Thomas Knowles, Serena Trowbridge, eds. Insanity and the Lunatic Asylum in the Nineteenth Century. Perspectives in Economic and Social History Series. London: Pickering and Chatto, 2014. 256 pp. $150.00 (cloth), ISBN 978-1-84893-452-8.

Reviewed by Hazel Morrison (University of Glasgow)
Published on H-Disability (April, 2016)
Commissioned by Iain C. Hutchison (University of Glasgow)

This is a presentation of eleven essays, grouped by the book’s editors into three parts: “Literary,” “Quantitative,” and “Cultural.” Serena Trowbridge and Thomas Knowles’s introduction, while treading a well-worn historiographical path, makes way for the original contributions made to asylum history by the text’s eleven authors. Renewed interest and critical appraisal of major political thinkers, such as Michel Foucault (1926-84), Henri Lefebvre (1901-91), Elaine Showalter, and Andrew Scull, suggest originality in the approaches of the contributors, while evidence of contradictory arguments invite debate and discussion.

Rebecca Wynter’s essay, “‘Horrible Dens of Deception’: Thomas Bakewell, Thomas Mulock and Anti-Asylum Sentiments, c. 1815-58,” begins part 1, “Literary.” Spanning the mid-eighteenth to mid-nineteenth centuries, this chapter charts multiple voices of support, as well as opposition, to the nationwide establishment of public asylum provision in England. Threaded throughout this chapter is the published correspondence of two central figures, Thomas Bakewell (1761-1835) and Thomas Mulock (1789-1869), both opponents of Staffordshire County Lunatic Asylum. One a private madhouse proprietor, the other a former asylum patient, their correspondence thematically coalesces on the subjects of public asylum mismanagement, profiteering, and lack of segregation between large patient populations.

Wynter adeptly analyzes articles written for the popular press, contemporary literature, and professional medical reports, each debating the state of public and private asylums. Such sources punctuate Wynter’s chapter with lively, often highly opinionated contemporary debate, to the effect of establishing for the reader a range of popular and professional opinion. The financial burden public asylum provision placed on local councils was, for instance, demonstrated as a common concern voiced in the popular press. Charges leveled against public asylums for profiteering and for aiding wrongful confinement are moreover drawn to the reader’s attention through Wynter’s analysis of literary works and public correspondence. Wynter balances such qualitative accounts by paying attention to financial ledgers and annual reports, which show statistically the economic foundations on which public concern was rooted. Patient case note records are used to unveil contradiction between populist ideals of public asylum mismanagement and the recorded experiences of patients and their treatments. By studying the various agendas brought into public debate over the expansion of public asylum provision, Wynter shows the necessity of triangulating these various sources to look beneath the subjective opinion of select historical actors. “If anything,” writes Wynter, attention to such sources remind the reader “of the dangers of misinterpreting evidence and romanticising ‘the lunatic’” (p. 27).

The lives of individual asylum patients have long piqued the interest of readers of psychiatry/mental illness. The life of Matilda Betham (1776-1852), a gifted poet, artist, and political activist, is no exception, as depicted in Elaine Bailey’s “‘This Most Noble of Disorders’: Matilda Betham on the Reformation of the Madhouse.” Betham’s repeat forced admittance to mental institutions exemplifies for Bailey the role of familial control and social expectation in defining and confining lunacy. Bailey’s engagement with Betham’s history opens up the social and political context to Betham’s life, while offering a critique of contemporary legal and medical mechanisms for institutionalization.

The real strength of this chapter lies with the author’s analysis of language. Bailey writes that, for Betham, mainstream language was understood as a vehicle of patriarchal control, its meanings manipulated by a wealthy, powerful elite. An unusual, often metaphorical style of communication presented itself to Betham as a means to usurp established power structures within society. However, Bailey suggests it was Betham’s public and private experiential writings, rather than her demeanor, that was seen by her contemporaries as evidence of madness. Through hermeneutic enquiry, Bailey demonstrates periods where Betham’s linguistic experimentation came to signify, for family and friends, a state of madness. Contrasting the favorable reception of her political writings within literary circles, to the condemnatory reaction of her family (who in 1822, forcibly placed her in a private madhouse), Bailey presents a compelling portrayal of female autonomy and political activism, construed as a form of madness.

