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The lunatic asylum, insane asylum or mental asylum was an institution where people with mental illness were confined. It was an early precursor of the modern psychiatric hospital.
Modern psychiatric hospitals evolved from and eventually replaced the older lunatic asylum. The treatment of inmates in early lunatic asylums was sometimes brutal and focused on containment and restraint.[1][2] The discovery of anti-psychotic drugs and mood-stabilizing drugs resulted in a shift in focus from containment in lunatic asylums to treatment in psychiatric hospitals. Later, there was further and more thorough critique in the form of the deinstitutionalization movement which focuses on treatment at home or in less isolated institutions.
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Medieval era
In the Islamic world, the Bimaristans were described by European travellers, who wrote about their wonder at the care and kindness shown to lunatics. In 872, Ahmad ibn Tulun built a hospital in Cairo that provided care to the insane, which included music therapy.[3] Nonetheless, British historian of medicine Roy Porter cautioned against idealising the role of hospitals generally in medieval Islam, stating that "They were a drop in the ocean for the vast population that they had to serve, and their true function lay in highlighting ideals of compassion and bringing together the activities of the medical profession."[4]: 105
In Europe during the medieval era, a small subsection of the population of those considered mad were housed in a variety of institutional settings. Mentally ill people were often held captive in cages or kept up within the city walls, or they were compelled to amuse members of courtly society.[5] Porter gives examples of such locales where some of the insane were cared for, such as in monasteries. A few towns had towers where madmen were kept (called Narrentürme in German, or "fools' towers").[citation needed] The ancient Parisian hospital Hôtel-Dieu also had a small number of cells set aside for lunatics, whilst the town of Elbing boasted a madhouse, the Tollhaus, attached to the Teutonic Knights' hospital.[6] Dave Sheppard's Development of Mental Health Law and Practice begins in 1285 with a case that linked "the instigation of the devil" with being "frantic and mad".[7]
In Spain, other such institutions for the insane were established after the Christian Reconquista; facilities included hospitals in Valencia (1407), Zaragoza (1425), Seville (1436), Barcelona (1481) and Toledo (1483).[4]: 127 In London, England, the Priory of Saint Mary of Bethlehem, which later became known more notoriously as Bedlam, was founded in 1247. At the start of the 15th century, it housed six insane men.[4]: 127 The former lunatic asylum, Het Dolhuys, established in the 16th century in Haarlem, the Netherlands, has been adapted as a museum of psychiatry, with an overview of treatments from the origins of the building up to the 1990s.
Emergence of public lunatic asylums
The level of specialist institutional provision for the care and control of the insane remained extremely limited at the turn of the 18th century. Madness was seen principally as a domestic problem, with families and parish authorities in Europe and England central to regimens of care.[8]: 154 [9]: 439 Various forms of outdoor relief were extended by the parish authorities to families in these circumstances, including financial support, the provision of parish nurses and, where family care was not possible, lunatics might be 'boarded out' to other members of the local community or committed to private madhouses.[9]: 452–56 [10]: 299 Exceptionally, if those deemed mad were judged to be particularly disturbing or violent, parish authorities might meet the not inconsiderable costs of their confinement in charitable asylums such as Bethlem, in Houses of Correction or in workhouses.[11]: 30, 31–35, 39–43
In the late 17th century, this model began to change, and privately run asylums for the insane began to proliferate and expand in size. Already in 1632 it was recorded that Bethlem Royal Hospital, London had "below stairs a parlor, a kitchen, two larders, a long entry throughout the house, and 21 rooms wherein the poor distracted people lie, and above the stairs eight rooms more for servants and the poor to lie in".[12] Inmates who were deemed dangerous or disturbing were chained, but Bethlem was an otherwise open building. Its inhabitants could roam around its confines and possibly throughout the general neighborhood in which the hospital was situated.[13] In 1676, Bethlem expanded into newly built premises at Moorfields with a capacity for 100 inmates.[8]: 155 [14]: 27
A second public charitable institution was opened in 1713, the Bethel in Norwich. It was a small facility which generally housed between twenty and thirty inmates.[8]: 166 In 1728 at Guy's Hospital, London, wards were established for chronic lunatics.[15]: 11 From the mid-eighteenth century the number of public charitably funded asylums expanded moderately with the opening of St Luke's Hospital in 1751 in Upper Moorfields, London; the establishment in 1765 of the Hospital for Lunatics at Newcastle upon Tyne; the Manchester Lunatic Hospital, which opened in 1766; the York Asylum in 1777 (not to be confused with the York Retreat); the Leicester Lunatic Asylum (1794), and the Liverpool Lunatic Asylum (1797).[14]: 27
A similar expansion took place in the British American colonies. The Pennsylvania Hospital was founded in Philadelphia in 1751 as a result of work begun in 1709 by the Religious Society of Friends. A portion of this hospital was set apart for the mentally ill, and the first patients were admitted in 1752.[16] Virginia is recognized as the first state to establish an institution for the mentally ill.[17] Eastern State Hospital, located in Williamsburg, Virginia, was incorporated in 1768 under the name of the "Public Hospital for Persons of Insane and Disordered Minds" and its first patients were admitted in 1773.[16][18]
Trade in lunacy
There was no centralised state response to "madness" in society in century Britain until the 19th century, however private madhouses proliferated there in 18th on a scale unseen elsewhere.[8]: 174 References to such institutions are limited for the 17th century but it is evident that by the start of the 18th century, the so-called 'trade in lunacy' was well established.[15]: 8–9 Daniel Defoe, an ardent critic of private madhouses,[19]: 118 estimated in 1724 that there were fifteen then operating in the London area.[20]: 9 Defoe may have exaggerated but exact figures for private metropolitan madhouses are available only from 1774, when licensing legislation was introduced: sixteen institutions were recorded.[20]: 9–10 At least two of these, Hoxton House and Wood's Close, Clerkenwell, had been in operation since the 17th century.[20]: 10 By 1807, the number had increased to seventeen.[20]: 9 This limited growth in the number of London madhouses is believed likely to reflect the fact that vested interests, especially the College of Physicians, exercised considerable control in preventing new entrants to the market.[20]: 10–11 Thus, rather than there being a proliferation of private madhouses in London, existing institutions tended to expand considerably in size.[20]: 10 The establishments which increased most during the 18th century, such as Hoxton House, did so by accepting pauper patients rather than private, middle class, fee-paying patients.[20]: 11 Significantly, pauper patients, unlike their private counterparts, were not subject to inspection under the 1774 legislation.[20]: 11
Fragmentary evidence indicates that some provincial madhouses existed in Britain from at least the 17th century and possibly earlier.[8]: 175 [15]: 8 A madhouse at Kingsdown, Box, Wiltshire was opened during the 17th century.[8]: 176 [20]: 11 Further locales of early businesses include one at Guildford in Surrey which was accepting patients by 1700, one at Fonthill Gifford in Wiltshire from 1718, another at Hook Norton in Oxfordshire from about 1725, one at St Albans dating from around 1740, and a madhouse at Fishponds in Bristol from 1766.[8]: 176 [20]: 11 It is likely that many of these provincial madhouses, as was the case with the exclusive Ticehurst House, may have evolved from householders who were boarding lunatics on behalf of parochial authorities and later formalised this practice into a business venture.[8]: 176 The vast majority were small in scale with only seven asylums outside London with in excess of thirty patients by 1800 and somewhere between ten and twenty institutions had fewer patients than this.[8]: 178
Humanitarian reform
During the Age of Enlightenment, attitudes began to change, in particular among the educated classes in Western Europe. "Mental illness" came to be viewed as a disorder that required some form of compassionate but clinical, "rational" treatment that would aid in the rehabilitation of the patient into a rational being. When the ruling monarch of the United Kingdom, George III, who had a mental disorder, experienced a remission in 1789, mental illness came to be seen as something which could be treated and cured. The introduction of moral treatment was initiated independently by the French doctor Philippe Pinel and the English Quaker William Tuke.[21]
In 1792, Pinel became the chief physician at the Bicêtre Hospital in Le Kremlin-Bicêtre, near Paris. Before his arrival, inmates were chained in cramped cell-like rooms where there was poor ventilation, led by a man named Jackson 'Brutis' Taylor. Taylor was then killed by the inmates leading to Pinel's leadership. In 1797, Jean-Baptiste Pussin, the "governor" of mental patients at Bicêtre, first freed patients of their chains and banned physical punishment, although straitjackets could be used instead.[22][23] Patients were allowed to move freely about the hospital grounds, and eventually dark dungeons were replaced with sunny, well-ventilated rooms. Pinel argued that mental illness was the result of excessive exposure to social and psychological stresses, to heredity and physiological damage.[citation needed]
Pussin and Pinel's approach was seen as remarkably successful, and they later brought similar reforms to a mental hospital in Paris for female patients, La Salpetrière. Pinel's student and successor, Jean Esquirol, went on to help establish 10 new mental hospitals that operated on the same principles. There was an emphasis on the selection and supervision of attendants in order to establish a suitable setting to facilitate psychological work, and particularly on the employment of ex-patients as they were thought most likely to refrain from inhumane treatment while being able to stand up to patients' pleas, menaces, or complaints.[24]
William Tuke led the development of a radical new type of institution in Northern England, following the death of a fellow Quaker in a local asylum in 1790.[25]: 84–85 [26]: 30 [27] In 1796, with the help of fellow Quakers and others, he founded the York Retreat, where eventually about 30 patients lived as part of a small community in a quiet country house and engaged in a combination of rest, talk, and manual work. Rejecting medical theories and techniques, the efforts of the York Retreat centred around minimising restraints and cultivating rationality and moral strength.
