Victorian Asylum Research Articles

Professional Update

A key Government pledge, to ensure that all people with learning disabilities are provided with accommodation in the community and are out of old-fashioned Victorian asylums by April 2004, will be missed.

Professional Update

A key Government pledge, to ensure that all people with learning disabilities are provided with accommodation in the community and are out of old-fashioned Victorian asylums by April 2004, will be missed.

Mania, dementia and melancholia in the 1870s: admissions to a Cornwall asylum

In the 1870s St Lawrence's Hospital in Bodmin, Cornwall, had been running for 50 years, one of sixteen county asylums set up between 1811 and 1842. By examining 511 admissions between 1870 and 1875 to this typical Victorian asylum we hoped to shed light on this mid-point of the asylum era. The 511 patients were all classified as 'paupers', whose admissions were publicly funded. A few privately funded patients were admitted during this period but are not included. Asylum populations rose greatly through the 19th century. Whether this rise was mainly due to an increase in psychotic illness or to a decrease in tolerance of the mentally ill in the community is unclear. Many patients were admitted under the Poor Law and Lunacy Acts. After amending acts of 1853, the parish medical officer was required to visit all paupers in his areas four times a year. He was expected to notify the guardians or the overseers of those who seemed in need of mental treatment.1 If any were thought to need treatment in the asylum, admission was certified by the medical officer and the local justice of the peace.

Mental Disability in Victorian England: The Earlswood Asylum, 1847-1901 (review)

Summing up historians' approaches to the history of mental illness, David Wright quotes Roy Porter's statement that "madness continues to exercise its magic, but mindlessness holds no mystique" (p. 3). While there is a wealth of literature on lunacy, mental disabilities present from birth—termed "idiocy" and "imbecility" in the nineteenth century—have received much less attention. Wright addresses this imbalance in his social history of the Earlswood Asylum, England's first charitable asylum for mentally disabled children and adults, which included mostly cases from the "deserving" poor, but also some paying middle-class patients. His case study of Earlswood makes important contributions to the growing history of disabilities as well as to debates on Victorian asylums and social welfare.

Staff morale in the merger of mental health and social care organizations in England.

Following the closure of the last Victorian asylum in Somerset, the health authority and county council undertook a review of mental health services. A major outcome of this review was the creation of an integrated mental health and social care provider. The current paper explores the impact of this integration on the morale of staff members involved, using a conceptual model derived from the literature on organizational behaviour. During the year immediately following integration, the average ratings on all measures of role clarity and job satisfaction reduced. For staff members involved in the integration, by far the largest group of whom were mental health nurses, job satisfaction was related to team role clarity, team identification, emotional exhaustion and gender. These effects of the integration on staff morale are discussed in light of the wider research into the determinants of job satisfaction and the conditions for success in merging organizations. The study has significant implications for managerial and professional leadership during organizational change.

Beyond the walls of the asylum: information and organization in the provision of community mental health services

In the last twenty years or so the UK National Health Service (NHS) has witnessed tremendous changes in the provision of mental health services. As the vast Victorian asylums have progressively been run down and closed attention has switched to the planning and delivery of services based on the idea of ‘care in the community’. This paper explores some of the temporal and spatial dimensions of the problems of organizing that have marked this transition. Drawing on research conducted within a hospital department responsible for psychiatric services in the community, it addresses some of the issues faced by mental health professionals in struggling to put in place and maintain mental health services while simultaneously under pressure to demonstrate their professional accountability. In this regard, particular attention is paid to the role of technology (principally information and the information systems) in managing services in the context of the transition to care in the community as well as addressing some of the problems generated by it.

John Clare: a literary life

Acknowledgements Textual Note and Chronology A Cage Glass all Round: Dilettante Patrons and Literary Philanthropists That Man I Would Have Him to Be: Public Relations and Peasant Poetry The Importance of Being Earnest: Manly Artisans and Sincere Sages High, Flighty and Frolicsome: Mad Poets and Moral Managers A Government Prison where Harmless People are Trapped: Regency Poets and Victorian Asylums Notes Further Reading Index

Madness, suicide and the Victorian asylum: attempted self-murder in the age of non-restraint.

