The Victorian Asylum is a system that has long gone and it is doubtful that such a system will exist again.
How did the Asylums come about?
The first recorded Lunatic Asylum in Europe was the Bethlem Royal Hospital in London, it has been a part of London since 1247 when it was built as a priory. It became a hospital in 1330 and admitted its first mentally ill patients in 1407. Before the Madhouse Act of 1774, treatment of the Insane was carried out by non-licensed practitioners, who ran their Madhouses as a commercial enterprise and with little regard for the inmates. The Mad House act established the licensing required to house insane patients, with yearly inspections of the premises taking place.
In 1792, the York Retreat was set up by William Tuke. This was the first establishment in the UK to treat their patients as human beings and offer a therapeutic setting for them. Mechanical restraints were discontinued and work and leisure became the main treatment. In 1808, the County Asylum Act was passed, which allowed counties to levy a rate in order to fund the building of County Asylums. The intention was to remove the insane from within the Work Houses and provide them with more a sufficient and dedicated care system. However, due to the Act deficiencies, only 20 County Asylums were built around the country.
How did the mass construction come about?
Due to deficiencies of the 1808 Act, counties did not begin mass construction of Asylums throughout the country. It was not until the passing of the County Asylum / Lunacy Act in 1845 did the construction begin to take hold. Due to a change in the law, Counties were legally obliged to provide Asylum for their Lunatics. This Act, based on the work of John Conolly and Lord Shaftsbury saw the lunatics being treated as Patients and not prisoners. It also took into account the moral treatment pioneered by William Tuke and saw the care of the lunatics being funded by the individual County. During this time, the Asylums become vastly overcrowded and rapid expansion of the ensued. Between the passing of the act and 1890, when the next act was passed, over 60 Asylums were built and opened (A further 40 were opened after this date).
What was it like for the Patients?
Without a time machine, it is hard to say! In all honesty, it varied depending on which era you looked at, conditions were ever changing. The most notable condition for the patients was the segregation of the sexes. It was not until the early 20th century that the sexes were allowed to mix, albeit they still slept in same sex wards.
Patients lived within the confines of the hospital, privacy was minimal. Wards were able to house up to 50 patients, in very close proximity and little personal space. The daily regime was strictly regimented, with little room for variation and often under the watchful eye of staff. During the early years of the Asylums, wards were locked and security was kept high as attendants were fined for every patient that escaped on their watch. As the years passed, this was more relaxed, and by the time the asylums were coming to a close, patients were allowed much more freedom and were actively encouraged to leave the hospital and visit the local towns.
Throughout the entire life of the Asylum system, patients were encouraged to work and undertake recreation. Local artisans were employed to teach skills and aid in the production of goods that were sold and used to fund social events. Sports teams were formed, and inter-hospital rivalries were formed. The able bodied were put to work around the hospital grounds, males running the farms and traditional male activities, and the females the laundry and kitchens. The sick and infirm patients were housed in their own wards and will have spent the majority of their time there. Angry, violent or suicidal patients were housed within the wards, and on occasions, locked within a padded cell. Seclusion rooms were also employed, but these were mainly used for patients who would disturb others during the night, in latter years they were sued for patients as a reward so that they could have some privacy.
What was the Work and Recreation?
Work and Recreation was central to life within the Asylum. Sport was made available to the patients, but walking within the grounds and woodlands was the most widely available. This started out as being heavily supervised walks, but as time passed, it was realised that other activities such as art, music and dancing were beneficial. The social activities of the hospital progressed with those of society as a whole, and holidays and interaction with outsiders was encouraged, helping to rehabilitate them. Sports became more prevalent as time passed, and many different teams were formed.
The Farm was the main centre of employment for the male patients, where they grew food stuff for the hospitals consumption. The farms proved to be one of the most profitable activities the patients undertook, but with the advent of the NHS the farms began to close and the land sold off. The kitchens were also a great source of employment, with food grown and produced by the patients being served. Patients were also employed in the distribution of the dinners, and each patient undertook that task every day. So one patient would make porridge for the entire hospital, everyday! The Laundry was the largest female employer within the Asylums. Clothing and bedding were sorted in the wards, booked out and transported to the laundry for washing. Patients who worked in the laundry were normally housed within the Laundry Ward. There was also various other work departments around the buildings, dealing with trades such as shoe repair, printing, clothing repairs, the libraries and various aspects of the engineering departments. It was known for patients to be paid for the work.
How was it different for the sexes?
According to case notes, most women came in for short periods only simply to recover from the stress and exhaustion of their domestic lives – once rested and relaxed they were sent on their way. Women were also admitted from problematic marriages or as a result of giving birth to illegitimate children – even if a result of rape. Post natal depression was also a common reason for a women admittance.
The females wards differed vastly from the male wards; they were based around Victorian ideals of femininity with little opportunity for them to go outside and even fewer opportunities to play games. It was only later that this changed. As with the tradition at the time the women’s activities were confined to the indoors, which led to a strong bond being formed between both female patients and staff. The women were put to work throughout the asylum, mainly undertaking jobs in the needle room, the laundry and general housekeeping duties around the ward – the latter was kept for problematic patients.
The daily routine of the ward remained unchanged for many many years, patients would rise at 7am for breakfast which would consist of coffee, tea or cocoa with porridge and bread as the main. After breakfast the ‘good’ patients would have been taken to there respective jobs in the laundry or needle room – the others would have waited around until the airing courts were opened later in the morning. Lunch would have been served at around 12:30 and would have consisted of food produced on the local farm; this was the main meal of the day. The airing courts were then opened up again in the middle of the afternoon for just over an hour. Tea was served in the early evening and was known to consist of bread and cake. Due to staff shortages on the female side of the hospitals, nurses were known to have dosed the patients with paradehyde in the evenings to ease the load.
