‘They were ugly blemishes upon the British landscape and upon its history. Whatever magnificence they once possessed could neither undo their reputation nor see fit to spare them. They had to be erased.’ Swansong, Chapter 1
My debut novel ‘Swansong’ follows two stories of closure: the tragic life of a mentally disturbed girl in 19th Century England, and the tragic legacy of the Asylum to which she was committed.
The process of building the dark, lonely world of ‘Swansong’ has caused me to embark upon a harrowing journey; to explore the history of the Mental Asylums of Britain. In this week’s post, I will outline their origins and how they evolved over two hundred years alongside western society’s struggle to cope with its mentally ill and disabled, up to the inevitable death of the asylums in the 1980s and 90s. While I have built my fictional asylum to appear as sinister, gothic and notorious as the parameters of writing would allow, I endeavour to colour it with facts from the true history of Britain’s mental health system.
The majority of Britain’s Asylums lie abandoned and derelict, burned and vandalised, condemned for demolition and serving as dark and dangerous attractions for Ghost Hunters and Urban Explorers. This state of existence will be fleeting, as every year more and more of these buildings are pulled down to make way for modern redevelopment.
In the novel, I have given the asylums a voice, through my modern narrator and through the conversations between the characters that walk the empty wards in search of signs from beyond the grave, as well as personifying the fictional Asylum itself by giving it the appearance of possessing moods, expressions and an eerie personality of its own. In short, the Urban Exploration – come –Ghost Hunt that is portrayed can give the Asylum its ‘Swan Song’.
Lunatics and Bedlamites: Mediaeval – 18th Century Methods against Madness
Britain did not always have an asylum system. Neither did it have any degree of understanding towards mental illness, its causes and how best to treat it. Before the ‘Enlightenment’, the mentally ill were known as ‘lunatics’, a term derived from Roman Mythology (being ‘moonstruck’ by the Goddess Luna,) while the mentally disabled were referred to as ‘natural born idiots’. Mental illnesses were most often regarded as supernatural. Sufferers were seen to be in the possession of evil spirits, demons or devils. It was also often regarded as a moral issue, whereby mental disorders were believed to be a punishment from God, or a ‘test of faith’. Treatments ranged from Exorcism carried out by members of the clergy, or strict course of fasting and prayer. Furthermore, there was the option of Trepanning: cutting open a hole in the skull. It was believed that Trepanning would release evil spirits or demons from the body, thus alleviating the madness in the person. The process of Trepanning is still used today to relieve swelling in the brain caused by severe trauma to the head. Despite these extreme cases, there were other, more mundane explanations for mental illness in Medieval Britain, including ideas about intemperate diet, alcoholism, overwork and grief.
For the larger part of the Middle Ages, hospitals for the insane were virtually unheard of. Instead, it was the responsibility of the family and the local community, including the local Parish. It has often been considered that the mentally ill of the Middle Ages may have received more support and involvement from their communities than the mentally ill of today.
By the beginning of the 18th Century, understandings of the causes of madness had begun to move away from the supernatural, and it was more often identified as an organic, physical phenomenon which could be addressed through advances in logic, science and reason. This may indicate a giant advancement in understanding and dealing with mental illness, but it was not. Typically, the mentally ill were viewed as insensitive, wild animals, which had to be treated accordingly.
Up until the 18th Century, madness was still widely viewed as a domestic problem, where families and local Parish authorities were seen as central to the care of lunatics, although those who were thought to be particularly violent, aggressive or disturbing could be sent to a House of Correction, a Workhouse or even to Gaol. However, changes were looming. Lunatics were increasingly being interpreted as cunning and dangerous to society; as a result there needed to be a form of mastery brought upon them, to break their spirits with methods of fear and intimidation. A process began to segregate lunatics from society. The asylums movement was beginning.
New asylums gradually began to appear across England throughout the course of the 18th Century: Bethel Hospital in Norwich in 1713, the Chronic Lunatic Ward at St. Guys Hospital, London in 1728, St. Luke’s Hospital in Upper Moorfields in 1751, the Hospital for Lunatics, Newcastle upon Tyne in 1765, The Manchester Lunatic Hospital in 1766, The York Asylum (not to be confused with the York Retreat) in 1777, the Leicester Lunatic Asylum in 1794, and the Liverpool Lunatic Asylum in 1797. However, there is one name that is synonymous – and infamous – with the treatment of the mentally ill of the Enlightenment – Bedlam.
