Saturday, June 1, 2013

From Madhouse to Asylum: The Evolution of the Treatment of Mental Illness

by Debra Brown

My previous post, A Brief History of Mental Illness and its "Cures", discussed how while in some parts of the earth advances were made in the understanding and treatment of mental illnesses, in Europe superstition and religious edicts and misinformation combined to increase the suffering of the sick and the fears of the rest of the population. The mentally ill were thought to be demon-possessed, witches or subhuman. 

"Solutions" included driving the madman out of the city gates at night to fend for himself, shipping him off to distant towns and arresting oddly-behaved women as witches and obtaining their confessions by torture. Many of these were cruelly put to death.

Families sought help for their insane loved ones; some protectively hid their relatives and sought treatment as best they could find from priests, physicians and healers. Exorcism, purging, application of holy relics or herbal therapies might be tried.

As time went on hospitals developed, originally from religous houses, to house the mentally ill--more for the protection and peace of mind of the sane than for treatment of the sick. A far cry from healing their ailments, they were subjected to miserable living conditions, some even caged and fed like animals and put on display to the public for a profit.

As time went on, more attention began to be paid to the possibility of mad behavior being caused by poor health of the mind. 

In the mid-17th century Richard Morton treated an eighteen-year-old girl who refused to eat until she looked like "a skeleton clad with skin". Morton appled plasters to her stomach to draw out the bad humors. He forced her to inhale ammonia fumes to subdue her violent passions, and tried to build up her strength with medicines containing iron. She died within a few months, and likely would have without this treatment, but at least he was trying to help.

As European doctors learned more about the brain, they gave up the concept of the four humors and ascribed emotional disturbances to problems of the nervous system. Women were considered prone to "nervous complaints"--at least wealthy women, while  poor women in the same condition were "mad". 

The cause of the illness? Some doctors returned to an ancient Greek notion that the womb wandered throughout the body in search of children, causing hysteria (thus the hysterectomy connection). Privileged women were warned to avoid study or hard work which might overtax their delicate nervous systems. Their menfolk tried to prevent excitement which might bring on an attack of "the vapors".

In 1728 Daniel Defoe, the author of Robinson Crusoe, protested the horrors of the madhouse system. He wrote an outraged expose about husbands  

"sending their wives to madhouses at every whim and dislike, that they may be more secure and undisturbed in their debaucheries ... This is the height of barbarity and injustice in a Christian country. ...If they are not mad when they go into these cursed houses, they are soon made so by the barbarous usage they there suffer ... Is it not enough to make anyone mad, to be suddenly clapped up, stripped, whipped, ill-fed, and worse use? To have no reason assigned for such treatment, no crime alleged or accusers to confront, and what is worse, no soul to appeal to but merciless creatures who answer but in laughter, surliness, contradictions, and, too often, stripes [lashes with the whip]?"

After a series of similar protests, the British Parliament investigated private madhouses in London and found that sane persons were indeed incarcerated against their wills. In 1774 Parliament passed a law requiring a medical certificate before any non-pauper [!] could be locked away as insane. Medical certificates, however, were all too easy to obtain, even for persons of means. 

Somehow, this well-intentioned effort of Parliament did not do much good for even the beloved King George III, who apparently had a physical disorder, porphyria, which caused severe psychiatric symptoms. Agitated, irritable and incoherent, he received the full horrors of eighteenth century treatment. The Countess Harcourt said, "The unhappy patient ... was no longer treated as a human being. His body was immediately encased in a machine which left it no liberty of motion. He was sometimes chained to a stake. He was frequently beaten and starved, and at best he was kept in subjection by menacing and violent language." He was purged, bled and given emetic drugs. His madness, however, helped to stir Parliament's interest in the treatment of the mentally ill.

In 1793,in an era called the Age of Enlightenment, Philippe Pinel was appointed director of a notorious Paris madhouse, Bicetre. The bloody French Revolution promised equality, liberty and brotherhood. Yet Pinel found many of the patients locked in filthy cells or chained to the walls. He hoped to treat these patients humanely and bring forth their inborn humanity as he had seen accomplished in Spain and other places. He was deeply impressed by the wife of a hospital official, Madame Poussin, who treated the patients with kindness and used her imagination successfully to reach into the private realm of the sick.

Pinel determined to unchain the madmen of Bicetre. Many Parisians were alarmed. As he predicted, however, the patients were grateful for their freedom and did not attack him or other members of the staff. Evidence of humanity!

Also in the 1790s, William Tuke led an investigation of English madhouses. At York Hospital he discovered a tiny room, eight feet square (six square meters), where thirteen women slept on filthy straw. Like Pinel, he was convinced that mad persons should be treated with kindness rather than cruelty. He determined to create "a place in which the unhappy might obtain refuge--a quiet haven in which the shattered bark may find a means of reparation or safety." His York Retreat opened in 1796. It heralded in a new era in the treatment of the mentally ill, the age of the asylum.

William A. F. Browne, superintendent of the Montrose Asylum in Edinburgh, Scotland wrote:

"The inmates ... all are busy, and delighted by being so ... You meet the gardener, the common agriculturalist, the mower, the weeder ... The bakehouse, the laundry, the kitchen, are all well supplied with indefatigable workers ... There is in this community no compulsion, no chains, no corporal chastisement, simply because these are proved to be less effectual means of carrying any point than persuasion, emulation, and the desire of obtaining gratification ... You will pass those who are fond of reading, drawing, music, scattered through handsome suites of rooms, furnished chastely but beautifully ... In short, all are so busy as to overlook, or are all so contented as to forget, their misery. Such is a faithful picture of what may be seen in many institutions, and of what might be seen in all, were asylums conducted as they ought to be."

Was this the end of the terrible treatment of the mentally ill? Could they now begin to heal in peace and plenty? Surely some were greatly benefitted in the improved conditions, and their gratitude would have moved them to cooperate as best they could. In my next post, however, we will look at more of what lay ahead in the treatment of the mentally ill.

Snake Pits, Talking Cures, & Magic Bullets: A History of Mental Illness by Deborah Kent


Debra Brown is the author of The Companion of Lady Holmeshire.

Her current work is on a novel, For the Skylark, about an emotionally disturbed woman, based on Charles Dickens' Miss Havisham, and her adult twins.  


  1. Thank you for this interesting, thought provoking, and rather heart breaking post. I can't imagine the horrors these poor people must have suffered.

  2. An interesting post into a difficult subject. We would like to think that you are right Debra, in assuming all has been well since, but I'm sad to say that I think that cruelty and neglect, sometimes due to ignorance but at times due to a few extremely nasty characters who managed to gets posts in our major institutions for the mentally ill, still happened up until the middle of the last century. The most moving book I ever read was 'The Skaligrigg' by Michael Horewood. Fiction I know, but it also explores the lack of understanding of the intelligence of people with Cerebral Palsey, for instance, which would be unheard of today. Thank God times have changed eh. All the best Diana

  3. Thanks for your comments.

    I did not assume all was well since, Diana. :) Sadly not. It is still a work in progress. The next post will tell more.


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