Lecture 13 Kill or Cure Madness and Its Confinement

Asylumdom ‘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 1900 100,000 people confined in asylums in England and Wales, 150,000 by 1950. In US 1950 500,000 patients.

Themes Different forms of asylum – private (18thC) and public/county asylum system (growth in 19thC). Why were they established? Who put patients there? Were asylums places of cure or confinement?

Bethlem: Thomas Rowlandson, 1789

Thomas Rakewell in Bethlem: William Hogarth 1763

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.

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…’

Private Asylums: Trade in Lunacy Brislington House Private Asylum

Ticehurst Asylum

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, recretion, 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!

Pinel freeing the insane from their chains (at la Salpêtrière) Pinel freeing the insane from their chains (at la Salpêtrière). Oil painting by T. Robert-Fleury, ca. 1876

York Retreat, founded 1796

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

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

Growth of asylums in England and Wales Asylums Patients Av No 1827 9 1,046 116 1850 24 7,140 297 1860 41 15,845 386 1870 50 27,109 542 1880 61 40,088 657 1890 66 52,937 802 1900 77 74,004 961

Two explanations for growth Analyses that set the growth of asylums in the context of wider social changes, including the rise of capitalism, urbanization, migration and increasing ‘social control’ (Scull). Walton claims families delayed confinement. (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, ideas of expertise. (Cure)

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’

John Conolly: Hanwell Asylum

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

Colney Hatch Asylum, entertainment for patients, 1853

Devon County Asylum, 1845

High Royds Hospital, Ilkley, built 1888

Claybury Asylum, Woodford, Essex, 1891

Claybury Asylum, Woodford, Essex, c.1893

Provincial Licensed houses 1,920 33% 1860 County Asylums 17,432 11% Confinement not cure Pauper patients % Curable 1844 County Asylums 4,244 15% Provincial Licensed houses 1,920 33% 1860 County Asylums 17,432 11% Provincial Licensed houses 2,356 15% 1870 County Asylums 27,890 8% Provincial Licensed houses 2,204 13% Silting up of asylums late 19th century ‘psychiatric lumber rooms’ and ‘domiciles for incurable lunatics’ Growth meant moral management compromised

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).

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’

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 alshttp://www2.warwick.ac.uk/fac/arts/history/chm/outreach/trade_in_lunacy/ for a theatre production on the private asylum trade and http://www2.warwick.ac.uk/fac/arts/history/chm/outreach/migration/ for a second production on migration and mental illness. And Hilary Marland and others on ‘In Our Time’ on Bedlam Hospital http://www.bbc.co.uk/programmes/b0739rfg