Founding Friends: Families, Staff, and Patients at the Friends Asylum in Early Nineteenth-Century Philadelphia

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Founding Friends: Families, Staff, and Patients at the Friends Asylum in Early Nineteenth-Century Philadelphia By Patricia D'Antonio (Bethlehem, PA: Lehigh University Press, 2006) (253 pages; $34.50 cloth)

What began as a plan to study the work of nineteenth-century attendants in U.S. asylums for the insane eventually grew into a detailed study of the intricacies of daily life in one institution, the Friends Asylum, founded by Philadelphia's Quaker community in 1817. In Founding Friends, Patricia D'Antonio thoughtfully interprets the institution's early history, from 1814 until 1850, using the diaries of the asylum's lay superintendents as her main source. Aspiring and thought provoking, this concise analysis of the complex interactions among families, staff, and the wider Quaker community has generated a unique book. It provides a detailed new look at the powerful dynamics that drove, and gradually transformed, the daily regimen of work and lay care that were grounded in the asylum's initial ideals of moral treatment.

In a carefully crafted introduction, D'Antonio outlines the framework of the study, building upon a well-established international historiography of the asylum and of relationships among families, communities, and institutions, emphasizing the negotiated nature of asylum care. Her own subjective position as a nurse and historian has shaped her analysis. Nurses, D'Antonio argues, most often intimately involved with families and patients on a day-to-day basis, had an essential role in shaping the actual experience of hospitalization. Nursing is the quintessential discipline that "exists precisely at the intersection of multiple sources of authorities, or, more precisely, at the 'fold,' in the fabric of control, domesticity, and gender," according to D'Antonio (p. 24). The notion of "multiplicities of authorities" (p. 21), informed by Foucault, frames this perspective. The gendered notion of domesticity, central to nineteenth-century reform but with even older roots in Quaker communities, was at the heart of the "virtual domestic space" (p. 53) that the lay community of asylum managers and attendants meant to create in close collaboration with families. These families requested admission for their relatives and envisioned the institution as an extension of their own family. Subtly threaded throughout the book is the provocative story of the Hinchman family, a case study illustrating the dilemmas and challenges, and ultimately legal implications, that Quaker staff and families could face when relatives were admitted.

In six subsequent chapters, chronologically as well as thematically organized, D'Antonio explores the intricate interactions among families, staff, and patients. In attempting to construct the asylum as a family, the lay managers and families followed religious, gendered, and domestic patterns with which they were familiar and in which they deeply believed. They embraced the pedagogic ideals of moral treatment, already worked out in the example of the Quaker York Retreat in London, England, emphasizing a kind, humane environment for patients with just the right amount of stimulating work and leisurely amusement. Yet a treatment that seemed to be a close fit with the Quaker philosophy eventually proved to have its limitations. The book's central theme is that the inherent complexity of dealing with difficult, disruptive, and trying behavior eventually compelled the asylum community to rework the family ideal grounded in a personalized Quaker philosophy into a much more depersonalized, professional approach, shaped more strongly by medicine and science. Eventually, the medical metaphor, as D'Antonio puts it, replaced the lay family ideal, although the appeal of the founding values and the attachment to family approaches remained a powerful inspiration throughout psychiatric history. Yet, in its initial lay form, the "asylum as a family" (p. 103) fell short in balancing the needs of the individual against those of the group. …