The word Bedlam comes from the Priory of St Mary at Bethlehem which was founded in London during the thirteenth century.  By 1377 it had become home to people suffering from mental illness or as the inhabitants were described at the time – “distracted persons.”  The law meanwhile was concerned that landowners were of sound mind and indeed the law continued to be concerned about property throughout the centuries.  By 1735 Hogarth was using Bedlam to end his social moral fable of the Rake’s Progress and the conditions in which patients found themselves were horrendous.

Fans of Poldark will no doubt have noted that the care of George Warleggan in the eighteenth century has to date not been kind following the death of his wife Elizabeth – he’s been half drowned, starved, restrained and leeched within an inch of his life.  However, this is not a post about the eighteenth century or earlier.  I want to look in this post  at the development of the law during the nineteenth and early part of the twentieth century with a view to understanding the process by which women could become confined to a county mental hospital during the Great War.  This post is not a definitive guide – its research for my own nefarious reasons.  It would have to be said that the terminology by which mental health was described throughout history gives very little thought to the patients or their families.

By the end of the nineteenth century more than 70,000 patients had passed through the doors of an insane asylum of some kind or other.  Nationally there were 120 asylums.   The 1800 Criminal Lunatic Act was particularly interested in securing those people who wanted to assassinate the monarch and the criminally insane.  The 1808 County Asylum Act dealt with fund raising methods that combined taxation with public subscription.  The idea was that the poor insane should be removed from workhouses and prisons. The wealthy insane were being paid for by their families and resided in private sanitariums or were locked up in various secluded attic rooms (see Jane Eyre and The Woman in White for literary examples.)  Almost inevitably lunacy became a condition in many counties as a method of differentiating between the deserving and undeserving poor.  There was also the fact that men and women who behaved in a socially unacceptable way could be deemed to be mad and shut away, often for the rest of their lives.  Records reveal that many people spent their lives locked in asylums having been sent there for reasons other than madness, including in one instance for excessive shopping in her husband’s opinion.

Sneinton in Nottingham was the first asylum founded by a mixture of subscription and taxation. The county had not offered care of any kind for poor people suffering from mental health difficulties before that date.  The West Riding’s asylum opened in Wakefield in 1818 though its minutes date from 1814.  Further parliamentary acts defined lunacy, attempted to regulate private asylums and sought to monitor the health care provided – good practice and well meaning concern was mixed with what modern eyes would define as barbaric practice.

In 1828 an act required all pauper lunatics to be documented and certificated.  This in turn would mean that commissioners would be able to inspect institutions and people incorrectly placed in asylums would be released (in theory) and care could be monitored – gradually more humane treatment became more the norm although restraint remained common practice for a very long time as did incarcerating people not for mental health problems but for their socially unacceptable behaviour or for having the misfortune to be born with learning difficulties.

In 1845 county asylums became a legal obligation and the Lunacy Commissioners were appointed to oversee the running of asylums. It was only in 1890 with the passage of another act that county asylums began to move away from their pauper associations to begin their evolution to hospitals caring for all walks of life.

Interestingly Wakefield was one of the first asylums to employ therapeutic employment, though this was thanks to the enlightened attitude of Dr William Ellis who moved from Wakefield to Hanwell in 1832. Ellis was a believer in the benefits of outdoor work rather than the brutality espoused by earlier “mad doctors.”  It is perhaps for this reason that many of the Victorian asylums were set in beautiful grounds.  Hanwell is also an example of changing attitudes in terms of names.  It opened as an asylum in 1832 but became a hospital  in 1926 and was then completely renamed in a bid to dissociate itself from past stigma. Not that this has ever been successful as group memory lasts longer than a name change – The Garlands in Carlisle was guaranteed to make my mother-in-law concerned for the mental well being of anyone sent there irrelevant of the fact that it had long since been renamed and re-purposed.  Many hospitals were not only renamed but shut and then demolished during the later half of the twentieth century and early twenty-first century.  For example,  Derby’s mental hospital remains a building site although the twin brick entrances remain – architecturally it is helpfully described by Kelly’s Directory.

The Lunacy Act of 1890 covered admission to private asylums but did not change the 1845 Lunacy Act and 1853 Act for pauper lunatics – by which it meant anyone unable to earn the money to pay for their care – on the grounds they were confined or without sufficient wealth to fund their care as averse to the destitute. The Lunacy Act of 1845, required  two medical certificates signed by qualified medical doctors for admission to lunatic asylums. The qualified medical doctor could incidentally be a pharmacist.  In theory a JP or official should have organised the doctor to examine the person to be admitted but it seems as though this happened prior to the jp being involved. In practice it would appear that one doctor and a vicar would be enough to certify a poor person in some locations.   The 1890 Act required an additional “summary reception order” particularly in the case of private admissions. This was also known as  “legal certification.” The 1890 law stated, as an additional safeguard against wrongful committal, that a justice of the peace specially appointed, a county court judge, or a magistrate could issue legal certification for privately admitted patients.  There was a £50 fine for any institution that was found not to have followed the correct procedure. The 1890 act also applied a time limit to the the duration of a stay in a private asylum.  The 1890 act also ensured that a policy of licensing developed that would help to bring about the demise of private asylums.

The act of 1890 reflects the increasing opposition to private asylums following examples of wrongful confinement relating to inheritance and unhappy marriage etc but as is the way of these things people still wanted to get rid of difficult, embarrassing or inconvenient relations so there was a flurry of illegal nursing homes prosecutions during the period that followed. The problem still existed after the passage of the 1927 act pertaining to the care of people with mental health disorders.

In 1910 there were slightly more than a thousand criminal lunatics, approximately 10,500 private patients and a staggering 118,901 pauper lunatics.  The numbers would steadily rise until the 1950s.  The State was concerned about the growth of insanity in the poorer classes.  Amongst this number were people suffering from senility and dementia, epilepsy, melancholia, learning difficulties, moral insanity and congenital insanity.  The causes were variously listed as heredity, excessive drinking, syphilis, influenza apparently caused madness in 2.8% of cases, starvation and mental stress.  It was also recognised that the onset of puberty could trigger some mental illness. 53% of female private cases were because of childbirth.  Essentially the first six weeks of motherhood left rich women at risk of insanity but only 7.5 % of pauper women.

The Mental Deficiency Act of 1913 identified four categories of young person who might need to be managed and cared for – these included the feeble-minded and the moral imbecile. This rather effectively ruled out the requirement for medical certification as a parent or guardian just needed to petition for the person to be placed in an institution.

Feeble minded:  that is to say, persons in whose case there exists from birth or from an early age’ mental defectiveness not amounting to imbecility, yet  so pronounced that they require care, supervision, and control for their own protection or for the protection, of others, or, in the case of children,’ that they by reason of such defectiveness appear to be permanently incapable of receiving proper benefit from the instruction in ordinary schools.

http://studymore.org.uk/mhhtim.htm#1920

Victorian Era Lunatic Asylums

Showalter,  Elaine. (1987) The Female Malady: Women, Madness and English Culture, 1830-1980 London: Virago.

Takabyashi, Akinobu.  “Surviving the Lunacy Act of 1890: English Psychiatrists and Professional Development during the Early Twentieth Century” Med Hist. 2017 Apr; 61(2): 246–269 accessed from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426304/