Bibliotherapy: Tracing the Roots of a Moral Therapy Movement in the United States from the Early Nineteenth Century to the Present

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2013-4

Bibliotherapy: tracing the roots of a moral therapy movement in the United States from the early nineteenth century to the present

Len L. Levin University of Massachusetts Medical School

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Repository Citation Levin LL, Gildea R. (2013). Bibliotherapy: tracing the roots of a moral therapy movement in the United States from the early nineteenth century to the present. Library Publications and Presentations. https://doi.org/10.3163/1536-5050.101.2.003. Retrieved from https://escholarship.umassmed.edu/ lib_articles/143

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Bibliotherapy: tracing the roots of a moral therapy movement in the United States from the early nineteenth century to the present

DOI: http://dx.doi.org/10.3163/1536-5050.101.2.003

Hospital libraries, including ones care in his 1812 book, Medical and Mental Pathology, Galt wrote designed for patient use, share a Inquiries and Observations Upon the that ‘‘To many patients, [reading] common history with hospitals in Diseases of the Mind. His thoughts proves a source of agreeable feel- the evolution of health care deliv- stemmed from similar innovations ings, during time which would ery [1]. The library as a component that began in England, France, and otherwise be full of the tedium of of the early ‘‘insane asylum’’ in the Italy in the eighteenth century [6]. ennui’’ [10]. United States is well documented, While some of his recommenda- In 1854, Thomas Story Kirkbride, and many had been established by tions, such as blood-letting, would physician and superintendent of the mid-nineteenth century. While be anathema today, he suggested the Pennsylvania Hospital for the these libraries certainly existed as a having psychiatric patients engage Insane, wrote a prominent series of means of recreation for asylum in ‘‘amusements’’ such as reading. articles in the American Journal of patients, this historical communi- ‘‘In order to assist all the remedies Insanity. From these articles would cation will demonstrate they also that have been mentioned, it will be come the ‘‘Kirkbride Plan’’ that served as a center for ‘‘bibliother- useful, as soon as our patients begin would influence the design of both apy,’’ the use of reading as a to discover any marks of the revival public and private asylums well means of healing. of mind, to oblige them to apply into the twentieth century. The Prior to the 1800s, the plight of their eye to some simple and unique feature of a Kirkbride hos- the mentally ill was seen mostly entertaining book,’’ offered Rush. pital was its staggered wings that through a lens of superstition. He also encouraged copying man- allowed light and adequate cross- They were believed to be pos- uscripts and reading to the illiterate ventilation. Over thirty such Kirk- sessed by Satan or under punish- listener, concluding that these tasks bride hospitals were built in the ment by God for their sins and would fix the patient’s mind on one United States, with a few still in use were either hidden by their fami- subject and distract it from others today [11]. One of the amenities lies or consigned to poorhouses or that may be causing the condition. called for in these articles were jails [2]. In the early 1800s, a To facilitate this ‘‘mode of exciting libraries, one for male patients and religious revival known as the and regulating the faculties and one for female patients [12]. ‘‘Second Great Awakening’’ swept operations of the mind,’’ Rush While most early practitioners of the country and ushered in a series suggested that patients be exposed the moral therapy movement gen- of social reforms such as women’s to books of history, travel, and erally favored bibliotherapy, what rights, abolition, and a better un- fiction and that these should ‘‘com- the patients should read was open derstanding of mental illness [3]. pose a part of…every public and to a much wider interpretation. Insanity was for the first time seen private mad-house’’ [7]. Rush called for patients to be as a condition that was physiolog- Another prolific author of early exposed to fiction [7]. He advised ical in nature and could be treated nineteenth century psychiatry was that reading novels would serve and often cured [4]. The asylum John Minson Galt, superintendent as a needed diversion to those was ideally a retreat where pa- of the Eastern Lunatic Asylum in suffering with mental illness. Not tients with mental illness could go Williamsburg, Virginia. In his 1846 all, however, were in agreement. to rest and recover. A significant textbook, he, like Rush, prescribed ‘‘Cheap novels and trashy news- portion of this recovery included reading as an important therapy papers [are] more a cause than a ‘‘moral therapy,’’ which promoted for his patients. He also went a cure of insanity,’’ wrote Isaac Ray, activities such as gardening, wood- step further, calling for the creation superintendent of Butler Hospital working, playing games, sewing, of libraries as a basic element in the in Providence, Rhode Island. He and reading in addition to medical many similar asylums that were felt that reading was important, care. It was within this moral being founded at that time [8]. going so far as to lament that while therapy movement that bibliother- ‘‘And we,’’ he wrote in his 1843 the architectural elements of his apy, using books and reading as a annual report, ‘‘have felt the want new facility ‘‘fully answered his cure for mental and physical ill- of a regular library…so as to expectations, they were yet to have ness, first came to be [5]. render this a valuable and regular a library in place.’’ But he felt that Prominent Philadelphian Benja- additional agent in moral treat- the material read by patients min Rush was the first American ment’’ [9]. In 1853, writing in the should not ‘‘overly excite’’ the physician to write about psychiatric Journal of Psychological Medicine mind. In fact, a not-so-infrequent

