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Models of madness in Victorian asylum practice

Published online by Cambridge University Press:  28 July 2009

Laurence J. Ray
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Extract

During the past few years there has been a rapid growth of interest in the sociological history of psychiatry. Prior to this, the history of psychiatry had been left largely to the psychiatric historian, who tended to proceed, as Thomas Szasz claimed, ‘as a socially neutral person, discovering the historical “facts” when in truth, he is a psychiatric propagandist, actively shaping the image of his discipline’ (1). Writers such as Michel Foucault, Vieda Skultans, Andrew Scull, David Rothman, Klaus Doerner, and Szasz himself have attempted to underline, as Skultans says, ‘the specific uses to which psychiatry has been put in the past, in order to make a more general claim about the nature of psychiatry as such’ (2). This aim, however, is not always made fully explicit (3). In this paper it will be argued that psychiatry, viewed as a historically constituted social activity, was characterised by a dualism. It was constituted by a medical or curative model of practice, in that psychiatry developed as a branch of medicine. Yet the ‘diseases’ which psychiatrists have historically come to regard as part of their field competence are distinguished by at least two criteria: first, their symptoms consist primarily of actions that are highly inappropriate to their social context; secondly, that their etiology is ambiguous. It will be argued here that an ambiguity regarding the etiology of mental disorder, which is often seen as both physically and psychologically caused, was central to psychiatric discourse.

Type
Comprendre Les Cas Extrêmes
Information
European Journal of Sociology / Archives Européennes de Sociologie , Volume 22 , Issue 2 , December 1981 , pp. 229 - 264
Copyright
Copyright © Archives Européenes de Sociology 1981

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References

(1) Szasz, T.S., Manufacture of Madness (London, Paladin, 1973), p. IIIGoogle Scholar. I have in mind historians such as Hunter, R. and McAlpine, I., Three Hundred Years of Psychiatry, 1535–1860 (New York, Oxford University Press, 1963)Google Scholar, or Psychiatry for the Poor (London, Dawsons, 1974)Google Scholar; Alexander, F. G. and Selsnick, S. T., The History of Psychiatry: an evaluation of psychiatric thought and practice from prehistoric times to the present (New York, Harper and Row, 1966)Google Scholar; Zilboorg, G. Z. and Henry, G., A History of Medical Psychology (New York, Norton, 1969)Google Scholar. This is not at all to deny the scholarship of such work, but to draw attention to its perspective. Note how these titles, for example, imply a ‘march of progress’ view of scientific knowledge, so that ‘psychiatric thought and practice’ can be discovered in ‘pre-history’.

(2) Skultans, V., Madness and Morals, Ideas on Insanity in the Nineteenth Century (London, Routledge and Kegan Paul, 1975), P. 25Google Scholar.

(3) Foucault, M., Madness and Civilization. A history of madness in the age of reason (New York, Vintage, 1972)Google Scholar. Skultans, V., Madness and Morals. Scull, A. T., Museums of Madness. The social organisation of insanity in nineteenth-century England (London, Allen Lane, 1979)Google Scholar. Szasz, T. S., Myth of Mental Illness. Foundations of a theory of personal conduct (London, Paladin, 1973)Google Scholar, and Manufacture of Madness. Rothman, D. J., Discovery of the Asylum (Boston, Little, 1971)Google Scholar. Doerner, K., Madmen and the Bourgeoisie (New York, Urizen, 1979)Google Scholar.

(4) Report of the Commissioners in Lunacy (hereafter CiL), No. 33 (1879)Google Scholar. Parl. papers, 1878–9, XXXII.

(5) Computed from Scull, , Museums of Madness, p. 224Google Scholar.

(6) Granville, J. M., The Care and Cure of the Insane, 2 Vols. (London, Hardwicke and Bogue, 1877) I, p. 6Google Scholar.

(7) Scull, Museums of Madness, ch. VII, discusses the reasons given by alienists for this increase in insanity.

(8) Patients removed to other asylums are included in these ‘resolved’ cases, and it could be argued that these are really part of a ‘circulating’ chronic population. Removals were rare from Lancaster: only three from the first, and sixteen from the later batch. At Brookwood, removal accounts for 17.5 % of the 1870s and 6.3 % of the 1890s batch.

(9) These figures exclude those discharged to the care of a relative, or not improved, but include those discharged relieved or discharged recovered.

(10) There is, of course, the question of the re-admission rate. This is difficult to assess. Granville quotes an average re-admission rate for Brookwood 1867–74 of 17.05%, against a rate for all County and Borough Asylums of 36.1%. The latter is quite high, although a high re-admission rate is really a feature of institutions with rapid turnovers, not of custodial institutions.

(11) The notion of metaphors of illness here derives from Susan Sontag, , Illness as a Metaphor (London, Allen Lane, 1979)Google Scholar. Sontag argues that TB and cancer have been surrounded in fantasies, which attribute their etiologies in some measure to moral failings of the victim. The origin of these metaphors is diverse—in cultural images and economic structures—but they serve to render scientific understanding of the disease more difficult.

