atlantic. Britain’s Lunacy Act explicitly classified the mentally ill as “patients” and mandated accessible and regularly inspected institutions. #SchizoChat
Dorothea Dix, a Civil War era nurse, fought for the welfare of downtrodden people by campaigning for public asylums, successfully starting the first public institution in Pennsylvania in 1853. She went to Europe to lead similar campaigns #SchizoChat
I think I'll do a whole #SchizoChat about Dorothea Dix at some point, she seems super cool and I want an excuse to read more about her.
It’s a good(?) time to mention that the folks in mental institutions were predominantly women, perhaps because of Victorian-era gender roles. Women were often solitary homemakers, under immense social pressure yet lacking social support systems. #SchizoChat
Historians also suggest that institutionalization was used as a form of social control to maintain male-dominated systems. Unruly and opinionated women were often sent to asylums by male relatives. Would you have been? #SchizoChat
I’m not making this up because I’m a crazy unruly extreme feminist (although I am): here’s a very simplified (if not terribly nuanced) webpage about it if you want some references: broughttolife.sciencemuseum.org.uk/broughttolife/…
At some point I'll do a #SchizoChat on the way gender influences our perspectives on mental illness, especially #schizophrenia. Because why not?
Mental hospitals/asylums/institutions surged in popularity in the US as folks decided that mentally ill folks needed help rather than prison. According to Wikipedia, between 1825 and 1865 the number of institutions went from 9 to 62. #SchizoChat
By 1904, 150,000 people were housed in mental institutions in the US, numbers that mirrored the expansion in other parts of western Europe. #SchizoChat
We see remnants of this system all over the country-- many towns still have the old asylum buildings. They may be spooky abandoned structures, but most often they were re-purposed into other facilities. Have you seen one?
#SchizoChat
#SchizoChat
Last week’s #SchizoChat (linked below) talked about some historical treatments for mental illness. These were the sort of treatments patients could undergo in 20th century (1900s) institutions. #SchizoChat
In addition to these often horrifying “treatments,” patients were often sterilized against their will or even (in the case of Nazi Germany) euthanized. Japan allowed forced sterilization (officially) as late as the 1950s. #SchizoChat
Institutionalization was also used as a political device. Dissidents could be deemed “crazy” and confined and abused in mental hospitals.
Yet we still frequently throw around terms like “crazy” or “lunatic” when discussing the antics of current leaders, weird. #SchizoChat
Yet we still frequently throw around terms like “crazy” or “lunatic” when discussing the antics of current leaders, weird. #SchizoChat
Side note: stop calling Trump and Johnson crazy, I’m crazy and I don’t want to be lumped in the same category as them, please and thank #SchizoChat
As we discussed two weeks ago, effective antipsychotics were developed in the 1950s. Now patients could be treated with drugs rather than shocking or brain surgery. Of course these can be abused—they're often given without a patients’ consent but hey, no surgery! #SchizoChat
As the 20th century progressed, funding for mental institutions was cut (at least in the US). This led to overcrowding and even more abuse, leading to what we call the deinstitutionalization movement. #SchizoChat
Many of the institutions were closed, which meant that a lot of people avoided some abusive situations. But then what? The closing of the institutions did not cure major mental illness, where are folks supposed to go? #SchizoChat
At least at the time of tweeting, most respondents to this #SchizoChat poll agreed that the deinstitutionalization movement was not as good as it might appear on paper:
Many mentally ill folks who would have been institutionalized previously (like me!) can maintain somewhat “normal” lives with regular care. Some hospitals have psychiatric (“psych”) wards to temporarily house patients. #SchizoChat
These psych wards are controversial (I’ll do a #SchizoChat about them with more details later) but they still often restrain and medicate patients without their consent. Which sounds way less than ideal to me. But they can also save lives. #SchizoChat
Bedlam (the Bethlem Royal Hospital) still includes a National Psychosis Unit in use to this day. Within the last twenty years it has been the site of controversy about fatal restraints and a sit-in protest on its 750th anniversary. #SchizoChat
But unfortunately the resources (money) that used to be funneled into asylums is no longer granted to these psych wards or even other community support programs. Where do patients in need of long term support find the care? #SchizoChat
What about the patients who don’t respond well to medication or who can’t afford stays at the psychiatric wards? Unfortunately, a lot of them end up incarcerated. #SchizoChat
Author Heather MacDonald wrote “jails have become society’s primary mental institutions, though few have the funding or expertise to carry out that role properly.” #SchizoChat
