1. Lecture 8 Kill or Cure Madness and Mental Health

2. Themes
‘Asylumdom – care in asylums dominated approaches to care and containment of ‘lunatics’ from 18th to 20th centuries throughout Western World.
‘Great confinement’ (Foucault) and asylum ‘total institution’
Number of patients confined in asylums grew enormously during this period. By ,000 people confined in asylums in England and Wales, 150,000 by In US ,000 patients.

3. Themes
Different forms of asylum – private and public/county asylum system (rich and poor).
Why were they established?
Were asylums places of cure or confinement?

4. Bethlem: Thomas Rowlandson, 1789

5. Thomas Rakewell in Bethlem: William Hogarth 1763

6. Private Asylums: Trade in Lunacy Brislington House Private Asylum

7. Trade in Lunacy
Origins of private madhouse trade vague and shadowy – small houses e.g. by 1661 Reverend John Ashbourne caring for lunatics in Suffolk. By mid-17th century several small-scale madhouses in London.
Run by medical men (e.g. Dr Francis Willis who ran madhouse in Lincolnshire ‘cured’ George III of his madness in 1788) and other entrepreneurs. Often family businesses.
Proliferated in Britain in 18th century – 45 recorded in England and Wales by 1815.
At this point, little other provision for care of mentally ill – Bethlem in London (established 1247), workhouses, chained in cellars and attics.

8. Trade in Lunacy
Some small scale but others large – London’s Hoxton House had 468 patients by 1815 and Haydock Lodge similar number (catered for pauper patients).
Ticehurst Asylum, set up by apothecary Samuel Newington in 1792, cared for affluent patients.
Secrecy - madhouses ‘in the business of preserving discreet silences’, hid difficult relatives, resolved property disputes.
Roy Porter called them both ‘sites of therapeutic innovation’ and ‘running sores of scandal’.
William Cowper was sent to Nathaniel Cotton’s private asylum at St Albans in 1763
‘I was not only treated with kindness by him when I was ill, and attended with the utmost diligence…’

9. Ticehurst Asylum

10. York Retreat
Set up 1796 by Quaker tea merchant, William Tuke – turning point in treatment of insanity
Moral therapy – humanity, kindness and reason, work therapy, regularity, diet, recreation, encouraged self-worth
Importance of family and religious framework
Heralded period of reform
Introduced moral management – system that prevailed in all 19th century asylums
Phillipe Pinel in Paris – removed chains of lunatics – symbolically!

11. York Retreat, founded 1796

12. William Norris, confined in Bethlem 12 years, c.1820
1815 Select Committee inspected all places where ‘insane’ confined – charitable hospitals, county asylums, private madhouses, workhouses
Shocking evidence of cruelty and mismanagement in many institutions
Further inquiry 1842

13. Legislation and Reform
1774 Madhouse Act - set limit on the number of patients who could be admitted into madhouses; licenses and regular inspections for madhouse proprietors and necessary to obtain medical certification for the incarceration of lunatics.
1808 County Asylums Act – magistrates permitted to raise funds to build asylums for pauper patients – 15 by 1844
1845 Lunatics Act – established Lunacy Commission to inspect, report and license all asylums in England and Wales and erection of County Asylums made compulsory
1930 Mental Treatment Act – extended provision for voluntary admissions.
1959 Mental Health Act – made provision for community facilities

14. Growth of asylums in England and Wales
Asylums Patients Av No , , , , , , ,

15. Two explanations for growth
Analyses that set the growth of asylums in the context of wider social changes, including the rise of capitalism, urbanisation and increasing ‘social control’.
(Confinement)
Analyses that relate the growth of asylums to medical factors: reforms in the conditions of asylum life, claims for the role of the asylum in curing patients, and the rise of the power of medical practitioners.
(Cure)

16. Andrew Scull
Faith in expertise and institutional solutions: Rise of profession of psychiatry By the mid-nineteenth century… ‘insanity had been transformed… into a condition which could be authoritatively diagnosed, certified, and dealt with by a group of legally recognised experts… the asylum was endorsed as the sole, officially approved response to the problems posed by mental illness’

17. John Conolly: Hanwell Asylum

18. Women and confinement
Women and confinement – particularly related to gender and female life cycle
Also social situation of women
Argued more women than men confined in asylums

19. Colney Hatch Asylum, entertainment for patients, 1853

20. Devon County Asylum, 1845

21. High Royds Hospital, Ilkley, built 1888

22. Claybury Asylum, Woodford, Essex, 1891

23. Claybury Asylum, Woodford, Essex, c.1893

24. Provincial Licensed houses 1,920 33% 1860 County Asylums 17,432 11%
Confinement not cure
Pauper patients % Curable
1844
County Asylums 4, %
Provincial Licensed houses 1, %
1860
County Asylums 17, %
Provincial Licensed houses 2, %
1870
County Asylums 27, %
Provincial Licensed houses 2, %
Silting up of asylums late 19th century ‘psychiatric lumber rooms’ and ‘domiciles for incurable lunatics’
Growth meant moral management compromised

25. Historiographical perspectives
MICHEL FOUCAULT:
Asylum was one of a broader range of institutions that aimed to enforce social control.
Mad, along with immoral, dangerous and criminal, were social deviants who had to be segregated and confined. ‘Great confinement’
ANDREW SCULL:
Emphasis on economic factors.
Emergence of capitalist economy challenged social bonds and kinship ties.
Insane were a financial and emotional strain on families; unproductive member of the domestic household (other historians, including John Walton, dispute this).

26. End of asylums
1950s onwards end of asylums after c.200 years of dominating care of mentally ill.
Ability to cure? Despite new therapies, asylums seemed unable to cure patients effectively – though new drugs encouraged idea patients need not be in institution
1959 Mental Health Act – faith in community care.
1961 Enoch Powell (Minister of Health) ‘Water Tower Speech’

27. Further viewing Recommended series on mental illness and asylums:
Jonathan Miller, Madness, Episode 2 ‘Out of Sight’, 1991
Available on YouTube
Part of a four-part series, but this is most relevant to this lecture.
See also
for a theatre production on the private asylum trade