Thomas Knowles’s chapter, “The Legacy of Victorian Asylums in the Landscape of Contemporary British Literature,” evokes the significance of language as he perambulates across a swathe of twenty-first-century literature. Reviewing such literary works as Iain Sinclair’s London Orbital (2002) and Will Self’s Umbrella (2012), his chapter looks to explore the legacy of Victorian asylums upon contemporary British literature. These literary works range in subject from asylum closure in favor of care in the community, to the lost generation of patients suffering the debilitating effects of the encephalitis lethargica disorder. Among such diversity, Knowles teases from these texts a unifying literary motif through which to explore notions of place, possession, erasure, and displacement within the context of asylum history (fact and fiction).

The unifying motif is that of circumambulation, cyclical movements, and patterns of repetition. Evoking the politics of psycho-geographers alongside readings of Foucault and Lefebvre, Knowles deftly explores how the repurposing of old asylum buildings and the dispersion of its patients is effectively effacing the past. Knowles’s reading of Sinclair’s London Orbital exemplifies how repetitive movement, that is, of revisiting and reinvesting a space with memory and meaning, is a form of resistance (enacted in literature) to the erasure of asylum histories. Politics of remembrance, possession, and repetition are re-evoked in Knowles’s conclusion. Reinforcing the idea that cyclical patterns, rather than traditional, linear historical trajectories, underwrite histories of the asylum, his final remarks presuppose the repetition of asylum histories within future spaces and eras.

Part 2, “Quantitative,” commences with Bernard Melling’s “Building a Lunatic Asylum: ‘A Question of Beer, Milk and the Irish.’” Charting the construction of Lancashire’s fourth public asylum, Whittingham, during the 1860s and 1870s, Melling’s chapter sits well within this publication. It is the first of the contributions to part 2 yet thematically it overlaps with many of the book’s other chapters, touching on such concerns as debate over asylum building costs, knock-on impacts on the public purse, and the role of the popular press in shaping public opinion over institutional provision. Moreover, Melling introduces the subject of drink and its perceived causal connection to insanity, later explored by Kostas Makras.

This chapter would have benefited from the outset by more clearly stating its aims. However, Melling’s close attention to contemporary source material convincingly sets out to the reader a time and place in asylum history when local government was in the hands of a prosperous elite. Following the trajectory of public debate surrounding Whittingham Asylum’s design and construction, Melling suggests it was those prosperous few who held the ability to shape local provision of, and indeed local opinion on, new increased asylum provision. Meticulously, Melling steers the reader back and forth, engaging with the debate of various stakeholders in local newspapers, contemporary journals, and county magistrate meeting records. Local newspapers are shown by Melling to have given voice to middle-class concerns, exemplified in correspondence between ratepayers and council members. However, when the time came for debate to be put into practice, it is ostensibly the voice of social elites whom Melling credits with having determined the course of mental health-care provision.

Both Shawn Phillips (“‘Just Can’t Work Them Hard Enough’: A Historical Bioarchaeological Study of the Inmate Experience at the Oneida County Asylum”) and Claire Chatterton (“‘Always Remember That You Are in Your Senses’: From Keeper to Attendant to Nurse”) explore notions of the “ideal,” in terms of the doctrine of labor therapy and the model nursing attendant, respectively. They do this through comparison of published rhetoric—found in nursing manuals and visitor, inspector, and superintendent annual reports—with unpublished evidence (and exhumed remains in the case of Phillips), which are of greater value in illustrating everyday life for asylum patients and attendant nursing staff. Very much in alignment with the Foucauldian notion of an “archaeology of knowledge,” these writers look to unearth histories of underrepresented, often silenced asylum communities, through studies of the material, cultural, social, and economic contexts of their everyday experiences.