On 20 July 1870, Catherine Tyrrell found herself transferred to another asylum. The 32-year-old nurse suffering from melancholia had previously been a private patient in Bethlem Hospital; but, having had her twelve months expire at that institution, she was conveyed across the metropolis and into the bucolic countryside and county asylum of Buckinghamshire. Up to this point, Catherine had had a long and sad history of suicide attempts and food refusal. Indeed, when she was transferred the following year, this time from Buckinghamshire to the Surrey County Asylum at Wandsworth, she was listed as “very suicidally disposed”. Now diagnosed as suffering from “mania”, she managed only three months before arriving at her fourth institution in as many years—the Surrey County Asylum at Brookwood. On admission, the medical superintendent described, with transparent disapproval, the precautionary clothing that held her suicidal impulses in check:She was brought in a canvas garment which fitted her person even down to her ankles, the arms however not going through the sleeves, but being folded across her chest close to her skin, the hands being locked in leather gloves. The jacket or whatever it is called being [fastened] at the back by 5 locks. All this complicated arrangement was immediately removed. There was no clothing of ordinary kind under it.

From retreat to health centre: legislation, commercial opportunity and the repositioning of a Victorian private asylum

This paper examines the interplay of commercial imperatives and health care legislation in the survival of a privately owned psychiatric hospital in Guelph, Ontario, Canada. Using documentary and archival evidence, we show how the Homewood Retreat (later Sanitarium, and eventually Health Centre) was able to respond to and anticipate legislative developments through the agency of successive medical superintendents and the structural positioning of the institution as an inextricably integrated element in local and provincial mental health provision. Our case study is used to draw out wider lessons concerning agency, legislative context and treatment modality in the determination of organizational histories. We conclude by noting the important role of the private sector in ensuring the continued provision of an asylum form of mental health care.

Food refusal and insanity: Sitophobia and anorexia nervosa in victorian asylums

Although anorexia nervosa emerged as a new syndrome in the second half of the 19th century, this clinical picture seemed to be unknown in the psychiatric hospitals or asylums. In asylum medicine, the commonly used concept of sitophobia to designate food refusal in the insane covered a wide variety of mental disturbances and cannot be plainly equated with anorexia nervosa. A major difference is the occurrence of hallucinations and delusions specifically centered around religion and digestion. Most probably, anorectic patients were not treated in asylums, but at home, in the doctor's office, or in general hospitals. This pattern may be partly attributed to the fact that both patients and doctors were focusing on symptoms of self-starvation like emaciation, constipation, and amenorrhea, which were primarily interpreted as referring to somatic diseases. Additionally, wealthy families probably preferred private care in water-cure establishments, sanatoria, and rest homes to the stigmatizing referral of their anorectic daughter to an asylum. Hence, the fact that late 19th-century institutionalized psychiatry was only incidentally confronted with anorexia nervosa may explain its lack of interest in the emerging syndrome. © 2000 by John Wiley & Sons, Inc. Int J Eat Disord 27: 390–404, 2000.

Food refusal and insanity: sitophobia and anorexia nervosa in Victorian asylums.

Although anorexia nervosa emerged as a new syndrome in the second half of the 19th century, this clinical picture seemed to be unknown in the psychiatric hospitals or asylums. In asylum medicine, the commonly used concept of sitophobia to designate food refusal in the insane covered a wide variety of mental disturbances and cannot be plainly equated with anorexia nervosa. A major difference is the occurrence of hallucinations and delusions specifically centered around religion and digestion. Most probably, anorectic patients were not treated in asylums, but at home, in the doctor's office, or in general hospitals. This pattern may be partly attributed to the fact that both patients and doctors were focusing on symptoms of self-starvation like emaciation, constipation, and amenorrhea, which were primarily interpreted as referring to somatic diseases. Additionally, wealthy families probably preferred private care in water-cure establishments, sanatoria, and rest homes to the stigmatizing referral of their anorectic daughter to an asylum. Hence, the fact that late 19th-century institutionalized psychiatry was only incidentally confronted with anorexia nervosa may explain its lack of interest in the emerging syndrome.

