Insanity, Institutions and Society, 1800-1914

Bill Forsythe, Joseph Melling, Bill Forsythe, Joseph Melling

• Publisher: Routledge
• Year: 2013
• Print ISBN: 9781138868243
• eBook ISBN: 9781134668748
• Edition: 1
• Topic: Storia
• Subtopic: Storia mondiale

This comprehensive collection provides a fascinating summary of the debates on the growth of institutional care during the nineteenth and twentieth centuries. Revising and revisiting Foucault, it looks at the significance of ethnicity, race and gender as well as the impact of political and cultural factors, throughout Britain and in a colonial context. It questions historically what it means to be mad and how, if at all, to care.

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ACCOMMODATING MADNESS

New research in the social history of insanity and institutions

Joseph Melling

The social history of insanity is a recent growth area within medical history. Before the 1970s historians and social scientists showéd relatively little interest in the history of psychiatry or the institutions where their patients were housed.¹ One explanation may lie in the limited prestige enjoyed by psychiatrists within a medical profession which had been greatly expanded by the growth of welfare states but which had devoted few resources to mental health provision.² As numerous scholars have noted, physicians who claimed a professional expertise in healing the insane were limited by the weakness of their scientific credentials and the evidence that large numbers of incurable patients were languishing in asylum care for decades.³ Whilst psychiatric medicine struggled to establish its prestige within the wider medical profession after 1945, the renewed debates on the role of mental institutions in the regulation of deviance and the future of psychiatric care in the community raised profound reservations about the success of the facilities developed to care for the mentally ill.⁴ These debates gave an urgency to the historical reappraisal of the asylum system which received a powerful stimulus from Michel Foucault’s brilliant polemic against the Enlightenment, Madness and Cinilisation.⁵

Most scholars would date the eruption of detailed investigations into the workings of asylums from the publication of Foucault’s tirade against the pretensions of modern science and the appearance of the anti-psychiatry studies of the 1960s, which prefigured the revisionist accounts of Michael MacDonald, Roy Porter, Andrew Scull and many others.⁶ As Scull comments in his contribution to the present volume, the Foucauldian vision of madness and society has always been subject to critical modification by such scholars whilst exerting a powerful influence on the revisionist interpretation of lunacy reform which swept the new social history of medicine in the 1970s–80s.⁷ This new generation of revisionist historians was, therefore, at least as concerned to refine and correct the extravagant historical inaccuracies of Foucault’s grand narrative of the history of madness as it was to integrate his profound insights into the processes of institutional growth and intellectual classification. The critical responses to Foucault have defined much of the literature in the social history of medicine since 1970. Within the rich and varied field of study devoted to the history of psychiatric practices and mental health institutions, scholars have presented at least three main criticisms of Foucault’s work. One of the most fundamental difficulties in Foucault’s account of the history of madness, which Scull, Porter and others have noted, is that it offers a model of modernisation without a compelling historical narrative.⁸ Foucault often assumes a correspondence between intellectual engagement, institutional reform and a social environment which collapses the specific histories of different societies into a single chronology.⁹

Not only does Foucault’s story leave us without a coherent, sustainable account of institutional reform in the process of modernisation, but his account also reduces the cast of contemporary actors to a few leading players whose intellectual pretensions are brilliantly exposed but whose importance in the historical drama of insanity reform is hardly challenged.¹⁰ As Chartier has noted, Foucault’s work offers an ambiguous reading of the relationship between power, resistance and agency, whilst cultural historians similarly focus on the production of texts and exclude the different ways in which specific audiences and communities appropriate these products for their own purposes.¹¹ More broadly, Foucault’s brilliant essays obscure the fierce debates over asylum reform and the location of the asylum itself as a site of continuing social and political conflicts. His emphasis on the surgical division of space and the manufacture of the modern patient in the hands of the professional physician has given historians a distorted perspective from which to gaze at the institution, marginalising the agency of social classes, kinship networks and political movements in the shaping of the treatments offered for insanity at different periods in different societies.¹² For all his emphasis on the scope for opposition as well as the exercise of power, Foucault’s work often implies that the rule of Reason determined the terms on which resistance could be mounted.¹³

A third aspect of Foucault’s work which has presented difficulties for historians of institutions concerns the different forms in which he has posed the problem of power and rights within the modern state, including what contributors to the present volume have referred to as the history of ‘asylumdom’. For Foucault often presents us with an institutional narrative that lacks a sense of institutional politics. Subsequent research on the historical relationship between the rise of the asylum and the elaboration of a penal system in modern societies has sought to provide at least some of this detail, though the analysis of the functions of the asylum in relation to the state’s provisions for the poor has only recently been undertaken.¹⁴ The contributors to the present collection continue to draw on Foucault in their studies, not least in studies of colonial medicine where the relationship between labour regulation, penal regulation and medical practices has been particularly apparent in the process of capitalist modernisation.¹⁵ There is also a noticeable move away from Foucault’s concern with the intellectual and physical mechanics of asylum life and towards a sharper contextualisation of the asylum’s multiple functions within specific contemporary societies and communities.