(12) Skultans, Madness and Morals, Introduction.

(13) Siegler, M. and Osmond, H., Models of Madness, Models of Medicine (London, Macmillan, 1974)Google Scholar, and Gordon, G., Role Theory and Illness: a sociological perspective (New Haven, College and University Press, 1966)Google Scholar.

(14) For example Siegler and Osmond, ibid. pp. 267–8 for a list of their eighteen articles on this topic.

(15) Siegler, and Osmond, , The sick role revisited, in Albrecht, G. L. and Higgins, P. (eds.), Health, Illness and Medicine. A reader in medical sociology (Chicago, Rand McNally, 1979), pp. 146–66Google Scholar. Regarding the sick role concept, the literature is extensive. See for example Parsons, T., The Social System (London, Routledge and Kegan Paul, 1970)Google Scholar; Parsons, , The sick role and the role of physician reconsidered, Health and Society (1973), pp. 257–77Google Scholar. Gordon, , Theory and Illness Freidson, E., Profession of Medicine. A Sociology of professional knowledge (N. Y., Dodd, Mead, 1971)Google Scholar. Robinson, D., The Process of Becoming Ill (London, Routledge and Kegan Paul, 1971)Google Scholar.

(16) Foudraine, J., Not Made of Wood. A psychiatrist discovers his profession (London, Quartet, 1975)Google Scholar; Goffman, E., Asylums (London, Penguin 1971)Google Scholar, and the work of Laing and Scheff. On articulation of patient roles as a response to powerlessness, see Szasz, Manufacture of Madness.

(17) Siegler and Osmond, Models of Madness, Models of Medicine; Id. The sick role revisited, p. 159.

(18) J. Bucknill and D. H. Tuke, A Manual of Psychological Medicine, 1858 (Reprinted, London, Harper, 1968). When citing textbooks of psychiatry from this period, it is difficult to know how significantly they affected or reflected asylum practice. This work however, was probably widely used, since it went into four editions between 1858 and 1879. Both authors occupied influential professional positions: Bucknill was editor of the Asylum Journal from 1853–62 and a Visitor in Lunacy from 1862–76. Tuke was the great-grandson of William, founder of the Retreat; he also edited the Dictionary of Psychological Medicine, 1891, and wrote Chapters in the History of the Insane in the Brisish Isles, in 1887.

(19) B. Rush, Medical Inquiries (reprinted, New York, Hafner, 1962) argues that the whip is justified when used by a physician or keeper in self-defence. Almost universal avoidance of restraint was reflected in the replies of asylum managers to a survey carried out by the CiL in 1854 (Report No. 9).

(20) Bucknill, and Tuke, , Manual, pp. 240–60Google Scholar.

(21) Bucknill and Tuke, Ibid. p. 88.

(22) Graham, T., Observations on disorders of the mind and nerves, in Modern Domestic Medicine. A popular treatise18 (London, Simplin and Marshall, 1848)Google Scholar.

(23) Tuke, D. H., Insanity in Ancient and Modern Life with Chapters on its Prevention (London, Macmillan, 1878), p. 124CrossRefGoogle Scholar.

(24) Graham, Observations, loc. cit.

(25) Burrows, G. M., Commentaries on Insanity (London, Underwood, 1828)Google Scholar. Prichard, Treatise on Insanity.

(26) Burrows, ibid. p. 696. Graham, Observations, p. 12. J. Conolly, An Inquiry Concerning the Indications of Insanity with Suggestions for the Better Care and Protection of the.Insane, 1830 (Reprinted, London, Dawsons 1973), p. 496. Conolly was unusual in not regarding asylum committment as a panacea. Indeed, one of the most important decisions for physicians, according to Conolly, was not to say whether or not someone was insane, but whether the insanity was such that they would benefit from removal to an asylum.

(27) This is not to ignore the process by which physicians came to view insanity as an exclusively medical concern. This is discussed at length by Scull, Museums.

(28) The York Retreat, founded in 1792 opened in 1796, became well known after the publication of S. Tuke'S Description in 1813. This model of asylum management was important in reformers' attempts to have a county asylum system established.

(29) Scull, , Museums, p. 167Google Scholar.

(30) Bucknill, and Tuke, , Manual, p. 88Google Scholar.

(31) See for example: Combe, D., Observations on Mental Derangement (London 1831) p. 191Google Scholar; Conolly, Inquiry Bucknill, and Tuke, , Manual, p. 172Google Scholar.

(32) Graham, , Observations, p. 8Google Scholar.

(33) Ibid. p. 7.

(34) Ibid. p. 8.

(35) Ibid. p. 13. Emphasis added.

(36) Smith, F.B., The People's Health, 1830–1910 (London, Croom Helm, 1979) pp. 229–38Google Scholar.