Originally built as a Priory in 1247, St. Mary’s of Bethlehem became a Hospital in 1330, and admitted its first mental patients in the early 15th Century; in 1407 it was housing 6 male lunatics. Benefitting largely from the Great Fire of London in 1666, St. Mary’s of Bethlehem – now more commonly called Bethlem – was relocated to new buildings at Moorfields in 1676, where it was enlarged to house 100 ‘inmates’. Throughout the 18th Century, Bethlem or ‘Bedlam’ gained a notorious reputation as being crowded, noisy, filthy and generally out of control; where the patients, also known as ‘Bedlamites’ were confined, restrained with iron shackles and harnesses and subjected to the most brutal and demeaning treatments, believed to suppress their animalistic passions. Such measures including being submerged in freezing cold water (known as ‘cold bathing’,) being given Mercury Pills, bled with leeches and being forced to vomit. The most notorious ‘therapy’ carried out at Bedlam by far was the ‘Rotating Chair’. A patient was strapped to a chair with leather harnesses at the throat, chest, stomach, wrists and ankles, before being hoisted up into the ceiling and spun around so violently that the patient was likely to vomit, urinate or even defecate himself. The Rotating Chair was so terrifying; staff used it as an intimidation tactic, to threaten the patients into controlling their behaviour.
Possibly the most shocking fact about Bedlam’s 18th Century past was its popularity as a tourist attraction. Wealthy, educated people were encouraged to visit in order to learn the science of madness. Visitors paid a penny to be admitted to the wards, where they could view and observe the lunatics, and even poke them through the bars of their cells with a walking stick to watch their reactions. It was meant to encourage a lesson in human morality; the process of witnessing humanity at its most base and pitiful form was believed to serve as a warning that overindulgence in the passions – whether it be lust or alcohol or diet – could unleash the madness that was lurking within us all. Unfortunately, instead of attracting the educated elite, tourism at Bedlam encouraged the lower spectrum of 18th Century society to mingle with the patients for hours on end, and often riots broke out. Seen as becoming increasingly downmarket, Bedlam eventually closed its doors to tourists in 1770, where it sunk into a shroud of secrecy and suspicion, and became an institution feared by the public rather than enjoyed. For the patients, the changes brought increased isolation and fear as staff were able to enact any measures that they fancied within the safety of Bedlam’s locked doors.
It may have seemed as though no sentence could be worse for a mentally ill person than to be sent to Bedlam; however alongside Bedlam and its public asylum cousins, a lucrative business in running private madhouses was also in operation throughout the 18th Century. It has been speculated that their creation was down to the new capitalist social relations and the need to work in a service based national economy, meaning that families were no longer able (or perhaps willing) to care for disturbed relatives as they had been in previous centuries. By the end of the 18th Century they had gained a popularity in England on a scale unseen elsewhere; and many Madhouse owners made a fortune through being paid by wealthy families to ‘store away’ their mentally ill relatives. Treatment in these Madhouses was carried out by unlicensed practitioners as commercial enterprises; with little regard or respect for their patients. Due to their status as private businesses, they were also able to carry out whatever manner of treatment they saw fit. After the Madhouse Act was passed in 1774 however, the private Madhouses were forced to obtain licenses and undergo yearly inspections; however treatment changed very little despite the changes in laws.
The Advent of the Mad King: Sympathisers of the Mentally Ill in the late 18th Century
In 1788 a constitutional crisis took shape when the King of England, George III, fell into madness. It caused a storm of worry – if the King himself had gone mad, what was to happen to the rest of the country? Despite the panic however, the ‘madness of King George’ served to help shape a growing public sympathy for the plight of the Mad. Elsewhere in the world, attitudes towards the mentally disturbed and their treatment were also beginning to show signs of change. At the Bicetre Asylum in Paris, Phillipe Pinel was the first European credited with introducing more humane methods into the treatment of his patients, while in America; Benjamin Rush sought the integration of the mentally ill back into society, and introduced talk-based therapy which paved the way for the Occupational Therapy still used today. In Britain, Christian duty motivated some to change the ways in which insane patients were treated. In 1792, a Quaker businessman named William Tuke opened the ‘York Retreat’ – the first establishment in the country to treat its patients humanely and to replace physical restraints and punishments with work and leisure based therapy. As the medical understandings of insanity (known as ‘mad doctoring’) had come to be associated with the atrocities carried out in places like Bedlam, the York Retreat abandoned medical approaches in favour of understanding, hope and moral responsibility. The work of individuals such as Pinel and Tuke began what came to be known as ‘Moral Management’.