She goes on to say that in 2009 28% of the inmates at Rikers required mental health care and that figure continues to grow. #SchizoChat
This sad reality is why many mental health providers argue that closing public institutions was problematic. They needed to be reformed, for sure, but a reformed safe place for the chronically mental ill could definitely be helpful. #SchizoChat
So, finally, what do we think of when we think of asylums? Problematic institutions whose role in society has shifted with social movements? A humane alternative (when done properly) to prison? Or something more sinister? #SchizoChat
I personally think of the media portrayal-- the bound and raving lunatics, dilapidated ruins haunted with murderous crazy ghosts, the setting for a local haunted house. #SchizoChat
Side note: I once took part in a historical investigation at a local nursing center that was a former mental institution. We discovered that a nurse had been murdering patients to sell their bodies as scientific cadavers. Spooky in a not-fun way. #SchizoChat
Don’t forget—public institutions may not be common, but there are still certainly private centers and psychiatric wards. These institutions that become horror movie plots, settings for crime procedurals, and Halloween costumes—they’re still real. With real people. #SchizoChat
So why do we use real people in presentations of horror media and costumes? Remember, this has been happening since the stage plays near Bedlam in the 15th century. Psychosis and other major mental illnesses are scary. #SchizoChat
Psychosis and other illnesses are scary for family, friends, and (most importantly) the patients. I’m frightened by myself when I yell at hallucinations in public, I can’t blame other people for being scared of me. #SchizoChat
And we sensationalize what is scary in order to intrigue, provoke, and entertain. It is a really human impulse. I’ll have a whole #SchizoChat about schizo in the media (probably separate ones for film, books, TV, and music).
But we don’t have to use “craziness” to horrify. In order to #EndTheStigma about major mental illness we need to think critically about why and how we portray mental illness in media (and in Halloween costumes). #SchizoChat
Are our portrayals necessary and with compassion? Whose stories are we choosing to tell? What is the goal of our use of mental illness—is it a cheap side gimmick to develop the protagonist or an in-depth portrayal of the humanity of mentally ill people? #SchizoChat
I’d argue that dressing like a straightjacket-wearing lunatic is not necessary, not with compassion, not the story that most mentally ill folks prefer you tell, and not based on a portrayal of humanity. #SchizoChat
Yet this happens all of the time. At the time of tweeting, most respondents had seen a portrayal of mental illness in some Halloween context in person-- and some had even seen it this year! My local haunted house is asylum-themed. #SchizoChat
You say, hey @SchizoScientist, what’s the big deal, it’s just some fun on Halloween?! Sorry but it is a big deal. The stigma against mental illness is very very real—psychiatrists don’t treat us, insurance doesn’t help us, doctors are scared of us #SchizoChat
Until we make a system where my illness doesn’t become a threat to my life, my career, and my bank account you don’t get to trivialize my illness as just some Halloween fun. #SchizoChat
I’d say “you wouldn’t dress as a dying cancer patient for Halloween, would you?” but I’m really sorry to guess that that has probably happened. #SchizoChat
That being said, if you are a psychotic person wear the hell out of those straightjackets if you want, you’ve earned it by putting up with all of this shit. Just don’t be grumpy if I have a panic attack and collapse. #SchizoChat
I’m really really afraid of being forcibly restrained, my dudes/dudettes/gender-neutral-form-of-dudes. #SchizoChat
...just make sure you dress as an extra-sexy straightjacket-wearing person I guess. #SchizoChat
I want to know if psychotic people are more or less likely to like Halloween. On one hand, folks may present some awful stereotypical caricature of a deranged "lunatic." This is definitely a bummer, at least for me. #SchizoChat
But on the other hand... my whole life is filled with whispering voices, appearing monsters, spooky smells, etc. because of my psychosis. It's kind of fun that everyone else is experiencing that stuff with me for a brief window every year. #SchizoChat
Not sure if that's why I am particularly drawn to spooky things, but I definitely am (finding a way to include my favorite gif in case my fiance, who hates it, reads through the #SchizoChat this week).
So that ends our spooky asylum/Halloween #SchizoChat! Please let me know what you want to chat about—I’m running out of ideas.
These #SchizoChat-s take anywhere from 5-10 hours of work a week, so I may have to start doing them every other week so I can, you know, do my job. #academia
Haven’t decided what topic I'm going to cover week, so give me some ideas! #SchizoChat
Hey @threadreaderapp could you unroll this for me so I can share it with everyone? Thanks!
@threadreaderapp Here's the whole thing in html form in case you want to share this around! threadreaderapp.com/thread/1189678…