Community in-patient units and halfway hospitals

There is a current gap in the nomenclature of psychiatric in-patient services. There are few descriptions of types of in-patient care and over recent years the literature has abounded with debates concerning alternatives. However, it may be argued that these debates have been based on the creation of the ‘straw man’ of the psychiatric admission, which is only fit for knocking down. Although a post-war consensus has emerged concerning the need to abandon the Victorian asylums, this has often been misrepresented as the need to avoid in-patient admission. The poorly articulated and emotional concept of community care and its lack of clear and consistent definition in public policy and key legislation have contributed to this (Bulmer, 1987). Recent changes in our view of community care have led to a refining of the concept and a shift from its comforting appellations (Titmus, 1968) to a pragmatic approach that matches it to empirical experiences and new resources. This approach sees psychiatric services for adults as being based locally and provided by a spectrum of services – in-patient, residential and ambulatory (Department of Health, 1996) – based on best available evidence. This article has been written with these issues in mind. We will address the current problems of in-patient care and the current literature on alternatives and supplements to traditional in-patient units.

From the asylum to the community: A longitudinal study of staff involved in the transition from Tone Vale Hospital to community-based services

A longitudinal study of the effects on staff (N =108) of the transition from a Victorian asylum to dispersed community-based services is reported. The majority of staff supported the policy of community care in general and following the closure, two-thirds thought it better for staff, although only half considered it was better for people with mental health problems. Four months after the closure there was little change in perceived job responsibilities, but after a year working in the new services very significant changes were reported in working practices, in line with a more communityorientated and therapeutic model. Throughout the transition, relatively low levels of stress were reported and job satisfaction was high. Role clarity and low role conflict were predictors of low stress and job satisfaction. Job satisfaction was also predicted by supportive management and job responsibilities. The study demonstrates that major changes in working environments and in job responsibilities can be accomplished without undue stress and uncertainty and also that the job satisfaction of mental health staff can be maintained.

Therapeutic interventions and milieu in psychiatry in the NHS between 1948 and 1998

This paper will attempt to describe the evolution of mental health care over the past 50 years by examining different aspects of treatment and service provision.The last half century has seen enormous developments in both treatment and the environments in which it is delivered. It has seen the demise of insulin coma therapy, and the Victorian asylum and the development of community mental health team. The roles of doctors and nurses are radically different, with nurses carrying out assessment and treatment rather than being mere custodians. were embryonic, such as clinical psychology, are now powerful in both the positions that their members occupy in contemporary mental health practice, but also in the power that has been exerted on the knowledge base by psychological research. The paper explores some of these central changes in philosophy and approach. phenothiazines and the Some professions which

Migration, family structure and pauper lunacy in Victorian England: admissions to the Devon County Pauper Lunatic Asylum, 1845–1900

The lunatic asylum remains one of the most remarkable institutional monuments of the modern world, dominating the social landscape of Victorian Britain and exercising a powerful attraction for social historians of medicine, an attraction almost as great as the spectre of the madhouse for contemporary novelists. Our image of the Victorian asylum is still pervaded to a surprising degree by the gloomy spectacle of the total institution presented by Michel Foucault, though it has been modified by a whole range of institutional and philosophical accounts undertaken in the past three decades. Pioneering studies by researchers such as Andrew Scull have illuminated not only the power exercised by the new asylum superintendents, armed with medical discourses of moral treatment and the early promise of curability, but also the continuing dominance of the ‘mad doctors’ in the sombre years of neo-Darwinian pessimism and eugenics doctrines. More recent contributions to the now enormous literature on the social history of insanity have shifted the focus of attention from earlier concerns with charting the rise of the asylum and the elaboration of medical discourses under the psychiatric gaze of physicians to a detailed reconstruction of the social environment of the asylum and especially to the interplay between familial circumstances and the way institutions responded to the insane. Such concerns were also clearly evident in important earlier studies by Walton, Scull, Digby and others, which drew on fundamental work by Anderson on the changing role of the family during industrialization. These scholars drew attention to the importance of family and kinship relations in the negotiation of a lunatic's passage to the Victorian asylum, as well as the role of wider forces of economic change, population growth and migration in shaping the environment in which decisions about the care of the mad were made.

