1. Confinement of the insane Lecture 17 Medicine, Disease and Society in Britain, 1750 - 1950

2. Lecture Outline and Themes The increase in insanity (real or apparent?) The increase in insanity (real or apparent?) The growth of public asylums in the C19 The growth of public asylums in the C19 Explanations for the rise of psychiatry and institutionalisation Explanations for the rise of psychiatry and institutionalisation

3. Two Explanations Analyses that set the growth of asylums in the context of wider social changes, including the rise of capitalism, urbanisation and increasing ‘social control’. Analyses that set the growth of asylums in the context of wider social changes, including the rise of capitalism, urbanisation and increasing ‘social control’. 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. 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.

4. Andrew Scull By the mid C19th…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. By the mid C19th…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.

5. Growth of asylums in England and Wales (Jones (1993) p. 116) Asylums Patients Av.No. 182791,046116 1850 247,140297 18604115,845386 18705027,109542 1880 6140,088657 18906652,937802 19007774,004961

6. John Conolly: Hanwell Asylum John Conolly: Hanwell Asylum

7. Devon County Asylum, 1845

8. Certificate of Insanity

9. Confinement not cure Pauper patients % Curable 1844 County Asylums 4,24415% Provincial Licensed houses1,92033% 1860 County Asylums 17,43211% Provincial Licensed houses2,35615% 1870 County Asylums 27,8908% Provincial Licensed houses2,20413%

10. Historiographical perspectives FOUCAULT: Asylum was one of a broader range of institutions that aimed to enforce social control. 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. Mad, along with immoral, dangerous and criminal, were social deviants who had to be segregated and confined. ANDREW SCULL: Emphasis on economic factors. Emphasis on economic factors. Emergence of capitalist economy challenged social bonds and kinship ties. 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. Insane were a financial and emotional strain on families; unproductive member of the domestic household.

11. John Walton (1981)- Lancaster Asylum Case Study Asylum not used in a systematic way to deal with the disorderly poor. Asylum not used in a systematic way to deal with the disorderly poor. Little evidence that asylums were used to quell political or religious dissent. Little evidence that asylums were used to quell political or religious dissent. Few admissions came through the law courts and police rarely involved. Few admissions came through the law courts and police rarely involved. ‘Impossible people’, violence, either self-harm or suicide, or directed towards family members was involved in over half the admissions. ‘Impossible people’, violence, either self-harm or suicide, or directed towards family members was involved in over half the admissions. Concluded that families only used asylums as a last, not first, resort. Concluded that families only used asylums as a last, not first, resort.

12. Medical Factors Redefining madness: boundaries of what constituted insanity were expanded to include heredity, ‘moral insanity’, general paralysis, old age etc. Redefining madness: boundaries of what constituted insanity were expanded to include heredity, ‘moral insanity’, general paralysis, old age etc. Medical men: asylum = an institutional base Medical men: asylum = an institutional base 1841 Association of Medical Officers of Asylums and Hospitals for the Insane (later Medico- Psychological Association) – collective identity. 1841 Association of Medical Officers of Asylums and Hospitals for the Insane (later Medico- Psychological Association) – collective identity. Journal of Mental Science and treatise – exchange knowledge and experiences. Journal of Mental Science and treatise – exchange knowledge and experiences.

13. Medical Factors From 1840s there was a growth in education and training. From 1840s there was a growth in education and training. Institutions increasingly conducted informal training. Institutions increasingly conducted informal training. Late C19th, the MPA introduced an exam for medical students in mental diseases. Late C19th, the MPA introduced an exam for medical students in mental diseases.

14. Conclusion Links between urbanisation and asylums are not straightforward. Links between urbanisation and asylums are not straightforward. Urban life did not necessarily break social bonds. Urban life did not necessarily break social bonds. Admission was often a last, not first, result; families struggled to cope with long-term emotional strain of caring. Admission was often a last, not first, result; families struggled to cope with long-term emotional strain of caring. Confinement of the insane was an historical phenomenon deeply embedded in broader social change. Confinement of the insane was an historical phenomenon deeply embedded in broader social change.