Abstract
Background: Nurses have always had an interest in the relationships among families, clinicians, and healthcare institutions. This case study of the Friends Asylum for the Insane in early 19th century Philadelphia examines the historical roots of these relationships.
Methods: Data sources are archival documents about the male founders of the Friends Asylum, its constituent families, and the committees responsible for the creation and the maintenance of the institution.
Results: Families seeking a temporary respite from day-to-day turmoil created The Friends Asylum in Philadelphia. The Friends Asylum allowed them to continue to explore the processes that ultimately gained them an enduring identity as members of the newly emerging middle-class.
Discussion: These data suggest that the Asylum served individuals limited in their capacity for the self-control needed for a new kind of middle-class identity and those families vulnerable to the demands made by the roots of this new identity. For individuals, it provided a place that replicated the intimate domestic ideal. And for families, it allowed the sharing of care-taking responsibilities with kin who wanted the insane out of the home, but not out of the family.
Conclusion: In the early 19th century, families presented clinicians not just with dilemmas, but with solutions that carried substantial cultural weight. This study suggests that theoretical innovations in healthcare might draw from the transformations in normative rules about domestic, work, and social roles. It suggests that nurses remain aware of the possibility that it may not be nurses who empower patients; it may be patients who empower nurses.