J Med Lib Assoc 101(2) April 2013 89 Clio’s column

diagnosis for admission to an duties [16]. Today, bibliotherapy what is today the Worcester Recov- asylum in the mid-1800s was in- is commonly used in the cognitive ery Center and Hospital, felt it did sanity caused by ‘‘reading novels’’ behavioral therapy milieu. Librar- not matter. Whether patients read [13]. ‘‘Travel books, histories and ians have not proliferated as prac- to relieve the tedium of everyday biographies’’ were recommended titioners of bibliography, most asylum life, to expand their knowl- by Ray as well as by many of his likely due to the special training edge of a subject, to pray, or to peers [14, 15]. and certification required to work simply escape, early bibliotherapy Another point of contention was with patients in a clinical setting was an essential part of treatment. whether or not the Bible should be [17]. Although bibliotherapy has evolved included in an asylum library. Modern hospitals are now re- along with mental health care, its Religious excitement was another turning to some of the basic prin- roots and connection with the li- common diagnosis found on ad- ciples espoused by the moral ther- brary are very much intact. mission records of patients labeled apists in the design of new insane in the nineteenth century. facilities. A recent study at a Len Levin MSLIS, MA, AHIP, Persons who adhered to Millerism Midwestern hospital found the [email protected], Head, Edu- or other ‘‘fundamental’’ or ‘‘non- decibel level at a bedside during cation & Clinical Services, and In- Orthodox’’ religious beliefs (a label the 7:00 a.m. shift change reached structor, Department of Family Med- often applied then to anything as high as 113 decibels, the equiv- icine and Community Health, Lamar outside of the Protestant church) alent of a jackhammer, hardly Soutter Library, University of Mas- were frequently labeled as lunatics beneficial for rest and healing. sachusetts Medical School, 55 Lake and sent to asylums. As a result, Roger Ulrich, psychologist and Avenue North, Worcester, MA 01655; the Bible was kept away from these professor of architecture at Texas Ruthann Gildea, MLS, AHIP, patients ‘‘whose disease [might] A&M University states that ‘‘Re- [email protected], Director, Isaac lead them to make improper use search shows that even little touch- Ray Medical Library, Butler Hospital, of [the Scriptures],’’ wrote George es [in new design] can have a 345 Blackstone Boulevard, Provi- Chandler of the New Hampshire substantial impact. Patients feel dence, RI 02906 Asylum. On the other hand, Galt and do better if the hospital offers said that the Bible was ‘‘the book pleasant distractions such as sooth- most desired and read’’ by his ing artwork on the walls, windows References patients. He considered the daily that offer views of nature, and reading of consoling Psalms and places to visit such as gardens 1. Wolfgram PA. Hospital libraries in New Testament passages a must and lounges’’ [18]. In addition to the United States: historical anteced- for those patients suffering from enhancing the hospital environ- ents. Bull Med Lib Assoc. 1985 Jan; melancholia [8]. ment, bibliotherapy can play a role 73(1):32–8. By the late 1800s, the patient in holistic care. 2. Dadoly JL, Levin L, Palmer LA. Dr. census of most US asylums had In the fall of 2012, the Worcester Samuel B. Woodward: a 19th century pioneerinAmericanpsychiatriccare. begun to rapidly outgrow the size Recovery Center and Hospital Poster presented at: MLA ’05, 105th An- of their facilities. Causal factors opened in Worcester, Massachu- nual Meeting of the Medical Library Asso- included the explosion of the pop- setts. This is the newest mental ciation; San Antonio, TX; 14–19 May 2005 ulation due to immigration. Hos- health hospital in the United States [cited 23 Jul 2012]. ,http://escholarship. pital overcrowding quickly defeat- and will replace inpatient wards in umassmed.edu/lib_postpres/5/.. ed the goals of calm, time-intensive aging buildings at other state facil- 3. Tomes N. The art of asylum-keep- moral therapy. Thus many asy- ities. The 428,000 square-foot cam- ing: Thomas Story Kirkbride and the lums, much to the frustrations of pus, designed by architect Frank origins of American psychiatry. Phila- institutional leadership, became Pitts, would probably meet the delphia, PA: University of Pennsylva- more custodial in nature and less approval of Rush, Galt, and the nia Press; 1994. 4. Grob GN. The state and the mental- therapeutic [4]. Among the activi- other moral therapists. Included in ly ill: a history of Worcester State ties that began to suffer with these the design are 320 single patient Hospital in Massachusetts, 1830–1920. changes was the general availabil- rooms, outdoor courtyards, a gym- Chapel Hill, NC: University of North ity of patient reading programs. nasium, a music room, a school, Carolina Press; 1966. Bibliotherapy, however, did not game rooms, and a large, bright 5. Brewster E. ‘Medicine for the soul’: end. It simply moved from one of patient library with books for bibliotherapy and the public library the moral therapies, usually over- pleasure reading and computer [thesis] [Internet]. [Sheffield, UK]; Uni- seen by an asylum superintendent workstations [19]. versity of Sheffield; 2007. 75 p. [cited 23 (or a patient), to that of a special Superintendents of early asy- Jul 2012]. ,http://extra.shu.ac.uk/sinto/ service maintained by trained staff. lums recognized that reading was Issues/Documents/MEDICINE%20FOR% 20THE%20SOUL.pdf.. In 1904, E. Kathleen Jones, chief a healing activity for their patients. 6. Dunkel LM. Moral and humane: librarian at McLean’s Hospital in Some, such as Ray, attempted to be patients’ libraries in early nineteenth- Belmont, Massachusetts, first be- prescriptive about the types of books century American mental hospitals. gan practicing bibliotherapy with available. Others, such as Samuel Bull Med Lib Assoc. 1983 Jul;71(3): patients as part of her official Woodward, first superintendent of 274–81.