Phillips, in particular, offers a novel method for unearthing such histories by paying attention to Oneida County Asylum patients’ skeletal remains, in other words, from a bioarchaeological perspective. Phillips contrasts the ideal moral benefits of “labor therapy” (agricultural, domestic, etc., work) as espoused by North American asylum reformer Dorothea Dix (1802-86) with tangible evidence—“continual hard, forced labour”—that wrought physical damage on patient bodies (p. 82). When bioarchaeological remains are read alongside the financial ledgers of Oneida and other county asylums, evidence suggests that the doctrine of labor therapy went beyond the bounds of healthy physical activity. Although more detailed extrapolation from the bioarchaeological sources would have strengthened Phillips’s argument, this preliminary investigation indicates that the excessive incidence of patient labor was a practical response of asylum officials to the demands of running a large county asylum. Such demands, Phillips concludes, ultimately outweighed the moral impetus of labor therapy.

Emphasis on the physicality of asylum patient bodies is likewise present in the work of Jennifer Wallis, “‘Atrophied,’ ‘Engorged,’ ‘Debauched’: Muscle Wastage, Degenerate Mass and Moral Worth in the General Paralytic Patient.” Wallis persuasively argues that the body of the syphilitic male patient, wrought with “muscular weakness” and “staggering gate,” was, by the early twentieth century, understood through disparate explanatory models, varying from moral to biomedical (p. 100). Wallis demonstrates how medical understanding of the soft, rotting tissues of the postmortem syphilitic patient was in many ways informed by latent nineteenth-century notions of moral degeneration. As muscular softness was causally equated to the overindulgence “in alcohol and sex,” the patient’s muscular bodily breakdown “became the disease anthropomorphized” (pp. 111-112) (see also Makras’s chapter on muscle and morality). However, within the evolving sphere of anatomy and neuroscience, the syphilitic body was also envisaged to reveal something deeper: the neurological processes within the brain that were, by the late nineteenth century, suspected to enjoin syphilitic infection to the latter, degenerative stages of the disease known as general paralysis of the insane (GPI).

Wallis’s choice of West Riding Asylum under Superintendent James Crichton-Browne (1840-1938) is interesting in that it exemplifies a medical space in which anatomy, neurology, and psychiatry were brought together, an ideal opportunity for discovering the link between syphilis and GPI. However, West Riding was a rare exception during this period, with most British asylums lacking all but the most rudimentary of facilities for “pathological,” “bacteriological,” and “histological” research.[1] Recognition of West Riding’s exceptional status would have added to Wallis’s essay, as would have a comparison between British asylums and the better equipped and more academically attuned Germanic teaching hospitals of the time, from which the vast number of discoveries linking GPI with syphilis emanated in the early twentieth century. Finally Wallis’s chapter could have been strengthened by engagement with the work of Gayle Davis in “The Cruel Madness of Love”: Sex, Syphilis and Psychiatry in Scotland, 1880-1930 (2008), which would have enabled comparison with the Scottish psychiatric system.

The final part, “Cultural,” begins with Amanda Finelli’s “‘Attitudes Passionelles’: The Pornographic Spaces of the Salpêtrière.” While Finelli’s chapter is likewise concerned with the moral, economic, and corporeal constitution of asylum patients’ bodies, her work is interesting for its historiographical critique. By engaging with Foucauldian and feminist debate, her interpretation of female hysteria wrangles with the diagnoses’ current “pop cultural” status, which, she argues, falls short of unveiling the social, economic, and cultural roots through which to understand hysteria’s pathology (p. 115).

Finelli uses well-known photographs of Salpêtrière patients to demonstrate how women, seemingly caught in postures of “helpless supplication,” “frenzy,” and “attitudes passionelles,” have commonly been viewed as displaying the eroticized female body. Notions of hysteria and eroticism, argues Finelli, have often gone hand in hand, enabling such feminist writers as Elaine Showalter and Juliet Mitchell to argue that eroticism became for women a form of female protest through which to oppose patriarchal oppression. However, Finelli challenges such interpretations, arguing instead that the pathology of hysteria is inextricably linked to female disempowerment and exploitation. Such photographs, she writes, should not be interpreted as expression of eroticism (and by extension female bodily protest) but rather as pornography, as the commodification and subjugation of the sexualized female body.

