Mental Illness and Learning Disability since 1850

Finding a Place for Mental Disorder in the United Kingdom

Pamela Dale, Joseph Melling, Pamela Dale, Joseph Melling

• Publisher: Routledge
• Year: 2006
• eBook ISBN: 9781134218158
• Edition: 1
• Topic: History
• Subtopic: World History
• Index: History

Taking forward the debate on the role and power of institutions for treating and incarcerating the insane, this volume challenges recent scholarship and focuses on a wide range of factors impacting on the care and confinement of the insane since 1850, including such things as the community, Poor Law authorities, local government and the voluntary sector.

Questioning the notion that institutions were generally 'benign' and responsive to the needs of households, this work also emphasizes the important role of the diversity of interests in shaping institutional facilities.

A fresh, stimulating step forward in the history of institutional care, Mental Illness and Learning Disability since 1850 is undoubtedly an important resource for student and scholar alike.

1 The politics of mental welfare

Fresh perspectives on the history of institutional care for the mentally ill and disabled

Pamela Dale and Joseph Melling

Introduction

Scholars continue to be troubled by the history of institutional care. The spread of national models of welfare provision and the rhetoric of the ‘welfare state’ during the middle decades of the twentieth century appeared to have relatively little impact on the provision of services for those considered mentally unwell or disabled. Yet it was these amenities which bore the brunt of the subsequent assault on state-centred medical institutions by intellectuals who criticized the extent to which the large mental hospitals served the interests of the professional elite who managed the patient population and upheld an unequal social order in which the deviant were consigned to the custody of probation officers, social workers and psychiatric nurses.¹ By the 1970s there were a number of serious challenges to the sympathetic account of the growth of psychiatry and the evolution of institutional care from the Hanoverian and Victorian asylum to the modern mental hospital which scholars such as Kathleen Jones had offered.² Critical of such benign visions of the progress of institutional care as an exercise in naive optimism, more radical historians also attempted general if not global models of psychiatric advance and institution-building.³

More detailed recent research has led to important modifications of the grander narratives of institutional provision, grounded as they often were on distinctive British and North American experience during the nineteenth century. Elegant general models have been found wanting as different actors come into view, striving for particular goals and reaching a specific accommodation in regard to reform settlements. At the same time, the sheer volume of fresh research on different countries has encouraged a stronger international dimension and attempts at comparative analysis of national initiatives in providing services for those seen as mentally unwell or defective. In a recent collection of national case studies, the editors noted the uneven pace of asylum building as modernizing regimes alternated between promoting and abandoning such projects according to political fashion. Elsewhere they appear to favour a greater emphasis on understanding patterns of provision in terms of the demand created by demographic shocks to the family household and the pathological or behavioural characteristics of the host population.⁴

Similar tensions are apparent within much of the most important recent research on the history of institutional care as researchers attempt to assess the influence of different agents and the political structures within which they acted. Scull’s early research emphasized the absolute and relative growth in the number of pauper lunatics identified in the English population from little more than 2,000 in 1807 to more than 86,000 in 1890, equivalent to at least a tenfold increase in the numbers of people certified as insane within the general population.⁵ Contemporaries were well aware of the Lunacy Commission’s claims that much of this expansion in the numbers held in the asylum and related institutions was due to increasing longevity of long-stay patients, though there remained formidable evidence of a disproportionate and unexplained rise in Ireland as well as England, Wales and Scotland which political critics of the Commission were anxious to publicize.⁶ A similar if distinct pattern may be detected in the numbers recorded as suffering from mental deficiency in the late nineteenth and early twentieth centuries.⁷ Explanations for the rising numbers classified as insane and/or mentally defective have usually discarded the models of social control and ‘total institutions’ more popular in the third quarter of the twentieth century, in favour of an institutional complex of regulation.⁸ Garland’s analysis of the ‘penal-welfare system’ remains an influential approach, interpreting the evolution of the asylum within a network of controls which portrayed the institution in relation to the growth of the workhouse and the prison, fashioning a heterogeneous population of inmates and monitoring distinct forms of deviant behaviour.⁹ Arieno’s valuable survey of the broader literature on asylum provision draws attention away from regulation in noting the significance of stress created by poverty and deprivation as well as the concern of elites and legislators to ameliorate such conditions while selecting those most capable of sustaining a productive lifestyle.¹⁰

Interpretations of the origins and social function of the asylum continue to debate questions of class, and more particularly gender, within the broader discussion of the impact of poverty on admissions to such institutions. Recent research continues to cast doubt on earlier feminist interpretations since evidence from a range of national studies suggests that men as well as women were admitted in roughly proportionate terms, though some variations in diagnosis and treatment are also evident.¹¹ There is less evidence of the care of both women and men within the boundaries of the asylum, research on the twentieth century indicating that in some instances males rather than females may have received more brutal as well as innovative therapies depending on gendered assumptions about resistance and the suitability of subjects for experiment.¹² The experience of mental deficiency institutions suggests those boys capable of being trained, rather than girls, were seen as the fittest subjects for the idiot asylums established during the nineteenth century.¹³ Voluntary initiatives to cater for adult female ‘defectives’ in the twentieth century reflected the greater concern of the British state with males who were seen as having a greater potential for deviant and criminal behaviour.

