Life in the Victorian Asylum: The World of Nineteenth Century Mental Health Care

by Mark Stevens

  Yet female attendants are so much cheaper to hire, and so less has been invested in each new wife lost to us. This investment is partly in time and partly in study. Training for attendants is a comparatively recent development, but now that it is available we have embraced it. Many new attendants arrive fresh from the field or the scullery, and once garnered they must be capable of quickly absorbing a little of the human condition. Each new recruit is sent through the Medico-Psychological Association certificate, and we have additionally endeavoured to offer this route to our more established staff. Gone are the days when an attendant was selected for employment purely on their physical presence, and then placed in the ward to learn only from the memory of his closest colleague and through the bitter difficulties of experience. The modern attendant must have a range of knowledge at his or her finger tips.

  This knowledge is then tested fully over a period of six months’ probation. During those months new attendants work around each ward in turn. This is a necessary exception to our usual rule of continuity, as it is vital that each apprentice has experience of the different types of mental disorder and how these manifest in patients. A journey round the wards at speed is the best way to achieve this, but the result is that if you welcome a probationer to your ward then try not to form a great attachment to them.

  Once fully trained, the new attendant should be able to employ the kindness, patience and understanding imperative within the asylum regulations. The regulations cover much of the usual daily business relating to patients which touch upon clothing, cleanliness and supervision, as well as instructions to inform senior staff of any incident or of any patient movements.

  The language in which the regulations are written should leave you in no doubt that our organisation aims to present an attitude of beneficence at all times. Alienists have long since recognised that any creature, no matter how sick in mind, may be adduced to co-operation through the gentle application of the asylum routine by persons who display a soothing nature. There are, of course, penalties laid down in statute for any staff who ill-treat or wilfully neglect a patient, but it is our aim to do somewhat better than simple competence.

  You should never be made to feel worse by an attendant; it is their duty to respond appropriately to your condition. Not even the most extravagant delusions will be mocked, yet nor will they be deferred to or encouraged. Attendants must refrain from making personal comments or discussing the case of any patient in public hearing. Suicidal patients will never be allowed alone, epileptic patients will be escorted up and down stairs, and the melancholy will be in receipt of cheery conversation. The quiet patient should receive protection from the boisterous and vice versa, the frail or timid should be protected from those prone to excessive demonstrations of force or high volume utterances. If another patient intimidates you, or makes you anxious, then the attendants on the ward will be alive to this possibility and seek to protect you.

  Attendants are obliged to be industrious, so that they set a good example for the patients. The day attendants rise early and are late to bed. They are encouraged to take part in the occupations, amusements and other entertainments offered to the patients, to be creative in their use of occupation, and to use any opportunity to engage a patient in some helpful task.

  The other essential part of an attendant’s character is the ability to observe patients and to draw inferences about their behaviour. For the attendant is the superintendent’s eyes and ears on every asylum ward. Two are on duty in any ward at any time and they will notice if you are acting out of character, or if any change has been detected in the atmosphere of the room. They will make reports on accidents, outbursts, illness or refusal of food. They are under strict instructions never to leave any ward, day-room or bathing room unsupervised, nor any window or door dangerously open.

  The management of danger forms the last notable feature of the attendant’s role. At times they must take action for the patients’ safety, and when such eventualities occur an attendant will be firm with you, restraining you as necessary. The attendants are also aware at all times of the possibility of weapons being acquired or fashioned by patients, as many household objects can become sources of attack. From time to time it may be necessary for an attendant to search you, so please comply with their request. Similarly, you may find certain articles are removed from your possession or your ward, and if you have need of something, then please ask the attendants whether it can be granted.

  Although the list of attendants’ tasks seems daunting, you should think of them as the people whose primary task is to make your life comfortable and ensure you do not go hungry, dirty or unoccupied. A good attendant can address all things without the patients becoming aware that work is done.

  Outdoor Servants

  The Engineer

  Every modern asylum needs a man who can understand the workings of heating and lighting apparatus. The boilers, engines and pipe work that deliver these marvels for our comfort all must be managed and maintained. The engineer performs this vital task, and the importance of his position is reflected in the wages offered to him - slightly higher than those of our head attendant - and the fact that he is also offered accommodation on the site. Emergencies are wont to occur at any time, such as when water froze around our gasometer one winter’s night, impeding our supply, and it makes sense to have the engineer on immediate hand for their efficient rectification.

  The engineer also acts as an inspector, checking the fuel systems and those of the asylum sanitation. If he finds that repairs are required, he will inform the steward of their cost and importance, so that his senior officer might decide a course of action. He oversees other essential jobs of housekeeping, ensuring that the chimneys are swept and the gutters cleared. You may occasionally see him deep in conversation with another member of staff, but he will not come and speak to you, nor should he, as his job places him behind the scenes.

