Insanity, Race and Colonialism

Managing Mental Disorder in the Post-Emancipation British Caribbean, 1838-1914

L. Smith

• Publisher: Palgrave Macmillan
• Year: 2014
• Print ISBN: 9781137028624
• eBook ISBN: 9781137318053
• Topic: History
• Subtopic: North American History
• Index: History

Despite emancipation from the evils of enslavement in 1838, most people of African origin in the British West Indian colonies continued to suffer serious material deprivation and racial oppression. This book examines the management and treatment of those who became insane, in the period until the Great War.

1

Caribbean Institutions in Context

A study of the development of provision for people deemed insane in the British West Indies cannot be approached in isolation. It needs to be placed within a wider context encompassing several key determinants, some common to Britain and its empire but others more specific to the region. In approaching the problems associated with insanity, colonial authorities sought to adopt similar remedies to those utilised in Britain where, from the mid-eighteenth century, a growing consensus emerged that mentally disordered people required care, treatment, and containment in a specialist institution. By 1840 the English lunatic asylum system had attained a degree of sophistication.¹ The institutional model was already being disseminated to the empire, based on an assumption that it would meet the needs of diverse colonial societies, as part of the civilising infrastructure. In its transmission to the West Indian colonies, the British approach required adaptation to meet the particular social, political and economic challenges of a region dominated by the complex realities and consequences associated with the prolonged enslavement of African people, and their emancipation in 1838. Social dislocation and dysfunction were endemic throughout the region and persisted into the next century. These conditions produced fertile breeding grounds for the genesis and perpetuation of mental disorders.

The rise of the public asylum in England

Although the great expansion of England’s asylum system occurred during the nineteenth century, its roots were older. The origins of Bethlem Hospital in London dated back several centuries. The opening of the magnificent new Bethlem at Moorfields in 1676 proclaimed that the mentally disordered poor constituted a public charitable responsibility. The hospital remained the nation’s most prominent institution for the insane for another hundred years, simultaneously a symbol of enlightened, humane care for a deeply unfortunate group of people and also, in its characterisation as ‘Bedlam’, a place of disorder, neglect, and mismanagement.² The emergence of the voluntary hospital movement in the eighteenth century offered an alternative model.³ The establishment of St Luke’s Hospital for Lunaticks in 1751, financed by public subscription, was subsequently followed by other lunatic hospitals or asylums in several provincial cities, including Manchester, York, and Liverpool.⁴ These voluntary institutions were portrayed as a benevolent alternative to the growing number of private ‘madhouses’ catering both for the wealthy insane and, increasingly, for ‘pauper lunatics’ supported financially by their parishes.⁵

A rationale of these lunatic hospitals, and some better managed private asylums, was the principle that effective treatment required early removal of the patient from the environment in which the disorder had originated to an institution managed by a specialist practitioner assisted by experienced ‘keepers’.⁶ Michel Foucault has famously construed the eighteenth century as the period of the ‘great confinement’ of all manner of damaged and disadvantaged people, the mentally disordered among them; all were social misfits incapable of contributing to the labour market and earning a living.⁷ He identified the emergence throughout Europe of specialist institutions for the insane, which became increasingly medical in character.⁸ Other historians, particularly Roy Porter, have contended that Foucault’s perspective over-states what occurred in England, where the numbers confined as lunatics in specialist institutions, though rising, stayed relatively small.⁹ Indeed, many mentally disordered people still remained in their families and communities, or in parish workhouses, some well cared for whilst others were subjected to neglect and harsh treatment.¹⁰

The currents of thinking and activity associated with the era of ‘Enlightenment’ yielded significant changes in approaches to madness and its treatment. Earlier conceptions of the madman as a wild beast who required taming, or a savage whose excesses had to be forcibly controlled, gave way to an acceptance that insanity constituted a loss of reason and rationality but not of humanity. Treatment became increasingly directed toward the restoration of reason, albeit accompanied by practical measures to minimise risk to the sufferer and those around him.¹¹ Madness, as a disease of the brain, was seen to require medical interventions, directed by a physician, who might deploy medicines as well as physical treatments like bleeding, blistering, and water-based remedies such as warm baths or cold showers.¹²