Fresh directions and debates

Contrasting interpretations of the structure and function of asylum provision since the nineteenth century have drawn attention, therefore, not only to the different social constituencies which sought to shape and utilize the institutions created in this period, but also the changing concepts of governance and expertise which informed the design and administration of these therapeutic communities. Recent research has stressed the uneven influence of ideology and intellectual culture on specific programmes of legislative change.¹⁴ Bartlett argued that the 1845 lunacy laws were the outcome of inconclusive battles between traditionalists and innovators, while Macnicol and Thomson have each suggested that the Mental Deficiency legislation of 1913 was the unintended consequence of similar battles between intellectual and political adversaries.¹⁵ Earlier scholarship which privileged the growth of empire and imperial defence in schemes to promote national efficiency and social discipline by means of welfare reforms is revisited in Porter’s claim that the comparative history of asylum building indicates the concern of metropolitan and colonial states to institutionalize racial, ethnic and other minorities.¹⁶ The language of imperial dominance and eugenic selection finds an echo in discussions of ‘colonies’ for mental defectives during the early years of the twentieth century, though research on African asylums as well as those within the United Kingdom (including Ireland) registers the remarkable diversity and uneven development in both policies and practices between states.¹⁷

The interplay between ideas, political agency and institutional reform is apparent in the attempts made by medical scientists to discriminate between insanity and mental deficiency in the Victorian and Edwardian years. During the 1870s there was a renewed interest in the accurate classification of institutional populations, including those lodged in different kinds of asylum. Earlier attempts to distinguish between the lunatic as furiously insane compared to the more passive feeble-minded individual were clearly inadequate, since they depended on a shifting conception of dangerousness. Jackson’s study of the period noted the significance of legal definition, the continuing importance of lay opinion and a limited evidence of medical imperialism in provisions made for the mentally deficient child.¹⁸ Thomson similarly emphasized the long history of legal controls over idiots from the thirteenth century, while the history of Bethlem completed by Andrews and others stressed both the well-established distinction between idiocy and lunacy and the tendency for institutional practices to obscure this legal boundary.¹⁹ Bethlem experienced a problem in the early modern period which is often associated with ‘chronic’ patients in a much later era of asylum provision: namely, the difficulties encountered in discharging idiots from care once they had been admitted.

The growing recognition among asylum historians of the importance of legal as well as medical expertise in framing provisions for those considered insane and mentally defective may also be extended to a consideration of the importance of court cases which drew upon medical expertise.²⁰ As Scull noted, the asylum doctors recognized that their formidable authority lay in the institutional control of a growing inmate population rather than the professional expertise of psychiatry and even within the institution their power was circumscribed by legal regulations and supervision. Threats of legal action were sometimes made against such institutions by people of modest as well as substantial means.²¹ In other instances, medical personnel not only came into conflict with legal experts within the judicial system but could clash with disciplinary regimes in other areas of state power. Even within the closed world of British prisons, doctors could assume the role of the inmates’ advocate rather than simply associating with the penal goals of the authorities.²² Prominent asylum superintendents could sustain their vision of institutional leadership only with the tacit support of the governors, a point sometimes overlooked in studies which construct a chronology in terms of medical personnel.²³ Consideration of the neglected role of the fee-paying asylums, as well as the careers of the most eminent of the Victorian alienists, indicates that the mad doctors were able to capitalize on their reputations by providing private care for the wealthy rather than by demonstrating a capacity to cure large numbers of poorer inmates.²⁴

An appreciation of the limits of the intellectual and legal authority which could be claimed by asylum psychiatrists during the nineteenth century has contributed to a broader debate in regard to the effective boundaries of these institutions and the capacity of different groups to influence their policies and practices. It is now commonplace for historians to place asylum provision within a larger, mixed economy of care, moderating earlier perspectives of a single dominant institution.²⁵ A number of historians have sought to frame questions of agency and of gender within a discussion of the key role of family households in the admission and discharge processes. Studies which emphasize the importance of kinship bonds and the life cycle of the nuclear family include Prestwich’s account of Parisian asylum admissions and Wright’s analysis of Victorian idiot and lunatic asylums.²⁶ Complementing Bartlett’s argument on the central role of Poor Law authorities in the application and administration of English lunacy laws, these accounts offer support for earlier accounts of sympathetic kinship while criticizing the class-based interpretation of asylum provision developed by Scull and others.

