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justbishop
09-08-2012, 07:54 PM
I'm working on a young girl character (11-13 y/o), and need some info on what her experience may have been, re: treatment for what we'd know today as Schizophrenia (a term which was not coined until a later point). She hears various voices, hallucinates people that aren't there, etc.

Her family is fairly well off in the United States, and I'm thinking that they would choose to bring staff in and have her treated in-home. Please advise if her being sent to an institution/asylum would be more historically accurate.

I'm also wondering what the course/progression of treatment would be for a child of that age? The research I've done isn't bringing up much other than hypnosis, "talking" therapy, and dream analysis. When none of that helps, I'm thinking they'd just move on to sedation. Barbiturates seem to have been officially introduced for medical use in 1903, but I need something for use in 1902 (can't change the year), so I'm wondering if it could be a case of "there's this VERY new treatment we could try, but it's still in the experimental phase..."

Any thoughts would be appreciated!

Belle_91
09-08-2012, 08:17 PM
If they are wealthy, then yes, they may try to treat her at home. They will also do their best to keep her out of sight. Their help may know about her, but that's all. It was believed back then that your blood could be "tainted" if you were releated to someone with that disease. Even if you weren't affected, people might not want to marry you in the fear that your future children would have the disease.

There were places set up for people to send family members away to. Maybe you could have it where the family tries to take care of her at home, but she gets too out of control/they don't know the proper techniques for dealing with someone like her, and thus they send her away. I can't say for sure, but I think the patients at those aslyumns would be drugged up and possibly given a lobotomy.

Also, I don't think there were any nurses/doctors specifically trained to deal with the mentally ill at this time. They would probably just assign one of their staff to deal with the child.

Ironically enough, there was an old mental institute in Salem, Massachusetts that opened I think around the mid-1800s. It was shut down and left abandoned for awhile, but that might be a good place to research. You might find out about how those places treated their patients. My cousin actually broke into it--when it was abandoned (I think now they've made them into apartment complexs), and she talked about all of the weird stuff she saw. I don't think she saw any padded rooms or anything, but apparently the people just left everything there, including some records.

I know it's wikipedia, but this may help point you in the right direction.

http://en.wikipedia.org/wiki/Danvers_State_Hospital

*It was in Danvers not Salem even though Danvers used to actually be Salem Village and where the "witches" lived. Just a random side note.

justbishop
09-08-2012, 08:33 PM
Thanks for the thoughts, Belle :)

My research is showing that the lobotomy procedure wasn't really developed until the 1930s, but I might be missing something in my Googling, I don't know. Everything I'm reading is indicating that there wasn't much being done as treatment for mental illness of this type aside from Frued's work, which is where I'm getting the hypnosis/Talking therapy/dream analysis course of treatment from.

I'd like to know if there are any other treatments that may have been attempted on this child before they resort to straight sedation and/or restraint.

Drachen Jager
09-08-2012, 08:37 PM
Treatments varied widely in those days as there were hundreds of competing theories and few conclusive studies.

I'd recommend going on manybooks or project gutenberg and looking up psychological manuals of the era (shouldn't take long to find). There's a ton of material out there, if you know where to look.

There's some info in this article, and it may lead you to more detailed sources.

http://en.wikipedia.org/wiki/History_of_psychiatry#19th_century

Cyia
09-08-2012, 09:07 PM
Mental illness in an affluent family would have been covered up every way possible. The child would never be seen in public. She'd likely be hidden at home, with around the clock private nurses who wouldn't be allowed to speak about her - assuming she wasn't simply shuttled off to a sanitarium and never mentioned again.

justbishop
09-08-2012, 09:17 PM
Mental illness in an affluent family would have been covered up every way possible. The child would never be seen in public. She'd likely be hidden at home, with around the clock private nurses who wouldn't be allowed to speak about her - assuming she wasn't simply shuttled off to a sanitarium and never mentioned again.

