Fact or fantasy?

In a previous post I’ve talked a little about the nineteenth-century asylum being something of an anomaly when it comes to the public perception of asylums. In culture and media, stereotypical elements of pre- and post-ninteenth-century treatment are merged to create the asylum’s defining characteristics, and we tend to think of lobotomies, electro-convulsive therapy, or chains. But some tweets I saw recently swung the pendulum to the other side, to a perspective I see far less often: romanticisation.*

The thread opened:

Continuing, the author added that patients weren’t locked up; they were encouraged to go outdoors, and engage in activities such as crafts and gardening; they were allowed to smoke, and to keep pets. The kind of asylum life described in the tweet thread is more in keeping with nineteenth-century asylums, rather than twentieth-century asylums which patients alive today would remember. But these aspects of the nineteenth-century asylum system are actually accurate - at least on a surface level - and they are things I remain surprised by as I undertake the research for this project.

Asylum managers were encouraged to equip the wards with means of entertainment - bagatelle boards were a regular feature, and were highly encouraged by the Commissioners in Lunacy, such as at the North Wales County Asylum in 1871.¹ Some asylums had billiards tables, though usually for the wealthier patients. Books and periodicals, as my research examines, were considered an essential feature of a well-run asylum. Patients were absolutely encouraged to spend time outside - institutions built in this period were often situated in the countryside, and asylum authorities spent considerable sums on landscaping, providing covered walks, even ornamental gardens. Throughout 1878, visiting Commissioners in Lunacy who visited the Inverness Asylum complained of the ‘bare’ appearance of the grounds, repeatedly instructing the managers to plant trees and shrubs in order to improve the gardens and to provide shelter to patients walking in rain or sunshine.² Claire Hickman’s work on the visual experience of asylum landscapes is particularly interesting, as she highlights the therapeutic potential of viewing the landscape alongside its use as a recreational space.³

A plan of Hanwell Asylum, from William Ellis’ A treatise on the nature, symptoms, causes, and treatment of insanity (London: Samuel Holdsworth, 1838); digitised by Wellcome Library, originals held by Harvey Cushing/John Hay Whitney Medical Library at Yale University.

A large part of the outdoor space in many asylums was made up of farmland, which many patients would work on. This became a key part of patients’ activities under the moral treatment regime. W. A. F. Browne wrote in his description of the ‘ideal’ asylum that ‘Gardens, grounds, farms, must be attached to each establishment, and must be cultivated by or under the direction of lunatics.’⁴ Vegetables, meat, milk, and even beer were produced in the asylum, and many became semi-self-sufficient. William Ellis, Superintendent at Hanwell Asylum in London, describes the agricultural activity of the asylum in his Treatise on the nature, symptoms, causes, and treatment of insanity in 1838. There is an ‘abundant’ supply of vegetables, meat from the pigs and milk from the cows, and the entirety of the bread and beer are produced in-house.⁵ In many asylums, tobacco was provided to patients who worked outdoors as a reward for industriousness. Patients at the Birmingham Asylum, originally housed in London asylums, complained to the Commissioners in 1897 that the amount of tobacco they were allowed in exchange for working was smaller than in London, and the Commissioners agree that this seems unfair.⁶ Beer was regularly given to patients as part of their diet, sometimes with extra given to those working outdoors. Birmingham Asylum set up a brewery in 1854, to supply patients and staff with their regular allowance.⁷

James Hadfield, Epitaph of my poor Jack, c. 1834 (© Bethlem Museum of the Mind)

The cheering influence of animals was well acknowledged, and this blog by Lesley Hoskins at Pet Histories explores the significance which relationships with animals could hold for patients. At the Glasgow Royal Asylum, gulls were introduced into the airing courts for the men;⁸ the Murthly Asylum in Perth kept goldfish;⁹ and Commissioners in Lunacy who visited asylums repeatedly suggested the addition of singing birds. The Crichton Royal Institution had a veritable zoo of their own, including squirrels, jackdaws, owls,¹⁰ and even tortoises.¹¹ James Hadfield, held at Bethlem for trying to assassinate King George III, had several pets: two dogs, three cats, several birds, and finally his squirrel, Jack. He apparently also preserved his pets as taxidermy specimens.¹²

“Pets occupy the leisure time of others. Another lady has succeeded in securing the confidence of a robin to such an extent as to induce it to feed from her hands in the grounds. To our usual stock we have to add a cargo of tortoises, recently received.”

