1. Above All a Patient Should Never Be Terrified: Moral Treatment and Management in Hampshire, U.K. 1845-1914. Diane Carpenter University of Southampton University of Portsmouth 1 1

2. Hampshire, England, UK c.1851 2 2

3. INTRODUCTION AIMS: Evaluate the experiences of mentally ill patients and their carers during the period 1845-1914 Synthesise data from local primary sources with national policies, legislation, medical science and curricula for the training of nurses and attendants upon the insane. 3 3

4. Rationale To ascertain the extent to which our knowledge of the practice of moral treatment during the asylum era has been represented correctly in the literature, and the degree to which local practice conformed to any national standards and systems of care. 4

5. METHODOLOGY Human Geographical Social Anthropological Sociological Political Economic Legal 5 5 DRAMAS OF MEDICAL HISTORY THE HEALER THE SICK PERSON DISEASES DISCOVERING & COMMUNICATING KNOWLEDGE MEDICINE & HEALTH INTERACTING WITH SOCIETY DE- MEDICALIZATION ANNALES ALLTAGSGESCHICHTE HCLA and BPLA NARRATIVE OF THE PATIENT JOURNEY

6. CASE STUDIES 6 6 Hampshire County Lunatic Asylum (HCLA) Borough of Portsmouth Lunatic Asylum (BPLA)

7. SOURCES Reception Orders, Case Books, Administrative records (daily running including accounts and staffing), Maps, Plans, Photographs, Quarter Session Reports, Censuses, Newspapers, Original textbooks and journals, Personal letters, Contemporary fiction. 7 7

8. ETHICS 100 – Year restriction re Medical Records Permission sought and gained from the Local Research Ethics Committee (NHS Research Ethics Service) June 2008. 8 8

9. Historiography Focus on control and order (moral management) Other determinants of moral treatment involved improved diet, fresh air, exercise, entertainment, meaningful occupation – in an aesthetically pleasing environment. These have been the specific province of local historians 9

10. Focus of this Paper To what extent did the quality of asylum life compare with the main alternatives for pauper lunatics? To what degree was the quality of life consistent in all asylums nationally? Is there evidence to suggest that the quality of moral treatment improved or deteriorated between 1845 and 1914? 10

11. 11 Figure 1: BPLA DIETARY, 1879. BREAKFASTDINNERTEA BreadButterTeaMeatSoupBreadMeat Pie VegSuet Pud AleBreadButterCheese MON8 oz½ oz1 pt3 oz1lb½ pt8oz½ oz2 oz TUE8 oz½ oz1 pt5 oz1lb½ pt8oz½ oz2 oz WED8 oz½ oz1 pt2 oz2 pt5 oz8oz½ oz2 oz THU8 oz½ oz1 pt12oz1lb½ pt8oz½ oz2 oz FRI8 oz½ oz1 pt5 oz1lb½ pt8oz½ oz2 oz SAT8 oz½ oz1 pt3 oz1lb½ pt8oz½ oz2 oz SUN8 oz½ oz1 pt16-18oz½ pt8oz½ oz2 oz TOTAL56oz3½oz7pts18oz2 pt5 oz12oz5lb16-18oz3pts56oz3 ½ oz 14oz Source: C.I.L. Report, 1880

12. 12 Comparison of the Weekly Dietary for Male Patients at Five Asylums fluid /oz Sources: Crammer, Asylum History, p.110; P.C.R.O. PR/H8/1/7/1, BPLA, 1880, A.R.M.S., p. 34; H.R.O. 48M94/A9/1, HCLA, A.R.M.S., 1853, p.11; Cherry, Mental Health, p77; Gardner, Sweet Bells, p.51. Precise details were not available in all categories for the NLA. Butter and tea were more frequently given to female patients.

13. 13 MalesNo.FemalesNo. Architect1Agricultural Servant1 Boat Builder1Dairy-woman1 Brick Burner1Domestic Employment7 Cabinet Maker2Domestic Servant17 Clerk1Dress-maker1 Coach Maker1Game-keepers Wife1 Cooper1Governess1 Dyer1Inn-keepers Daughter1 Gardener3Labourers Daughter2 Hawker1Labourers Wife18 Joiner1Laundresses3 Labourers32Lodging-house Keeper1 Land Surveyor1Paupers4 Pensioner1School-masters Wife1 Polish Refugee1School-mistress1 Ships Pilot1Seamans Wife1 Shoe-maker1Tailors Wife2 Tailors2Weavers Wife1 Teacher of Navigation1Without occupation5 Thatcher1 Tramp1 Without Occupation5 Total61Total69 Occupations of Patients Admitted to the HCLA, 1854.