It was within this setting of developing debate that Scull framed his initial contribution to the field with a deeply researched and provocative account of the growth of public asylums in England during the ‘long nineteenth century’.¹⁶ As his reflections in the present collection make clear, Museums of Madness was written in an attempt to provide a corrective to the imprecisions and distortions of Foucault’s analysis whilst offering a substantive empirical grounding for many of his assertions. Scull completed detailed historical research on the growth of different institutions during the Victorian decades, whilst retaining a bold conceptual sweep of the English experience which offered an ambitious historical sociology of the making of insanity in modern society. The asylum was located in the landscape of industrialising Britain where the commercialisation of economic life and labour relations weakened many traditional ties and strained the resources of communities which could not cope with the growing numbers of social casualties. The upheaval which followed the commercial and consumer revolutions of the eighteenth century provided the new asylums with their key function in absorbing those individuals who could not function effectively within the new market environment. The purpose of the new asylums was to model social behaviour around the norms of rational bourgeois expectations. Damaged human capital was repaired and worthless labour was warehoused in the corridors of buildings which quickly became museums filled with lifeless artefacts of humanity.’¹⁷ The mad were managed by a new breed of superintendents who recognised that the stock of the private madhouses was falling under close scrutiny from humanitarian reformers such as Lord Ashley and that opportunities for professional advancement lay in the new public institutions which every county was compelled to introduce after the legislation of 1845. These mad-doctors laid claim to a large area of medical practice which was underpinned by the intellectual schema of moral treatment (pioneered by Tuke and others in the eighteenth century) and subsequently by the growing conviction that a significant residuum of the population was afflicted by hereditary insanity.

The importance of Scull’s contribution lay in the construction of an imaginative historical sociology to explain the rising population of asylums and their place within modern commercial society, offering a critical account of the political economy of madness which many earlier historians had overlooked or rejected.¹⁸ Recognising the limited analysis of class politics provided by Foucault, Scull posed the issue in part at least as one of class interests and working-class regulation by the new bourgeois intellectuals including the mad-doctors who were clearly anxious to join the elite groups of medical professionals in Victorian society.¹⁹ In revising his analysis as The Most Solitary of Afflictions,Scull extended his arguments on the commercialisation of English society whilst reaching for a much bolder synthesis of scholarship to sustain a broad analysis of madness and modernity.²⁰ His thesis is laid out with characteristic clarity and verve in 1991.

Over the course of the first half of the nineteenth century, in England, in Continental Europe and in North America, the typical response to the deranged underwent dramatic and radical changes…. Whereas in the eighteenth century only the most violent and destructive amongst those now labelled insane would have been segregated and confined apart from the rest of the community with the achievement of what was widely portrayed as a major social reform, the asylum was endorsed as the sole officially approved response to the problem posed by mental illness. And, in the process, the boundaries of who was to be classified as mad, and thus was to be liable to incarceration, were themselves transformed.²¹

Here is the thrust of the revisionist interpretation of the history of psychiatry and of social reform which Scull has defended and refined in the face of often acerbic exchanges with professional psychiatrists and academic researchers.²²

In the process of refinement Scull drew on original studies by Andrews, Digby, Finnane, Porter, Walton and many other scholars whose research enriched the analysis and revealed a host of historical actors who attended on the making of the lunatic in the eighteenth and nineteenth centuries.²³ The personalities of Scottish as well as English psychiatrists have been explored in the collective biographies of alienists who were assembled as Masters of Bedlam.²⁴ Subsequent empirical research has, as Scull acknowledges here, modified the interpretation offered in Museums of Madness. The foundations of the ‘new’ social history on which much of Scull’s work rested have also been weakened by the seepage of post-modernist arguments into historical debates and the problematising of such core concepts as social class.²⁵ The contributions to the present volume reflect this wider transformation of the historian’s practice, though Scull’s own work remains the starting point for these current reappraisals of the social history of madness even if the methods adopted and conclusions reached may diverge.

Most of the essays gathered in this volume are devoted to some part of the long nineteenth century, i.e. 1780–1914, which Scull identifies pace Foucault as the critical period in the development of ‘asylumdom’. Yet the authors often reach very different conclusions from those found in The Most Solitary of Afflictions. One important point of variance can be seen in the different perceptions of modernity which have developed in recent years. Historians are less confident about dating the emergence of a commercial society to the long eighteenth century, still less the long nineteenth century, and the consumer society which earlier historians found at the close of the 1700s has been relocated by scholars to earlier expansion ‘irregular but incremental, of consumer cultures associated with commercial capitalism’.²⁶ If we view the growth of commercial society in a longer trajectory of economic and social change then the correspondence between lunacy reform and the expansion of capitalist markets becomes less compelling. Nor is it clear that the increased migration of labour, weakening community and kinship bonds and the spread of commodity relations during the first half of the nineteenth century, which provide the context for asylum growth in the work of Walton and Scull, had direct and consistent consequences for lunacy admissions in different regions of England and Wales.²⁷ The chapters on Wales, Scotland and Ireland as well as India and South Africa demonstrate the imperialist impetus behind the modernisation of institutions as well as the accommodation with the forces of tradition which marked the development of medical practice in different societies.

The crisp chronology of institutional innovation which is outlined in Scull and other work remains the subject of debate. L.D. Smith’s chapter suggests th...

Table of contents

• Cover
• Half Title
• Studies in the Social History of Medicine
• Full Title
• Copyright
• Contents
• Notes on contributors
• Preface
• 1 Accommodating madness: new research in the social history of insanity and institutions
• PART I The English experience of the county lunatic asylum
• PART II Therapeutic regimes in the nineteenth century
• PART III On the edge: the English model and national peripheries
• PART IV The colonial vision
• PART V Reflections
• Select bibliography of the history of insanity
• Index