The entire Tuke family became known as founders of moral treatment.[28] They created a family-style ethos, and patients performed chores to give them a sense of contribution. There was a daily routine of both work and leisure time. If patients behaved well, they were rewarded; if they behaved poorly, there was some minimal use of restraints or instilling of fear. The patients were told that treatment depended on their conduct. In this sense, the patient's moral autonomy was recognised. William Tuke's grandson, Samuel Tuke, published an influential work in the early 19th century on the methods of the retreat; Pinel's Treatise on Insanity had by then been published, and Samuel Tuke translated his term as "moral treatment". Tuke's Retreat became a model throughout the world for humane and moral treatment of patients with mental disorders.[29]
The York Retreat inspired similar institutions in the United States, most notably the Brattleboro Retreat and the Hartford Retreat (now the Institute of Living). Benjamin Rush of Philadelphia also promoted humane treatment of the insane outside dungeons and without iron restraints, as well as sought their reintegration into society. In 1792, Rush successfully campaigned for a separate ward for the insane at the Pennsylvania Hospital. His talk-based approach could be considered as a rudimentary form of modern occupational therapy, although most of his physical approaches have long been discredited, such as bleeding and purging, hot and cold baths, mercury pills, a "tranquilizing chair" and gyroscope.
A similar reform was carried out in Italy by Vincenzo Chiarugi, who discontinued the use of chains on the inmates in the early 19th century. In the town of Interlaken, Johann Jakob Guggenbühl started a retreat for mentally disabled children in 1841.[30]
The modern era of institutionalized provision for the care of the mentally ill, began in the early 19th century with a large state-led effort. Public mental asylums were established in Britain after the passing of the 1808 County Asylums Act.[31] This empowered magistrates to build rate-supported asylums in every county to house the many 'pauper lunatics'. Nine counties first applied, and the first public asylum opened in 1811 in Nottinghamshire.[32] Parliamentary Committees were established to investigate abuses at private madhouses like Bethlem Hospital – its officers were eventually dismissed and national attention was focused on the routine use of bars, chains and handcuffs and the filthy conditions the inmates lived in.[33] However, it was not until 1828 that the newly appointed Commissioners in Lunacy were empowered to license and supervise private asylums.[34]
The Lunacy Act 1845 was an important landmark in the treatment of the mentally ill, as it explicitly changed the status of mentally ill people to patients who required treatment. The Act created the Lunacy Commission, headed by Lord Shaftesbury, to focus on lunacy legislation reform.[35] The commission was made up of eleven Metropolitan Commissioners who were required to carry out the provisions of the Act:[36] the compulsory construction of asylums in every county, with regular inspections on behalf of the Home Secretary. All asylums were required to have written regulations and to have a resident qualified physician.[37] A national body for asylum superintendents – the Medico-Psychological Association – was established in 1866 under the Presidency of William A. F. Browne, although the body appeared in an earlier form in 1841.[38]
In 1838, France enacted a law to regulate both the admissions into asylums and asylum services across the country. Édouard Séguin developed a systematic approach for training individuals with mental deficiencies,[39] and, in 1839, he opened the first school for the "severely retarded". His method of treatment was based on the assumption that the "mentally deficient" did not suffer from disease.[40]
In the United States, the erection of state asylums began with the first law for the creation of one in New York, passed in 1842. The Utica State Hospital was opened approximately in 1850. The creation of this hospital, as of many others, was largely the work of Dorothea Lynde Dix, whose philanthropic efforts extended over many states, and in Europe as far as Constantinople. Many state hospitals in the United States were built in the 1850s and 1860s on the Kirkbride Plan, an architectural style meant to have curative effect.[41]
Looking into the late 19th and early 20th century history of the Homewood Retreat of Guelph, Ontario, and the context of commitments to asylums in North America and Great Britain, Cheryl Krasnick Warsh states that "the kin of asylum patients were, in fact, the major impetus behind commitment, but their motivations were based not so much upon greed as upon the internal dynamics of the family, and upon the economic structure of western society in the 19th and early 20th centuries."[42]
Women in psychiatric institutions
Based on her study of cases from the Homewood Retreat, Cheryl Krasnick Warsh concludes that "the realities of the household in late Victorian and Edwardian middle class society rendered certain elements—socially redundant women in particular—more susceptible to institutionalization than others."[42]
In the 18th to the early 20th century, women were sometimes institutionalised due to their opinions, their unruliness and their inability to be controlled properly by a primarily male-dominated culture.[43] There were financial incentives too; before the passage of the Married Women's Property Act 1882, all of a wife's assets passed automatically to her husband.
The men who were in charge of these women, either a husband, father or brother, could send these women to mental institutions, stating that they believed that these women were mentally ill because of their strong opinions. "Between the years of 1850–1900, women were placed in mental institutions for behaving in ways the male society did not agree with."[44] These men had the last say when it came to the mental health of these women, so if they believed that these women were mentally ill, or if they simply wanted to silence the voices and opinions of these women, they could easily send them to mental institutions. This was an easy way to render them vulnerable and submissive.[45]
An early fictional example is Mary Wollstonecraft's posthumously published novel Maria: or, The Wrongs of Woman (1798), in which the title character is confined to an insane asylum when she becomes inconvenient to her husband. Real women's stories reached the public through court cases: Louisa Nottidge was abducted by male relatives to prevent her committing her inheritance and her life to live in a revivalist clergyman's intentional community. Wilkie Collins based his 1859 novel The Woman in White on this case, dedicating it to Bryan Procter, the Commissioner for Lunacy. A generation later, Rosina Bulwer Lytton, daughter of the women's rights advocate Anna Wheeler, was locked up by her husband Edward Bulwer-Lytton and subsequently wrote of this in A Blighted Life (1880).
In 1887, journalist Nellie Bly had herself committed to the Blackwell's Island Insane Asylum in New York City, in order to investigate conditions there. Her account was published in the New York World newspaper, and in book form as Ten Days in a Mad-House.
In 1902, Margarethe von Ende de, wife of the German arms manufacturer Friedrich Alfred Krupp, was consigned to an insane asylum by Kaiser Wilhelm II, a family friend, when she asked him to respond to reports of her husband's gay orgies on Capri.[46]
New practices
In continental Europe, universities often played a part in the administration of the asylums.[47] In Germany, many practising psychiatrists were educated in universities associated with particular asylums.[47] However, because Germany remained a loosely bound conglomerate of individual states, it lacked a national regulatory framework for asylums.
