"Lunacy Reform"

Beginning in the early years of the new century, however, a movement began to replace the private madhouses and to accommodate in statesupported asylums those lunatics still housed in gaols, in poor-law institutions, or hidden in attics and closets. Particularly in its early stages, lunacy reform formed part of a much broader movement of "philanthropic" social reform characteristic of the late eighteenth and early nineteenth centuries. Borrowing both personnel^[25] and ideas from these related movements, it was at first a somewhat confused and ill-defined enterprise. Those involved in it shared in varying degrees a concern to protect society from the disorder threatened by the raving; a desire to simplify life for those charged with administering the local poorhouses and gaols; and an equally unfocused and unsystematic feeling that the insane themselves deserved to be treated in a more "humane" fashion. But they possessed no clear ideological vision of what could or should replace existing arrangements. This lack of clarity was evident both in

[23] Bethlem was a medieval foundation that for centuries had been the only specialized institution for the insane, albeit a small one. In 1632 it contained only twenty-seven inmates, and in 1642, forty-four. The new building, for about 150 inmates, opened in 1676 and was further enlarged in the 1720s.

[24] Richard A. Hunter and Ida Macalpine, Three Hundred Years of Psychiatry, 1535 to 1860: A History Presented in Selected English Texts (London, Oxford University Press, 1963), 475. One should note, however, that it scarcely makes sense to describe even these charity asylums as "purpose-built" in the sense in which this term becomes applicable in the nineteenth century. Little connection was seen at this time between architecture and "cure"—the latter being held to depend primarily upon physical treatments of various sorts. Apart from its uses for decorative purposes or for show (the exterior of Bethlem, for example, was modeled on the Tuileries), the architecture of these places was designed primarily to secure "the safe confinement and imprisonment of lunatics" (House of Commons, Report of the Select Committee on Madhouses [1815], 76) an aim that led later generations to comment on "the prison-mindedness of eighteenth-century insane asylum designers." (The words are J. D. Thompson and G. Goldin's, taken from their study of hospital design, The Hospital: A Social and Architectural History [New Haven: Yale University Press, 1975]; but such sentiments were a commonplace in nineteenth-century reform circles.) It is perhaps of interest to recall, therefore, that the architect of St. Luke's Hospital—perhaps the most influential of the eighteenth-century charity asylums—was George Dance the Younger, who was also responsible for the design of the new Newgate Prison.

[25] For example, Sir Samuel Romilly, Samuel Whitbread, and William Wilberforce at the parliamentary level; and Sir George O. Paul and the Rev. John Thomas Becher at the local level.

the first parliamentary inquiry the reformers instituted into the treatment of the insane, which simultaneously found little but insufficient institutional provision to complain about and bestowed considerable praise on precisely the existing madhouses and asylums the reformers were shortly to criticize so vehemently;^[26] and in the vague, weak permissive legislation of 1808 that the reformers then secured. Counties were henceforth allowed (although not required) to provide asylum accommodation at public expense; but even the reformers appeared to have little conception at this point of why the asylum was desirable or what kind of institution it should be.^[27]

Within less than a decade, they possessed answers to both questions. A hitherto obscure provincial Quaker institution, the York Retreat, attracted national attention and provided the reformers with both a model to be copied and an account of the superiority of properly run asylums as a treatment setting.^[28] Sharply departing from traditional practices, the staff at the Retreat insisted upon "the superior efficacy . . . of a mild system of treatment." External, physical coercion was minimized and, in its most blatant forms—"gyves, chains, and manacles"—done away with entirely. In its place came an emphasis on "treating the patient as much in the manner of a rational being as the state of mind will possibly allow" and on carefully designed measures to induce the inmates to collaborate in their own recapture by the forces of reason^[29] (see Figure 8).

[26] House of Commons, Report of the Select Committee on Criminal and Pauper Lunatics (1807).

[27] Magistrates were provided with scarcely any guidance concerning the construction or administration of the new asylums, other than the advice that they should be placed "in an airy and healthy situation, with a good supply of water, and which may afford the probability of the vicinity of constant medical assistance" (Preamble to 48 Geo 111 c96)—simply an adaptation of John Howard's prescription of the proper site for a reform prison: "It should not be cramped among other buildings, but should be in open country—perhaps on a rise of a hill to get the full force of the wind, and it should be close to a running stream" (quoted in Robin Evans, "'A Rational Plan for Softening the Mind': Prison Design, 1750–1842: A Study of the Relationship Between Functional Architecture and Penal Ideology" [Ph.D. dissertation, Essex University, 1975], 107).

[28] Particularly important in drawing attention to the Retreat, which had been opened in 1796, were the book by the founder's grandson, Samuel Tuke (Description of the Retreat: An lnstitution near York for Insane Persons of the Society of Friends [1813], facsimile ed., ed. Richard A. Hunter and Ida Macalpine [London: Dawsons, 1964]), and its review in the Edinburgh Review (1814) by Sydney Smith. One should note that, though it was the Retreat's experience that became the reformers' model, the approach adopted here was not unique. A number of other madhouse proprietors were independently experimenting along similar lines in this period: cf. E. L. Fox, Brislington House: An Asylum for Lunatics (Bristol: For the Author, 1806); John Ferriar, Medical Histories and Reflections, vol. 2 (London: Cadell and Davies, 1795).

