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| title | chunk | source | category | tags | date_saved | instance |
|---|---|---|---|---|---|---|
| Anti-psychiatry | 2/13 | https://en.wikipedia.org/wiki/Anti-psychiatry | reference | science, encyclopedia | 2026-05-05T09:08:59.919288+00:00 | kb-cron |
The first widespread challenge to the prevailing medical approach in Western countries occurred in the late 18th century. Part of the progressive Age of Enlightenment, a "moral treatment" movement challenged the harsh, pessimistic, somatic (body-based) and restraint-based approaches that prevailed in the system of hospitals and "madhouses" for people considered mentally disturbed, who were generally seen as wild animals without reason. Alternatives were developed, led in different regions by ex-patient staff, physicians themselves in some cases, and religious and lay philanthropists. This "moral treatment" was seen as pioneering more humane psychological and social approaches, whether or not in medical settings; however, it also involved some use of physical restraints, threats of punishment, and personal and social methods of control. As it became the establishment approach in the 19th century, opposition to its negative aspects also grew. According to Michel Foucault, there was a shift in the perception of madness, whereby it came to be seen as less about delusion, i.e. disturbed judgment about the truth, than about a disorder of regular, normal behavior or will. Foucault argued that, prior to this, doctors could often prescribe travel, rest, walking, retirement and generally engaging with nature, seen as the visible form of truth, as a means to break with artificialities of the world (and therefore delusions). Another form of treatment involved nature's opposite, the theater, where the patient's madness was acted out for them in such a way that the delusion would reveal itself to the patient. Thus the most prominent therapeutic technique became to confront patients with a healthy sound will and orthodox passions, ideally embodied by the physician. The "cure" involved a process of opposition, of struggle and domination, of the patient's troubled will by the healthy will of the physician. It was thought the confrontation would lead not only to bring the illness into broad daylight by its resistance, but also to the victory of the sound will and the renunciation of the disturbed will. We must apply a perturbing method, to break the spasm by means of the spasm.... We must subjugate the whole character of some patients, subdue their transports, break their pride, while we must stimulate and encourage the others (Esquirol, J. E. D., 1816). Foucault also argued that the increasing internment of the "mentally ill" (the development of more and bigger asylums) had become necessary not just for diagnosis and classification but because an enclosed place became a requirement for a treatment that was now understood as primarily the contest of wills, a question of submission and victory.
The techniques and procedures of the asylums at this time included "isolation, private or public interrogations, punishment techniques such as cold showers, moral talks (encouragements or reprimands), strict discipline, compulsory work, rewards, preferential relations between the physician and his patients, relations of vassalage, of possession, of domesticity, even of servitude between patient and physician at times". Foucault summarized these as "designed to make the medical personage the 'master of madness'" through the power the physician's will exerts on the patient. The effect of this shift then served to inflate the power of the physician relative to the patient, correlated with the rapid rise of internment (asylums and forced detention). Other analyses suggest that the rise of asylums was primarily driven by industrialization and capitalism, including the breakdown of traditional family structures. By the end of the 19th century, psychiatrists often had little power in the overcrowded asylum system, acting mainly as administrators who rarely attended to patients in a system where therapeutic ideals had turned into institutional routines. In general, critics point to negative aspects of the shift toward so-called "moral treatments", and the concurrent widespread expansion of asylums, medical power and involuntary hospitalization laws, that played an important part in the development of the anti-psychiatry movement.