By the end of the 18th Century, general attitudes towards the Mad were undergoing major change; which also signalled for a more critical evaluation of the country’s methods for looking after mentally disturbed members of society. In 1814, there was a Parliamentary Enquiry into the conditions of Bedlam after they had been exposed in an investigation carried out by Edward Wakefield. Wakefield reported how he found patients left naked, confined and chained to the walls or to straw covered floors, while his description of the harnessing of one patient in particular, James Norris, caused outrage:
a stout iron ring was riveted about his neck, from which a short chain passed to a ring made to slide upwards and downwards on an upright massive iron bar, more than six feet high, inserted into the wall. Round his body a strong iron bar about two inches wide was riveted; on each side of the bar was a circular projection, which being fashioned to and enclosing each of his arms, pinioned them close to his sides. This waist bar was secured by two similar iron bars which, passing over his shoulders, were riveted to the waist both before and behind. The iron ring about his neck was connected to the bars on his shoulders by a double link. From each of these bars another short chain passed to the ring on the upright bar … He had remained thus encaged and chained more than twelve years.—Edward Wakefield, 1815
The Enquiry led to the resignation of Bedlam’s chief physician and the closing down of the Moorfields building which had fallen into such a state of disrepair as to be mostly uninhabitable; Bedlam was relocated to new buildings in Lambeth.
While the condition of Asylums was being revealed and improved; the medical profession of ‘mad doctoring’ was also beginning to gain a new identity for itself. Mad Doctors were increasingly being referred to as ‘Alienists’ (as they treated people who had been ‘alienated’ from society) while the term ‘Psychiatry’ was coined in 1808 by Dr. Johann Christian Reil, derived from Greek words meaning ‘medical treatment of the mind’. However it was the idea of Moral Management that would bring forward the next chapter in the history of Britain’s mental health system.
From Hanwell to Claybury: The success and failure of the Victorian Asylum
It is the LUNATIC ASYLUM for the county of Middlesex…a temple sacred to benevolence, a monument and memorial of the philanthropy of our times. ~ Sylvanus Urban, The Gentleman’s Magazine (July- December 1858)
This quotation, from an 1858 issue of the Gentleman’s Magazine, is referring to the first Middlesex County Asylum at Hanwell. Opened in 1831, Hanwell was the first purpose built Asylum in Britain and a pioneer for the moral management of the mentally ill. Inspired by ideas carried out by Robert Gardiner Hill and Edward Parker Charlesworth at Lincoln Asylum, John Adams and Dr. John Connolly at Hanwell began using a new coercion-based treatment for their patients, which eliminated the need for mechanical restraining.
Hanwell was seen as a model institution for Victorian principals of care towards the mentally ill and generally, the insane of the 19th century were handled with much more dignity and much greater care; but with just as much misunderstanding.
The idea of the asylum as the best solution to the problem of mental illness was synonymous with the Victorians’ ‘brick and mortar solutions’, the process of compartmentalising society into ‘appropriate’ buildings also saw the criminals placed within a new prison system, the poor into the Workhouses, and the mentally ill into Insane Asylums.
In 1841, an Act was passed which required the Government to inspect every asylum. A report on ‘Lunacy’ was presented in the Westminster Review of 1845 and in the same year, the Government passed the Lunacy Act; stating that all counties and boroughs must provide accommodation for the community’s mentally ill. A similar law had been laid down earlier in 1808 – the County Asylum Act –in which local authorities were given the choice to levy funds to build asylums for disturbed members of society. Unsurprisingly, few counties took up the task, so by 1845 they were obliged to provide asylums by law.
This turnaround in attitudes and the interest of a government sympathetic to social reforms brought a popularity to asylums which came to be known as ‘the great confinement’ or ‘the asylum era’. The early Victorian asylums were small scale hospitals; but the rise in dependency upon them; brought about by a steady increase in the amount of people officially diagnosed with mental disorders and a lower social tolerance for unusual behaviour caused them to expand alarmingly over the coming decades.
