Photograph of a corridor at the Crichton Royal Institution, taken by John Rutherford of Jardington some time in the 1890s. (Wellcome Library DHG1/8/1/4)
Due to the general impression of the historic asylum system, most of us don’t imagine an asylum as a place where people would have been allowed recreation and entertainment. We picture dim rooms, manacles, straitjackets. Most people I’ve spoken to about my research certainly wouldn’t think of large grounds, farms or sports facilities, or libraries. But, under the developing regime of ‘moral treatment’, the nineteenth century saw new approaches in the architecture and management of asylums, and the therapeutic approaches utilised within their walls. Of course, many problems still existed in institutional mental health care, and much was still to be learned about mental illness - but much of the nineteenth century remains somewhat an anomaly in the context of our conception of the history of the asylum.
W. A. F. Browne’s What asylums were, are, and ought to be, 1837 (Cushing/Whitney Medical Library, Yale University, digitised by the Hathi Trust)
The formation of ‘moral treatment’ is generally attributed to Phillipe Pinel, who in the late eighteenth century France revolutionised attitudes towards mental health treatment.1 Until this point, patients were frequently treated as closer to animals than humans, responding better to punishment than to reason, and requiring control through physical restraint. Pinel promoted the idea that mental illness was often curable, and that doctors should take more time to understand each patient personally in order to provide effective treatment. Doctors such as Robert Gardiner Hill, John Conolly, and William Alexander Francis Browne were influenced by these ideas, and helped introduce them to to the medical establishment in Britain and Ireland. Among others, these doctors eventually prompted huge change in the asylum system.
Legislative reform in the British Isles during the early to mid nineteenth century paved the way for a new asylum system - one supported and inspected by the state. In England in 1808, the first County Asylums Act allowed counties to use local taxes to build asylums; the 1845 Act compelled them to do so.2 Further Acts affecting the rest of the British Isles followed, resulting in widespread building programs. The new asylums were modelled on new ideas, and reformers embedded moral treatment into the buildings from the ground up, literally. The asylum environment was able to influence the behaviour of the patients within, and so architecture and design required careful consideration.3 In developing the Retreat at York, the Tuke family believed that replacing a dark, dingy, prison-like atmosphere with one which exuded familiarity and homeliness would put patients at ease and allow their minds to heal. As new asylums sprang up around the British Isles, ‘cheerfulness’ was a key aspect. Inspecting Commissioners of Lunacy criticised poorly lit and ventilated wards and praised decorative efforts such as wallpapers, prints and illustrations.
Men at the Crichton Royal Institution on the curling lake, 20th century. Curling was a regular activity at Crichton from the nineteenth century, often written about in the Superintendents’ reports. (Wellcome Library, DGH1/8/5)
A central element of the ‘moral treatment’ system was the provision of occupation for patients (as well as leisure time.) Michel Foucault characterised this element as essential to the ‘tethering of the spirit’ which he argued moral treatment aimed to enact: by forcing patients to engage in work with no ‘production value’, imposed on a strict timetable, those running the asylum would control patients’ liberty mentally, rather than physically as previously.4 However, things were more complex in practice. Patients were encouraged, but not forced, to work, and usually on more flexible timetables.5 In a report for The Lancet in 1877, J. M. Granville noted that work in asylums should not have the ‘measured haste of an industrial regime, nor the monotony of prison discipline.’6 In many asylums, such as at Hanwell Asylum in London, considerable effort was made to provide a large variety of options - from farm work and gardening to upholstery, shoemaking and even printing and bookbinding. Those who chose not to work, or were unable, did not have to. Leisure activities were available in most institutions, and encouraged. The Crichton Royal Institution had space for cricket and even curling; The Royal Edinburgh Asylum had its own collection of natural history specimens and held educational lectures.7 Crucially for my research, most asylums of this period also developed their own, often sizeable, libraries for patient use, as well as providing newspapers and periodicals.
Moral treatment is now largely dismissed as a ‘failure’, due to an intense focus of both asylum authorities of the time and their successors on the notion of ‘cure’. Its existence has largely disappeared from mainstream discussions of the asylum. However, the evidence within asylum archives can provide a more nuanced view, and a growing body of historical scholarship challenges some of the assumptions of the past. Whilst curative effects weren’t necessarily gained, and motivations were contested, many practitioners did aim to improve the lives of their patients humanely, and the day to day experiences of many patients were much more positive than they had been decades earlier.
Sources:
1 Dora B. Weiner, ‘Phillipe Pinel’s “Memoir on Madness” of December 11th, 1794: A Fundamental Text of Modern Psychiatry’, American Journal of Psychiatry (1992)
2 Leonard D. Smith, Cure, Comfort and Safe Custody: Public Lunatic Asylums in Early Nineteenth-Century England (Leicester University Press, 1999)
3 Barry Edginton, ‘The Design of Moral Architecture at The York Retreat’, Journal of Design History (2003)
4 Michel Foucault, History of Madness, translated by Jonathan Murphy and Jean Khalfa (Routledge, 2006)
5 Pranjali Srivastava, ‘“Work as Therapy” in the Asylums of Colonial India, 1858-1910’, Proceedings of the Indian History Congress (2014)
6 J. M. Granville, The Care and Cure of the Insane: Being the Reports of The Lancet Commission on Lunatic Asylums, 1875-6-7 (Hardewicke and Bogue, 1877)
7 Maureen Park and Robert Hamilton, ‘Moral treatment of the insane: Provisions for lifelong learning, cultural engagement, and creativity in nineteenth-century asylums’, Journal of Adult and Continuing Education (2010)