Lecture 9
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
Private Asylums: Trade in Lunacy
Brislington House Private Asylum
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…’
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!
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
• 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
Confinement not cure
Pauper patients
% Curable
1844
County Asylums
4,244
Provincial Licensed houses 1,920
15%
33%
1860
County Asylums
17,432
Provincial Licensed houses 2,356
11%
15%
1870
County Asylums
27,890
Provincial Licensed houses 2,204
8%
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 also
http://www2.warwick.ac.uk/fac/arts/history/chm
/outreach/trade_in_lunacy/
for a theatre production on the private asylum trade