The Asylum as Utopia

W.A.F. Browne and the Mid-Nineteenth Century Consolidation of Psychiatry

Andrew Scull

• Publisher: Taylor & Francis
• Year: 2014
• eBook ISBN: 9781317911746
• Edition: 1
• Topic: Psychology
• Subtopic: Social History
• Index: Psychology

What Asylums Were, Are, and Ought to Be, first published in 1837, was of considerable significance in the history of lunacy reform in Britain. It contains perhaps the single most influential portrait by a medical author of the horrors of the traditional madhouse system. Its powerful and ideologically resonant description of the contrasting virtues of the reformed asylum, a hive of therapeutic activity under the benevolent but autocratic guidance and control of its medical superintendent, provided within a brief compass a strikingly attractive alternative vision of an apparently attainable utopia. Browne's book thus provided important impetus to the efforts then under way to make the provision of county asylums compulsory, and towards the institution of a national system of asylum inspection and supervision.

This edition, originally published in 1991 as part of the Tavistock Classics in the History of Psychiatry series, contains a lengthy introductory essay by Andrew Scull. Scull discusses the social context within which What Asylums Were, Are, and Ought to Be came to be written, examines the impact of the book on the progress of lunacy reform, and places its author's career in the larger framework of the development of Victorian psychiatry as an organised profession. Through an examination of Browne's tenure as superintendent of the Crichton Royal Asylum in Dumfries, Scull compares the theory and practice of asylum care in the moral treatment era, revealing the remorseless processes through which such philanthropic foundations degenerated into more or less well-tended cemeteries for the still-breathing – institutions almost startlingly remote from Browne's earlier visions of what they ought to be.

What Asylums Were, Are, and Ought to Be:

Being the Substance of

Five Lectures

Delivered Before

The Managers

of the

Montrose Royal Lunatic Asylum.

by

W. A. F. Browne, SURGEON,

Medical Superintendent of the Montrose Asylum, Formerly President of the Royal Medical Society, Edinburgh, &c.

Edinburgh:

Adam and Charles Black,

And Longman, Rees, Orme, Brown, Green, and Longman, London.

MDCCCXXXVII.

This Work

Is Dedicated,

with Sincere Respect and Gratitude,

to

Andrew Combe, M.D.,

Physician to their Majesties the King and Queen of the Belgians; Author of “Observations on Mental Derangement;” “Principles of Physiology, as Applied to Health and Education,” &c.

as an Acknowledgment

of the Benefits Conferred on Society,

by

his Exposition of the Application of Phrenology in the

Treatment of Insanity and Nervous Diseases;

and

of Private Benefits Conferred,

as

the Most Enlightened Preceptor, the Most Disinterested

Adviser, and the Kindest Friend,

of the

Author.

To the Managers of the Montrose Royal Lunatic Asylum.

MY LORD AND GENTLEMEN,

To the many obligations which you have already conferred upon me, is now to be added the permission to publish the following pages under your sanction and patronage. In offering them for your acceptance, as a very imperfect proof of the importance which I attach to the office to which you appointed me, and as an equally imperfect acknowledgment of my gratitude for the uniform kindness and support which I have received from you, I have to express the deep respect and admiration which I entertain for the anxiety which you have ever manifested, and the exertions which you have made, and are now making, to promote the happiness and cure of those lunatics whose interests are more immediately confided to your care.

I have the honour to be,

MY LORD AND GENTLEMEN,

Very much your obedient servant,

W. A. F. Browne.

Montrose, May 1837.

Preface.