At first, asylums were built to cater – under the principals of Moral Management – for a small population of patients, up to 500 per asylum. The success of the asylum movement however, coupled with a swelling national population, meant that asylums were redesigned and expanded to take on more and more patients, new ones were built to relieve pressure on older ones, and they housed up to and in excess of over 2,000 patients per asylum by the close of the century. Small hospital buildings expanded into long corridor wards joined by an administration block (Corridor Plan, 1830 – 1890) or expanded outwards into a series of separate detached and semi detached blocks (Pavilion Plan, 1870 – 1907) and were later laid out as separate buildings interconnected by corridors (Eschelon Plan, 1880 – 1932.) By the close of the 19th century, many asylums resembled small towns rather than the small hospitals they had once been. Naturally, under limited staff, space and resources, the ideals of Moral Management began to slip away.
It is well documented that despite the success of Moral Management, very little therapeutic activity took place within the new Asylum System, meaning that forward thinking asylums such as Hanwell remained a minority. Despite the changes in attitude to treatment, life inside a Victorian Asylum was hugely regimented. Patients were divided according to first their gender, and then the manner of their diagnosis and its severity. ‘Sick’, ‘Acute’ and ‘Chronic’ were all terms often used in asylums when categorising patients. Wards housed up to fifty patients in very close proximity to each other, where privacy and personal space was minimal to non – existent. Wards were always kept locked and security was high (attendants were fined for every patient that escaped on their watch,) while the day to day regime was strictly controlled with little room for variation:
Patients were awoken at 7am for breakfast, which was usually porridge and bread served with tea, coffee or cocoa. Good patients were then sent to work, while the others were left to wait for the ‘airing courts’ (enclosed exercise yards) to open later. Lunch was at 12.30pm and was the main meal of the day, consisting of food produced on the Asylum’s farm. The Airing Courts were opened again for an hour in the middle of the afternoon. Tea was served early in the evening and was usually bread or cake. It had been reported than in some instances, patients were given paraldehyde to make them drowsy and more manageable during the evenings.
Work and recreational activities differed greatly between the sexes. Men were sent to work on the Asylum’s farm, contributed to the upkeep of the grounds and the gardens, and were employed in artisan workshops and engineering. They were allowed to join sports teams and musical bands formed at the Asylum. Women on the other hand were given little opportunity to play games and were rarely allowed outside. They were sent to work in the laundry and in the kitchens, and were also expected to help around the wards.
The sexes also found themselves being admitted to the asylums for very different reasons; while their experience of life on the ward also differed greatly between them. Asylums admitted far more women during the 19th century, as they were seen to be more susceptible to madness than men. Their wards were always larger, and were based around the Victorian ideals of women. They were admitted for reasons ranging from exhaustion from their domestic lives, problematic marriages and illegitimate children (even if they were the result of rape) to post natal depression. They were also far more likely to be committed to an Asylum by their families, spouses or the community around them if they displayed behaviour that did not fit with the social norms expected of women. Men on the other hand were admitted after they had ‘fallen on hard times’ and had no spouse to look after them. Alcoholism and delusional behaviour were also common reasons to commit. Male wards were run with a much stricter discipline, although escape was still a common occurrence.
While the process of managing an asylum had changed beyond all recognition to how they had been during the previous century and mental doctors were beginning to be seen as professional in their own right – first calling themselves ‘Alienists’ and later ‘Psychiatrists’ – there was still very little understanding of what caused mental disorders or how best to treat them. Also, while new terminologies for mental disorders were being created such as ‘Hysteria’, ‘Mania’, ‘Catatonia’, ‘Melancholia’ (Depression,) ‘Circular Insanity’ (Bipolar Disorder,) and Dementia Praecox (Schizophrenia,) distinctions between one illness and another were still muddled.