The majority of male patients within the asylum system before the first world war were often poor and without spouses to look after them. After WWI, ‘Shell Shock’ was a prevalent condition among men admitted to the Asylums. At the time of this condition being diagnosed it cause controversy due to the condition being similar to the female psychosis. Alcoholism and the delusion related with it were also common reasons for certification. Unlike the female sides of the asylums, the male sides were smaller in numbers. Escape was more common with male patients than females; but due to the smaller numbers of males in some hospitals it was noted that they had a more stable time within the ward.
The males wards had the same daily schedule as the female wards and instead of being involved with the laundry and needle rooms, they worked the kitchen and the bakehouse. They were also involved in the daily housekeeping of the wards. Other than the difference in activities the male wards were normally run with a stricter discipline; which most of the patients would have been used to given their backgrounds within the military. The male population of the Asylums received a wider range of activities for their recovery; they were allowed to join sports teams and the hospital band (if there was one); there were also inter-hospital leagues fort hem to compete in. Rational patients were also employed on working the farms and the upkeep of the grounds and gardens; they were also employed in various workshops and engineering practices. One such example is an account from Severalls of a male patients were used to lay 2-inch piping to the cricket ground, and build a band stand.
What were the treatments that were used?
The treatments used throughout the history of the Asylums have varied massively. When the Asylums first opened, there was little knowledge of the psychiatric conditions or how to treat them. The lunatics were kept calm and occupied as much as possible, and when the need arouse then restraint was employed. The first therapy that was employed throughout the Asylum system was the treatment of General Paralysis of the Insane, caused by Syphilis, with Malaria infected mosquitoes. This treatment was used through until the 1950s when a new drug was developed. The next treatment that was developed was the Deep Insulin Therapy, where it was believed that Schizophrenia was caused by a high blood sugar in the brain. Insulin would be administered until the body went into shock and then the patient was revived with a sugary dose of tea. In the 1930s, two major treatments were developed in Europe, these were the Electroconvulsive Therapy (ECT) and the Lobotomy. Both these treatments involved stresses to the brain. ECT involved passing a current through the brain and induce an epileptic fit, which was known to cause injury to the patient. ECT proved to be very effective for patients suffering with depression and still used in very rare cases today. The lobotomy involved cutting the brain tissue within the frontal lobes of the brain. This had mixed results and was discontinued in the 50s.
The big breakthrough in the psychiatric treatments was the introduction of drugs to the Asylum system. The first drug to be used, discovered by a French Naval Surgeon was Chlorpromazine (Largactil) and was the first antipsychotic to be developed and it had a huge impact on the condition of patients. This development led to the rapid introduction of drugs within the psychiatric world. The next large development was talking through patients problems, and occupational therapy.
Were mechanical restraints used?
In short, yes. Before the advent of drugs and other treatments, manic, aggressive and suicidal patients were dealt with through restraint. Padded cell were also used to house patients who were self harming, or violent towards other (see our padded cell section). The most common restraints were the straight jacket and fingerless gloves. Both of these inhibited the movement of the patient. Less common forms were the used of continuous baths patients were placed in a warm bath and a sheet affixed over the top, with their head and shoulders coming through it and bed restraints. In the early years of the Asylums, restraints were common place, and their used recorded. After the 1890 Act, the use of restraints was severely limited and had to be approved by a medical officer and each use recorded.
Why did they close?
They had become to large, unwieldy and the system had opened itself up to abuse. In 1961 the Minister of Health, Enoch Powell was invited to speak at the AGM of the National Association for Mental Health. In his speech he announced that it the government of the day intended to “the elimination of by far the greater part of the country’s mental hospitals.” At the same time, regional boards were asked to “ensure that no more money than necessary is spent on upgrading and reconditioning”. This announcement had stunned the medical professions as there had been no indication that the government was going to head in this direction; only a handful of experimental community care programmes existed around the country. It would take 25 years for these plans to take afoot and the closures to start.
There were two reasons for the decline in the large institutions, the advancement in psychiatric treatment meant that a standard hospital was able to provide care to acute cases that required immediate attention, and the drugs available meant that patients did not need twenty-four hour care. This meant that the traditional asylum was left with fewer long term patients to care for – patient numbers reduced from over 150,000 in 1950 to 80,000 in 1975. The second reason for the closure of the mental hospitals was the passing of the Mental Health Act 1983 – this saw the people being committed to the large asylums being given back their full rights and having the ability to appeal their certification; it also saw the mentally deficient being moved back into the community under the care in community projects.
The first hospital to close due to the shift in medical treatment and public perception was Banstead Hospital in 1986, others followed suit over the next twenty years, with only a handful remaining open today. The medical staff at many hospitals still keep in contact with their old patients to make sure that the arrangements are working for them. The hospitals themselves either stand empty and derelict, or have been demolished and converted to cheap affordable housing, with only a few reminders to the residents of the previous history there.
The Victorian Asylums are now a long forgotten memory, however in a recent NHS study, they have found that people suffering from mental illnesses recover when they are in a safe environment and are involved in their treatment, rather than being allowed to fend for themselves. In speaking with a number of retired nurses who had worked within the system, they were unsure as to whether the mass closures and the entire move to the care in the community method was the right one. One even felt that the number of hospital that closed shouldn’t have been so high, with a few being kept as regional specialists that could provide a more comprehensive support system. At the grounds of Horton Hospital, two of the old villas have recently been refurbished to act as a care home for the mentally ill.