My object in publishing the following Lectures, was to draw the attention of the public, and especially of those who are by profession engaged in, or who by philanthropy are prompted to, works of mercy, to the consideration of what has been done, and what remains to be done, for the relief of the most unfortunate of our fellow-men: of those who may be almost literally said to “sit in darkness, and in the shadow of death: being fast bound in misery and iron.” My inducements to publish were, first, the countenance and encouragement which I received from the Directors of the establishment under my charge, to whom my observations were in the first instance addressed; and, secondly, the hope that a plain and clear statement of facts by a practical man might reach and influence those who administer either by their opinion or by their power to the necessities of the “poor in spirit.” If my appeal should, even to a limited extent, excite the sympathy of those who are blessed with a sane, a benevolent, and a cultivated mind, and engage them as cordially in the attempt to ameliorate the condition of the lunatic, as similar, and even less clamant appeals have done in behalf of the slave, the oppressed, the destitute; little difficulty will be found in removing the evils, and in carrying into effect the improvements which I have suggested, and an amount of happiness will be secured to the objects of my solicitude which has hitherto been denied to them, but to which they are as clearly entitled as the slave to freedom, or the poor to pity and relief.

I have no claim to originality, either in the design or the execution of the present production. A large portion of the volume refers to the past, and is necessarily occupied with historical details: that portion which refers to the future I have as scrupulously as was practicable collected and collated from the writings and opinions of others: and when presenting a synoptical view of the different forms under which mental disease may appear, I was indebted rather to the science upon the principles of which that arrangement was founded, than to any peculiar views or philosophical analysis of my own. To those who are acquainted with the doctrines of Phrenology, the extent of my obligations in this particular case, and throughout the work, will be readily recognized; and to those who are still ignorant of these doctrines, I have to offer the assurance that Insanity can neither be understood, nor described, nor treated by the aid of any other philosophy. I have long entertained this opinion: I have for many years put it to the test of experiment, and I now wish to record it as my deliberate conviction. While, however, I have constantly availed myself of the principles, I have avoided the phraseology of the science, first, because my original auditors were not, and my readers may not be phrenologists; and, secondly, and chiefly, because my object was not to advocate or promote particular truths, but to employ and apply these in the elucidation of the object in view, and thereby to place in as clear, and conclusive, and acceptable a manner as possible, the noble cause which I have undertaken.

CONTENTS.

LECTURE I.

WHAT IS INSANITY?

Erroneous views on the Subject—Propensities, Sentiments, Reflective and Perceptive powers—The dependance of these on Organization.—Derangement a disease of the Brain—The changes which occur in the structure of the Brain—Evidence that such changes take place—Extent of diseased action which constitutes Insanity—Description preferable to definition of the disease where the regulation of the internal economy of Asylums is concerned—Nosological classification of the varieties of the Disease—Arrangements of Arnold, Heinroth, and Author—Idiocy—Its four gradations—Fatuity, partial, complete—Monomania, erotic, homicidal and destructive, proud, vain, timid, suspicious, religious and superstitious, desponding and suicidal, imaginative, avaricious, benevolent, and affectionate—Incapability of perceiving the relations of ideas—Incapability of perceiving the relations of external objects—Incapability of perceiving the qualities of external objects—Mania, with and without increased activity—Conclusion

LECTURE II.

WHAT ARE THE STATISTICS OF INSANITY?

The numbers and distribution of Lunatics in Britain—Is insanity increased by civilization—Does it increase in a greater ratio than the population—Does it attack men of particular professions, or of particular ranks—Does it prevail chiefly under free, or under despotic forms of Government—What period of life does it principally attack—Does marriage diminish the liability to the disease—Are Males or Females most exposed—What is the proportion of cures—Kate of Mortality—Does Insanity prolong or shorten life—Influence of season on Mortality—Diseases affecting Lunatics—Proportion of Furious, Paralytic and Epileptic, Fatuous and Idiotic, Dirty, Noisy and Suicidal Madmen—Lucid Intervals—Relapses—Complete isolation—Early confinement—Employment as a means of cure—Proportion of Lunatics that may be employed—Does it promote the cure?—The kind of occupation—Is it safe?

LECTURE III.

WHAT ASYLUMS WERE.

