The Rise of the Asylum

Article by Ellie Veryard, Edited by Jack Barnes, Additional Research by Ellie Veryard.

Bedlam depicted in William Hogarth's 'A Rake's Progress' (1735)

Asylums have long captured the public imagination, viewed as institutions of cruelty and horror, of injustice and paranormal incidents, from films to novels to stage plays such as the Jacobean tragedy The Changeling. Recently Martin Scorsese’s Shutter Island centred around an investigation into a disappearance at a hospital for the criminally insane where the protagonists turn out not be who they seem. In the nineteenth century Wilkie Collins’ brilliant novel The Woman in White took the theme of false imprisonment, cruel husbands and real madness to give us one of the first examples of the mystery novel.  Today visitors to the London Dungeons must walk through ‘Bedlam’, where a one figure in a sea of mist watches you hesitantly meander through iron bars until he can scream at you. Even kids films present the same information; Beauty and the Beast sees Gascon and a decrepit-looking asylum manager threaten Belle’s father with incarceration if she refuses to marry Gascon.

But how did the asylum come to be associated with fear and horror? Was this about our changing attitudes to mental illness over the centuries or much more about what mental health ‘hospitals’ represented about institutionalisation and imprisonment?

Possession and demonic activity are two of the ways in which the contemporary public frequently believe our ancestors understood madness. Some of our forebears certainly believed they had seen the devil and whilst popular opinion maintained that some cases of mental illness were caused by the devil, physicians were quick to point out that such an occurrence was unlikely.

dementia, megalomania, acute mania, melancholia, idiocy, hallucination, erotic mania and paralysis (1857).

Whilst it can be tempting to view the public and physicians as two polar opposites; one in magic and misunderstanding, the other in learning and enlightenment, there was much more of an overlap between medical and popular understandings of mental illness. As Michael McDonald has argued, definitions of mental illness by physicians can always be oulined but it is only with public consent that these definitions come to be used in the classification of what contemporaries understood to be mental illness. Thus the most frequently perceivable symptoms, or those most represented in literature and popular culture, came to be the signs by which the public measured ‘madness’. The dangerous, raging person we picture upon hearing words such as ‘insane’ and ‘lunatic’ was not a frequent occurrence; most identified symptoms correspond to what we would term depressive or hysterical behaviour.

Studying the notebook of the seventeenth-century physician Richard Napier, McDonald noted down the terms most used to describe Napier’s mental health patients. ‘Troubled in mind’ was the most frequent, followed by ‘melancholy’ and ‘mopishness’ but further down the list we find ‘hallucinations’, ‘talks too little’, talks too much’, ‘inactive’, ‘suspicious’ and ‘suicidal’, as well as ‘laughs’ and ‘stubborn’.  The most severely perceived form of ill health, McDonald argues, was ‘criminality and sickness’, with ‘melancholy and lethargy’ the less threatening form of mental illness.  At the most basic level it becomes clear signs of mental illness were taken to be contraventions of social and behavioural norms.

Diagnosing madness meant that among the symptoms spotted by family and neighbours was odd laughing, frantic behaviour or a lack of clothes. But people also characterised things they couldn’t understand as mental illness; the destruction of relations with friends and family, attacks on them or even the inability to recognise them were all signs of madness because these seemed such odd and detrimental actions.

'The Madhouse', Francisco de Goya (1746-1828)

Before the eighteenth century only the most dangerous sufferers of mental illness were locked away. Michel Foucault’s highly influential study Madness and Civilisation has likened the early treatment of mental illness to leprosy; arguing that most sufferers were not shut up but simply forced out of towns, and where incarceration was concerned took place on the borders of habitation, signifying the barrier between the rational and irrational. The family took care of those suffering from less severe forms of mental illness, treating them as though they were sick. Whilst there is evidence of the cruelness of medieval society to sufferers, including domestic confinement in cells or ‘domestic cages’ and the association of madness with sin, McDonald argues that in most instances neighbours knew of madness in their community, and the sufferer was not shunned as a more dangerous person may have been. The court was tolerant when those with mental illness where presented before them accused of a crime, though some writers feared that demonstrations of madness in court meant that real criminals might try to feign madness for a more lenient hearing.

Through the sixteenth and seventeenth centuries, Bethlehem Hospital, most commonly known as Bedlam, housed about thirty inmates at a time. By 1700 the accommodation for inmates had expanded allowing 96,000 visitors per year to enter and witness those confined within. Typically the most dangerous continued to be confined within Bedlam, the unpredictable chained up from the terrified public. Visits to Bedlam allowed new ideas on madness to spread, ‘madman’ came to be used as a term of abuse and the violence of the inmates was likened not to an illness but criminality.

The more rigorous separated of madness from society is generally agreed to have taken place in the seventeenth century; Foucault calls this period ‘The Age of Confinement’ and this shift came about partly due to the increasing idea that madness was simply not possible. Deviant behaviour could therefore only be perceived as a willing challenge to society.

Bethlehem Royal Hospital (Bedlam) as it stands today.

Charting the rise of the asylum Andrew Scull believes the driving factor behind the increase to be the changing economic structure of society; no longer believing the elite had a duty to provide assistance, less relief was given to families struggling to care for members with mental health disorders. Coupled with the growing belief that madness did not exist sufferers were incarcerated in the newly emerging workhouses, becoming part of a system that institutionalised those who could not or did not work to create an incarcerated labour pool. Vagrants, sufferers of ill-mental health, petty criminals and the poorest members of society were classed under one over-arching definition of ‘deviancy’.

As so often is argued in the history of social institutions the nineteenth century was the age of reform, and the creation of separate mental health hospitals is cited among them. Foucault maintained the period in fact saw the dehumanisation of sufferers so that control and order could be maintained within such institutions, an argument which H.C.Erik Midelfort notes many academics feel uncomfortable to acknowledge, preferring to view the period as one of progress towards compassion. The century certainly saw a vast increase in the number of institutions set up to contain the mentally ill, with some stretching out over mile long areas. Private institutions were set up for profit, and Andrew Scull argues, created a self-perpetuating myth by claiming the separation of ‘deviants’ was necessary, and then once established the institution itself demonstrated the necessity of separation. Control, Scull reiterates, was the predominant reason for the establishment of these institutions and overwhelming housed the poorer members of society. From a few thousand at the beginning of the century to around 100,000 by the last decade the nineteenth century saw a huge increase in committals. The ‘asylum’ as a place of repression and fear was born; a reminder of conformity and a ‘part of the process in attempting to control deviance.’ Out flooded the stories of forced incarcerations of the sane, of intolerable cruelty and abuses. The asylum was firmly set in public mind as a place of horror and terror.

  • Admittance to psychiatric hospitals today is voluntary in all but the most severe cases, where doctors believe a patient poses a real danger to themselves or others. They provide both long term assisted accommodation and temporary care or treatment for patients. Deinstitutionalisation took place over the twentieth century, allowing patients to remain at home or reside in ‘communities’ designed for care and assistance. Advances in medical science too have allowed people with mental health problems to live freely.
  • It is still possible to find asylums across Europe and the rest of the world and attitudes towards mental illness are still not as progressive as many charities would like, partly due to ignorance, misunderstanding and sometimes apprehension of how to deal with mental illness. To counter this The Mental Health Foundation has held a Mental Health Awareness Week in the UK every year since 2001 to try and raise awareness, understanding and greater interaction.
  • The works of Andrew Scull, Michael McDonald, Michel Foucault and H.C.Erik Midelfort provided the basis for this article but to find out more about the history of psychiatric institutions and mental health the writings of Roy Porter, Robert Burton and P. Elmer are also useful.

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