Although Tuke, Pinel and others had tried to do away with physical restraint, it remained widespread in the 19th century. At the Lincoln Asylum in England, Robert Gardiner Hill, with the support of Edward Parker Charlesworth, pioneered a mode of treatment that suited "all types" of patients, so that mechanical restraints and coercion could be dispensed with—a situation he finally achieved in 1838. In 1839 Sergeant John Adams and Dr. John Conolly were impressed by the work of Hill, and introduced the method into their Hanwell Asylum, by then the largest in the country. Hill's system was adapted, since Conolly was unable to supervise each attendant as closely as Hill had done. By September 1839, mechanical restraint was no longer required for any patient.[48][49]
William A. F. Browne (1805–1885) introduced activities for patients including writing, art, group activity and drama, pioneered early forms of occupational therapy and art therapy, and initiated one of the earliest collections of artistic work by patients, at Montrose Asylum.[50]
Rapid expansion
By the end of the 19th century, national systems of regulated asylums for the mentally ill had been established in most industrialized countries. At the turn of the century, Britain and France combined had only a few hundred people in asylums,[51] but by the end of the century this number had risen to the hundreds of thousands. The United States housed 150,000 patients in mental hospitals by 1904. Germany housed more than 400 public and private sector asylums.[51] These asylums were critical to the evolution of psychiatry as they provided places of practice throughout the world.[51]
However, the hope that mental illness could be ameliorated through treatment during the mid-19th century was disappointed.[52] Instead, psychiatrists were pressured by an ever-increasing patient population.[52] The average number of patients in asylums in the United States jumped 927%.[52] Numbers were similar in Britain and Germany.[52] Overcrowding was rampant in France, where asylums would commonly take in double their maximum capacity.[53] Increases in asylum populations may have been a result of the transfer of care from families and poorhouses, but the specific reasons as to why the increase occurred are still debated today.[54] No matter the cause, the pressure on asylums from the increase was taking its toll on the asylums and psychiatry as a specialty. Asylums were once again turning into custodial institutions[55] and the reputation of psychiatry in the medical world had hit an extreme low.[56]
In the 1800s, middle class facilities became more common, replacing private care for wealthier persons. However, facilities in this period were largely oversubscribed. Individuals were referred to facilities either by the community or by the criminal justice system. Dangerous or violent cases were usually given precedence for admission. A survey taken in 1891 in Cape Town, South Africa shows the distribution between different facilities. Out of 2046 persons surveyed, 1,281 were in private dwellings, 120 in jails and 645 in asylums, with men representing nearly two-thirds of the number surveyed.[57]
Defining someone as insane was a necessary prerequisite for being admitted to a facility. A doctor was only called after someone was labelled insane on social terms and had become socially or economically problematic. Until the 1890s, little distinction existed between the lunatic and criminal lunatic. The term was often used to police vagrancy as well as paupers and the insane. In the 1850s, lurid rumours that medical doctors were declaring normal people "insane" in Britain, were spread by the press causing widespread public anxiety. The fear was that people who were a source of embarrassment to their families were conveniently disposed of into asylums with the willing connivance of the psychiatric profession. This sensationalism appeared in widely read novels of the time, including The Woman in White.[57][58]
20th century
Physical therapies
A series of radical physical therapies were developed in central and continental Europe in the late 1910s, the 1920s and most particularly, the 1930s. Among these, we may note the Austrian psychiatrist Julius Wagner-Jauregg's malarial therapy for general paresis of the insane (or neurosyphilis) first used in 1917, and for which he won a Nobel Prize in 1927.[59] This treatment heralded the beginning of a radical and experimental era in psychiatric medicine that increasingly broke with an asylum-based culture of therapeutic nihilism in the treatment of chronic psychiatric disorders,[60] most particularly dementia praecox (increasingly known as schizophrenia from the 1910s, although the two terms were used more or less interchangeably until at least the end of the 1930s), which were typically regarded as hereditary degenerative disorders and therefore unamenable to any therapeutic intervention.[61] Malarial therapy was followed in 1920 by barbiturate-induced deep sleep therapy to treat dementia praecox, which was popularised by the Swiss psychiatrist Jakob Klaesi. In 1933 the Vienna-based psychiatrist Manfred Sakel introduced insulin shock therapy, and in August 1934 Ladislas J. Meduna, a Hungarian neuropathologist and psychiatrist working in Budapest, introduced cardiazol shock therapy (cardiazol is the tradename of the chemical compound pentylenetetrazol, known by the tradename metrazol in the United States), which was the first convulsive or seizure therapy for a psychiatric disorder. Again, both of these therapies were initially targeted at curing dementia praecox. Cardiazol shock therapy, founded on the theoretical notion that there existed a biological antagonism between schizophrenia and epilepsy and that therefore inducing epileptiform fits in schizophrenic patients might effect a cure, was superseded by electroconvulsive therapy (ECT), invented by the Italian neurologist Ugo Cerletti in 1938.[62]
The use of psychosurgery was narrowed to a very small number of people for specific indications. Egas Moniz performed the first leucotomy, or lobotomy in Portugal in 1935, which targets the brain's frontal lobes.[7] This was shortly thereafter adapted by Walter Freeman and James W. Watts in what is known as Freeman–Watts procedure or the standard prefrontal lobotomy. From 1946, Freeman developed the transorbital lobotomy, using a device akin to an ice-pick. This was an "office" procedure which did not have to be performed in a surgical theatre and took as little as fifteen minutes to complete. Freeman is credited with the popularisation of the technique in the United States. In 1949, 5,074 lobotomies were carried out in the United States and by 1951, 18,608 people had undergone the controversial procedure in that country.[63] One of the most famous people to have a lobotomy was the sister of John F. Kennedy, Rosemary Kennedy, who was rendered profoundly intellectually disabled as a result of the surgery.[64]
In modern times, insulin shock therapy and lobotomies are viewed as being almost as barbaric as the Bedlam "treatments", although the insulin shock therapy was still seen as the only option which produced any noticeable effect on patients. ECT is still used in the West in the 21st century, but it is seen as a last resort for treatment of mood disorders and is administered much more safely than in the past.[65] Elsewhere, particularly in India, use of ECT is reportedly increasing, as a cost-effective alternative to drug treatment.[citation needed] The effect of a shock on an overly excitable patient often allowed these patients to be discharged to their homes, which was seen by administrators (and often guardians) as a preferable solution to institutionalisation. Lobotomies were performed in the thousands from the 1930s to the 1950s, and were ultimately replaced with modern psychotropic drugs.
Eugenics movement
The eugenics movement of the early 20th century led to a number of countries enacting laws for the compulsory sterilization of the "feeble minded", which resulted in the forced sterilization of numerous psychiatric inmates.[66] As late as the 1950s, laws in Japan allowed the forcible sterilization of patients with psychiatric illnesses.[67]
Under Nazi Germany, the Aktion T4 euthanasia program resulted in the killings of thousands of the mentally ill housed in state institutions. In 1939, the Nazis secretly began to exterminate the mentally ill in a euthanasia campaign. Around 6,000 disabled babies, children and teenagers were murdered by starvation or lethal injection.[68]
Psychiatric internment as a political device
Psychiatrists around the world have been involved in the suppression of individual rights by states wherein the definitions of mental disease had been expanded to include political disobedience.[69]: 6 Nowadays, in many countries, political prisoners are sometimes confined to mental institutions and abused therein.[70]: 3 Psychiatry possesses a built-in capacity for abuse which is greater than in other areas of medicine.[71]: 65 The diagnosis of mental disease can serve as proxy for the designation of social dissidents, allowing the state to hold persons against their will and to insist upon therapies that work in favour of ideological conformity and in the broader interests of society.[71]: 65
In a monolithic state, psychiatry can be used to bypass standard legal procedures for establishing guilt or innocence and allow political incarceration without the ordinary odium attaching to such political trials.[71]: 65 In Nazi Germany in the 1940s, the 'duty to care' was violated on an enormous scale: A reported 300,000 individuals were sterilised and 100,000 killed in Germany alone, as were many thousands further afield, mainly in Eastern Europe.[72]
From the 1960s up to 1986, political abuse of psychiatry was reported to be systematic in the Soviet Union, and to surface on occasion in other Eastern European countries such as Romania, Hungary, Czechoslovakia and Yugoslavia.[71]: 66 A "mental health genocide" reminiscent of the Nazi aberrations has been located in the history of South African oppression during the apartheid era.[73] A continued misappropriation of the discipline was subsequently attributed to the People's Republic of China.[74]
The 20th century saw the development of the first effective psychiatric drugs.
The first anti-psychotic drug, chlorpromazine (known under the trade name Largactil in Europe and Thorazine in the United States), was first synthesized in France in 1950. Pierre Deniker, a psychiatrist of the Saint-Anne Psychiatric Center in Paris, is credited with first recognising the specificity of action of the drug in psychosis in 1952. Denier traveled with a colleague to the United States and Canada promoting the drug at medical conferences in 1954. The first publication regarding its use in North America was made in the same year by the Canadian psychiatrist Heinz Lehmann, who was based in Montreal. Also in 1954 another antipsychotic, reserpine, was first used by an American psychiatrist based in New York, Nathan S. Kline. At a Paris-based colloquium on neuroleptics (antipsychotics) in 1955 a series of psychiatric studies were presented by, among others, Hans Hoff (Vienna), Dr. Ihsan Aksel (Istanbul), Felix Labarth (Basle), Linford Rees (London), Sarro (Barcelona), Manfred Bleuler (Zurich), Willi Mayer-Gross (Birmingham), Winford (Washington) and Denber (New York) attesting to the effective and concordant action of the new drugs in the treatment of psychosis.[citation needed]
The new antipsychotics had an immense impact on the lives of psychiatrists and patients. For instance, Henri Ey, a French psychiatrist at Bonneval, related that between 1921 and 1937 only 6% of patients with schizophrenia and chronic delirium were discharged from his institution. The comparable figure for the period from 1955 to 1967, after the introduction of chlorpromazine, was 67%. Between 1955 and 1968 the residential psychiatric population in the United States dropped by 30%.[76] Newly developed antidepressants were used to treat cases of depression, and the introduction of muscle relaxants allowed ECT to be used in a modified form for the treatment of severe depression and a few other disorders.[7]
The discovery of the mood stabilizing effect of lithium carbonate by John Cade in 1948 would eventually revolutionise the treatment of bipolar disorder, although its use was banned in the United States until the 1970s.[77]
United States: reform in the 1940s
From 1942 to 1947, conscientious objectors in the US assigned to psychiatric hospitals under Civilian Public Service exposed abuses throughout the psychiatric care system and were instrumental in reforms of the 1940s and 1950s. The CPS reformers were especially active at the Philadelphia State Hospital where four Quakers initiated The Attendant magazine as a way to communicate ideas and promote reform. This periodical later became The Psychiatric Aide, a professional journal for mental health workers. On 6 May 1946, Life magazine printed an exposé of the psychiatric system by Albert Q. Maisel based on the reports of COs.[78] Another effort of CPS, namely the Mental Hygiene Project, became the national Mental Health Foundation. Initially skeptical about the value of Civilian Public Service, Eleanor Roosevelt, impressed by the changes introduced by COs in the mental health system, became a sponsor of the National Mental Health Foundation and actively inspired other prominent citizens including Owen J. Roberts, Pearl Buck and Harry Emerson Fosdick to join her in advancing the organization's objectives of reform and humane treatment of patients.[citation needed]
By the beginning of the 20th century, ever-increasing admissions had resulted in serious overcrowding. Funding was often cut, especially during periods of economic decline, and during wartime in particular many patients starved to death. Asylums became notorious for poor living conditions, lack of hygiene, overcrowding, and ill-treatment and abuse of patients.[79]
The first community-based alternatives were suggested and tentatively implemented in the 1920s and 1930s, although asylum numbers continued to increase up to the 1950s. The movement for deinstitutionalisation came to the fore in various Western countries in the 1950s and 1960s.