Character of System pursued previous to 1815—St Vincent de Paul—Insane consigned to Monks—Lunatics set at large to beg—Lunatics in Gaols, in Cages, in Caves, in Dungeons—Associating of Lunatics with criminals—Modes of quieting Lunatics—“Muôling”—Modes of feeding Lunatics—“Forcing’—Death from this process—Lunatics in Hospitals—Four or five sleep in one bed—Confined in Venereal Wards—Lunatics in Workhouses—Want of Medical attendance, classification, comfort, and cleanliness in these establishments—Sale of Idiot children—Madhouses at Venice, Nantes—Confinement of sane individuals—Carelessness of Medical men in granting certificates—Unusual modes of coercing the Insane—Coercion required for the poor, but not for the rich—Coercion resorted to as economical—Lunatics exhibited for a sum of money; excited and induced to gorge themselves with food, or filth, for the amusement of visitors—Gangrene of extremities from cold—Insufficient supply of food, of clothing—No medical or moral treatment—Superintendence confided to ignorant and dissolute keepers—Terror as a remedy—Cruelty and immorality of servants—No separation of sexes—Unhealthy cells—Concealment of mortality—Deaths from fury of keepers and patients—Records burned to frustrate inquiry, &c.—A visit to Asylums as they were

LECTURE IV.

WHAT ASYLUMS ARE.

The old system not altogether exploded—Commencement of the present system—Liberation of Lunatics at Bicêtre by Pinel—The adoption of enlightened principles partial, but a desire for improvement prevalent—First recognition of humanity and occupation as means of treatment in remote times, in Egypt and Belgium—Present mode of treatment characterized by want of classification, want of employment, want of bodily exercise—Asylums insufficiently heated—Error of supposing Lunatics impregnable to cold—Inattention to personal comfort of Lunatics—Corporal punishment professedly abandoned; but cruelty in various forms still committed—Patients confined to bed to accommodate servants—Inadequate number of keepers—Coercion as a means of cure, of protection—Character and qualifications of attendants on Insane—Evils of indiscriminate association of insane—No wards for convalescents exists—Grounds for separating Lunatics—Erroneous views of moral treatment—Night visits—Mental anxiety and disturbance produced by the oppressive, harsh, indelicate or derisive conduct of keepers—Substitution of convalescent patients for keepers—Important duties imposed on this class of servants—Difficulty of procuring well-educated persons to undertake such responsibility—Exclusion, desertion of friends of Lunatics—Asylums ill-adapted for reception of rich—Luxurious diet—Indiscriminate diet—Solitary meals—Prejudices of public present obstacles to improvement—Examples—How are these to be removed?

LECTURE V.

WHAT ASYLUMS OUGHT TO BE.

A perfect Asylum a Utopia—Belief of the inadequate provisions for the cure of the insane in asylums, general—Character of the physician—Benevolence, conscientiousness, courage—Intellectual qualifications—Site of an asylum—It may contribute to the cure of the inmates—Construction of the building—Size of apartments—Night-classification—Houses of one story—Dormitories—Night-keepers—Portion of asylum fire-proof—Pudding of walls—Heating the apurtinents by the circulation of hot water—Clothing—Airing-grounds—Shrubberies—Gardens—Farm-employment of patients—Payment for labour—Classification—Religious worship and instruction—Fallaciès in moral treatment—Dancing—Voisin’s and Esquirol’s establishments—Asylum at Sonnenstein—Library—Asylums at Naples, at Hartford, United States—Visit to an asylum as it ought to be

Lecture I.

What is Insanity?

Erroneous views on the Subject—Propensities, Sentiments, Reflective and Perceptive powers—The dependence of these on Organization.—Derangement a disease of the Brain.—The changes which occur in the Structure of the Brain—Evidence that such changes take place—Extent of diseased action which constitutes Insanity—Description preferable to definition of the disease where the regulation of the internal economy of Asylums is concerned—Nosological classification of the varieties of the Disease—Arrangements of Arnold, Heinroth, and Author—Idiocy—Its four gradations—Fatuity, partial, complete—Monomania, erotic, homicidal and destructive, proud, vain, timid, suspicious, religious and superstitious, desponding and suicidal, imaginative, avaricious, benevolent, and affectionate—Incapability of perceiving the relations of ideas—Incapability of perceiving the relations of external objects—Incapability of perceiving the qualities of external objects—Mania, with and without increased activity—Conclusion.