This is what I was envisioning, but I'm still at a bit of a loss as to what the nurses would actually be doing. Administering sedation? Would the patient be restrained in some fashion (strapped to a bed, straitjacket, etc.)?

LJD
09-08-2012, 09:30 PM
One thing to note is that schizophrenia is quite rare in children. Usual onset is early adulthood. Not impossible, but very rare in children. I see 1/40,000 as a statistic at various websites, but I'm not sure what the source of that is, compared with 1/100 for adults.

Niniva
09-08-2012, 09:53 PM
The central state facility in Milledgeville Georgia was in operation at this time as well as another slightly larger one in New York state somewhere. At the Milledgeville asylum, there was a tray in the door that allowed patients to be fed without opening it.

Care usually consisted of "conscientious neglect" trying their best with nothing to work with. Laudnum was a common sedative, but it would have hallucinogenic side effects. Lobotomy, as mentioned earlier, was not yet available.

I don't know when shock treatments were invented such as insulin shock therapy and electroconvulsive shock therapy. Both had the effect of temporarily resetting the brains of depressed people to something more normal. I also don't know if they were used for schizo-type illnesses.

This was a time of experimentation without consent. If I think of anything good, I'll come back.

Chasing the Horizon
09-08-2012, 10:04 PM
This is what I was envisioning, but I'm still at a bit of a loss as to what the nurses would actually be doing. Administering sedation? Would the patient be restrained in some fashion (strapped to a bed, straitjacket, etc.)?
The patient would be restrained if they needed to be. Depends on whether they were active and combative or not. Barbiturates may not have been invented quite yet, but powerful opiate derivatives had been around for decades and would probably be used for sedation.

The nurse's job would've been to keep them cleaned, watered, fed, and probably as calm and quiet as possible.

You might want to read up on how the Spiritualism movement and your characters' religion would've viewed Schizophrenia as well. It's very possible that they would turn to spiritual "treatments" back then.

Belle_91
09-08-2012, 10:55 PM
You're probably right about the lobotomy thing. I haven't really researched this subject, it was just one thing I thought of. That's probably due to inaccurate Hollywood movies.

Would they use opium? I know that used to treat people who are in pain, but maybe on the mentally ill as well? I know they used to use cocaine in stuff back then as well. Maybe for this?

I have never researched what exactly they used the above for, so that would be interesting to see.

But I agree with Cyia. The family is going to keep her underwraps. Only their staff will know about her existance. Sadly, people who were mentally ill would be seen as an embarressment to their family, a result of "bad blood". :(

There is a story where I live about a wealthy family who had a child with a mental illness. Apparently, the family basically kept him in the basement. He had the bare necessities and was probably only cared for by the staff. It's so sad.

justbishop
09-08-2012, 11:21 PM
One thing to note is that schizophrenia is quite rare in children. Usual onset is early adulthood. Not impossible, but very rare in children. I see 1/40,000 as a statistic at various websites, but I'm not sure what the source of that is, compared with 1/100 for adults.

She isn't actually schizophrenic, they just think she is. She's just extremely sensitive to the spirit world, and as such, the spirits are quite attracted to her ;)


The central state facility in Milledgeville Georgia was in operation at this time as well as another slightly larger one in New York state somewhere. At the Milledgeville asylum, there was a tray in the door that allowed patients to be fed without opening it.

Care usually consisted of "conscientious neglect" trying their best with nothing to work with. Laudnum was a common sedative, but it would have hallucinogenic side effects. Lobotomy, as mentioned earlier, was not yet available.

I don't know when shock treatments were invented such as insulin shock therapy and electroconvulsive shock therapy. Both had the effect of temporarily resetting the brains of depressed people to something more normal. I also don't know if they were used for schizo-type illnesses.

This was a time of experimentation without consent. If I think of anything good, I'll come back.

I will look up Laudnum, thank you! And from what I've found, insulin shock nor ECT were developed quite that early.

Maryn
09-08-2012, 11:37 PM
It's spelled "laudanum." I only know about it because Beth in "Little Women" took it. Not that it saved her or anything! Oops, was that a spoiler?