The prevailing public arguments, time of onset, and pace of reforms varied by country.[79] Class action lawsuits in the United States, and the scrutiny of institutions through disability activism and antipsychiatry, helped expose the poor conditions and treatment. Sociologists and others argued that such institutions maintained or created dependency, passivity, exclusion and disability, causing people to be institutionalised.
There was an argument that community services would be cheaper. It was suggested that new psychiatric medications made it more feasible to release people into the community.[80]
There were differing views on deinstitutionalization, however, in groups such as mental health professionals, public officials, families, advocacy groups, public citizens and unions.[81]
- Uganda has one psychiatric hospital.[79]
- South Africa currently has 27 registered psychiatric hospitals. These hospitals are spread throughout the country. Some of the most well-known institutions are: Weskoppies Psychiatric Hospital, colloquially known as Groendakkies ("Little Green Roofs") and Denmar Psychiatric Hospital in Pretoria, TARA[82] in Johannesburg, and Valkenberg Hospital in Cape Town.
In Japan, the number of hospital beds has risen steadily over the last few decades.[79]
In Hong Kong, a number of residential care services such as half-way houses, long-stay care homes, and supported hostels are provided for the discharged patients. In addition, a number of community support services such as Community Rehabilitation Day Services, Community Mental Health Link, Community Mental Health Care, etc. have been launched to facilitate the re-integration of patients into the community.
Countries where deinstitutionalisation has happened may be experiencing a process of "re-institutionalisation" or relocation to different institutions, as evidenced by increases in the number of supported housing facilities, forensic psychiatric beds and rising numbers in the prison population.[83]
New Zealand
New Zealand established a reconciliation initiative in 2005 in the context of ongoing compensation payouts to ex-patients of state-run mental institutions in the 1970s to 1990s. The forum heard of poor reasons for admissions; unsanitary and overcrowded conditions; lack of communication to patients and family members; physical violence and sexual misconduct and abuse; inadequate complaints mechanisms; pressures and difficulties for staff, within an authoritarian psychiatric hierarchy based on containment; fear and humiliation in the misuse of seclusion; over-use and abuse of ECT, psychiatric medication and other treatments/punishments, including group therapy, with continued adverse effects; lack of support on discharge; interrupted lives and lost potential; and continued stigma, prejudice and emotional distress and trauma.
There were some references to instances of helpful aspects or kindnesses despite the system. Participants were offered counselling to help them deal with their experiences, and advice on their rights, including access to records and legal redress.[84]
South America
In several South American countries[which?], the total number of beds in asylum-type institutions has decreased, replaced by psychiatric inpatient units in general hospitals and other local settings.[79]
United Kingdom
At the beginning of the 19th century, there were, perhaps, a few thousand "lunatics" housed in a variety of disparate institutions; but, by the beginning of the 20th century, that figure had grown to about 100,000. This growth coincided with the development of "alienism," now known as psychiatry, as a medical specialty.[8]: 14
United States
The United States has experienced two waves of deinstitutionalization. Wave one began in the 1950s and targeted people with mental illness.[85] The second wave began roughly fifteen years after and focused on individuals who had been diagnosed with a developmental disability (e.g. intellectual disability).[85]
A process of indirect cost-shifting may have led to a form of "re-institutionalization" through the increased use of jail detention for those with mental disorders deemed unmanageable and noncompliant.[86] In summer 2009, author and columnist Heather Mac Donald stated in City Journal, "jails have become society's primary mental institutions, though few have the funding or expertise to carry out that role properly... at Rikers, 28% of the inmates require mental health services, a number that rises each year."[87]
See also
- Deinstitutionalization
- History of mental disorders
- Kirkbride Plan
- Timeline of psychiatry
- History of psychiatric institutions in China
- List of asylums commissioned in England and Wales
- Ann Pratt
- ^ "Life Magazine". Archived from the original on 30 November 2012. Retrieved 18 January 2011.
- ^ "Life Magazine" (PDF). Archived (PDF) from the original on 9 October 2022.
- ^ Koenig, Harold George (2005). Faith and mental health: religious resources for healing. Templeton Foundation Press. ISBN 978-1-932031-91-1.
- ^ a b c Porter, Roy (1997). The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present. London: Fontana Press. ISBN 978-0006374541.
- ^ Tillack-Graf, Anne-Kathleen (2015). "Book Review: Thomas R. Müller, Wahn und Sinn. Patienten, Ärzte, Personal und Institutionen der Psychiatrie in Sachsen vom Mittelalter bis zum Ende des 20. Jahrhunderts". History of Psychiatry. 26 (4): 498–499. doi:10.1177/0957154X15605782d. ISSN 0957-154X. S2CID 20151680.
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- ^ Suzuki, Akihito (1992). "Lunacy, in Seventeenth- and Eighteenth-Century England: Analysis of Quarter Sessions Records Part II". History of Psychiatry. 3 (8): 29–44. doi:10.1177/0957154x9200300903. PMID 11612665. S2CID 28734153.
- ^ Allderidge, Patricia (1979). "Management and Mismanagement at Bedlam, 1547–1633". In Webster, Charles (ed.). Health, Medicine and Mortality in the Sixteenth Century. Cambridge: Cambridge University Press. p. 145. ISBN 9780521226431.
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- ^ a b Winston, Mark (1994). "The Bethel at Norwich: An Eighteenth-Century Hospital for Lunatics". Medical History. 38 (1): 27–51. doi:10.1017/s0025727300056039. PMC 1036809. PMID 8145607.
- ^ a b c Parry-Jones, William Ll. (1972). The Trade in Lunacy: A Study of Private Madhouses in England in the Eighteenth and Nineteenth Centuries. London: Routledge. ISBN 9780710070517.
- ^ a b William A. White (1920). . In Rines, George Edwin (ed.). Encyclopedia Americana.
- ^ "THE FIRST INSANE ASYLUM.; To Virginia Belongs the Credit in This Country". The New York Times. 16 July 1900. Retrieved 1 November 2009.
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- ^ Noll, Richard (2007). The Encyclopedia of Schizophrenia and Other Psychotic Disorders (3rd ed.). New York: Facts on File. ISBN 978-0816064052.
- ^ a b c d e f g h i j MacKenzie, Charlotte (1992). Psychiatry for the Rich: A History of Ticehurst Private Asylum. London: Routledge. ISBN 978-0415088916.
- ^ Elkes, A. & Thorpe, J.G. (1967). A Summary of Psychiatry. London: Faber & Faber, p. 13.
- ^ Weiner DB (September 1979). "The apprenticeship of Philippe Pinel: a new document, "observations of Citizen Pussin on the insane"". Am J Psychiatry. 136 (9): 1128–34. doi:10.1176/ajp.136.9.1128. PMID 382874.
- ^ Bukelic, Jovan (1995). "2". In Mirjana Jovanovic (ed.). Neuropsihijatrija za III razred medicinske skole (in Serbian) (7th ed.). Belgrade: Zavod za udzbenike i nastavna sredstva. p. 7. ISBN 978-86-17-03418-2.
- ^ Gerard DL (1998). "Chiarugi and Pinel considered: Soul's brain/person's mind". J Hist Behav Sci. 33 (4): 381–403. doi:10.1002/(SICI)1520-6696(199723)33:4<381::AID-JHBS3>3.0.CO;2-S.[dead link]
- ^ Cherry, Charles L. (1989), A Quiet Haven: Quakers, Moral Treatment, and Asylum Reform, London & Toronto: Associated University Presses
- ^ Digby, Anne (1983), Madness, Morality and Medicine: A Study of the York Retreat, Cambridge: Cambridge University Press
- ^ Glover, Mary R. (1984), The Retreat, York: An Early Experiment in the Treatment of Mental Illness, York: Ebor Press
- ^ Borthwick, Annie; Holman, Chris; Kennard, David; McFetridge, Mark; Messruther, Karen; Wilkes, Jenny (2001). "The relevance of moral treatment to contemporary mental health care". Journal of Mental Health. 10 (4): 427–439. doi:10.1080/09638230124277. S2CID 218906106.
- ^ Borthwick A.; Holman C.; Kennard D.; McFetridge M.; Messruther K.; Wilkes J. (2001). "The relevance of moral treatment to contemporary mental health care". Journal of Mental Health. 10 (4): 427–439. doi:10.1080/09638230124277. S2CID 218906106.
