The lady of the house – psychiatry in literature

In his American Notes (1842), Charles Dickens describes a visit to the State Hospital for the Insane in Boston which, he says, was an institution admirably conducted on enlightened principles of conciliation and kindness:

‘“Evince a desire to show some confidence, and repose some trust, even in mad people,” said the resident physician, as we walked along the galleries, his patients flocking round us unrestrained.’

Dickens notes with approval the beneficial influence of the physician's wife, seated calmly with another lady and a couple of children, in one of the wards where patients worked, read and played at skittles. He notices an elderly female sitting by the chimneypiece and leaning her head against it with a great assumption of dignity and refinement of manner. A head which he says was so strewn with scraps of gauze and cotton and bits of paper, and had so many queer odds and ends stuck all about it, that it looked like a bird's nest. The lady was radiant with imaginary jewels and wore a rich pair of undoubted gold spectacles. Dickens uses the physician's introduction of this person as an example of his manner of gaining and retaining the confidence of his patients:

‘“This,” he said aloud, taking me by the hand, and advancing to the fantastic figure with great politeness – not raising her suspicions by the slightest look or whisper, or any kind of aside to me: “This lady is the hostess of this mansion, Sir. It belongs to her. Nobody else has anything whatever to do with it. It is a large establishment, as you see, and requires a great number of attendants. She lives, you observe, in the very first style. She is kind enough to receive my visits, and to permit my wife and family to reside here; for which it is hardly necessary to say, we are much indebted to her. She is exceedingly courteous, you perceive,” on this hint she bowed condescendingly, “and will permit me to have the pleasure of introducing you: a gentleman from England, ma'am: newly arrived from England, after a very tempestuous passage: Mr. Dickens, – the lady of the house!”’

Every patient in this asylum, Dickens says, sits down to dinner every day with a knife and fork, and in the midst of them sits the gentleman whose manner of dealing with his charges I have just described.

By contrast, reports of the Physician Superintendent of Littlemore Hospital, Oxford, some 80 years later: ‘I regret that I had to summarily dismiss Male Nurse Frank Johnson. He overstayed his leave and entered the Hospital through a ward window on Dec 27’. ‘I regret that I have to report that on April 17th I summarily dismissed Night Nurse O'Hara for leaving knives about in the kitchen of the admission ward’. History's arrow is not straight forward.