[29] Tuke, Description of the Retreat, vi, 158. For a critical reexamination of this decisive shift in our characteristic ways of responding to and coping with the mentally disturbed, and an exploration of its links to larger social movements and processes, see Chapter 4 above.

Figure 8.
The original building of the York Retreat, opened in 1796. The domestic architecture
of this establishment reminded one early visitor of "une grande ferme rustique." In the
early nineteenth century, the institution (at first, with only thirty patients) acted as a
model for lunacy reformers. From: D. H. Tuke,  Reform in the Treatment of the
Insane  (London: Churchill, 1892), 18.
(Courtesy of the Wellcome Trustees.)

From most perspectives, the Retreat was an outstandingly successful experiment. It had demonstrated, to the reformers' satisfaction at least, that the supposedly continuous danger and frenzy to be anticipated from maniacs were the consequence of rather than the occasion for harsh and misguided methods of management and restraint; indeed, that this reputation was in great measure the self-serving creation of the madhouse keepers. It apparently showed that the asylum could provide a comfortable and forgiving environment that not only spared the insane the neglect that would otherwise have been their lot, but played a vital role in restoring a substantial proportion of them to sanity.

Now that the reformers had before them a practical realization of their own half-formulated ideals, their reaction to conditions in most existing madhouses became one of fierce moral outrage. Since the free trade in lunacy simply multiplied the opportunities and incentives for keepers to maltreat the mad (or so they now concluded), only a system of state-supported, rigorously inspected asylums would allow the extension of the benefits of moral treatment to all the insane. As early as 1815, therefore, the reformers were seeking legislation to secure these ends.

Any such measures, however, threatened a transformation in political relationships whose importance extended far beyond the narrow sphere of lunacy reform. If enacted, it would have set the precedent for a notable expansion of the central coercive machinery at the disposal of the state. Opposition to such a concentration of power at the national level remained extraordinarily widespread and well entrenched at both the structural and the ideological levels,^[30] so that it took some thirty years for the lunacy reformers to secure legislative enactment of their plans. (Indeed, they succeeded only after the obstacles to central administration had been confronted and dealt a decisive defeat, not over the marginal issue of the treatment of lunatics, but over the critically important issue of Poor Law reform.) In the interim, the reformers devoted themselves to winning over public opinion, through the periodic exposure of the evils necessarily attendant upon the continued operation of the private madhouse system and through the development of a steadily more elaborate ideological account of the virtues of properly constructed and run asylums.

Though it was further developed and refined by the newly emerging class of professional "alienists," the new institutional ideology drew heavily on the York Retreat for inspiration.^[31] It was insistently proclaimed that in the successful treatment of insanity, the requisite "means and advantages can rarely, if ever, be united in the private habitations even of the opulent."^[32] In part, this superiority simply reflected the much greater experience of asylum personnel with the shapes and forms of mental disturbance, which allowed them to handle the insane more easily and skillfully, in situations where the well-meaning but clumsy and misdirected interventions of relatives only aggravated the condition. But, beyond this, the public must recognize that "a private dwelling is illadapted to the wants and requirements of such an unfortunate being." Experience had convinced the experts charged with curing lunatics of "the improbability (I had almost said moral impossibility) of an insane

[30] Edward P. Thompson, The Making of the English Working Class (New York: Vintage Books, 1963), 82 and passim.

[31] The emerging institutions provided, on the one hand, a guaranteed market for an emerging profession and, on the other, the opportunity for an occupational group to develop empirically based skills in coping with madmen. The asylums thus formed the breeding ground for a new group of "experts" in the management of the mad, first known as "mad-doctors," later as "alienists," and only in the latter part of the nineteenth century referred to as "psychiatrists." For discussions of the growth and consolidation of the English psychiatric profession in this period, see W. F. Bynum, "Rationales for Therapy in British Psychiatry: 1780–1835," Medical History 18 (1974): 317–34; Chapter 6 above; and Andrew Scull, "Mad-Doctors and Magistrates: English Psychiatry's Struggle for Professional Autonomy in the Nineteenth Century," European Journal of Sociology 17 (1976): 279–305.

[32] William Charles Ellis, A Letter to Thomas Thompson Esq., M.P.,  . . . (Hull: Topping and Dawson, 1815), 8.

person's regaining the use of his reason, except by . . . a mode of treatment . . . which can be fully adopted only in a Building constructed for the purpose."^[33] The very physical structure, as this implied, was "a special apparatus for the cure of lunacy"^[34] quite as important as any drugs or other remedies in the alienist's armamentarium. In the words of Luther Bell, a leading American member of the fraternity,

An Asylum or more properly a Hospital for the insane, may justly be considered an architectural contrivance as peculiar and characteristic to carry out its designs, as is any edifice for manufacturing purposes to meet its specific end. It is emphatically an instrument of treatment.^[35]