Sex, gender, and medico-cultural constructions of these categories continue to feature in the next two chapters, “‘The Poison That Upsets My Reason’: Men, Madness and Drunkenness in the Victorian Period” by Kostas Makras and “‘Madness and Masculinity’: Male Patients in London Asylums and Victorian Culture” by Helen Goodman. Makras and Goodman explore a set of diagnostic histories through the prism of masculinity. Again, an understanding of the economic and cultural construction of masculinity is seen as pertinent to understanding the pathologization of mental disorders that were presented as the particular province of the male asylum patient.

Goodman presents late nineteenth-century diagnoses of nervous mental disorder as partly a “pathological by-product of Victorian gender roles” (p. 150). While mid- to late nineteenth-century asylum statistics show men as exhibiting symptoms synonymous to that of women, Goodman demonstrates that diagnoses and treatments were gendered and polarized. Analyzing asylum patient admission statistics alongside sources representative of mainstream Victorian culture, Goodman reveals evidence of tension, even paradox, for a generation of mind doctors for whom medico-socio ideals of gender and race came into conflict with symptom pictures exhibited by male patients.

At the heart of this problematic, suggests Goodman, are the early nineteenth-century concepts of nervous disorder. Early nineteenth-century anatomical theory rooted the causation of nervous disorder to the female reproductive organism, excluding the possibility of its occurrence in the male. Men, exhibiting symptom pictures characteristic of nervous mental disorder, such as hysteria, argues Goodman, posed a particular problem for asylum practitioners, as they threatened the ontological premise of earlier anatomical theory. A new framework for understanding and articulating male mental breakdown, writes Goodman, was therefore necessitated, one that could pathologize male nervous disorder without disrupting common medico-socio conceptions of distinct gender roles.

This new diagnostic language is shown to have emerged in the 1890s in response to the “boom and bust cycles of developing industrial capitalism,” with male nervous disorder in many cases attributed to “business anxieties and pecuniary difficulties” (pp. 153-154). Contemporary recognition that societal pressures, within the male sphere of work and commerce, were themselves a root cause of nervous disorder demonstrates conflicting medico-socio conceptions of masculinity during this period. Goodman explores such tensions to effect, suggesting how notions of biology, masculinity, lunacy, and civilization came into conflict during a period of “crises in masculinity and medicine” (p. 150).

The major drawback to this chapter lies with its conclusion. Rather than re-emphasize her main arguments, Goodman brings in yet more source materials to what is already a densely laden chapter. She makes brief remarks about the role of patient case note records, and she reflects on contemporary masculinity and mental illness. This leads the reader to presume this chapter is the condensation of a much larger body of work, the absence of which results in a lack of overall coherency.

Goodman’s argument focuses heavily on the diagnosis of hysteria, a diagnosis that became emblematic for twentieth-century feminist critique of nineteenth-century medico-cultural conceptions of “madness” as ostensibly a “female malady.” However, Makras argues that while studies have focused on the medico-socio gendering of madness in the nineteenth century, a “repetitive emphasis” on the feminization of mental illness resulted in a lack of study on the “vast number of men” diagnosed and institutionalized with other forms of mental disorder during this period (p. 135). His chapter, therefore, addresses a form of mental disorder well recognized in the nineteenth century as being particularly prone in the intemperate male: “delirium tremens.”

Through the use of nineteenth-century literary, medical, and temperance texts, Makras stresses how commonplace associations between intemperance and men’s physical and mental ill health came into conflict with popular discourses that extolled the benefits of alcohol to the laboring man. Using contemporary medical and literary fiction, Makras’s chapter is powerful for its articulation of a double bind, experienced by men during this period, with conflicting notions of masculinity/femininity, strength/weakness, and health/ill-health contained within debates surrounding alcohol.