Anyway, it contains real opium and was used to handle pain and to relieve coughing. I didn't know it was also a sedative, but maybe that's what stops the coughing, eh?

Maryn, no doctor

justbishop
09-08-2012, 11:50 PM
Ok, I think I'm set on having the family treat her at home. My main concern is what is the progression of events/treatments that are attempted when she begins (or at least begins to talk about) hearing voices/hallucinating? Here's what I have in my notes so far:

Initial treatments

Hypnosis
Talking therapy (Fruedian stuff)
Dream analysis

Shortly after

Laudanum (bitter tasting liquid opiate, given by mouth for sleep, not long term)

When the talking doesn't seem to be working

The Rest Cure (6 weeks of bed rest, seclusion, high calorie dairy based diet, and massage)

And finally, we give up

Barbiturates for long term sedation, confinement in home

frimble3
09-09-2012, 01:19 AM
Two points:
1) Whether they try to keep her at home or not would be affected by their social life, and family. If they entertain a lot, or have other children, it gets harder to keep a secret, easier to say she's got some illness and ship her off to a hospital, or to an obscure out-of-town relative, where she can be cared for by nurses, etc, without anyone seeing anything.
2) How smart is she? Because I'm thinking that quite a young child of normal intelligence, will learn pretty quickly to keep quiet about things that get them into trouble. I think that a child getting rebuked for talking to or about 'imaginary friends' would soon learn to stop doing that, long before the 'medical treatment' stage.
If this 'sensitivity' was something she was born with, and the 'symptoms' consist of her seeing and remarking on the doings of invisible creatures, I'd think she could keep her responses down to a level of 'quirky'. Bonus points if she's a pretty little girl, points deducted if she's unattractive, or unappealing in some other way.

Look at the truly horrible secrets children have kept from grown-ups.

mayqueen
09-09-2012, 04:21 AM
I don't want to make claims I can't back up, but I feel like talk therapy would have been somewhat controversial at that point in time. What was most certainly considered the conventional route for treatment would have been hydrotherapy (http://www.lib.uwo.ca/archives/virtualexhibits/londonasylum/hydrotherapy.html).

justbishop
09-09-2012, 05:04 AM
Two points:
1) Whether they try to keep her at home or not would be affected by their social life, and family. If they entertain a lot, or have other children, it gets harder to keep a secret, easier to say she's got some illness and ship her off to a hospital, or to an obscure out-of-town relative, where she can be cared for by nurses, etc, without anyone seeing anything.
2) How smart is she? Because I'm thinking that quite a young child of normal intelligence, will learn pretty quickly to keep quiet about things that get them into trouble. I think that a child getting rebuked for talking to or about 'imaginary friends' would soon learn to stop doing that, long before the 'medical treatment' stage.
If this 'sensitivity' was something she was born with, and the 'symptoms' consist of her seeing and remarking on the doings of invisible creatures, I'd think she could keep her responses down to a level of 'quirky'. Bonus points if she's a pretty little girl, points deducted if she's unattractive, or unappealing in some other way.

Look at the truly horrible secrets children have kept from grown-ups.

I haven't decided what the involvement of the family in society would be yet. It could go either direction, depending on the needs of the more important points of the story. This character could literally live anywhere in the world where availability of such treatments I decide to use on her are available at the point in time I need them to be.

I don't see a reason to make the character any more sooper speshul than being a spirit magnet already makes her, so I'd say she's of average intelligence for a girl her age. She does fall pretty passionately in "love" with one specific spirit, and my thought is that "love" at that age kind of trumps everything (plus they are actually best able to see and communicate with one another when she's sedated, so I don't think she'd fear that eventuality much). I was also thinking that even if she tries pulling the wool over the adults' eyes about the fact that she's still seeing and hearing things, the truth would come out during her hypnosis sessions (she'd probably be seeing a Dr. on a somewhat regular basis for mental checkup type stuff, if she'd exhibited these types of behaviors before).

