Bibliotherapy: Patient Libraries and Reading Programs, One Component of the Moral Treatment Revolution

OBJECTIVES: We will examine the utilization of bibliotherapy in 19th century psychiatric “asylums” focusing on two respected institutions; Butler Hospital and Worcester State Hospital as well as the writings of their respective superintendents, Isaac Ray M.D. and Samuel B. Woodward M.D. METHODS: Merriam-Webster’s Dictionary defines bibliotherapy as “the use of reading materials for help in solving personal problems or for psychiatric therapy”. “Bibliotherapy” first appears in the literature in conjunction with the work of Anna Freud in the early 20th century. However, it was being used extensively within the practice of the “moral therapy” movement in mental health institutions in the 1800’s. In the many new American public and private psychiatric hospitals that were being founded at that time, superintendent/physicians saw reading as one of many “occupational therapies” that would assist in the recovery of the institutionalized patient. We will examine primary resources describing patient library services, focusing specifically on the works of Woodward, Ray and others of the thirteen “revolutionary” founders of the group which eventually became the American Psychiatric Association and which held its first meeting in Philadelphia in 1844. RESULTS & CONCLUSIONS: Were “cheap novels” a cause of insanity (as Ray wrote) or a diversion from the “depression of spirits” as proposed by prominent Philadelphia physician Benjamin Rush (1745-1813)? Would newspapers “help” patients stay current or would they or “hurt” by exposing them to horrors of life outside? These were some of the questions being asked by leaders of America’s early psychiatric institutions. Nonetheless, bibliotherapy was a foundational treatment of the moral therapy era and it appears that most if not all new institutions of the time had therapeutic reading programs and/or patient libraries. While neither Woodward nor Ray wrote extensively on this subject in their Annual Reports or correspondence, there is ample evidence in the primary literature of the importance of bibliotherapy. We will demonstrate this through the use of quotations, images, sketches and examples of items on the shelves of patient libraries in the early to mid 1800’s. BIBLIOGRAPHIC REFERENCES: Butler Hospital for the Insane. (1847). Report of the board of trustees of the Butler Hospital for the Insane. Providence, John F. Moore, Printer. Butler Hospital for the Insane. (1848). Report of the board of trustees of the Butler Hospital for the Insane. Providence, John F. Moore, Printer. Buttolph, H. A. (1847). Modern asylums. American Journal of Insanity, 3(4), 364-378. Dunkel, L. M. (1983). Moral and humane: Patients’ libraries in early nineteenth-century American mental hospitals. Bulletin of the Medical Library Association, 71(3), 274-281. Edginton, B. (1997). Moral architecture: The influence of the York Retreat on asylum design. Health & Place, 3(2), 91-99. Galt, J. M. (1846). The Treatment of Insanity. New York: Harper. Kirkbride, T. S. (1845). A sketch of the history, buildings, and organization of the Pennsylvania Hospital for the Insane, extracted principally from the reports of Thomas S. Kirkbride, M.D., physician to the institution. American Journal of Insanity, 2(2) 97-114. Moral treatment of insanity. (1847). American Journal of Insanity, 4(1), 1-15. Mott, F. L. (1930). A history of American magazines, 1741-1850. New York: London, D. Appleton. Rush, B. (1962). Medical inquiries and observations upon the diseases of the mind. [facsimile. of the Philadelphia, 1812 ed.]. New York: Hafner. Spiller, R. E., ed. Thorp, W., ed. Johnson, T. H., & ed. Canby, H. S. (1963). Literary history of the United States (3d ed. rev ed.). New York; London: Macmillan; Collier-Macmillan. Thompson, J. D. G., Grace, & Joint Author. (1975). The hospital: A social and architectural history. New Haven: Yale University Press. Trustees. (1839). Sixth annual report of the trustees of the state lunatic asylum at Worcester. Boston: Dutton and Wentworth, State Printers. Trustees. (1840). Seventh annual report of the trustees of the state lunatic hospital at Worcester. Boston: Dutton and Wentworth, State Printers. Weimerskirch, P. J. (1965). Benjamin Rush and John Minson Galt, II. Pioneers of bibliotherapy in America. Bulletin of the Medical Library Association, 53(4), 510-526. Presented at the Medical Library Association Annual Meeting on May 21, 2007, in Philadelphia, PA