Wilhelm Griesinger’s Mental Pathology and Therapeutics and a Changing Understanding of Patient Care in Mental Asylums
By Willow Michele Catellier
Wilhelm Griesinger (1817-1868), a German psychiatrist, is noted by many modern historians as being an impactful figure to the field of psychiatry in the middle of the moral treatment movement and during prominent developments of brain pathology in the mid-19th century. His original 1845 textbook Mental Pathology and Therapeutics and the later 1882 second edition have been recognized because they were “philosophically clear and permeated by an objective psychology,” “based on pathological anatomy,” and “included the new neurophysiology” [2]. The second edition was influenced by the success of the first one with the hope that it would draw attention to the advancements of psychiatry, gain the developing science respect in universities, and change the popular view of mental illness into one that was more scientific [3]. Throughout the second edition, Griesinger focused on creating a functional guide for those in the field to best treat and understand patients with mental illness. At the time of its publishing, it was noted as being distinctly different from other medical textbooks on mental illness as it combined both medicine and philosophy [4]. Griesinger’s book demonstrates the creation and developments of the moral treatment movement in the mid-19th century as understandings of mental illness started to emphasize the pathology of the brain as an organ and treatment focused on providing complete, functional care for individuals.
Philippe Pinel in France and William Tuke of England are often considered to be the early founders of the moral treatment movement as they “provided both the rationale and the organizational model for public intervention on behalf of the insane” [5]. Before the 19th century, asylums and mental hospitals concerned themselves with containing those deemed mentally ill more than they did treating and curing them. Ideas of lunacy were loosely defined and, since there was no solid understanding of how pathology played into these behaviors, patients were typically left untreated and chained to the walls of overcrowded buildings where abuse ran rampant [6]. However, Tuke’s 1796 York Retreat and Pinel’s changes to hospitals like the Salpêtrière demonstrated a new understanding of these patients where their conditions could be better categorized along pathological lines and they could be treated, not by chains and tranquillizing chairs, but by relaxation, exercise, and fresh air. With these new understandings, hospitals were constructed throughout the mid-19th century that were purpose-built and focused on moral treatment. This is the context in which Griesinger writes Mental Pathology and Therapeutics. Not only were ideas of moral treatment spreading, but entire institutions were either restructuring themselves or being newly built based on these principles. Griesinger’s book acts in conversation with Tuke and Pinel, their successors, and other professionals across Europe.
Prior to writing Mental Pathology and Therapeutics, Griesinger had worked at the German public asylum, Winnenthal, from 1840 to 1842 [7]. His book not only contains his own philosophy on care, but also the practical medical therapeutics that he tested at this well-respected institution. He outwardly described old asylum practices as barbaric and those that conducted them as bigots [8]. He criticized old humoral theory and the beliefs that insanity was caused by “excitation” and a “local inflammation process” that did not account for the complexity of the brain [9]. Instead of following these beliefs, Griesinger contributed to the effort of linking mental health symptoms to specific mental functions. He is known for how he explained the links between the brain and mental disorders, especially as he analyzed the brain in complex ways, recognizing its functional structure while refusing to simplify its processes and localize “mental powers… in any specific brain structure” [10].
Old ideas of bloodletting and restraining patients were fading during this time but had yet to entirely disappear [11]. This can be seen in Greisinger’s work as he recognizes that venesection was “not only useless, but injurious” while still approving and encouraging the occasional use of localized, intentional bleeding by using cupping-glasses and leeches for acute meningitis and intense cerebral congestions [12]. He also denounced the use of ether and chloroform for prolonged sedation but accepted the occasional use in “violent puerperal mania” [13]. Restraints, he believed, “should never be suggestive of a house of correction…, neither should they shock the imagination, as did those great apparatus which were used till very recently in many places” [14]. Instead, Griesinger represented many other psychologists when he wrote that restraints should only be used to prevent “the patient from inflicting injury to himself or others, to prevent that rage and fury, especially such manifestations of his insane desires as would afford them new nourishment, and thereby to aid his self-control” [15].
However, other practices explored by Griesinger were a complete upheaval from older practices, as the new asylum supported by Griesinger emphasized the importance of “diet,” “regulation of rest and activity,” “fresh and open air,” and even the “abundance of outdoor exercise on foot” and the prescription of “cheerful games” [16]. He guided readers on how to talk to patients in order to help them feel understood rather than judged for their experiences or “delusions” [17]. Mental Pathology and Therapeutics also continuously stressed the importance of treating every patient as an individual and puts the burden of responsibility on the physician to unveil the exact nature of every patient’s character and condition [18].
As the specifics of brain pathology were only beginning to be understood, many Griesinger’s practices reflect the newer transition to believing mental illness to be treatable and physiological. However, while this type of medical understanding was new, diagnosis of insanity as a “bodily disease” was still “often rendered very difficult” and objective diagnosis had to be “carefully practiced” [19]. Thus, there is a significant shift from old, “barbaric” practices, but not a complete elimination of them, as Griesinger and his peers were reflective of the gradual transition into modern medical understanding in regard to mental health care.
This post was written for the course HIST H364/H546 The History of Medicine and Public Health. Instructor: Elizabeth Nelson, School of Liberal Arts, Indiana University Indianapolis.
References
[1] Anatoly Terentiev (Ipaat), Monument to Wilhelm Griesinger in Berlin, Wikipedia, July 11, 2009, https://commons.wikimedia.org/wiki/File:Wilhelm_Griesinger_berlin.jpg.
[2] Otto M. Marx, “Wilhelm Griesinger and the History of Psychiatry: A Reassessment,” Bulletin of the History of Medicine 46, no. 6 (1972): 521, https://www.jstor.org/stable/44450830.
[3] Wilhelm Griesinger, Mental Pathology and Therapeutics, trans. C. Lockhart Robertson and James Rutherford. William Wood & Co, 1882, v.
[4] The Oxford Handbook of Philosophy and Psychiatry, ed. Martin Davies, K.W.M. Fulford, et al. Oxford University Press, 2013, 59.
[5] Joseph P. Morrissey and Howard H. Goldman, “Care and Treatment of the Mentally Ill in the United States,” The Annals of the American Academy of Political and Social Science 484 (1986): 14, https://www.jstor.org/stable/1045181.
[6] Peta Longhurst, “Madness and the Material Environment: An Archaeology of Reform in and of the Asylum,” International Journal of Historical Archaeology 21, no. 4 (2017): 850, https://www.jstor.org/stable/45154375.
[7] Marx, “Wilhelm Griesinger and the History of Psychiatry,” 522.
[8] Griesinger, Mental Pathology and Therapeutics, 326.
[9] Ibid.
[10] The Oxford Handbook of Philosophy and Psychiatry, 359.
[11] Morrissey and Goldman, “Care and Treatment of the Mentally Ill in the United States,” 14.
[12] Griesinger, Mental Pathology and Therapeutics, 334-335.
[13] Ibid., 339.
[14] Ibid., 348.
[15] Ibid., 338.
[16] Ibid., 342.
[17] Ibid., 342-344.
[18] Ibid., 345.
[19] Ibid., 334.
