Asylums

The treatment of insanity in the 19th century

The dissolution of the monasteries and the Reformation had a negative impact on the provision of charitable institutions for the care of those who could not care for themselves. The expression "bedlam" is derived from the name of the country's first, and for a long time only, lunatic asylum: this was the infamous Bethlem Hospital in Moorfields, London. This horrific institution was built in 1676, when the previous premises, established in 1247 by the Order of St. Mary of Bethlehem, were destroyed by fire.

The purpose-built asylum, from the outside a very imposing building, had, on the inside, become a kind of "freak show", and people from all walks of life would go there to see and perhaps taunt the inmates. According to Roy Porter, "Bedlam became a byword for man's inhumanity to man, for callousness and cruelty" (Roy Porter, Mind-Forg'd Manacles, 1987, p. 123).

The cruelty Roy Porter associates with the treatment of mentally-ill people took many forms. Some institutions were badly run and the patients' standard of personal care was often very low. People were frequently placed in single confinement, in cold and damp rooms, with only dirty straw to lie on. Corrupt surgeons or governors often provided poor meals and since inmates were not able to complain and were not believed even if they did make themselves heard, it was difficult for reforms to the living conditions to work. Committees of Visitors made up of justices were meant to regularly check the local asylums to see that all was as it should be. In practice this system did not work and complaints of relatives were frequent.

Sometimes attendants would bully patients and abuse them. But one of the worst kinds of cruelty was the so-called medical treatment. In the absence of effective tranquillisers, all kinds of horrendous devices were invented in an attempt to calm people down. In addition to straitjackets, shackles, cold water baths, electric shock treatment and brain surgery, a revolving swing-chair was invented. The unfortunate patient was strapped into this chair and revolved up to one hundred times a minute, leading to the gushing of blood from ears and nose and even unconsciousness. It was hoped that this kind of trauma would shock the patient into sanity! (Roy Porter, p. 221)

Many physicians did not consider insanity to be a mental illness, a condition which may be curable, temporary or affect people only intermittently. Until the 19th century it was thought that the best thing to do was to lock up the unfortunate patients and in many cases shackle them or keep them in straitjackets and chains. Many mentally-ill people therefore ended up in gaols or workhouses.

Psychiatry as a profession only began to develop during the 19th century, when physicians and surgeons started to take an interest in mental conditions and began experimenting with drugs and more humane forms of treatment. With the rapid increase in the size of the population, the need for public asylums became acute. The government passed a law making it the duty of each county to provide an asylum for lunatics (Charles Renton, The Story of Herefordshire's Hospitals, Logaston Press, 1999, p. 186).

[Original author: Toria Forsyth-Moser, 2004]