asylums

asylums for the insane had medieval origins in Britain, with London's Bethlem Hospital (Bedlam) the most famous. Its shortened name passed into the language in association with foolishness, loss of control, and the abdication of reason and humanity, as befitted a prevailing frame of mind in which madness was equated with descent into brutishness and kept in check with chains and whips. The patients in Bedlam were a spectacle for curious visitors in the 17th and 18th cents. During the latter century a private madhouse system developed, as medical entrepreneurs made claims for cure as well as management and security. At the turn of the 18th and 19th cents. reformers such as Pinel in France began to claim that asylums could be turned into therapeutic environments, in which insanity could be cured by seclusion from external stresses and a system of moral management could lead patients back into recognizing the need for acceptable, self-disciplined behaviour. This line was taken by the Tuke family at their York Retreat, an asylum for quakers which became a model for later developments. An Act in 1808 empowered counties to set up asylums for pauper lunatics with a view to possible cure as well as custody. Such asylums gradually spread, and the emergence of the ‘non-restraint’ system under practitioners like John Conolly provided an additional legitimacy, as locks and chains were struck off and a humane regime based on an appeal to reason supposedly took over. In 1845 legislation required the general establishment of pauper asylums, and commissioners in lunacy were established to inspect, remedy abuses, prescribe best practice, and deal with alleged cases of wrongful confinement, when patients were certified and confined at the behest of relatives who would benefit financially from their incarceration. Charles Reade's mid-Victorian novel Hard Cash dealt forcefully with this issue; but the promise of cure made asylums seem more legitimate and less frightening even as the pauper asylums became less able to live up to the reformers' promises. As they filled up with incurable patients and were unable to attract or train staff with appropriate attitudes, patient–staff ratios increased, pauper asylums reverted to custodial control rather than cure, and doctors' pretensions to understanding and treating insanity failed to develop beyond asylum management. Huge ‘museums of madness’ proliferated in the late 19th cent., and silted up with long-term inmates. The abuses of the system came to seem to outweigh its humanitarian and therapeutic pretensions, and physical as well as moral restraints were reintroduced. The emergent psychiatric profession had used ‘moral treatment’ to enhance its credibility, but failed to deliver cures in significant numbers. The sheer scale of Victorian investment in the system, and the administrative power of the psychiatrists, kept it in being until the last quarter of the 20th cent., when a fashion for decarceration and the liberation of inmates led to replacement with so-called care in the community, whose limitations were quickly made apparent in the absence of appropriate funding. With all its defects, the asylum was more than (as one critic suggested) ‘a convenient place to get rid of inconvenient people’: it was a refuge for those who could not cope, and the failure of alternative systems showed that it had its virtues as well as its drawbacks for patients, as well as for those who sought to shape and sanitize the social order through the promotion of custodial care.

John K. Walton