The most significant therapeutic development in the latter half of the eighteenth century was the elaboration of psychological techniques. Dr William Battie, the first physician to St Luke’s Hospital, and his colleague and rival Dr John Monro of Bethlem Hospital, both highlighted the importance of ‘management’ in approaching an individual’s mental disorder, according it a significance at least equal to that of medicine.¹³ ‘Management’ referred both to the direct interactions between practitioner and patient, and to the regime and environment within which they occurred. Its essence lay in the physician gaining a degree of control over the patient, by the simultaneous or alternating use of stern authority and a humane, kind demeanour. The methods became refined under the heading of ‘moral treatment’, describing approaches that were primarily psychological or social rather than medical. Although the Quaker-inspired York Retreat, opened in 1796, has been closely identified with the conception of ‘moral treatment’, the associated practices were already established in several enlightened public and private institutions.¹⁴ Radical critics of the asylum, like Foucault and Andrew Scull, have construed ‘moral treatment’, as practised at the Retreat, as offering a sophisticated psychological technique to restrain deviant, non-conforming behaviour, different mainly in degree from the physical and mechanical forms of restraint still prevalent in most lunatic asylums.¹⁵

By the early nineteenth century, an active lunacy reform movement was promoting the extension of public asylum provision. The parliamentary investigation of 1807 led to legislation in 1808 giving county magistrates powers to erect an asylum for pauper lunatics, or to join with voluntary subscribers and provide also for charitable and private patients.¹⁶ Within a decade several counties had opened an asylum, and others were following.¹⁷ Major parliamentary enquiries in 1815–16 and 1827 highlighted abuses in certain public institutions (York Lunatic Asylum and Bethlem Hospital) and some private ‘madhouses’, particularly in London.¹⁸ Their deficiencies were contrasted with the progressive practices of the York Retreat, the new county asylum at Nottingham, and a few well managed madhouses.¹⁹

One of the key emerging elements in ‘moral treatment’ practices was the elevation of work as an instrument of therapeutics. It had been introduced on a small scale at the York Retreat and at St Luke’s Hospital, where patients might be engaged in gardening, domestic tasks, or in assisting with building maintenance.²⁰ The benefits were first propounded by Dr William Saunders Halloran, in 1810, based on his experience at the Cork Lunatic Asylum in Ireland.²¹ However, it was William Ellis at the West Riding Asylum, Wakefield, who first implemented an extensive structured programme of work for patients in a public asylum. By 1825 many of his male patients were engaged in agricultural and gardening work, and trades like tailoring, carpentry, shoe-making, and weaving, in addition to domestic work on the wards, in the laundry and the kitchens.²² Ellis’s efforts at Wakefield demonstrated that work could channel patients’ thoughts and energies away from distressing and risky symptoms, thereby promoting recovery and preparing them for a return to the community and labour market. The model was gradually disseminated through the public asylum system, Ellis himself replicating it on a grand scale at the Middlesex County Asylum, Hanwell, after becoming its medical superintendent in 1830.²³

By the late 1830s there was a well-established ‘mixed economy of care’ in provision for the insane in England. Mentally disordered people might find themselves institutionalised in a voluntary lunatic hospital, a county asylum, a private asylum, or a local workhouse.²⁴ The nature and quality of care and treatment ranged throughout from the humane and enlightened to the custodial and seriously defective. The lunacy reformers’ cause was boosted in 1838 with the proclamation of the ‘Non-Restraint System’ in two important public institutions. Robert Gardiner Hill published his celebrated lecture, announcing his complete abolition of strait-waistcoats, chains, straps, handcuffs, and all the other paraphernalia of mechanical restraint, in the (voluntary) Lincoln Lunatic Asylum.²⁵ Within months John Conolly had replicated abolition in the huge Middlesex County Asylum at Hanwell. Their claimed achievements animated medical and asylum discourses, arousing heated controversy between advocates and opponents of ‘Non-Restraint’.²⁶ A new standard had nevertheless been set for the humane management of insanity, to be incorporated into the armoury of ‘moral treatment’.

Armed with the philosophies of non-restraint and work-based treatment, Lord Ashley²⁷ and his fellow reformers secured a nation-wide investigation into all forms of institutional provision, conducted by the Metropolitan Commissioners in Lunacy during 1842–43.²⁸ Their seminal report of 1844 provided a comprehensive, detailed survey of conditions in public and private asylums, as well as workhouses accommodating insane patients. The commissioners condemned custodial facilities and the excessive use of mechanical restraint, praising places where these practices had ended and patients were kept occupied. The deplorable state of many private asylums was exposed, whilst the advantages of existing county asylums were highlighted, notwithstanding their overcrowded state.²⁹ The ensuing report and its recommendations proved highly influential. In 1845 Peel’s government implemented the legislation that directed provision for years to come. Henceforth, each county or county borough was required to provide a pauper lunatic asylum, either on its own or in conjunction with neighbouring authorities. A national regulatory body, the Commissioners in Lunacy, would systematically inspect public and private institutions, lay down standards, and oversee the licensing of private asylums.³⁰