GENTLEMEN,—The pages which I am about to submit to you, and subsequently to the public, possess one quality which many regard as a merit, but which I am inclined to think is a misfortune. It is that of originality. No attempt, so far as I know, has yet been made to condense, in a plain, practical, and still popular form, the results of observation in the treatment of insanity, for the specific and avowed purpose of demanding from the public an amelioration of the condition of the insane. The motives which have actuated me in bestowing a very careful, and, I humbly trust, a candid examination on the subject, have been a profound sympathy for the misfortunes of the insane, and a keen feeling of indignation that these misfortunes should often be multiplied through the apathy, or ignorance, or cruelty of those who have it in their power to become benefactors, in the noblest sense of the term, and in the noblest cause which can arouse virtuous ambition. Should this attempt to enlist in that cause the feelings of justice and mercy in every bosom, in any degree succeed, as by the blessing of a just and merciful God I trust it may, and should the cry for improvement in public Asylums be raised where hitherto the silence of indifference has reigned, the only reward which I covet will have been obtained.

What is insanity? The question may be put and answered in two senses; either philosophically or practically; either as directed to ascertain the actual condition of the mind which constitutes disease, or to determine that amount of diseased action which compromises the safety of the sufferer, and justifies legal interference. Our chief concern is with the aspect which the disease presents, after the law has interfered. In order to arrive at just conclusions on such a subject, it is incumbent to understand something of the nature, the powers, and the laws of the mind while in possession of health and vigour. This is generally overlooked in the investigation, and the verdict of the public and of a jury is as recklessly and ignorantly pronounced respecting mental strength, as if the points at issue were the discovery of the perpetual motion or the utility of a comet. It is not to be expected that either of these tribunals should be composed of metaphysicians; but it is highly desirable that every man, qualified by his station in society to judge or legislate in such matters, should be competent by education to found and form his judgments on a knowledge of what consciousness and observation shew to be the laws of our spiritual nature. So vague are the ideas generally entertained, or, rather, so destitute is the great majority of even educated men of any ideas or definite options as to mental philosophy, that very recently the capability of repeating the Multiplication Table was gravely propounded in an English court of law as a test of sanity. This looks like satire on the reputed money-making propensities of this nation, but the proposal had no such origin. And to prove how momentous the interests are which hinge upon a clear comprehension of what insanity is, it may be mentioned that in the very case where this arithmetical crux was suggested, immense property and the reputation and affections of many individuals were at stake.

So far as our present purpose is concerned it may be sufficient to know, that the mind consists of four classes of powers. The first of these are mere instincts or impulses, manifested by us in common with the lower animals, capable of being directed by reason, or the moral feeling, to great and noble ends, but in themselves prompting merely to love, to combat, to acquire, and so forth. The second class comprehends the sentiments where there is a vivid emotion superadded to a propensity to act; among these are feelings of pride, vanity, veneration, hope, &c. The purely intellectual powers constitute the third class. By them we recognise the relations of ideas, of the impressions of the mind itself; we are enabled to trace effects to their causes, to ascertain the difference or agreement of propositions, and to conduct what is commonly called a process of reasoning. In the fourth class are the observing powers, those by which we perceive the qualities and relations of external objects.

Now it appears that all these feelings and faculties are gradually developed and that they gradually decline; that they are weak in infancy, strong at maturity, and again weak in old age; that their evolution and decay correspond with the changes in organization. Farther, it has been ascertained, that the condition and intensity of these powers is influenced by the state of the body, by external and internal stimuli; that in certain affections of the nervous system, as intoxication, their energy is impaired; and that in certain other affections, as phrenitis and ramollissement, their operation is altogether destroyed. Lastly it is proved, that the integrity and health of these powers depend upon the structure of the brain and its coverings; that if this organ be prevented from attaining a certain size, no mental manifestations appear; that if by accident or disease, the nervous mass should be directly or indirectly injured, these manifestations are diminished in number, impaired in strength, or annihilated. In what manner this connexion between mind and matter is effected, is not here inquired into. The link will, perhaps, ever escape hu...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Original Title Page
• Original Copyright Page
• Table of Contents
• Introduction
• What Asylums Were, Are, and Ought to Be
• Index