- ^ Müller, Christian. "Guggenbühl, Johann Jakob". www.hls-dhs-dss.ch (in German). Retrieved 23 June 2016.
- ^ Roberts, Andrew. "Mental Health History Timeline;1808". studymore.org.uk. Retrieved 24 June 2016.
- ^ Roberts, Andrew. "Mental Health History Timeline;1811". studymore.org.uk. Retrieved 24 June 2016.
- ^ Roberts, Andrew. "Index of Lunatic Asylums and Mental Hospitals;1815". studymore.org.uk. Retrieved 24 June 2016.
- ^ Roberts, Andrew. "The Lunacy Commission, A Study of its Origin, Emergence and Character;Chap.3.1.1". studymore.org.uk. Retrieved 24 June 2016.
- ^ Unsworth, Clive."Law and Lunacy in Psychiatry's 'Golden Age'", Oxford Journal of Legal Studies. Vol. 13, No. 4. (Winter, 1993), pp. 482.
- ^ Roberts, Andrew. "The Lunacy Commission, A Study of its Origin, Emergence and Character;Chap.5.1.3". studymore.org.uk. Retrieved 24 June 2016.
- ^ Roberts, Andrew. "The Lunacy Commission as a government department". studymore.org.uk. Retrieved 24 June 2016.
- ^ Shorter 1997, p. 34, 41.
- ^ King. A History of Psychology p.214. ISBN 9780205512133
- ^ "Edouard Seguin (American psychiatrist)". Encyclopædia Britannica. 6 December 2013. Retrieved 15 April 2014.
- ^ Yanni, Carla (2007). The Architecture of Madness: Insane Asylums in the United States. Minneapolis: Minnesota University Press. ISBN 978-0-8166-4939-6.
- ^ a b Warsh, Cheryl Krasnick (1988). "The First Mrs. Rochester: Wrongful Confinement, Social Redundancy, and Commitment to the Private Asylum, 1883‑1923". Historical Papers. 23 (1): 145–167. doi:10.7202/030985ar. hdl:10613/3065.
- ^ "Women and Psychiatry – Hysteria, Feminism, and Psychoanalysis". Archived from the original on 7 July 2016. Retrieved 9 July 2016.
- ^ Packard, E.P. (1873). Modern persecution, or, Insane asylums unveiled as demonstrated by the report of the Investigating Committee of the Legislature of Illinois. Hartford: Investigating Committee of the Legislature of Illinois.
- ^ Geller, Jeffrey F. (1994). Women of the Asylum: Voices from Behind the Walls, 1840–1945. Anchor Books.
- ^ "Storia gay - Friedrich Alfred Krupp (1854-1902), l'omosessualità e lo scandalo di Capri". www.giovannidallorto.com.
- ^ a b Shorter 1997, p. 35.
- ^ Suzuki, Akihto (January 1995). "The politics and ideology of non-restraint: the case of the Hanwell Asylum". Medical History. 39 (1): 1–17. doi:10.1017/s0025727300059457. PMC 1036935. PMID 7877402.
- ^ Edited by: Bynum, W. F; Porter, Roy; Shepherd, Michael (1988) The Anatomy of Madness: Essays in the history of psychiatry. Vol.3. The Asylum and its psychiatry. Routledge. London EC4
- ^ "British Outsider Art Exhibitions, John Joseph Sheehy London and Group Show in Paris 2008". Retrieved 15 January 2009.
- ^ a b c Shorter 1997, p. 34.
- ^ a b c d Shorter 1997, p. 46.
- ^ Shorter 1997, p. 47.
- ^ Shorter 1997, p. 48-49.
- ^ Rothman, D.J. (1990). The Discovery of the Asylum: Social Order and Disorder in the New Republic. Boston: Little Brown, p. 239. ISBN 978-0-316-75745-4
- ^ Shorter 1997, p. 65.
- ^ a b Roy Porter; David Wright (2003). The Confinement of the Insane: International Perspectives, 1800–1965. Cambridge University Press. ISBN 978-0-521-80206-2.
- ^ "by the brooke: lunacy panic". Bythebrooke.blogspot.com. 12 November 2008. Retrieved 15 April 2014.
- ^ Brown Edward M (2000). "Why Wagner-Jauregg won the Nobel Prize for discovering malaria therapy for General Paresis of the Insane". History of Psychiatry. 11 (44): 371–382. doi:10.1177/0957154X0001104403. S2CID 71299293.
- ^ Ugo Cerletti, for instance, described psychiatry during the inter-war period as a "funereal science". Quoted in Shorter 1997, p. 218
- ^ Hoenig J (1995). "Schizophrenia. In Berrios, German and Porter, Roy (Eds.), A History of Clinical Psychiatry. Athlone: p. 337; Meduna, L. J. (1985). Autobiography of L.J. Meduna". Convulsive Therapy. 1 (1): 53.
- ^ Shorter 1997, p. 190–225.
- ^ Shorter 1997, p. 226–229.
- ^ Henley, Jon (12 August 2009). "The Forgotten Kennedy". The Guardian.
- ^ Yanni, Carla. (12 April 2007). The Architecture of Madness: Insane Asylums in the United States (Architecture, Landscape and Amer Culture) (1 ed.). University of Minnesota Press. pp. 53–62. ISBN 978-0-8166-4940-2.
- ^ World Health Organization. "Eliminating forced, coercive and otherwise involuntary sterilization: an interagency statement" (PDF). unaids.org. Retrieved 23 June 2016.
- ^ TSUCHIYA, Takashi. "Japanese Eugenic Sterilization, Newsletter of the Network on Ethics and Intellectual Disability, Vol.3, No.1 [Fall 1997], pp.1–4". www.lit.osaka-cu.ac.jp. Retrieved 23 June 2016.
- ^ Torrey E.F.; Yolken R.H. (16 September 2009). "Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia" (PDF). Schizophrenia Bulletin. 36 (1): 26–32. doi:10.1093/schbul/sbp097. PMC 2800142. PMID 19759092. Archived from the original (PDF) on 3 August 2012.
- ^ Semple, David; Smyth, Roger; Burns, Jonathan (2005). Oxford handbook of psychiatry. Oxford: Oxford University Press. p. 6. ISBN 978-0-19-852783-1.
- ^ Noll, Richard (2007). The encyclopedia of schizophrenia and other psychotic disorders. Infobase Publishing. p. 3. ISBN 978-0-8160-6405-2.
- ^ a b c d Medicine betrayed: the participation of doctors in human rights abuses. Zed Books. 1992. p. 65. ISBN 978-1-85649-104-4.
- ^ Birley, J. L. T. (January 2000). "Political abuse of psychiatry". Acta Psychiatrica Scandinavica. 101 (399): 13–15. doi:10.1111/j.0902-4441.2000.007s020[dash]3.x. PMID 10794019.
- ^ "Press conference exposes mental health genocide during apartheid, 14 June 1997". South African Government Information. Retrieved 16 January 2012.
- ^ van Voren, Robert (January 2010). "Political Abuse of Psychiatry—An Historical Overview". Schizophrenia Bulletin. 36 (1): 33–35. doi:10.1093/schbul/sbp119. PMC 2800147. PMID 19892821.
- ^ The text reads: When the patient lashes out against "them" – THORAZINE (brand of chlorpromazine) quickly puts an end to his violent outburst. 'Thorazine' is especially effective when the psychotic episode is triggered by delusions or hallucinations. At the outset of treatment, Thorazine's combination of antipsychotic and sedative effects provides both emotional and physical calming. Assaultive or destructive behavior is rapidly controlled. As therapy continues, the initial sedative effect gradually disappears. But the antipsychotic effect continues, helping to dispel or modify delusions, hallucinations and confusion, while keeping the patient calm and approachable. SMITH KLINE AND FRENCH LABORATORIES leaders in psychopharmaceutical research.
- ^ Thuillier, Jean (1999). Ten Years that Changed the Face of Mental Illness. Trans. Gordon Hickish. Martin Dunitz: pp. 110,114, 121–123, 130. ISBN 1-85317-886-1
- ^ Shorter, Edward (1 June 2009). "The history of lithium therapy". Bipolar Disorders. 11 (Suppl 2): 4–9. doi:10.1111/j.1399-5618.2009.00706.x. PMC 3712976. PMID 19538681.
- ^ Albert Q. Maisel (6 May 1946). Bedlam 1946. LIFE magazine. p. 102.
- ^ a b c d e Fakhourya W, Priebea S (August 2007). "Deinstitutionalization and reinstitutionalization: major changes in the provision of mental healthcare". Psychiatry. 6 (8): 313–316. doi:10.1016/j.mppsy.2007.05.008.
- ^ Rochefort DA (Spring 1984). "Origins of the "Third psychiatric revolution": the Community Mental Health Centers Act of 1963". J Health Polit Policy Law. 9 (1): 1–30. doi:10.1215/03616878-9-1-1. PMID 6736594. Archived from the original on 9 July 2012. Retrieved 29 November 2009.
- ^ Scherl DJ, Macht LB (September 1979). "Deinstitutionalization in the absence of consensus". Hosp Community Psychiatry. 30 (9): 599–604. doi:10.1176/ps.30.9.599. PMID 223959. Archived from the original on 6 January 2012.