One of the most popular theories of what caused mental illness – dismissed as quackery by the end of the 19th Century – was known as ‘Phrenology’. It was believed that a person’s mannerisms, personality and behaviour could be determined by the shape of their head; and advocated the belief that the brain was divided up into segments which controlled individual mental faculties and traits of character; such as lust, hope, anger, curiosity, etc. The idea had evolved from studying the heads of criminals – looking for similarities that could culminate in showing the typical face of someone who was (or was likely to become) a criminal. The examination was carried out with a pair of Phrenology Calipers – curved prongs with blunted tips that were held together with a screw. The Calipers were designed to measure the shape of the head and work out any abnormalities or inconsistencies in the shape. The positions of the inconsistencies were then compared with a Phrenologist’s chart, which identified which trait it corresponded with. These inconsistencies were believed to indicate areas of the brain that were most developed. Phrenology was used henceforth to determine mood, temperament, likelihood for violence or criminal behaviour, drunkenness, abusiveness, happiness and so on.
It was also increasingly believed that poverty was a cause of mental illness – people became insane because they lived in bleak, industrial surroundings with little to eat and no time for recreation. Therefore, asylums were required to provide a modest quantity of healthy food and be built in suburban locations with access to fresh air.
When the new asylums first opened, ideas for direct treatment were minimal. Patients were kept calm and occupied as much as possible. Processes for ensuring calmness in patients ranged from ‘continuous baths’ (being placed in a warm bath with a sheet fixed over the top with a hole for the head and shoulders) to being given drugs such as Opium and Laudanum or even Morphine and Heroin. Since chained or mechanical restraints had fallen out of favour, violent, angry and suicidal patients were put into straitjackets, locked in padded cells or seclusion rooms, or were restrained to their beds. It was known for some patients to feign violence so that they could be put into a padded cell or seclusion room to get some privacy.
As a final note – at the heart of a Victorian Asylum there was always a chapel. This indicated that faith in God still had a massive impact upon the wellbeing of patients, and was still seen as paramount to their recovery.
War, Depression and Ice Picks: Early 20th Century Asylums
By the turn of the century, Asylums were firmly rooted as the answer to the social problem of madness. The mentally disturbed were seen to be kept in a safe environment, and society was seen to be kept safe from the mentally disturbed. Further advances in the field of Psychiatry were being made; and the dawn of the 20th Century saw the development of ‘Psychoanalysis’, while Asylum superintendents – seeking to improve the status and image of their profession – renamed their Asylums as ‘Hospitals’ and lunatics as ‘Mentally Ill’.
Beneath the surface however, Asylums had become huge, impersonal institutions overburdened with a complex mix of patients; sometimes ranging from the mildly disturbed to the criminally insane, and were increasingly becoming used as the ideal ‘dumping grounds’ for society’s misfits. In retrospect, the turn from the 19th to the 20th century can be seen as the beginnings of a dark period in the mental health system’s history, where asylums were increasingly becoming the locations for horrific living conditions, patient maltreatment and medical experimentation.
By the 1920s, Asylums were overrun with soldiers returning from the Front and suffering with a new and terrifying disorder: Shell Shock. Figures reported that at the time of World War I, some 110,000 people were living within the mental health system in Great Britain.
At the same time, an Austrian psychiatrist, Julius Wagner Jauregg, was conducting studies that led to the first medical treatment for mental disorders – Malarial Therapy for General Paresis of the Insane (or Neurosyphilis.) This method was first used in 1917 and it heralded the rejection of Victorian methods of therapy and the beginning of a radical, experimental era in psychiatric medicine. Three experimental medical treatments in particular from this era became infamous in medical history: Insulin Shock Therapy, Electroconvulsive Therapy and the Trans – orbital Lobotomy.
During the early 20th Century, it was believed that Dementia Praecox – now known as ‘Schizophrenia’ – was caused by the presence of high blood sugar in the brain. Introduced in 1933 by Manfred Sakel, a Viennese psychiatrist, Insulin Shock Therapy was a process whereby Insulin was administered until the body went into shock – after which the patient was then brought back around with a dose of sugary tea.
Electroconvulsive Therapy (also known as Electric Shock Therapy or Electroshock Treatment) was devised in 1938 by Italian psychiatrists Ugo Cerletti and Lucio Bini. The process was used to calm aggressive patients in order to prevent them from harming themselves or others. An electrical current was passed through the brain to induce an epileptic fit, which then left the patient in a state of absolute calm. The process was highly dangerous and risked brain damage, most often being temporary or even permanent memory loss.