  The engineer additionally has a role to play in managing supplies. For he acts as a safety valve against excessive consumption, monitoring the use of gas, wood and coal by every ward. Irregularities are always investigated.

  The Bailiff

  As the engineer is to fuel, so the bailiff is to food. He manages our farm, our fields and gardens: if new spades are required, he will tell the steward; if we must purchase lambs, or pigs, or cows then he will identify the need and inform the visitors; when the time comes to order seeds he will construct the inventory. He also keeps a record of the dairy, eggs and crops that accrue to us. The bailiff is, therefore, another of our practical men, and you may never see him unless the farm is your place of work, but behind the scenes his keen understanding of nature, animals and the seasons is vital, and he puts it to good use. He also has a creative side: for it is under his direction that the planting of trees, shrubs or other plants is undertaken in the airing courts and gardens.

  Asylum bailiffs have usually managed farms on country estates, and as you might expect, this means that they tend to be married men, which can provide additional benefits to the asylum. The wife of our present bailiff, for example, is engaged as our dairywoman and oversees the milking of the cows.

  Other Outdoor Servants

  The steward, the engineer and the bailiff obviously do not act alone. At any time, the operation of the asylum estate may have need of further help, and on the permanent staff we employ a gasman, whose sole responsibility is to oversee that element; a baker, whose task is to keep stocks of fresh bread plentiful; and a stoker, who loads the boilers. All these jobs must be filled by reliable persons who are careful and diligent. The roles of gasman and baker are considered so important for the running of the asylum that their salaries are comparable with that of the head attendant.

  The bailiff also has the assistance of a permanent gardener, a man who can undertake the practical work of planting, directing a patient cohort to assist him. Then there is the carter, who transports supplies, as well as staff and patients, and collects further goods from local b
usinesses. You will see him and his horses from time to time along the drive or hear the distant noise of hooves against the highway stones.

  Additionally, we make use of a small number of seasonal labourers, who arrive at harvest time or to help with the regular maintenance of the building. They are paid higher wages in the summer, and a winter retainer to ensure they will return the following year. Bricklayers, painters and carpenters may all sometimes be seen about the estate and you could find yourself working with them, if you assist with labouring duties.

  Indoor Servants

  The indoor servants will be invisible to you, unless you are assigned to work at one of their stations. The three most senior indoor servants are the porter, the cook and the laundress.

  The porter transports items from one place in the asylum to another, including foodstuffs, clothing and furniture. He works under the direction of the steward and provides a little assistance in the keeping of the stores. It is his responsibility to guarantee that no illicit liquors are brought into the asylum, and that no asylum property finds its way out. The cook is in charge of the running of the kitchens, and makes sure that food is readied and served for every meal, as well as keeping an eye on the larder stores for condition and for quantity. The laundress oversees wash days, drying, ironing and then the movement of clothes back into the stores. All three of these positions are paid at a higher rate than the attendants, and all three have extra junior staff to assist them.

  These last posts must be considered at the bottom of our hierarchy: the gatekeeper (who logs the comings and goings of staff, as well as deliverymen); the kitchen maid, house maid; and two laundry maids. They have live-in accommodation provided, but at a salary around one twenty-fifth that of the superintendent’s you may not be surprised to hear that they are usually filled by younger staff, who do not have the expense of a family.

  Finally, we have a number of mechanic attendants who are not salaried employees, but are paid an hourly rate. These artisans look after the workshops: a carpenter, shoemaker, tailor and upholsterer. They are all expected to be off the asylum premises by 5.30pm after the shops have been closed for the day, the tools counted and the surfaces cleaned.

  Staff Discipline

  It is perhaps appropriate, before leaving the matter of staffing, to make reference to the question of discipline. The behaviour of staff is taken very seriously within the asylum. The superintendent has the power to summarily dismiss any of his staff, though a right of appeal exists to the committee of visitors. However, any member of staff wishing to challenge the superintendent’s opinion will place the visitors in a difficult position, and it is extremely unlikely that they should wish to overturn their representative’s judgement.

  As in any institution the best discipline is often that which is administered immediately. Senior staff are encouraged to admonish any practice found wanting the instant it is discovered. Many such incidents require no further hearing or investigation and will never be set down in written form. To prevent any deterioration in performance, regular reports on attendants are received by the charge staff responsible for each ward. These will include notes of any occasion where staff have not met our high standards. Any complaint you might make against a member of staff will be included in such a report and ill discipline amongst the staff will be recorded. We keep defaulters’ books, which act as the record of misdemeanours committed by the staff, and these include a note about subsequent enquiries and any action taken.

