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Allow about 10 minutes

What thoughts and feelings come to you when you hear the word ‘asylum’? Are they largely positive or negative? Can you identify what images give rise to these positive or negative feelings?

Spend some time trying to tease out why you feel the way you do.

Discussion

While the word ‘asylum’ – with its literal meaning of protection and safety – ought to have positive associations, for many the word will have negative meanings. Perhaps the negative associations are connected to the old asylums. As you have read, although the asylums were perhaps built with the intention of providing rest and safety, they became overcrowded, neglected and gloomy places. Perhaps our feelings are also influenced by the stigma that surrounds mental illness.

It might be interesting to reflect on whether this chapter changes your view of asylums.

The idea of confinement for those deemed insane was not new. Small-scale, private asylums operated by entrepreneurs who offered a paid service to take in and ‘care’ for the insane had proliferated through the eighteenth century. By the nineteenth century these institutions were being encouraged by a government which had a long-standing interest in controlling those whose deviant behaviour might threaten the social order. Since at least the sixteenth century, the government and local parishes had discouraged vagrancy and begging through a series of legislative initiatives called ‘poor laws’ (Brundage, 2002). The means of discouragement were frankly often cruel, with punishments such as whipping and branding dealt to those found vagrant.

As the perceived scale of the problem posed by the workless and destitute grew, a network of workhouses was built to provide minimal sustenance and accommodation to those too poor to support themselves. They also aimed to ‘train’ people in the values of labour and routine amid harsh environments that discouraged dependency. Whatever our moral judgement of the philosophy, too many people were simply unable to respond to the regime, and the workhouses filled with people who were old, ill or had disabilities. The next move was to differentiate ‘the poor’ so that particular kinds of shelter might be offered to those who were unable to benefit from the workhouse regime. A significant milestone came with Section 20 of the Vagrancy Act 1744, which charged local magistrates with responsibility for paupers and so-called pauper lunatics in their district (Bynum, 1974).

Pauper lunatic A term used in the eighteenth and nineteenth centuries to identify individuals who required local authority support due to poverty and who were also recognised to be suffering from insanity.

The identification of the ‘pauper lunatic’ as someone who required local authority support encouraged the expansion of private madhouses as they became a convenient means for local parishes to discharge their duty. These were controversial institutions, growing up as unregulated places of confinement with unclear rules about who could be confined against their will. In the early decades of the eighteenth century, the writer and journalist Daniel Defoe (author of Moll Flanders and Robinson Crusoe) noted the proliferation and wondered ‘how many ladies and gentlewomen’ were being locked away (Defoe, 1729, p. 23). He suggested that these private madhouses needed to be ‘suppress’d, or at least subject to daily examination’ (Defoe, 1729, p. 23). He reserved particular ire for a ‘vile practice’ that he suspected was common among wealthy men of ‘sending their wives to mad-houses at every whim or dislike’, allowing them to be ‘undisturb’d in their debaucheries’ (Defoe, 1729, p. 31). This claim was to be picked up in the twentieth century by a number of feminist critics of the psychiatric system. Chesler (1972) and Showalter (1985) argued that the institution of psychiatry and the various treatments that emerged through the nineteenth and into the twentieth centuries were profoundly patriarchal and were meant to pathologise and control women. The idea that the categories of insanity were aimed at women, and that asylums were correspondingly full of women, has been beguiling (Ussher, 1991).

Detailed analysis of asylum records, medical texts and cultural images suggests, however, that this was too simple a picture. As Busfield summarises, the idea that madness in the nineteenth century became ‘a distinctly female malady’ was certainly mistaken – it would be better to understand that ‘assumptions of gender’ were embedded within the multiplying ‘diversification of medical categories of madness’ (Busfield, 1994, p. 276).

Pause for reflection

Do you think there are differences in the way that men and women are portrayed as suffering from mental health problems?

Nevertheless, distaste grew about conditions in the private madhouses, and in the anxiety that ‘anyone’ might find themselves confined within them. This led the British Parliament to pass the Madhouses Act 1774 that brought the unregulated private asylums under supervisory control through systems of licencing and inspection. It was into this space of regulation and care that the new profession was to emerge. The emergence of a specialism in ‘insanity’ from within the ranks of the various forms of so-called medical men (Jones, 1972) meant that commonplace treatments aimed to work on the bodies of sufferers. It has been argued that some of the treatments for insanity that looked particularly barbaric – involving the use of restraint or even beatings – were not wilfully cruel, but rather reflected the widespread belief that those who were without reason were in fact like animals and so had to be trained to behave (Scull, 1979b).