The origins of the Trans-orbital Lobotomy can be traced back to late Victorian scientific and medical experimentation. It developed from an earlier process, known as the ‘Leucotomy’, which was pioneered by Antonio Egas Moniz and went through several incarnations throughout the 1930s, before it became the notorious procedure that we are familiar with today in some popular horror movies. Egas Moniz’s procedure of targeting the brain’s frontal lobes was adapted by Walter Freeman and James W Watts to become the Standard Prefrontal Lobotomy (or Freeman – Watts Procedure) before being developed by Freeman into the Trans-orbital Lobotomy from 1946 onwards. It was thought that operating on the frontal lobes altered the workings of the brain; calming the patient and changing their personality. Freeman’s Trans-orbital Lobotomy involved making two incisions (cuts) in the front of the head and inserting blades – known as ‘Orbitoclasts’ – into the brain, making two slices into the frontal lobes. It came to be known as the ‘Ice Pick Lobotomy’, referring to the similarity between the Orbitoclasts and mountaineers’ ice axes. Controversially, it was an ‘office procedure’ which did not need to be carried out in surgical theatre, and took as little as fifteen minutes to perform. The process was also incredibly risky. Patients faced the possibility of death, paralysis, becoming a ‘vegetable’, losing their faculties or their abilities to see, speak and function. Its effects and benefits were disputed immediately, but the process enjoyed a massive popularity in the Asylum system (particularly in America) throughout the 1940s and 50s. Most countries made it illegal by the 1960s.
It is easy to see why the period of the two World Wars was argued to be the heyday of Mental Asylum atrocities. However, there was one more shocking truth to emerge from the period: The Eugenics Movement and the Aktion T4 Euthanasia Program.
There had long been concerns of the mentally ill coming together and procreating create more mentally ill. The Eugenics Movement saw many countries enacting laws for the compulsory sterilisation of the institutionalised; resulting in the forced sterilisation of numerous mental patients within those countries. In their crusade against ‘Undesirables’, Nazi Germany advocated euthanasia programs upon the institutionalised mentally ill. Estimations of over 200,000 mentally ill and 6,000 disabled babies, children and teenagers were put to death by starvation or lethal injection as part of Aktion T4; which unlike the Holocaust, has received very little historical attention. At the centre of the planning, justifying and enacting of the atrocities were Germany’s asylums and psychiatrists.
Dawn of a New Regime: Closure of the Asylums in the later 20th Century
Even though Asylum numbers still continued to increase well into the 1950s, the second half of the 20th Century saw a crisis in mental health care, which was partly blamed on the Victorian Asylum buildings and their practises. They had by this time become too large and unwieldy; and the system had opened itself up to abuse. The conditions of the Asylum buildings themselves started to be questioned and many were considered to be out of date and in need of repair and refurbishing. Reports of overcrowding, barbaric scientific experimentations, poor hygiene and living conditions and maltreatment of patients also began to discolour their reputation. The 1950s and the decades that followed saw several major factors that would lead to the death of the Victorian Mental Asylum System in Britain.
Asylums were often the first places to suffer during periods of economic depression. With huge cuts made in their funds during the Second World War and its immediate aftermath, many asylum patients starved to death. Lack of adequate funding also meant upkeep of the buildings was not regularly carried out, and asylums could rarely expand themselves or build new accommodation for the ever increasing admissions of patients. Furthermore, the barbaric measures that were being taken to calm, treat and attempt to cure patients were beginning to be brought to the attention of wider society – with many people arguing that science was ‘going too far’.
During the later 1940s and 1950s, new drugs were being discovered that had the potential to be used as ‘anti psychotics’. Chlorpromazine or ‘Largactil’ was the first of these new drugs to be used on patients in the asylum system, followed by Lithium, which was discovered to contain mood-stabilising properties by John Cade in 1948. These new treatments revolutionised psychiatric care and lead to a reduction of people being admitted into asylums – but equally they were questioned for working ‘too well’, and rather than calming aggressive patients they seemed instead to turn them into unnatural automatons. Despite the concern, anti psychotic drugs were seen as the way forward; and further new drugs came onto the market. The 1970s saw the widespread use of Benzodiazepines for treating Anxiety and Depression, but were quick to fall out of favour when it emerged that they were highly addictive.