— Annual Report of the Crichton Royal Institution & Southern Counties Asylum, Dumfries

Some patients of the period, envisioning the ‘ideal’ asylum, produced plans including features rather like those discussed above. James Tilly Matthews was a patient at Bethlem, institutionalised for his belief that he (and others) were being subjected to torture and mind control via a machine called the ‘Air Loom’, and his case became well known through John Haslam’s publication Illustrations of Madness. Matthews’ family and several doctors argued that he was sane, and he was eventually moved to a private asylum. However, whilst he was a patient at Bethlem, he produced detailed architectural plans to submit to the public competition held by the Governors in 1810 to find a design for the new building. The forty-six pages of research and drawings (which earned him an unofficial £30 prize) detailed some of his ideas for the asylum: that patients should be allowed to grow vegetables, help with chores, and look after other patients.

James Tilly Matthews’ plan for Bethlem, 1810 (© Bethlem Museum of the Mind)

Discussing Bethlem in her chapter ‘Bedlam: fact or fantasy’, Patricia Alleridge draws attention to the way that Bethlem was often used as a ‘reach-me-down historical cliche’, a recognisable image often used to ‘fill in odd gaps in the picture’. ‘The reading public’, she writes, ‘seems preconditioned to accept that if it is bad enough, it is bound to be true.’¹³ The realities of asylums are more complex than even many historians make clear - Alleridge contrasts the cases of Matthews and James Norris. Norris was the famous case of a man who had been chained for years, which condemned Bethlem as a place of brutality. Whilst Norris was chained in an undoubtedly appalling fashion (largely due to the asylum authorities’ inability to deal with his extreme violence), he was also encouraged to read, and had a pet cat. He was also a patient at the same time as Matthews, who was drawing, writing, and even publishing from Bethlem. Norris has garnered much attention, whilst Matthews is rarely discussed - largely because one fit the stereotype of Bedlam, and the other does not. Alleridge is correct when she writes that:

“A Bethlem that contains both [Norris and Matthews], together with all the gradations in between, is likely to make a more rewarding subject for study, and to tell us more about, for example, attitudes to the insane, than a Bethlem dedicated to brutality and inhumanity as its sole policy.”

— Patricia Alleridge

It is worth considering the often less-discussed aspects of asylums, and many historians have produced excellent work engaging further with wider aspects of the asylum system since Alleridge’s chapter was first published in 1985. In the wider public, however, the tendency to slip into a dichotomy remains. In the second part of this post, I’ll discuss some of the things this tweet thread glossed over, and how I see my own research fitting into the puzzle.

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* The author has since partially deleted this thread as a result of criticism for it, so I won’t link to their account or the tweets themselves. The tweet pictured here via screenshot no longer exists.

Sources:

¹ The Twenty Third Annual Report of the North Wales Counties Lunatic Asylum, Denbigh: for the year 1871 (William Hughes, 1872), p. 8.

² Commissioners in Lunacy Patients’ Book, 1873-1893 (Highland Archive Centre, Inverness, HHB/3/2/2/2).

³ Claire Hickman, ‘Cheerful prospects and tranquil restoration: the visual experience of landscape as part of the therapeutic regime of the British asylum, 1800-60’, History of Psychiatry (2009), pp. 425-441.

⁴ W. A. F. Browne, What asylums were, are, and ought to be, (Adam and Charles Black, 1837), p. 192.

⁵ William Ellis, A treatise on the nature, symptoms, causes, and treatment of insanity (Samuel Holdsworth, 1838), p. 304-5.

⁶ Report of the Visiting Committee of the Lunatic Asylum for the City and County of Bristol (J. W. Arrowsmith, 1898), p. 7 (Glenside Hospital Museum).

⁷ Report of the Committee of Visitors of the Lunatic Asylum for the Borough of Birmingham (Benjamin Hunt & Sons, 1855), [for the year 1854], p. 7.

⁸ Seventh Annual Report of the General Board of Commissioners in Lunacy for Scotland (Thomas Constable, 1865); visit to Glasgow Royal Asylum, 14th May 1864, p. 166 (Highland Archive Centre, Inverness, HHB/3/19/1/3).

⁹ Seventh Annual Report of the General Board of Commissioners in Lunacy for Scotland; visit to Murthly Asylum, Perth, 30th July 1864, p. 179 (HHB/3/19/1/3).

¹⁰ Thirty-Second Annual Report of the Crichton Royal Institution and Southern Counties’ Asylum for the year 1871, [p. 6].

¹¹ Thirty-First Annual Report of the Crichton Royal Institution and Southern Counties’ Asylum for the year 1870, p. 5.

¹² Flora Tristan, Promenades dans Londres (Flora Tristan’s London Journal), trans. by Dennis Palmer and Giselle Pincetl (George Prior, 1980), via Yale Center for British Art.

¹³ Patricia Alleridge, ‘Bedlam: fact or fantasy’, in Anatomy of Madness: Essays in the History of Psychiatry, Volume II: Institutions and Society, ed. by W. F. Bynum, Roy Porter and Michael Shepherd (Routledge, 2004) (first published 1985).

The 'exceptional' asylum?

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.

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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)