By the beginning of the nineteenth century some of the physical treatments were becoming quite elaborate. Benjamin Rush, who ran the Pennsylvania Asylum, designed the ‘tranquilliser chair’ which held the body still while allowing cold water to be applied to the head and warm water to the feet – acting ‘as a sedative to the tongue and temper as well as the blood vessels’ (Rush, cited in Scull, 1981, p. 34).

Figure 1.1 Benjamin Rush and his tranquilliser chair

Despite the continuing interest in physical treatment, in the decades leading up to the establishment of the profession of psychiatry there was a significant move towards a more psychological orientation. A very important innovation was that of moral treatment – the idea that a cure would follow from the provision of a calm environment away from the stresses of modern urban living, where staff treat the afflicted with dignity, kindness and respect. Significant innovations occurred at the York Retreat in England, led by the Tukes (a wealthy Quaker family who were not medics), and by the noted medic Philipe Pinel in France. Samuel Tuke (1813) emphasised the psychological nature of insanity and its treatment: ‘If we adopt the opinion, that the disease originates in the mind, applications made immediately to it are obviously the most natural; and the most likely to be attended with success’ (Tuke, 1813, p. 84). Tuke gave credit to the work of Pinel, who had claimed that patients undergoing moral treatment were ‘treated with affability, soothed by consolation and sympathy’ and thus put on a road to ‘rapid convalescence’ (Pinel, 1806, p. 67).

Moral treatment A form of treatment for insanity that supposed that a cure could be achieved through placing a patient in calm, restful and attractive surroundings, treating them with respect and encouraging good behaviour. It was a key argument for the construction of asylums in the nineteenth century.

The rationale of this psychological form of treatment helped provide the new profession with a respectable identity. It construed insanity as identifiable and curable, which justified the construction of asylums. Eventually, this led to the Lunacy Act 1845 and County Asylums Act 1845, which required all local authorities to provide an asylum.

Figure 1.2 shows what an early asylum would have looked like. This asylum was opened in 1851, designed in the Gothic style by the renowned architect William Fulljames who also designed churches, commercial buildings and a country house in Gloucestershire. It was originally built to accommodate 210 patients as a joint county asylum (Herefordshire, Monmouthshire, Brecon and Radnor), but at its peak had well over 1000 inmates.

Figure 1.2 A contemporary drawing of Joint Counties Lunatic Asylum, which was built following the Lunacy Act 1845 and County Asylums Act 1845. It is quite typical in style: the country-house appearance was considered as important as the confinement that it provided.

These asylums were built under architectural assumptions that were very different from those of prisons and workhouses. They were designed to mimic grand houses and were placed within often large and pleasant grounds in order to create an atmosphere of calm and peace, thought crucial for cure (Edginton, 1997). In some important respects, their rapid success was their undoing. Scull (1979a) traces the increase in the numbers of so-called pauper lunatics (as a reasonable measure of the population of the asylums) and finds the numbers leapt from 16,821 in 1844 (representing a rate of 10.21 for every 10,000 of population) to 77,257 in 1890 (26.27 for every 10,000). This trend continued into the twentieth century. At their peak, in 1954, there were over 140,000 patients (in England) in psychiatric hospitals.

The substantial increase in the numbers of asylum inmates undoubtedly helped establish the idea that the psychiatric institutions were a necessary component of a modern society, but it also undermined the possibilities of moral treatment, as the new asylums quickly became overcrowded, underfunded and understaffed. They began to fully deserve the condemnation aimed at them through a new series of scandals about the poor conditions, even in the new asylums (Scull, 1996). Thus, eventually there was a turning away from the asylums through the second half of the twentieth century. Nevertheless, the asylums provided an institutional base for the emerging profession of psychiatry, while the claims for expertise in the criminal justice system were to raise its public profile.

Methodology: The connection between research and understanding history

Critics of psychiatry (such as Foucault) have often focused on the history of the profession. This might be for a number of reasons, including an interest in making links to past practices that can often appear barbaric. It might also be because an understanding of where our ideas and practices have come from can help us question our current assumptions.

The disciplines of psychology and psychiatry have been accused of being ahistorical – they do not take account of their own history and the circumstances that have created their own assumptions.

As this chapter suggests, however, there can be important differences between ways of understanding past events. Studies of history cannot use experiments as they are used in natural sciences, medicine and psychology. One might therefore pose the question: How do we decide which version of the past is the most accurate? Indeed, why might history (and one’s understanding of it) be important to understanding psychiatry and psychology?