The significance of the Poor Law and the role of families in the trans- mission of people to and from the asylum feature in a number of the chapters which follow. In an earlier assessment, Bartlett suggests alternative interpretations of the introduction of new lunacy legislation in England during 1845, including a concern to appeal to the ‘deserving poor’ whose members needed support and the demands of other reformers that the asylums should embody an earlier tradition of care. He concludes that it was the capacity of the asylum to appeal to all shades of opinion rather than fulfilling the aims of any particular ideological camp which explained its enduring success.²⁷ This analysis usefully draws attention to the impact of Poor Law reform on the lunacy debate in the decade after 1834, though it may be argued that the ideological strands described by Bartlett were less distinctive than he implies and the political struggles within the Poor Law unions and with the emerging asylum authorities remained intense in the years following 1845.²⁸ Many local Guardians and even the Poor Law Board continued to resist the Lunacy Commission’s directive that workhouse inmates be released to the care of the county asylums, while boroughs should build their own specialist institutions for the care of the insane and the mentally defective. The responsibilities accorded to the Poor Law authorities under the lunacy legislation can be explained, in part at least, by their strategic role as the established and most important taxraising body in local government and the only agency with the experience and staffing to support the magistracy in the administration of asylum committals. They also enjoyed considerable autonomy from the London authorities. The relative cost of care remained an important theme in the attitudes of local Poor Law Guardians and ratepayers to usage of specialist asylums, particularly before the important reforms of local government in 1888. The detention of the less hopeful ‘chronic’ cases in workhouse accommodation was permitted if not encouraged by legislative changes to the lunacy laws in 1862. The unions came under further pressure to improve their services in the 1880s and by 1900 the long-term care of ‘idiots’ and ‘imbeciles’ was concentrated in some areas within specialized workhouses.

In the century after 1845, workhouse provision appears to have been in consistent evolution as sites were dedicated to caring for groups such as adult females diagnosed with mental deficiencies, sometimes alongside illegitimate children.²⁹ Elaine Murphy’s study of Poor Law policy and lunacy provision in Victorian London (Chapter 2) draws out the distinctive patterns and continuities of provision in the Metropolis, amidst continuing debates on policy and practice during this period.³⁰ There is evidence of diverse and distinctive practices among Poor Law authorities dealing with the complex problem of caring for these groups until the early years of the twentieth century, when the passage of the Mental Deficiency Act altered the terms on which ‘idiots’ and ‘imbeciles’ could be accommodated. The Poor Law unions in London as well as Devon, for example, became significant clients of the large Starcross Idiot Asylum discussed in Dale’s chapter (Chapter 8), though after 1914 the bulk of admissions were sent by Devon’s county and borough authorities.³¹ The impression made by changes in the administrative boundaries as well as the scope of local government, including the major reforms of 1888 and 1929, is rarely discussed in the historical literature on institutional care, though such reforms were fundamental to shifts in Poor Law responsibilities.

The continuing influence of the Poor Law was also registered in the responsibility of Guardians for enforcing the legal duties of families, though the capacity of local authorities to police these obligations were considerably extended by the government reforms and legislative changes seen in the years 1888–1914. In his Earlswood study, Wright emphasized the key role of families in calculating the institutional committal of children while considering the needs of siblings and the household.³² Prestwich similarly regards the later introduction of the category of voluntary patient in asylum admissions as confirming a fresh relationship between doctors and families rather than physicians and individual patients, with compulsory admissions imposed on those households and kin who were reluctant to cooperate in decisions on the care of patients.³³ Illuminating the role of kinship groups in institutional care offers a useful corrective to earlier interpretations which often privileged class and gender as primary factors in asylum admissions. Evidence drawn from Poor Law and other sources points to the need for caution in assuming that families exercised either a benign or consistent influence in dec...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Illustrations
• Contributors
• Acknowledgements
• 1 The politics of mental welfare
• 2 Workhouse care of the insane, 1845–90
• 3 Needs and desires in the care of pauper lunatics
• 4 ‘Buried alive by her friends’
• 5 Separatism and exclusion
• 6 Family, gender and class in psychiatric patient care during the 1930s
• 7 The ‘manufacture’ of mental defectives
• 8 Tension in the voluntary–statutory alliance
• 9 ‘A satisfactory job is the best psychotherapist’
• 10 Inside the walls of the hostel, 1940–74
• Landmarks in the care of the mentally disordered
• Select bibliography and further reading