Alongside these developments in psychiatric medicine, developments in non medicinal therapy were also being made. Stress was begun to be seen as having a massive impact upon mental health (the term was first coined in the 1930s,) and measures such as Occupational Therapy and Cognitive Behavioural Therapy were brought into widespread practise by the 1970s, as well as simply ‘talking through’ patients’ problems. It is easy to see within these developments some echoes of the old 18th Century movements towards Moral Management. However, with the overwhelming numbers of patients and understaffing in most asylums, many psychiatrists simply did not have the time to see to all of the patients within their institution and these measures turned out to be difficult to apply in the asylum setting.
Furthermore, the study of psychiatry itself was undergoing major change. The 20th Century saw it expand to include a broader spectrum of mental difficulties and as a result, psychiatrists began to work outside of asylums. The number of those practising outside increased throughout the course of the 20th Century, from 8% in 1917 to 66% by 1970.
In the 1960s, society itself began to speak up against the Asylum system. An Anti – Psychiatry movement began to take shape, while academics started to question the entire practise of institutionalisation and governments’ attention was brought to the matter of what was to be done with society’s mentally ill. In 1961, a series of essays were published by the Canadian sociologist Erving Goffman in a book entitled: ‘Asylums – Essays on the social institution of mental patients and other inmates’. Goffman advocated the theory of ‘total institution’ – that the act of institutionalising the mentally ill and shutting them away depersonalised them and deconstructed views of the self. Also in 1961, the Minister for Health, Enoch Powell, delivered a speech in which he announced that the British Government intended to eliminate the majority of the Country’s Mental Asylums.
It had been concluded that the availability of drugs, coupled with the new advances in the field of psychiatry, meant that patients were no longer in need of 24 hour care, and standard hospitals could provide the care needed by acute cases.
The closing of the Asylums did not begin in earnest however until the 1980s, when the Mental Health Act was passed in 1983. This Act allowed patients to be given back their full rights and be given the opportunity to appeal their certification. It was no longer compulsory for people with mental disorder to be consigned to Asylums, and the process of moving patients back into the community had begun. The first Asylum to officially close its doors in England was Banstead Hospital in 1986.
By the 1990s, the Care in the Community Act was passed, meaning that large Asylums could now be closed down en masse, and care of the mentally afflicted could pass to community based mental health services. The heyday of the Asylum- with its history of both benevolence and barbarism – had come to end, although some asylums continued to work until as recently as the turn of the Millennium – with High Royds Hospital in Yorkshire closing down completely in 2003.
Brighter Days Ahead? The future of Mental Health Care
Fifty years earlier, society was questioning whether Mental Asylums should be closed down. Today, society questions whether the closing of the Asylums was a good idea. Recent studies carried out by the NHS have discovered that people suffering from mental illnesses recover when they are in a safe environment and are personally involved in their treatment, rather than being left to fend for themselves. There have also been reports that former asylum patients could not properly care for themselves or understand how to deal with day to day living in modern society, which resulted for some in living rough on the streets. Some speculate that closing down so many Asylums and releasing the mentally ill into the community was wrong – that more Asylums should instead have been kept open as specialist centres for the mentally ill. Uncomfortably still, society does not seem to feel at ease with the idea of sharing open space with mental health sufferers, and community mental health procedures have been known to be slow and in some cases, ineffective. The matter was highlighted poignantly by the former Labour Government, who called it ‘Couldn’t care less in the community.’
As for the former Asylums, most stand derelict and awaiting demolition, or have simply being left to be forgotten, attracting the attention of Urban Explorers and Ghost Hunters rather than sympathetic conservationists. Steps were made to give Cane Hill Asylum in Coulsdon Listed status, but a fire in the main administration block saw to its destruction in 2010.
In 1995, the NHS predicted that some 120 Asylum complexes were to become surplus and the land be put up for sale, and these sites were ripe for redevelopment. The historical and aesthetic value of the former asylum buildings was often ignored, the most cost effective solution for them being demolition. On the grounds of former Asylums there now stand housing estates and shopping centres. Some Asylums have survived however. St. Bernard’s Hospital (Hanwell,) Broadmoor, the York Retreat and the infamous Bethlem all survived as working hospitals, while others such as Claybury (now Repton Park) and Friern (now Princess Park,) saw their original buildings survive to become exclusive luxury houses and apartments.
While mental health care has progressed leagues forward from its roots in the late 18th Century, for some it still has a long way to go until the underlying issues and social stigmas attached to mental illness can truly be eliminated.
© Marion Aneira Capelsion, 2013