And I'm also not convinced that the threat of treatment--at least before she meets Mr. GhostRight--would be a deterrent. I've watched several documentaries about childhood onset Schizophrenia, and there is a sense of those children truly wanting to be helped and cured. I think it's feasible that a child would acquiesce to treatment, including being truthful about what's going on at any given time, if it meant getting the sometimes scary voices to stop.


I don't want to make claims I can't back up, but I feel like talk therapy would have been somewhat controversial at that point in time. What was most certainly considered the conventional route for treatment would have been hydrotherapy (http://www.lib.uwo.ca/archives/virtualexhibits/londonasylum/hydrotherapy.html).

I had considered that as something that is tried (and obviously abandoned because it fails to do anything significant for this case). Would it be believable for her family to have sent her away for treatment at some point, only to bring her home and continue on with the last resort sedation when the hospital has run out of ideas?

mayqueen
09-09-2012, 07:37 AM
I had considered that as something that is tried (and obviously abandoned because it fails to do anything significant for this case). Would it be believable for her family to have sent her away for treatment at some point, only to bring her home and continue on with the last resort sedation when the hospital has run out of ideas?
Possibly. Honestly, I can't say I know enough about the history of institutionalization to say yes or no. :) She could have gone to a private, expensive, experimental clinic for treatment maybe. I think that's believable. I wish I knew more about the history of psychiatry because it's a sad and fascinating history.

Lil
09-09-2012, 05:42 PM
There's a book by Roy Porter, MADNESS: A BRIEF HISTORY, that may be helpful (or may not--I don't remember it well enough).

Buffysquirrel
09-09-2012, 06:12 PM
Radium was in vogue around then as a treatment for anything and everything. Of course, you may not want to kill her.

strictlytopsecret
09-09-2012, 10:00 PM
My take on this is a little different. If I'm understanding you correctly, your character is not actually schizophrenic, nor is she violent or otherwise out of control. You're saying that she is some sort of medium, correct?

If so, I see no particular reason why her family would have her "treated" at all. Unless she proves to be an embarrassment to the family or presents as some sort of danger to herself or others, the most likely reaction of her family would probably be more along the lines of forbidding her from talking of such things or just telling her she is "dreaming" or "has a good imagination" (not an uncommon initial assumption of parents of children who actually *are* schizophrenic). And if the child is of at least average intelligence, she would quickly learn to keep her experiences quiet.

Good luck with your decision and your story,
~STS~

buz
09-09-2012, 10:26 PM
I guess it depends how you want the story to go...

It's conceivable that her family would choose to deal with her in-house. The "treatments" could have a wide range, depending on what they want to do, their beliefs, how "informed" they are (I think what we call schizophrenia now was only differentiated from sort of a generalized insanity in the late 1800s, right? some of the treatments mentioned would have been pretty new at the time...many doctors and places would have probably been more old school :D ), etc. I'm inclined to think that some religious intervention might have been standard in some areas, depending on their beliefs... it probably would be unusual to not involve religion, at least slightly. You might also have weird shit done to her, if you like--I found a brief reference to the use of cocaine, manganese, and animal blood injections, but I haven't gone deep enough into the literature to back that up or get definite timing for it. Of course, weird shit like that is likely to have some negative effects...

If they didn't want to deal with her, they'd put her in an institution. But most institutions were overcrowded, and even institutions founded with the best of intentions often fell victim to shitty conditions. Many of them were more human warehouses or prisons than hospitals. But I'm sure that a few were nice and staffed by actual doctors, maybe even a few who knew about experimental and newer treatments...you could invent it, if not. :D

You could go even farther "out there" with the treatments if need be and go REALLY old school...but I dunno how you wanna do it. :D

kuwisdelu
09-09-2012, 11:12 PM
Probably the best way to figure out which treatments to use would be to ask yourself how fucked up and traumatized do you want her to be afterward?