By 1860 most English and Welsh counties had established a lunatic asylum, creating a network of substantial purpose-built institutions, most with large tracts of land to provide both employment opportunities for patients and room for future expansion. Their regimes were intended to be therapeutic and humane, based on three key elements – the employment and occupation of patients; non-restraint; and the classification of people according to gender, nature and degree of their mental condition, and, in some instances, social class.³¹ Essentially, the ideas and principles of ‘moral treatment’ had been incorporated into a comprehensive system for the organisation and operation of large lunatic asylums, increasingly becoming systematised as ‘moral management’.³²

The scale of development of the county asylum network exemplified the great faith placed in these institutions. The years following the 1845 legislation witnessed a period of widespread ‘therapeutic optimism’. It was anticipated that the relief and recovery of the evidently growing numbers of lunatics could be accomplished in the new model asylums. Increasingly, however, that optimism came to be misplaced. The numbers of people being admitted continually exceeded the numbers leaving by either discharge or death. Although many recovered to a level permitting return to family and community, a significant number failed to get better and swelled the body of chronic patients whose condition was deemed ‘incurable’. By 1870 most asylums were overcrowded to a point where it was both uncomfortable and detrimental to recovery, and the problems continued to magnify. To meet the exigency, additional wings or stories would be added or new buildings erected.³³ In some counties second asylums were built, and in the most populous like Lancashire, Yorkshire, and Middlesex, several very large institutions had opened by the turn of the century.

There has been argument among historians as to the significance of the ever-growing numbers of people incarcerated in British asylums in the later nineteenth century and after, reflecting debates that took place at the time.³⁴ One incontrovertible factor was the steady rise in national population, particularly in urban areas.³⁵ On its own, however, this was not a sufficient explanation. There has been a recurrent assumption that societal changes and dislocations, like industrialisation, urbanisation and loosened family ties, increased the prevalence of mental disorder. Despite evidence to support some of these contentions, the case has not been conclusively proved.³⁶ More significant may have been a greater tendency to identify people as insane, either potentially able to benefit from asylum admission or otherwise to cause harm, distress, or inconvenience to other people. There were two elements to this greater identification. Firstly, as medical and welfare services became more sophisticated, a larger number of sufferers from mental disorder were observed or diagnosed. Secondly, as Andrew Scull has convincingly argued, the range and degree of mental maladies or deficiencies seen to merit removal and detention in an asylum was steadily expanding. As he represented it, the asylum became a place to sequester people whose behaviour was odd or disruptive, and who were socially inadequate and chronically decrepit.³⁷

By the early twentieth century the country possessed an extensive system of very large public lunatic asylums, each accommodating anything from several hundred to 2,000 patients. New, separate asylums had been developed, particularly in the London area, for specific groups such as ‘idiots’ and ‘imbeciles’ and the ‘quiet chronic’.³⁸ Although the ideals associated with ‘moral management’ continued to inform the operation of these institutions, the practicalities of maintaining large numbers of dysfunctional people proved daunting. Individualised treatment had become impracticable. Medical superintendents depended increasingly on detailed organisation, structure, order, and routine to enable the institution to function with a degree of efficiency. Certain elements of ‘moral management’ proved to be effective aids in the process. The classification of patients, according to behavioural presentation, type of disorder, and prospect of recovery, had become increasingly elaborate, with dedicated wards for ‘refractory’ patients, the ‘convalescent’, and people suffering from epilepsy. Work and occupation retained their place at the heart of the therapeutic programme; if anything their significance became even greater. As asylums expanded, so too did attached farmland acreages and the range of employment opportunities. Work was still regarded as the most effective means of promoting recovery, both by engendering a sense of self-worth and by the inculcation of normal routines which might prepa...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• List of Illustrations
• Acknowledgements
• List of Abbreviations
• Introduction
• 1. Caribbean Institutions in Context
• 2. The Early Lunatic Asylums
• 3. Scandal in Jamaica – The Kingston Lunatic Asylum
• 4. Reform – The Jamaica Lunatic Asylum
• 5. Colonial Asylums in Transition
• 6. Pathways to the Asylum
• 7. The Patient Challenge
• 8. The Colonial Asylum Regime
• Conclusion
• Notes
• Bibliography
• Index