Alcoholic intake, demonstrates Makras, was popularly viewed as a means to sustain men’s physical strength during periods of hard labor, while public houses spatially and symbolically demarcated the male sphere. However, “alcohol induced insanity” was arguably one of the most “discussed [and] feared ... disorders that could befall men,” resulting in emasculation, and social, physical, and mental degradation (p. 148). Makras marks out the male sphere of the public house as an exemplary space where business and politics were discussed alongside other “manly” activities, such as drinking and smoking. Prominent literary authors used such spaces to align alcoholic intake to contemporary ideals of masculinity, reason, class, and productivity, but with the warning that impotency, physical weakness, loss of earning potential, and temporary “madness” could result. These two conflicting ideals are moreover shown to have coalesced in a number of contemporary medical texts. While doctors proclaimed short-term benefits of alcoholic stimulant for increased labor productivity, long-term ill effects of excessive alcohol intake were likewise recognized; excessive alcohol use was seen to unman the grossly intemperate male. With notions of masculinity and the intake of alcohol so closely yet problematically aligned, statistical evidence of asylum admission in mid-nineteenth-century Britain seems to uphold Makras’s assertion of delirium tremens being a particularly male disorder, compounded by medico-socio constructions of masculinity.

Finally, Will Wiles’s chapter, “‘Straightjacket’: A Confined History,” offers an exemplar of an object-oriented essay that guides its reader to an intimate understanding of the item's use/abuse across the nineteenth century. Again this is an example of an essay that should have clearly introduced its aims at the outset. However, the author skilfully uses Foucauldian theory to explore the entangled history of an object that is both physically and symbolically ingrained in a model of mental health care dominated by the dictum of “moral treatment.” Wiles creatively demonstrates the “double bind” of an object that arguably enforced, through physical restraint and cultural association, the identity of mad man/woman to its wearer. The inability of wearers to wipe their noses, “cleanly urinate or move their bowels” is shown not only as an inconvenient by-product but also as a “crowning humiliation” on top of the “trauma of confinement” (p. 178). This is a powerful final chapter.

Overall, the breadth of topic covered by this book strongly compels both experts in the field and a more general readership to engage in this work. A variety of analytic methods, ranging from psycho-geography and bioarchaeology to more traditional historical and literary approaches, open up to the reader the creative potential for reexamining nineteenth-century asylum histories. When thinking about the timing of this publication, it is important to reflect on the sense of urgency, which comes across in the introduction, as well as in various chapters, to the necessity of engaging with the physical remains of asylum buildings before their inevitable loss to decay or redevelopment.

Moreover, insistence on the subject’s current relevancy is made evident by such contributors as Melling, for whom our present attempts to “understand, treat and care for the mentally ill” are seen as shaped by our understanding of “that which has gone before” (p. 69). The asylums of the nineteenth century, argue such contributors as Knowles and Goodman, offer compelling comparisons to present mental health concerns as we look to the gendering of current-day diagnoses or to the spatial segregation of the mentally ill within today’s towns and cities. The power of scholars to revisit asylum histories, and to critique their politicized, often (as Wynter reminds us) “romanticised” past, is made evidently clear within a number of revisionist chapters.

Reading this book in its entirety, however, one does feel the lack of a clear trajectory, or thematic rationale, which limits its impact on existing work in the field. Too often one also feels a chapter has been cut short, as in the case of Wiles, with space available for only the slightest commentary on method. In a book of this nature, perhaps this is inevitable, but in chapters such as Goodman’s, where yet more information is squeezed into the conclusion, there is a sense that these works belong within much larger contextual and explanatory frameworks of analysis. The strength of this book is therefore paradoxically the source of its weakness. The wide variance of chapter themes and methodology in effect dilutes what may potentially be a powerful set of critiques if they were placed within fields of research with a narrower focus than that of nineteenth-century asylum history.

Note

[1]. Herbert Weiner, “Psychosomatic Medicine and the Mind-Body Relation,” in History of Psychiatry and Medical Psychology, ed. Edwin R. Wallace and John Gach (New York: Springer, 2008), 786.

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Citation: Hazel Morrison. Review of Knowles, Thomas; Trowbridge, Serena, eds., Insanity and the Lunatic Asylum in the Nineteenth Century. H-Disability, H-Net Reviews. April, 2016.
URL: http://www.h-net.org/reviews/showrev.php?id=43634

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