- ^ "Tara H Moross Centre Hospital – Psychiatric Ward (Ward 8)". Medpages. Retrieved 28 May 2018.
- ^ Priebe S, Badesconyi A, Fioritti A, et al. (January 2005). "Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries". BMJ. 330 (7483): 123–6. doi:10.1136/bmj.38296.611215.AE. PMC 544427. PMID 15567803.
- ^ Dept of Internal Affairs, New Zealand Government. Te Āiotanga: Report of the Confidential Forum for Former In-Patients of Psychiatric Hospitals June 2007
- ^ a b Stroman, Duane. 2003. "The Disability Rights Movement: From Deinstitutionalization to Self-determination. University Press of America.
- ^ Domino ME, Norton EC, Morrissey JP, Thakur N (October 2004). "Cost shifting to jails after a change to managed mental health care". Health Serv Res. 39 (5): 1379–401. doi:10.1111/j.1475-6773.2004.00295.x. PMC 1361075. PMID 15333114.
- ^ Mac Donald, Heather. "The Jail Inferno". City Journal. Retrieved 27 July 2009.
Further reading
- Yanni, Carla (2007). The architecture of madness: insane asylums in the United States. U of Minnesota Press. ISBN 978-0-8166-4939-6.
- (in French) Michel Foucault, Histoire de la folie à l'âge classique, 1961, Gallimard, Tel, 688 p. ISBN 978-2070295821
- (in French) Claude Quétel, Histoire de la folie : De l'Antiquité à nos jours, 2009, Editions Tallandier, Texto, 618 pages. ISBN 978-2847349276
- Shorter, E (1997), A History of Psychiatry: From the Era of the Asylum to the Age of Prozac, New York: John Wiley & Sons, Inc., ISBN 978-0-471-24531-5
: CS1 maint: location missing publisher (link)


text:
Parents to the rescue
It was a bizarre scene outside the Democratic National Convention in Charlotte, N.C.
As about 400 convention-goers gathered to watch an advance screening of the movie Won't Back Down, a small gathering of protestors railed outside against the film's message.
The protestors were from Parents Across America, a North Carolina-based group funded by teacher unions. Union opposition to Won't Back Down has been strong, with American Federation of Teachers president Randi Weingarten denouncing the film as "divisive" and saying "it resorts to falsehoods and anti-union stereotypes."
Won't Back Down details the struggle of dedicated parents to transform a failing public school using "parent-trigger" laws that first appeared in California in 2010 and which have since been replicated, to at least some degree, in Connecticut, Indiana, Louisiana, Mississippi, Ohio and Texas.
Parent-trigger laws allow parents to force major changes at a single school if more than 50 percent of the school's parents sign a petition urging the change. Possible changes include (1) converting the school into a charter; (2) replacing staff and making budget decisions; (3) changing principals; or (4) closing the school and relocating its students to more successful schools nearby.
Teacher unions have fought against parent-trigger laws at every step. They lobby against the laws when state legislatures debate them, and — upon passage — campaign to discourage parents from signing the petitions.
After parents in Compton, Calif., signed petitions to force changes at a failing school, they reported harassment and lies by union operatives. Some parents said they were threatened with deportation if they didn't rescind their signatures.
Parents seeking to convert Desert Trails Elementary School in Adelanto, Calif., into a charter school reported similar tactics. Like the Compton school, Desert Trails serves mainly low-income and minority students. For six consecutive years the school has been classified as failing, and only 30 percent of sixth-graders are proficient in English or math.
Even after parents stood firm in the face of this harassment, the unions applied pressure to the local school boards, where election outcomes are largely determined by the unions' own clout. In both cities, school board members purposely delayed implementation of the changes, mounted legal challenges to the parent-trigger process and — when those legal challenges were unsuccessful — openly defied court orders.
The actions of Compton Unified School District against Compton parents were characterized in the Huffington Post as "so unconstitutional that L.A. Superior Court judges had to issue both a Temporary Restraining Order and a Preliminary Injunction" against the district.
Los Angeles Times editorials similarly lamented Adelanto school board members' behavior, saying the board "flouted the obvious spirit (and possibly the letter) of the law."
After a California Superior Court judge ruled that the board must allow the parents to "immediately begin the process of soliciting and selecting" proposals for the school's transformation, school board members unanimously defied the court order, imposing instead their own "reform" agenda of mild tinkering with the school's governance. One brazen board member even brought a pair of handcuffs to the meeting, saying, "If I'm found in contempt of court, I brought my own handcuffs, take me away. I don't care anymore."
How does all this relate to the bizarre scene of union picketing in Charlotte, and why is it so significant?
Teacher unions have long been loyal foot soldiers for the Democratic Party as well as the most significant financial contributors to Democratic campaigns. And yet, it's Democrats who have been behind parent-trigger laws in California and elsewhere.
This year's Democratic National Convention was chaired by Los Angeles Mayor Antonio Villaraigosa, who has been vocal in his support for parent-trigger laws and who appeared before conventioneers on a panel with education reformer (and fellow Democrat) Michelle Rhee after the screening of Won't Back Down. California's parent-trigger law was written and sponsored by Democratic state Sen. Gloria Romero. In Texas, it was Democratic Representative Mike Villareal who sponsored similar legislation.
This emerging rift between teacher unions and the Democratic Party is the manifestation of a growing crisis on the Left. A significant contingent of left-leaning policymakers are beginning to recognize that the traditional public school system, which, through the years, has been molded and manipulated by self-interested unions, is failing to prepare students for success in life. Moreover, the students most likely to be left behind are those found in the low-income, minority-laden neighborhoods that host the worst public schools.
For that reason, politicians from across the political spectrum — including both Barack Obama and Mitt Romney — have characterized education reform as "the civil rights issue of our time."
Happily, that means education reform can no longer be considered a partisan issue. It's simply a battle between those who believe that a public education system should benefit children and those who believe it should benefit adults.
The latter will continue to side with entrenched union interests, while the former will pursue changes that work better for children.
Geoffrey Lawrence is deputy policy director at the Nevada Policy Research Institute. For more visit http://npri.org.

subset: commoncrawl


text:
The Site is brought to you by Sinclair Pharma Ltd (Sinclair). Our registered office is 30-32 Whitfield Street, Whitfield Court, London, W1T 2RQ with company registration number 03816616.
Sinclair recognises the importance of providing a website that is accessible to all user groups including people with disabilities such as blindness and low vision, deafness and hearing loss, learning disabilities, cognitive limitations, limited movement, speech disabilities, photosensitivity and combinations of these.
Sinclair has designed the Site with accessibility in mind, following the guidelines laid down by the W3C Web Accessibility Initiative (WAI).
Web Content Accessibility Guidelines (WCAG) 2.0 covers a wide range of recommendations for making web content more accessible to a wider range of people with disabilities and will also often make web content more usable to users in general.
The 12 accessibility guidelines are:
- Provide text alternatives for non-text content.
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- Make content adaptable; and make it available to assistive technologies.
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text:
A teeth whitening procedure or bleaching simply refers to any process that will make the teeth appear whiter. It is considered a non-invasive procedure that is designed to whiten and brighten teeth that are stained, discolored, darkened, or yellowed. First introduced to the public in the 1980's, the popularity of teeth whitening products and procedures has soared. According to a survey conducted by the American Academy of Cosmetic Dentistry, when respondents were asked, "What would you like to improve most about your smile?" The most common response was: whiter and brighter teeth.
How white a tooth appears depends upon how light is reflected and scattered off the enamel, the outermost layer of the tooth. Teeth can look dark or discolored for a variety of reasons, with an imperfect appearance the result of outer surface stains or discoloration from within the tooth. While external tooth stains are typically due to certain foods and tobacco, internal tooth discoloration is mainly the result of hereditary factors, certain medications, tooth decay, restorations, or trauma. Additionally, the aging process can influence the color of a tooth. This is because over time the outer layer of enamel becomes thinner showing more yellowish tones from the underlying layer of dentin.
What are the advantages of a professional teeth whitening procedure performed by a dentist?
Although over the counter teeth whitening systems purchased in stores or online have become popular, there are health concerns and limitations with these products. If the manufacturers protocol is not correctly followed, certain products can damage the teeth and soft tissues in the mouth, and may not deliver the results as promised. Teeth whitening systems contain varying concentration of either hydrogen peroxide or carbamide peroxide, which act as the bleaching agents. When sensitive teeth, exposed roots, cavities, broken fillings, cracked teeth, or loose dental work are present, a teeth whitening procedure may be contraindicated. Also, since whitening systems do not have an effect on the color of dental fillings, crowns or bridges the presence of restorations is an important cosmetic consideration in treatment planning.
In general, individuals with yellow tones to their teeth respond best to teeth whitening procedures. Brown and grayish tinted teeth bleach respond less well and may require significantly longer dentist supervised tooth whitening regimens or alternative cosmetic treatments. Finally, teeth whitening may not be recommended in the presence of sensitive teeth, worn enamel and significant gum disease.
