History of Psychiatry: Madness,Science,Culture

The history of Lübeck psychiatry in the nineteenth century is presented and delineated with the State Asylum in Wakenitz Street as its centre. It is based on handwritten and printed files in the archives of the Hanseatic City of Lübeck and its Psychiatric Clinic of the Medical University. A concise presentation of the role of psychiatry in the City-State before the nineteenth century is given. Following a description of the history of the Asylum's construction and its finances the composition of the staff and patients is dealt with.

In three separate time-scales the schemes of diagnosis that were used as well as the general and specific psychiatric treatments that were applied are successively delineated as they underwent important changes in the course of time. Special emphasis is laid on a clear presentation of how the mentally ill were dealt with in everyday life. None of the physicians and psychiatrists practising in the Lübeck State Lunatic Asylum belonged to any one definite school of thought in a strict and one-sided manner. It is, nevertheless, possible to locate their approximate position within contemporary psychiatric trends and to give a characterization of their personalities and medico-scientific work.

Thomas Bakewell, the proprietor of Spring Vale private asylum in Staffordshire, was an outspoken critic of the movement to develop public lunatic asylums. The County Asylums Act of 1808 encouraged the building of asylums for pauper lunatics. Bakewell contended that the system under which large public asylums operated would lead to a failure of the therapeutic intentions of those who projected them. He campaigned vigorously over a twenty year period against the concept and the practices of these asylums, and argued for a fundamental change in state policy toward the insane. He advocated an alternative system of state run curative hospitals, to replace institutions that were largely custodial in their orientation.