  Most offences amongst the staff require no more than a warning. Attendants found sleeping on night duty by a senior colleague; who cannot account for a wandering patient or left a kitchen knife unattended; the man whose liquor-scented breath is discovered quickly upon his first “Good evening”; all these people are likely at most to have a note made against their name. Due to the nature of their tasks, it is the attendants who bear the brunt of such scolding. Nevertheless, they are not alone. One New Year’s Day the porter failed to return to his post, having been sent the previous day to the nearest town to get change for a five pound note. He claimed that he could remember nothing between entering one of the borough’s inns the night before and then waking up on board a train to London.

  More serious offences might be dealt with by suspension; these are cases where behaviour has been exhibited that is wholly unacceptable. Staff are expected to behave in a proper manner at all times, and not to engage in base activity, including the use of indecent language in the servants’ mess or other communal rooms, or harassment of the female staff. Another porter once employed would put nuts down the dresses of the younger staff and then try to retrieve them. A period of time without wages was felt to be a suitable response to his flagrant, indecorous conduct.

  The ultimate sanction for misconduct is dismissal. Offences that lead to a summary parting of the ways are those that indicate a complete unsuitability for continued employment: an obvious or wilful neglect of duty, persistent drunkenness, a fraud or deception, or steadfast insubordination in relation to a senior colleague. Over recent years, two attendants have been dismissed following a fight between them; similarly, a proven assault upon a patient was enough to terminate the employment of another.

  With transgressions of a moral nature such as these, an individual can usually be persuaded to do the honourable thing and resign. A male attendant who was intimate with a female colleague, resulting in her pregnancy, realised for example that it would be expedient for him to leave. The man who escorted his colleague’s wife home from the railway station – and not by the most direct route available – also recognised that continuation of his employment would be undesirable.

  Chapter 6

  The Daily Routine

  After your symptoms have been assessed, it is time to move you to whichever ward is most appropriate for your condition. This seems a suitable point at which to discuss your daily routine here. Routine is of the utmost importance to the asylum and its patients, as it allows for the asylum staff to know their stations, and for patients to understand the gentle forces applied to keep them active in the day.

  To a certain extent, your daily routine is also determined by your symptoms. Some patients will be better able to partake of the wide range of activities we offer than others. Please accept this and do not struggle against it; the medical officers will take charge of what is suitable for you and they will instruct the attendants accordingly. Within these boundaries it is possible still to illuminate the features of an average day.

  At the early, and consequently healthy, hour of 6am the day attendants come on duty (one hour later during winter), and this changeover from the night staff is the signal for all patients to rise. You will be wakened in good time to perform the necessary ablutions and evacuations. Convalescent patients in single rooms will be obliged to empty their chamber pots, while a similar activity is undertaken by the attendants in the dormitories. Those patients who have soiled themselves at night will be taken off to bathe.

  Also in the dormitories the lavatory table will be procured for those able to wash themselves, and flannels provided for the purpose, while in the more secure wards the attendants apply the flannels to patients directly. Each patient’s hair is combed and, if necessary, fixed-up for the day, and patients with false dentures are able to reclaim them. Patients with their own teeth will be allowed a toothbrush if they are capable of appreciating its use. Then it is time for all to change from their nightdress into daytime attire.

  While you prepare for your day, the kitchen staff are busy with your breakfast. When everyone within the dormitory is ready, your ward attendants will direct you to file, in as orderly a fashion as you can muster, out of your dormitory and down the stone stairs. You wait in the lobby on your side of the central corridor and from there progress towards the benches and tables in the dining hall.

  Breakfast begins at around 7am, or one hour later in the depths of winter. When all are present, grace is spoken. On the table before you the same fare is provided daily:
an 8oz ration per patient of bread from the previous day’s baking, cut into slices and coated with butter. This bread is mostly of brown whole-wheat or occasionally black rye. A tin mug sits waiting to be filled with tea from a pot as the attendants and their patient helpers make their rounds, and coffee is occasionally made available if it can be procured at an acceptable price.

  Eating is a social experience but is also constrained by the clock. Like you, the staff have a routine and, unless you are in the infirmary ward, it will not be possible for you to prolong your breakfast beyond that of the other members of your ward. You are perfectly at liberty to talk but please be aware of the passage of time and that, inevitably, the moment must come when you have to put down your mug and leave the plate behind you, in order that the daily routine continues.

  After breakfast some patients – around two in every ten – choose to attend chapel to hear the chaplain read the morning prayers. These begin at 8.20am, late enough that the sun will have risen on even the shortest winter’s day. There is no requirement to attend religious service; indeed, in some patients there is a danger that it may induce or contribute to religious mania. We recognise also the practical difficulties of encouraging large numbers of patients to and from the chapel. As a result, attendance is largely restricted to those convalescent patients called by faith, who choose to proceed quietly to our place of worship in fine weather or foul.