As a rule the healthiest and most effective methods of teeth whitening are the ones managed and supervised by the dentist. An in-office teeth whitening procedure as performed by the dentist is the most reliable and safest way to get the maximum results quickly. In as little as one hour a prescription-strength, in-office whitening procedure can dramatically whiten and brighten the natural teeth by several shades, while the surrounding tissues and any sensitive areas of the teeth are carefully isolated and protected from the bleaching agents.
A home whitening system from the dentist along with custom trays that have been fitted to the teeth is also an excellent option. Custom trays keep the bleaching agent in maximum contact with the teeth and away from the other areas of the mouth. With a take-home teeth whitening system, maximum results are less rapid than an in office procedure and are typically achieved over a longer period of time. A home whitening system can be used by itself or as recommended by the dentist as a follow up to an in office procedure in order to perfect or maintain the results.


text:
Hello Craftworld enthusiasts! Today, we're announcing a contest for the LittleBigPlanet community, where you'll have the chance to create this year's PAX Prime LittleBigPlanet Karting T-Shirt!
We're constantly amazed by the unique levels you all come up with, and we can't wait to see your creative talents put toward this T-Shirt design.
The rules are simple; the shirt can be any color and must:
- Contain a Classic (non-costumed, knitted) Sackboy
- Include a Kart
- Use only 1-3 colors
- Utilize up to 3 areas on the template
To participate, visit the contest site
Also, our artists can rework what you submit, so even if your drawing skills are not the greatest, go ahead and send in your creation! Winning designs will be selected by LBPK's production team. We will take the winner's design and place it on the exclusive T-Shirt that will be handed out at PAX Prime in Seattle.
The winner will, of course, receive their winning shirt. Additionally, they will receive a 3G PlayStation Vita unit, a copy of LittleBigPlanet PS Vita, and a copy of LittleBigPlanet Karting. Five runners up will also receive the winning T-shirt and a copy of LittleBigPlanet Karting. The contest is open now through August 8th, so submit away!


text:
What is the Manual Touchpoints importer?
The manual touchpoints importer will allow you to bulk add new manual touchpoints to people in Wicket. This is done using a templated excel file that's uploaded. The template is available to you for download when you access the manual touchpoints importer.
Access the Manual Touchpoints Importer
To access this feature, navigate to the Settings area of Wicket beside the search box. Click the gear icon, and select "Data Import" in the dropdown menu.
Set up your Import Job Type
On the first step of the import process, you will need to set up the type of import you are performing.
- Select the type of data you are importing from the dropdown (a required field). In this case, we are importing "Manual Touchpoints" data.
- Select the action you'd like to take with the data from the dropdown (a required field). In this case, we will "Add new records."
- Enter a name for this import job (an optional field).
- Click "Next."
Organize, upload, and validate your data
The next step is to gather your data and enter it into the provided XLS template.
- Download the blank XLSX template by clicking the "Download Manual Touchpoints Import Template" link. This template contains instructions and pre-defined columns based on your Wicket configuration.
- Populate the template with your data, and save it on your computer.
Note: It's important to read the General Instructions and Field Descriptions sheets within the template prior to populating your data. The Field Descriptions sheet will specify formatting, expected values, etc. for each column, if applicable. Following these will ensure a smoother data Validation process.
Important: Prior to uploading the template, delete the "General Instructions" and "Field Descriptions" sheets from the template, or move the "Import Template" sheet to the first position. - When you're satisfied with the data in the template, click "Choose File" (Note: this button may be named something else, depending on your browser) to select the file from your computer, then click "Next" to upload it to Wicket.
- When the file has completed uploading to Wicket, a Validation process will automatically execute. This process checks your data's structure and for any other major issues.
- When completed, you will be presented with validation results including a confirmation of the File Size, Number of Records, and the Validation Outcome.
When validation has passed, you will see a green "Passed" outcome. You can now move onto the next step "Job Dry Run."
If the validation of your data fails, you will see a red "Failed" outcome. Wicket will display a list of errors found. Resolve the validation errors by fixing or deleting the erroneous data. You can re-attempt your upload once completed.
Perform an Import Dry Run
The final step in validating your data is performing a dry run of the import. This process simulates the full import in order to check each individual record for compliance against data rules and policies in the template and considering existing data in Wicket.
- Click "Start Job Dry Run." A progress bar will appear to track the dry run process.
When the Dry Run has completed, you will be presented with the results including counts for any failed, and successful records. If any records have failed, a "Download Failed Records Report" link will appear. This report contains a line-by-line breakdown of the issues detected for each row of data.
If you wish to resolve the failed records, correct them within your XLSX and re-upload the file to execute the validation and dry run processes again.
If there are no failed records, or you would like to continue with the import process with known failed records, click "Next." The failed records will not be imported.
Process Data Import and Complete Job
When you're satisfied with the Dry Run results, you can complete your import job. On the "Job Processing" step, you will be presented with a final confirmation of the number of records that will be processed.
IMPORTANT: This process will import your data, and the corresponding Wicket records will be affected. This action can not be undone.
- Click "Process Data Import and Complete Job." A progress bar will appear to track the process.
When the job has completed, you will be presented with the results including the number of successful and failed records. If any records have failed, a "Download Failed Records Report" link will appear. This report contains a line-by-line breakdown of the issues detected for each row of data.
Note: After import completion, you will not be able to change or re-run this import job. Failed records can be fixed and re-imported by starting a new import process.


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I haven't posted for quite a while. My father-in-law reminded me this past weekend at our family reunion. He said he checks in from time to time to see what I'm up to! Well, I work a lot now and get very little done creatively.
A couple of weeks ago I stopped at a yard sale and purchased 14 old t-shirts for cheap because I want to make this. It just looks like fun.
Isn't it the cutest? Can't wait to wear one, but it's too hot here right now.
I entered this is in a show and it was rejected. 🙁
TriState Artisans will have a new name this year and a new brochure for our studio tour in December. We are losing a few artisans on the Illinois side and adding a couple of new ones. You won't want to miss it! Here is a photo of my work that will be featured in the new brochure.
More news: I am working on moving into a REAL studio space! A 20 x 80 foot building has come open across the street from where I work. The biggest portion of it will be my workspace and classroom for teaching. I am planning to put a small shop in the front part. Although I can't be open every day, the shop will have my art for sale as well as consigned items by other artists/artisans. I am looking forward to getting in and getting some work done!
Another piece of good news…I was going to order another Square swiper yesterday because the one they sent me didn't seem to work in my Android tablet. On a lark, I thought I would stick the one I had back in and check it. Lo, and behold, it worked! I could actually SWIPE the card, so I made two $1 payments to myself. Besides, I need to practice so I know how to use the darn thing. I guess the fees I paid were worth it! I think I'm going to love this little tool.


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We all heard about facebook ads. Rumors out there stated that paid ads in facebook do not work. And also there have been rumors that Facebook ad revenue decreases.
Ok, rumors are one thing and facts are another!
Marin Software an advertising management company proved that Facebook ads work. Especially Facebook's new ad units, Sponsored Stories which work in a social context are doing very well for social media marketing.
The simple reason why firms are not successful with their Facebook marketing is they do not understand that people go online to research and not to buy thing. In the case of Facebook marketing the people go to Facebook to connect, exchange ideas and to communicate. They go to Facebook to discover new things (research).
Companies which do Facebook marketing do some major mistakes when performing paid campaigns.
One major mistake is they attract the Facebook user to click on their Facebook ad and lead him or her away from Facebook. This is a bad idea as the people on Facebook want to communicate and learn about new things on Facebook and they do not want to be led away.
To avoid this mistake companies which perform Facebook paid ad campaigns should be creative and lead these ad attracted visitors to their Facebook page, for example with an exclusive offer. This would for sure improve the marketing results.
Another major mistake when businesses do Facebook social media marketing is, they do not take the opportunity to communicate with those ads attracted new visitors of their Facebook pages. Social media is about communication and connection with people. It's not about selling and sales pitches.
Businesses should take the time to communicate with their network and carefully listen to them. This can result in a massive revenue growth when done right.
Also a major mistake is to think, to be on Facebook as a brand is enough and the audience will follow. Why should they follow your business page on Facebook? Do you have something remarkable, valuable and interesting to share with your audience? Did you take this chance to build trust and position you as a professional resource there?
A great way how you can position your business and your brand in social media sites like Facebook is to publish and share remarkable, valuable and interesting content!
You can expand your brand reach very easy and quick by expanding the reach of your content through "Facebook Sponsored Stories". So your content reaches wide more people and the best thing is it reaches the right people. The way of social targeting helps to reach the right persons and attract those future customers to a business page.
This way you build trust and brand awareness the smart way.
The success of "Sponsored Stories" is huge. An increasing number of advertisers are using this smart marketing way to expand the reach of their custom created content.
Infographic: A Brief Insight Into Facebook Marketing
Here are five ways how you can make Facebook Sponsored Stories work for you:
1. Start a corporate blog and create and share content in social media like Facebook in which your audience is interested in
2. Create eBooks, whitepapers, how-to's, etc. and offer a free download in exchange of the visitors contact information on a landing page. This way you generate targeted leads
3. Set this landing pages under Facebook apps, so the user never need to leave Facebook
4. Start "Facebook Sponsored Stories" and direct the ad link to one of your Facebook landing pages
5. Encourage your audience to give you feedback regarding your content. This way you start the conversation
How about you, did you use "Sponsored Stories" yet and how is your opinion?