14. RESULTS: MORAL TREATMENT – THE QUALITY OF ASYLUM LIFE The basic determinants of the quality of life for the local asylum population appeared preferable to its alternatives Asylum diet was better than at the Workhouse, and often to what could be afforded at home Accidents and contagious diseases occurred, but probably, because of the precautions taken, less often than in the industrial or agricultural workplace Asylum provided safer environment than patients homes Standard of cleanliness was variable, but frequently checked High standards of personal cleanliness 14

15. THE QUALITY OF ASYLUM LIFE Continued. Clothing was institutional, but of very good quality – providing warmth. All patients were given shoes, boots and winter coats Opportunity for exercise (in the fresh air) was better in Portsmouth than in Hampshire. (In both cases this was better than it is today). Employment was aimed at developing skills or preventing de-skilling with the aim of rehabilitation and discharge A wide variety of amusements and entertainments was provided in both Asylums. 15

16. RESULTS: MORAL TREATMENT – CONTROL AND ORDER (MORAL MANAGEMENT) States of quietude were considered desirable by most (Medical Superintendents, Asylum Visitors and Commissioners in Lunacy) Physical control was achieved largely by secluding patients for short periods of time Occasional authorized mechanical restraint e.g. strong dresses More evidence of psychological control (than physical or chemical) e.g. daily routine 16

17. 17 Figure 2: BPLA DAILY REGIME, 1879 Hours to be observed during weekdaysOn Sundays 6.00a.m. First bell rings. All Attendants and Servants to get up - Patients to rise, wash, dress, and prepare for breakfast. 7.30 a.m. Bell - Attendant's breakfast. 8.00 a.m. Bell - Patients breakfast. 9.00 a.m. Patients all go to their work. 10.00 a.m. Bell - Working men's ale. 12.15 p.m. Bell - Preparation for dinner. 12.25 p.m. Bell - Patients' dinner. 1.00 p.m. Bell - Servants' first dinner. 1.30 p.m. Bell - Servants' second dinner. 2.00 p.m. Patients return to their work. 6.00 p.m. Bell - Patients return from their work - Supper 7.00 p.m. Bell - In Winter } 7.30 p.m. Bell - In Summer } 9.00 p.m. Servants' Supper. 10.00 p.m. Servants go to bed. 6.00a.m. First bell rings. All Attendants and Servants to get up - Patients to rise, wash, dress, and prepare for breakfast. 7.30 a.m. Bell - Attendant's breakfast. 8.00 a.m. Bell - Patients breakfast. 10.30 a.m. Bell - Chapel, to commence at 10.45 a.m. 12.25 p.m. Bell - Patients' dinner. 1.00 p.m. Bell - Servants' first dinner. 2.15 p.m. Bell - Chapel, to commence at 2.30 p.m. 6.00 p.m. Bell - Patients' Supper. 7.00 p.m. Bell - In Winter } 7.30 p.m. Bell - In Summer } 9.00 p.m. Servants' Supper. 10.00 p.m. Servants go to bed. Source: PCRO, PR/H8/1/8/1 Rules for the Government of the Borough of Portsmouth Lunatic Asylum,1879.

18. MORAL MANAGEMENT – SOCIAL CONTROL Social control in both asylums - encouragement of patients to conform to social mores e.g. chapel attendance, strict segregation of sexes (except for organized entertainment such as asylum dances) Visiting by patients relatives was limited, yet encouraged once the acute phase had passed Reliance on institution as surrogate family appears to have been encouraged 18

19. 19 The offices of religion have a soothing and favourable effect on many: - I have found the use of evening service, and the calm and sober strain of piety which pervades the Liturgy, to be well adapted to these unfortunate beings. Religious excitement of the feelings is always bad and has brought a great number of patients to this, as well as to every other Asylum. A patient should never be terrified.

20. CONCLUSIONS In conclusion, despite criticism by many of the quality of care for the mentally ill during the period 1845-1914, the local evidence would suggest that Asylum life was preferable to its alternatives Generalizations should not be made, and, in Hampshire, England, the quality of moral treatment did not deteriorate between 1845 and 1914 although it was poised for a considerable change. 20

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