With criteria like these, it looks the Victorians thought everyone was mad! But who decided if a person was mad or not? And just how did you end up in a Victorian asylum?
The answer is – it depends what sort of asylum.
In the early nineteenth century there were many private madhouses around Britain. They were totally unregulated. It was therefore absurdly easy for wealthy families to have a relative labelled a lunatic and incarcerated in a mad-house for life. All you had to do was pay your doctor enough money to write a certificate of lunacy, and hired thugs would kidnap your relative and whisk them away. Sarah Wise’s excellent book Inconvenient People shows that despite the stereotypes about unwanted wives being locked away, it was usually men who were wrongly incarcerated in asylums. It was a rare Victorian woman who had any money, and it was usually money that the family were after.
As the century went on, there were numerous scandals about sane people ending up in asylums, and the madhouses were gradually regulated. But not before a number of unfortunate rich people had had a really bad time.
At the other end of the social scale, there were a small number of public asylums. They were the closest you could get to hell without dying.
The state of these asylums was most memorably described by local magistrate Godfrey Higgins, who investigated York asylum in 1814. He found ‘evidence of wrongdoing on a massive scale: maltreatment of the patients extending to rape and murder; forging of records to hide deaths among the inmates; an extraordinarily widespread use of chains and other forms of mechanical restraint; massive embezzlement of funds; and conditions of utter filth and neglect.’ On one visit he forced his way through a hidden door to expose a tiny room crammed with thirteen elderly ladies, practically naked and covered in their own excrement. Higgins ‘became very sick and could no longer remain in the room. I vomited.’
By 1845 sustained campaigning against this dreadful state of affairs forced the government to bring in the County Asylums Act 1845. Every country now had to have its asylum, as well as a workhouse. They were highly regulated, inspected, and offered good quality care in pleasant surroundings. To be admitted to one of these asylums, the local JP and a doctor had to certify you insane. To protect against corruption, the doctor who signed the certificate could not be affiliated with the asylum in any way.
It was a massive improvement on the previous system. Patients included those with learning disabilities, epilepsy, senile dementia, and the grandiose delusions and physical paralysis that accompanied tertiary neuro-syphilis. Alcoholics and drug abusers often ended up in asylums as well. Many women passed through asylums too, usually suffering post-natal depression, or puerperal fever – then a common post-natal infection leading to mania and sometimes death.
Thousands of people passed through the county asylums, but they actually tried hard to keep patients out, for one simple reason. The Victorians hated paying taxes for public services even more than we do. But there was simply so much medical need, and nowhere else for many needy people to go except the asylum.
What, then, of the absurd diagnoses in the admissions table? Nineteenth century mad-doctors knew next to nothing about the mind. They tried to discover what had triggered a mental breakdown, and list that incident as the ’cause’ of the illness. This remained the case until Emil Kraepelin, a stereotypically logical German Professor of psychiatry, came out of leftfield with a wild new idea. He classified mental illness according to prognosis, instead of cause. He swept away the confused jumble of religious mania and excess novel-reading, and replaced it all with a logical, simple, practical, system. Apart from neurological disorders and diseases of old age, there were only two mental disorders. Manic-depressive disorders, from which patients would usually recover, if only at intervals, and schizophrenia – delusions with the mood being affected – which patients would never recover from. Kraepelin’s model of mental illness still forms the basis of all modern psychiatry.
Though you’d hardly know it, what with the ever-expanding Diagnostic and Statistical Manual of Mental Disorders (DSM). The current version includes anorexia, bulimia, attention deficit hyperactivity disorder, and a huge list of personality disorders. The new volume may add Binge Eating Disorder, Disruptive Mood Dysregulation Disorder and Generalized Anxiety Disorder, amongst other things. Perhaps a hundred years from now, people will look back on our definitions of mental illness and find them just as bizarre and all-encompassing as we do the Victorians’._______________
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