(37) Quoted from Allgemeine Zeitschrift für Psychiatrie und Psychisch gerichtische, in Asylum Journal of Mental Science, II (1856) 15, pp. 111–3Google Scholar.

(38) Review of Noble, D., Elements of Psychological Medicine, ap. The Asylum Journal, II (1856) 16, pp. 188–97Google Scholar. Emphasis added.

(39) The dualistic character of psychiatry has been analysed by Foucault, M., Maladie mentale et psychologie (Paris, P.U.F., 1966)Google Scholar.

(40) Burrows, , Commentaries, p. 103Google Scholar.

(41) Browne, D.T., Report of the State of New York Hospital and Bloomingdale Asylum, 1854, p. 35Google Scholar.

(42) Rosenburg, C.E., The bitter fruit; heredity, disease, and social thought in nineteenth-century America, Perspectives in American History, VIII (1974) pp. 189–235Google Scholar.

(43) Tuke, S., Description of the Retreat at York (York, Society of Friends, 1815), p. 208Google Scholar.

(44) Maudsley, H., Mind and Body (London, Macmillan, 1873)Google Scholar.

(45) Rosenburg, The bitter fruit, op. cit.

(46) Clouston, T.S., Clinical Lectures on Mental Disease (London, Churchill, 1887), P. 633Google Scholar.

(47) Maudsley, H., Physiology and Pathology of Mind (London, Macmillan, 1868), pp. 226–7Google Scholar.

(48) Maudsley, , Physiology and Pathology, p. 231Google Scholar.

(49) Ibid. p. 246.

(50) Ibid. p. 247.

(51) Clouston, , Clinical Lectures, p. 491Google Scholar.

(52) Brookwood Male Case Book (hereafter B.M.C.B.) z (1869–72), 145. Casebooks are cited as follows: vol. (date), page.

(53) B.M.C.B. 2 (1869–72), 156.

(54) Brookwood Female Case-Book (B.F.C.B.): 3 (1871–73): 21.

(55) B.F.C.B. 3 (1871–73): 194.

(56) Siegler and Osmond, The sick role revisited, op. cit.

(57) Average life expectancy was disputed during the century. See Table VI. The average age of those who died within the year of admission, for both Brookwood batches, was 46.5.

(58) Bucknill, and Tuke, , Manual, pp. 439–43Google Scholar. Pinel, Esquirol, Griesinger, Falret, and Haslam all described what they believed to be physical degeneration associated with general paralysis.

(59) B.M.C.B. 2 (1869–72): 122.

(60) B.M.C.B. 2 (1869–72): 112.

(61) Henry, Organic mental disease, in Zilboorg, and Henry, , History, p. 547Google Scholar.

(62) B.M.C.B. 2 (1869–72): 121.

(63) Lancaster Case Books (L.C.B.) 1/16 (1849–52): 3.

(64) Parsons, , The Social System, p. 449Google Scholar.

(65) Ibid. pp. 443–5.

(66) In 1875 alone, out of 3,786 deaths in county asylums in England and Wales, 2,339 autopsies were performed. (Granville, , Care and Cure, I, 198Google Scholar). For a discussion of the affective symbolism of autopsies, see Parsons, , The Social System, p. 449Google Scholar.

(67) Scull, Museums, develops this argument.

(68) Scull, ibid. and Szasz, Manufacture and Myth.

(69) B.F.C.B. 3 (1871–3): 37.

(70) B.M.C.B. I (1867–69): 6.

(71) B.F.C.B. I (1867–75): 49.

(72) Tuke, , Description, p. 156Google Scholar. Conolly, , Inquiry, p. 236Google Scholar.

(73) Lancaster Female Case Books (L.F.C.B.) 3/7 (1878–9): 75.

(74) L.C.B. 1/16 (1849–50): 122.

(75) L.C.B. 1/16 (1849–50): 43.

(76) CiL, No. 7 (1853), P. 7.

(77) L.F.C.B. 3/7 (1878–9): 64.

(78) L.F.C.B. 3/7 (1878–9): 58.

(79) Bucknill, and Tuke, , Manual, p. 481Google Scholar.

(80) Granville, , Care and Cure, I, 17–19Google Scholar.

(81) Ibid. pp. 264–70.

(82) Rosenburg, The bitter fruit. Mackenzie, D., Karl Pearson and the professional middle class, Annals of Science, XXXVI (1979), pp. 125–43CrossRefGoogle Scholar.

(83) Kreapelin, E., One Hundred Years of Psychiatry (New York, Philosophical Library, 1962), p. 51Google Scholar. Of the 120 contributors to Bucknill, and Tuke's, Dictionary of Psychological Medicine (1891)Google Scholar, 68 had hospital or university teaching or research appointments, and 50 were asylum supersional intendents or physicians. (A remaining 10 had no medical affiliation).

(84) Freud, S., Psychoanalysis and psychiatry, Introductory Lectures (London, Penguin Freud Library, Vol. I)Google Scholar, Lecture 16. Libido theory and narcissism, Introductory Lectures, Lecture 26.