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The Unintended Consequences of Energy Mandates and Subsidies on America's Civil Nuclear Fleet
Until recently, most energy analysts focused on challenges to expansion and new builds when discussing the future of America's nuclear power sector. Today, more and more observers are focused on the likelihood of an early shutdown of existing reactors due to a combination of market forces and distortions created by government intervention. According to market observers, 5 or 6 of the nation's 103 operating reactors could be at risk of early retirement over the next several years. Indeed, as many as a quarter of civil nuclear power facilities are currently cash-flow negative or at risk of becoming so.
Most related commentary emphasizes the impact of abundant, cheap shale gas on the economic viability of reactors—particularly smaller units located in competitive state electricity markets. A growing number of analytical reports, however, also point to the negative impact of renewable energy mandates and subsidies (direct and indirect) on the competitiveness of nuclear power. Today, 30 states and the District of Columbia have renewable portfolio standards (RPS) or other mandated renewable capacity policies, according to the Energy Information Agency. Most of these policies were enacted before the shale gas revolution and the Environmental Protection Agency's increased regulation of coal-fired power generation. As renewable targets ramp up in the coming years, we believe that reactors located within RPS states will come under increasing pressure, causing a number of them to shut down.
The early retirement of those reactors would have a substantial impact on the local economy. A job at a U.S. nuclear facility pays nearly 40 percent more than the average local salary, and the average plant generates close to $500 million a year in total output for the community in which it is located.
Moreover, a shutdown of a number of reactors would cumulatively affect university physics and engineering programs, material science laboratories, manufacturers, and the defense establishment—including the U.S. Navy's ability to recruit personnel to help operate its nuclear carriers and submarines. Certainly, with fewer employment opportunities available on separation from military life, recruits would be discouraged from seeking military work in a nuclear-related function.
We recognize the benefits of lower cost energy to manufacturers and consumers. From an economic and national security perspective, there is no question, for example, that shale gas has greatly benefited the nation.
However, the Nuclear Energy Program at CSIS plans to work with interested stakeholders to help educate the public and the policymaking community on the unintended consequences of subsidized generation on America's civil nuclear fleet—effects that are not generally well understood or appreciated. In particular, we wish to examine the impacts of renewable tax credits at the federal level and renewable portfolio and efficiency mandates, as well as subsidized gas plants at the state level. Given the indispensable role civil nuclear power plays in promoting U.S. national security interests and achieving air quality standards, we believe that there is a critical need for a more comprehensive, integrated discussion on stationary power issues, particularly as federal and state governments look to increase the share of renewable sources in the electricity mix.
The Wind Production Tax Credit: An Example of Unintended Consequences
Recent studies examining the impact of renewable energy policies point to their disruptive impact on competitive electricity markets, including the operation of nuclear plants located in those areas. The wind production tax credit (PTC) of $23 per MWh has been the focus of much of this research because of its link to negative pricing for electricity (i.e., when power providers must pay "congestion" charges to the grid to take their electricity).
Over the past decade, wind facilities have increased 10-fold to over 60 GW—thanks mostly to state renewable requirements and the wind PTC, which incents wind farms to produce electricity regardless of market demand, oftentimes during the late night and early morning when demand for electricity is at its lowest. Because wind generators are rewarded the tax credit, they are willing to pay "congestion" charges to the grid as long as those charges do not exceed the credit, thus guaranteeing them a profit. Negative pricing has grown from a very low occurrence before the introduction of renewable mandates to much higher levels, accounting for up to 13 percent of all hourly prices in some U.S. regions. Those numbers increase drastically in hours in which the wind blows more often.
Non-wind generators do not receive the tax credit. Consequently, other power sources, including nuclear facilities, must pay the congestion charge without the corresponding tax benefit. Nuclear reactors, which attempt to run at a set level of output for technical, safety, and cost recovery reasons, are hit hard by the increased cost of operation. Industry forecasts suggest that nuclear facilities will be forced to pay hundreds of millions of dollars in extra costs over the coming years because of negative pricing resulting from renewable policies. These costs will clearly increase as renewable energy targets ramp up in many states between now and 2025.
We are already seeing these impacts play out in several regions. The shutdown of the Kewaunee nuclear plant in Wisconsin, for example, was blamed on low natural gas prices and large volumes of new wind generation. And in Texas, Public Utility Commission chairman Donna Nelson testified at a state Senate Natural Resources hearing last September that "the market distortions caused by renewable energy incentives are one of the primary causes I believe of our current resource adequacy issue…[T]his distortion makes it difficult for other generation types to recover their cost and discourages investment in new generation." Exelon chief Christopher Crane went even further, warning the press earlier this year that "there is a very high probability that existing safe, reliable nuclear plants will no longer be competitive and will have to be retired early" if the PTC remains in place.
In a recent report by the Organization for Economic Cooperation and Development (OECD), analysts cautioned that high-fixed-cost technologies, such as nuclear, will leave the market due to their load and profitability loss resulting from increased penetration of wind power. Because of the departure of these despatchable sources from the grid, the volatility of electricity prices will increase substantially. OECD thus suggests that policymakers "swiftly" work to address this growing challenge by educating the public on the need to protect electricity supply security. We agree with this assessment.
Given the fact that roughly half of the nation's nuclear fleet is located in competitive electricity markets that also have renewable portfolio standards and other energy mandates and subsidies, we are clearly concerned about the future competitiveness of our nuclear units, which already face rising maintenance and fuel costs. Moreover, we anticipate greater deployment of wind installations because of the extension of the PTC, which was a component of January's deficit deal. In addition, President Obama has suggested making the wind PTC permanent starting in 2014. Although most observers doubt the political viability of such a proposal, it remains unclear how long the production tax credit will remain in place.
As part of our examination of such policies, the Nuclear Energy Program at CSIS will explore with interested stakeholders policy options that could alleviate this pressure on the nation's existing fleet of reactors. Understanding the longer-term impact of energy mandates and subsidies (direct and indirect) on our ability to maintain the current number of reactors and our options for expanding the fleet is clearly important to the national interest.
George David Banks is a senior fellow and Deputy Director of the Nuclear Energy Program at the Center for Strategic and International Studies (CSIS) in Washington, D.C.
Commentary is produced by the Center for Strategic and International Studies (CSIS), a private, tax-exempt institution focusing on international public policy issues. Its research is nonpartisan and nonproprietary. CSIS does not take specific policy positions. Accordingly, all views, positions, and conclusions expressed in this publication should be understood to be solely those of the author(s).
© 2013 by the Center for Strategic and International Studies. All rights reserved.


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Hear Robert Plant's New 'Charlie Patton Highway' Single
Robert Plant has released "Charlie Patton Highway (Turn it Up, Pt. 1)," the first new song from his upcoming anthology, Digging Deep: Subterranea.
You can hear the track below.
As the parenthetical part of the title suggests, the song is a more organic and muscular version of "Turn it Up," which first appeared on Lullaby and ... The Ceaseless Roar, Plant's 2014 album with the Sensational Space Shifters. Guitarist Buddy Miller and drummer Marco Giovino, who joined the former Led Zeppelin singer on 2010's Band of Joy album, appear on the new version of the song.
"I spent time in the hill country of north Mississippi around Como, dropping back to Clarksdale, the incredible center of black music talent over the years," Plant said of the inspiration behind the song. "I weaved my car through the Delta back roads, listening to the remarkable protestations of Mississippi AM radio. I was looking at my world and my times from this unfamiliar place and found myself exposed to a nightmare world of half-truths."
In addition to appearing on Digging Deep: Subterranea, a 30-track collection of songs from throughout Plant's solo career, "Charlie Patton Highway" is also slated for inclusion on an upcoming second Band of Joy collection. "I've done so many things," he told Classic Rock earlier this year. "I've got a whole album, Band of Joy II, that I did with Buddy Miller and Patty Griffin."
Plant was slated to introduce another new band, Saving Grace, to U.S. fans during a seven-date tour in May. Those plans were scuttled by the COVID-19 pandemic. Earlier this week, Plant launched the third season of his Digging Deep podcast, where he tells the stories behind songs from his solo and Led Zeppelin years.


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Episode 252: [58:32]
(Download: MP3 56MB, Flac 524MB, Ogg Vorbis 34MB or Stream)
In this show Chris 'Zeke' Hand, plays interviews with Lucas Hoving and Lourdes Lopez.
The theme song of the week is Del Shannon's version of Do You Want to Dance, the dance poem of the week is Pavlova in London by James Elroy Flecker, This Week in Dance History highlights Gelsey Kirkland, Russ Tamblyn, José Greco, Maurice Béjart, Harold Rhéaume, Fernand Nault, and Eddy Toussaint, and the music played during the show is from the Henry Threadgill Zooid CD This Brings Us To.
Originally published on Movement Museum