Families, Staff, and Patients at the Friends Asylum in Early Nineteenth-Century Philadelphia
Founding Friends is a history of day-to-day life inside the Friends Asylum for the Insane in early nineteenth-century Philadelphia. It uses an extraordinarily rich data source: the daily diaries that the Asylum's lay superintendents kept between 1814 and 1850. In their diaries, these men wrote about their own and their attendant staff's work. They also write about their patients: their conditions, the moral remedies applied, the medical prescriptions ordered by the consulting physicians, the reasons for chosen treatments, and the responses of patients and staff to the particular interventions. The Asylum's lay superintendents also wrote with unusual candor and detail about their own and their attendant staff's feelings: about the joys and the frustrations of working daily with insane patients. These diaries offer a new perspective on institutional life. This book shows how intricate negotiations and shifting alliances among families, communities, patients, and staff emerge as the most compelling determinants of an institution's changing form and function.
This history begins in 1817 when the Friends Asylum for the Insane opened as the first private American institution dedicated solely to the implementation of moral treatment, a radically new way of caring for the insane, by kind, committed, and lay Quaker men and women. But from the very beginning, families, staff, and patients all struggled to resolve the central dilemma of institutional life: how does one balance the needs of an individual for kind, compassionate, and personalized care against the equally compelling needs of the larger group to which he or she belongs for stability, predictability, and in the oft-repeated words of the Asylum's lay superintendents, "peace and tranquility"? The Asylum and its commitment to moral therapy might well have crumbled under this quandary. But its lay staff, families, and patients worked slowly, although often not smoothly, to recreate a depersonalized medical space that brought a sense of order to the too-often chaotic social and emotional experience of day-to-day institutional life. The book ends in mid-century, when the Asylum formally abandoned its lay model and joined its sister asylums in vesting all administrative, clinical, and day-to-day management responsibilities in the newly created role of a medical superintendent. But at the Friends Asylum physicians did not co-opt moral treatment. It was handed over to them.
The dilemma of balancing the needs of an individual against that of the larger group is neither time nor place specific. It occurs daily: in general hospitals, in nursing homes, in assisted living communities, and in the homes of families struggling to care for those whose behaviors raise fundamental issues about the safely of the individual and the security of the group. Founding Friends provides a framework that contextualizes and explains such dilemmas. This book provides a way to begin a meaningful dialogue among families, clinicians, and patients about the possibilities and problems inherent in meeting a simultaneous, often conflicting, rarely articulated, and ever-present commitment to both the individual and the institutional environment.
