Academic journal article Nineteenth-Century Prose

Daniel Hack Tuke Walking a Tight-Rope

Academic journal article Nineteenth-Century Prose

Daniel Hack Tuke Walking a Tight-Rope

Article excerpt

Abstract

In his Illustrations of the Influence of the Mind Upon the Body in Health and Disease (1872) the eminent British neurologist and psychiatrist Daniel Hack Tuke collects a large number of puzzling cases that defy medical understanding. Although he observes and intuits the role of the imagination in both causing and curing disease, he is unable to come up with a cogent explanation of the phenomena he confronts and therefore often reverts to the then current physicalist terminology of nerves, spasms, paroxysms, etc. Missing from his understanding is the concept of the unconscious that Freud was to put forward a quarter of a century later. Yet Tuke's work is an important landmark in the investigation of the mind/body relationship, notably for its emphasis on the place of irrational elements as a source of illness and well being.

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On the centenary of Daniel Hack Tuke's death on 5 March 1895 the British Journal of Psychiatry reprinted the three-page obituary, complete with picture, originally published in the Lancet. (1) This tribute is a recognition of Tuke's importance to the profession, although he is relatively little known nowadays outside the history of psychiatry, and even there he is overshadowed by his French contemporary, Jean-Martin Charcot (1825-93) and certainly by his junior by a quarter of a century, Sigmund Freud (1856-1939). So who was Daniel Hack Tuke? What was his significance? And why has his reputation been eclipsed?

Daniel Hack Tuke was the scion of a Quaker family with a long history of compassionate reform in mental health. He was the first in the family actually to become a physician. His great-grandfather, William Tuke (1732-1822), was a wholesale tea and coffee merchant in York. Williams eldest son, Henry (1755-1814) had an interest in medicine early in his life, but was directed to carry on his father's business as well as becoming a Quaker minister. Henry cooperated with his father in founding the Retreat at York in 1793 after a young Quaker widow died in a madhouse under mysterious circumstances that aroused suspicions of abuse. The Retreat was fully developed by Henry's son (and Daniel's father), Samuel Tuke (1784-1857), who published in 1813 Description of The Retreat, an Institution near York for Insane Persons of the Society of Friends, Containing an Account of its Origins and Progress, The Modes of Treatment, and a Statement of Cases. (2)

The "moral treatment," as it is known, introduced by Samuel Tuke at the Retreat entailed an enormous advance in the handling of those with mental disorders. The practice of confining lunatics to mad-houses had become widespread by the latter half of the eighteenth century. While the upper and middle classes endeavored to care for deranged family members at home, often in secrecy, (3) those either indigent or without willing relatives were forced into institutions. Madhouses were in effect little other than prisons, where those no longer fit to belong to society were segregated. The abysmal conditions in these places embody a moral judgment on their inhabitants, who were degraded to animal level and methodically brutalized as part of a program of physical coercion and depletion intended to quell them. The inhabitants were envisaged not as sick people but as possessed by demons, and therefore a danger to themselves and to others. Since the insane, in their irrationality, were seen as beyond the pale of rational science, the chief function of medical personnel was custodial rather than clinical. A battery of restraining devices such as chains, whips, and the "English camisole," as the straitjacket was called, were commonly used on patients. These barbaric methods could have caused the sudden death of the young widow that prompted the Tuke family's commitment to reform.

The advent of moral treatment brought both immediate change and her-aided a long-term shift. It has been defined as "A philosophy and technique of treating mental patients that prevailed in the first half of the nineteenth century and emphasized removal of restraints, humane and kindly care, attention to religion, and performance of useful tasks in the hospital. …

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