Home but away: Material evidence of lives in Victorian asylums, 1850–1950

This article focuses on some of the objects in the Museum of Victoria's history collections which give insights into the ways life was lived in the large lunatic asylums in Victoria between about 1...

Makin' over the asylum

When failed double glazing salesman and part time disc jockey “Ready Eddy” agrees to revive the radio station at “St Jude's” hospital, he has little idea of what he is taking on: until his arch rival disc spinner informs him that “It's a loony bin…you'll fit in well there, Eddy!” From here on in, the plot in BBC Scotland's new six part drama “Takin' Over the Asylum” is well signposted. From the cuckoo poking in and out of its clock in the first scene, to the standard bin-quip “you a patient or a member of staff?” (reprised thrice in the inaugural episode), writer Donna Franceschild has succumbed to the temptation to use all the usual mental health funnies. Gartloch Hospital is the Victorian Gothic asylum that plays “St Jude's” in the programme. It doesn't require cinematographic yellow and red sky filters to register the fact that Gartloch, its twin castellated towers …

Social Order/Mental Disorder: Anglo-American Psychiatry in Historical Perspective

1. Introduction - Reflections on the Historical Sociology of Psychiatry 2. Humanitarianism or Control? Some Observations on the Historiography of Anglo-American Psychiatry 3. The Domestication of Madness 4. Moral Treatment Reconsidered 5. The Discovery of the Asylum Revisited: Lunacy Reform in the New American Republic 6. From Madness to Mental Illness: Medical Men as Moral Entrepreneurs 7. John Conolly: A Victorian Psychiatric Career 8. A Convenient Place to Get Rid of Inconvenient People: The Victorian Lunatic Asylum 9. Was Insanity Increasing? 10. Progressive Dreams, Progressive Nightmares: Social Control in Twentieth Century America 11. Sex and Madness 12. Cyclical Trends in Psychiatric Practice: The Case of Bettleheim and Tuke 13. The Theory and Practice of Civil Commitment 14. The Asylum as Community or the Community as Asylum: Paradoxes and Contradictions of Mental Health Care

Models of madness in Victorian asylum practice.

During the past few years there has been a rapid growth of interest in the sociological history of psychiatry. Prior to this, the history of psychiatry had been left largely to the psychiatric historian, who tended to proceed, as Thomas Szasz claimed, ‘as a socially neutral person, discovering the historical “facts” when in truth, he is a psychiatric propagandist, actively shaping the image of his discipline’ (1). Writers such as Michel Foucault, Vieda Skultans, Andrew Scull, David Rothman, Klaus Doerner, and Szasz himself have attempted to underline, as Skultans says, ‘the specific uses to which psychiatry has been put in the past, in order to make a more general claim about the nature of psychiatry as such’ (2). This aim, however, is not always made fully explicit (3). In this paper it will be argued that psychiatry, viewed as a historically constituted social activity, was characterised by a dualism. It was constituted by a medical or curative model of practice, in that psychiatry developed as a branch of medicine. Yet the ‘diseases’ which psychiatrists have historically come to regard as part of their field competence are distinguished by at least two criteria: first, their symptoms consist primarily of actions that are highly inappropriate to their social context; secondly, that their etiology is ambiguous. It will be argued here that an ambiguity regarding the etiology of mental disorder, which is often seen as both physically and psychologically caused, was central to psychiatric discourse.