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

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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.  

Britain's Crossdressing Women

by Linda Collison


Women pretending to be men crop up regularly in English and Irish literature and contemporary dramatic productions. An upcoming film starring American actress Glenn Close as Albert Nobbs is based on a short story by 19th century Irish writer George Moore.

Albert Nobbs is the story of a nineteenth century British woman of illegitimate birth who portrays herself as a man in order to get work. The movie has been Glenn Close’s passion project for 15 years and is expected to be Oscar qualifying. The movie is to be released in January, 2012 and you can watch trailers of it on the internet.

Women passing as men are tantalizing archetypes as old as the Cheviot Hills. Most real women who dressed as men did so primariily for economic opportunities. I believe it may have been more common than we know, back in a time when a woman depended upon a man for her livelihood and her legal status.


Most of us have heard of Anne Bonny and Mary Read, infamous British pirates of the early 18th century. These two didn’t actually pretend to be men but dressed in trousers and lived the rough life of pirates alongside their partners and lovers, the most ruthless of men (although Mary Read was raised as a boy so she may have had some gender issues...)


Less well known is Christian Cavanagh, an Irish-born mother who disguised herself as a man and operated under several aliases including Welch, Welsh, Jones, Davies and Mother Ross. Daniel Defoe, an author with empathy for women as evidenced by his 18th century novels Moll Flanders and Roxanna, the Fortunate Mistress, chronicled her life in Mother Ross; The Life and Adventures of Mrs. Christian Davies, commonly called Mother Ross on Campaign with the Duke of Marlborough.  No pirate, she!

After the disappearance of her husband Christian left her children in the care of her mother and a nurse and pursued him into the army.  Dressed as a man, she first volunteered as a foot soldier and fought at the Battle of Laden during the Nine Years War, where she was wounded, captured and exchanged without being discovered as female. She later re-joined another campaign as a trooper of the 4th Dragoons where she served from 1701 to 1706 when she was wounded in action again -- and this time discovered.

Hannah Snell was a young Englishwoman who also went in search of her man who had run off. She ended up serving as a soldier and as a marine for a many years until she too, was wounded and found out. Hannah was honorably discharged and granted a pension in 1750 (increased in 1785), a rare thing in those days. A good account of Hannah Snell and two other women who served in the British Navy can be found in Lady Tars (a Fireship Press reprint). There may have been many more such women who never were detected because they were never wounded.

Patricia, natural daughter of an 18th-century Barbadian cane planter, poses as Patrick in the fictional Patricia MacPherson Nautical Adventure Series. Inspired by Star-Crossed, originally published by Knopf/Random House and soon to be republished by Fireship Press, the idea for the character came to me in the middle of the Pacific Ocean aboard the HM Bark Endeavour, a replica of Captain James Cook’s famous vessel, on which I served as a voyage crewmember in 1999. 

While climbing the rigging to make and furl sail, heaving on hempen lines as thick as my wrist in unison with my mates and taking my turn at the helm, I discovered a woman really could perform the same work as a man aboard a ship during the age of sail. But why would she, I wondered? And how might she pull it off?  Answering these questions has led to many years of research about the Royal Navy during the 18th century and other aspects of colonialism.

Romance and adventure aside, in a man’s world some women chose to become men rather than turn to the poorhouse or prostitution. It must've been a tough choice but not without its rewards.

Surgeon's Mate; Book Two of the Patricia MacPherson Nautical Adventure Series was released earlier this year by Fireship Press and is available world wide.  Book Three is underway. For more information please visit my website lindacollison.com. Check out my author’s blog for release date or follow me on Twitter.