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7. Rush B. Medical inquiries and ob- 11. McElroy E. Kirkbride buildings [In- Butler Hospital for the Insane. The servations upon the diseases of the ternet]. 2010 [cited 31 Jul 2012]. ,http:// Hospital; 1848. p. 18–9. mind [facsim. of the Philadelphia, 1812 www.kirkbridebuildings.com.. 16. Rubin RJ. Using bibliotherapy: a ed.]. New York, NY: Hafner; 1962. 12. Kirkbride TS. Remarks on the guide to theory and practice. Phoenix, p. 210. construction, organization and general AZ: Oryx Press; 1978. p. 12. 8. Galt JM. The treatment of insanity. arrangements of hospitals for the in- 17. Pehrsson DE, McMillen P. Compe- New York, NY: Harper & Brothers; sane. Am J Insanity. 1854;11(1–2):1–37, tent bibliotherapy: preparing counselors 1846. p. 566. 112–63. to use literature with culturally diverse 9. Galt JM. Report of the physician and 13. Weimerskirch PJ. Benjamin Rush clients [Internet]. Corvallis, OR: Oregon superintendent of the Eastern Lunatic and John Minson Galt, II. pioneers of State University; 2006 [cited 31 Jul 2012]. Asylum. Williamsburg, VA: Eastern bibliotherapy in America. Bull Med Lib ,http://www.counselingoutfitters.com/ Lunatic Asylum; 1843. p. 26. Assoc. 1965 Oct;53(4):510–26. Pehrsson.htm.. 10. Galt JM. On the reading, recrea- 14. Butler Hospital for the Insane. 18. McCarthy M. Healthy design. Lancet. tion, and amusements of the insane. In: Report of the Board of Trustees of the 2004 Jul 31–Aug 6;364(9432):405–6. DOI: Winslow F, ed. The journal of psycho- Butler Hospital for the Insane. The http://dx.doi.org/10.1016/S0140-6736(04) logical medicine and mental pathol- Hospital; 1847. p. 8. 16787-1. ogy. London, UK: John Churchill; 1853. 15. Butler Hospital for the Insane. 19. Wen P. For mentally ill, a design depar- p. 581–9. Report of the Board of Trustees of the ture. Boston Globe. 2012 Aug 16;Sect. A1:1.

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