BDSEmpire
09-10-2012, 01:17 AM
If your MC is from a wealthy family then I imagine she's going to be raised primarily by a nanny, not the mother and father directly. Kids are to be seen and not heard and so as long as she doesn't have one of her outlandish outbursts at the dinner table, then all is well. If she does then corporal punishment is an easy solution.

Little girls talking about spooks and phantoms and whatnot? Have you ever seen a little girl carrying on when hosting a tea party? The only difference is that she would give the invisible attendees more adult names but that's hardly anything to concern an experienced nanny.

It's expected that she'll grow out of this phase. That's where things would get worrisome - if she was in her teens and still talking nonsense about spirits and ghosts and phantasms.

Except this was 1902 and Spiritualism was in full swing. The Cottingley Fairies hoax was still on the horizon and people were credulous as hell about unseen spirits. Everyone and their cousin had known someone who knew a guy who was in touch with the afterlife. If your little girl started speaking to spirits, then you can decide how you want the parents to handle it - are they believers in spiritualism? They'll probably go out and hire all the mediums in a tri-county area to help their daughter. Is dad a harrumphing no-nonsense type who won't stand for such foolishness? Is mom a lost soul herself who latches onto spiritualists and other cult-like organizations to have a sense of belonging? Or, is it backwards where mom tries to curtail dad's excessive zeal when it comes to matters of the occult?

You're the author, you get to pick but I believe that the year you have picked and the symptoms you mentioned wouldn't be seen as mental illness so much as Forces From Beyond.

Belle_91
09-10-2012, 02:02 AM
I'm not sure about the 1900s, but I know that in the later part of the 1800s, seances were actually all the rage. I don't know this to be fact, but I believe seances were kind of up and coming and some very notable people participated in them. Among them was former first lady Mary Todd Lincoln after the death of one of her sons.

So while it is an embarressment for the family that she talks about "seeing dead people", apparently other people in this time period were more forthcoming about their abilities. You might want to look into that.

thothguard51
09-10-2012, 02:35 AM
Justbishop,

Based on what you have said about the character, I see no reason to send your character to be treated at some mental facility.

Your character is 11-13, average intelligence for her age, and her family is well off enough that a nanny could keep an eye on her. Perhaps the nanny also home schools her? I don't think the family would over react at this age, hoping she would grow out of this childish game by time she reaches a marrying age.

UNLESS...she has proven to be a danger to herself or other family members, which it does not sound like from your comments...

My biggest concern is the fact that you mention she falls seriously in love with Mr Right Spirit? What is the age of this Mr Right Spirit? The reason I mention this is because at 11-13, how many girls are thinking about Mr right, or love for that matter? A young boy spirit about her age might work for puppy love, but real love?

Also, if the spirit is older, there might be a backlash from readers if this is a YA novel.

justbishop
09-10-2012, 02:38 AM
All good stuff, thanks guys!

And I see what y'all are onto about her just learning to shut the hell up. She eventually kills herself at 13 years old. Would several failed attempts beforehand be reason for the family treating her as mentally ill and locking her up/sedating her?

I will have to think about how religion would play into this character's story. Hmm...

justbishop
09-10-2012, 02:39 AM
Yes, it is a YA novel. The spirit died at 18 years old, so I will definitely need to walk a fine line. I could modify her age a bit if needed.

strictlytopsecret
09-10-2012, 11:46 PM
Would several failed attempts beforehand be reason for the family treating her as mentally ill and locking her up/sedating her?

I will have to think about how religion would play into this character's story. Hmm...

Yes, I think repeated suicide attempts would prompt some action. My *guess*, given that she is the child of a wealthy family, is that that intervention would take the form of a 24-hour nanny/nurse. Sedating and/or restraining wouldn't be necessary if she was under watch constantly, and would be the least restrictive, least "embarrassing" way to deal with the situation.

You could still have her off herself by letting the duty nurse fall asleep (or similar).

If it is necessary for her to have a good bit of emotional trauma, other kids are great for that. You could have the kids @ school and/or her siblings tease her mercilessly about her 'imaginary friends'.

Best of luck with your novel,
~STS~