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Haunting portraits from an English lunatic asylum, 1870s

 

The Victorian era may not be the beginning of the institutionalization of patients with mental health problems, but it was certainly a time when the number of asylums and patients treated within them exploded.

Whether this increase was primarily due to an increase in mental illness or a decrease in the tolerance of the mentally ill in the community is not clear. Several patients were admitted under the Poor Law and Insanity Act.

The Insanity Act 1845 was an important milestone in the treatment of the mentally ill, as it explicitly changed the status of the mentally ill to patients who needed treatment.

This act meant that counties were legally bound to provide asylum for the mentally challenged. All asylums were required to have written regulations and a resident qualified medical practitioner.


The mental asylum was the historical equivalent of the modern psychiatric hospital. The word refuge comes from the earliest (religious) institutions that provided refuge in the sense of sheltering the mentally ill. Before asylum, people with mental illness or learning disabilities were cared for almost entirely by their families.

Prior to asylum admission in the 1860s, detailed information about the patient was also required. This includes: the name of the patient; gender and age; married, unmarried or widowed; Life and past occupation status; religious persuasion; Was this their first attack; age at the time of first attack; the duration of the current attack; considered reason; whether the patient was under epilepsy; Whether they are suicidal or dangerous to others.

Once admitted, there was no process for the patient to appeal against custody. They may, however, be discharged on the application of a relative or friend, as long as they confirm that they will take proper care of the patient and prevent them from injuring themselves or others.

Despite the good intentions of the Act of 1853, it appeared that there was still considerable room for abuse of the system. Unfortunately, for many, shelters were thought of as prisons disguised as hospitals.

It was a convenient way of weaning the poor and terminally off from society and for the moneyed, private asylums were often convenient dumping grounds for unwanted wives.


Although many patients were admitted for a short time, there are stories of many patients who were admitted to the asylum, often for very unsatisfactory reasons, and were basically forgotten. Some could spend twenty or more years in confinement, and sadly some patients died without being released.

The reasons for admission were very much down to personal judgment and appear to have been heavily weighted against women. In fact, there were often more women than men lodged in these institutions.

Depression associated with various conditions appears to be a common reason for women seeking refuge. Examples include legitimate reasons such as 'death of sons in war', 'death or death of husband' and 'domestic trouble'.

However, there are many other reasons too many fakes. For example, 'imaginary female trouble', 'immoral life' (often associated with carrying or delivering an illegitimate child), 'menstrual problems', 'menopause', 'uterine problems', 'female diseases' and ' Nymphomania'.

'Hysteria' is also being cited as the reason for admission. However, this is a subjective assessment and was easily misused. Women at that time were expected to be polite, courteous and agreeable to the men in their lives. Should a woman dare to take turns talking or arguing with her father or husband, however, she may be considered hysterical and in need of treatment.

Equally worrying was the fact that women admitted to having 'more action of the mind'. This may be because they wanted to educate themselves, or for some, it may be as simple as wanting to read. For example, 'book reading' is listed as a reason for admission to a Trans-Allegheny insane asylum.

By the end of the 19th century, a national system of regulated asylum for the mentally ill had been established in most industrialized countries. At the turn of the century, there were only a few hundred people in Britain and France combined, but by the turn of the century, that number had swelled to hundreds of thousands.

By 1904, 150,000 patients were placed in mental hospitals in the United States. There were over 400 public and private sector refuges in Germany. These refuges were important to the development of psychotherapy as they provided places of practice around the world.


However, in the mid-19th century the hope of curing mental illness through treatment was hopeless. Instead, psychiatrists were under pressure from an ever-increasing patient population. The average number of patients in asylum in the United States jumped 927%.

The numbers were similar in Britain and Germany. France was overcrowded, where refuges usually doubled their maximum capacity.

The increase in asylum populations may have been the result of the transfer of care from families and poorer homes, but the specific reasons why the increase occurred are still debated today.

Whatever the reason, increasing pressure on asylum was affecting asylum and psychiatry as a specialty. Asylums were once again turning into custody institutions and the reputation of psychiatry in the medical world was greatly diminished.

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