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

by Mark Stevens

  Work and Occupation

  After these first appointments of the day it is time to move on to work and occupation. This is not just a way of spending time but a vital part of your treatment here. Your improvement is contingent upon your industry. Many patients complain that they should not have to work and they reason that, as their treatment is forced upon them, they are under no obligation to assist with the smooth running of their surroundings, which some wrongly see as captivity. They also argue that if they are to give their labour then some recompense should be provided, as would be the case with any private employer.

  These objections are ones of principle. For the latter objection, we provide recompense where we can. Extra rations are available to the working patient in the form of lunch and an allowance of beer and a wider range of clothing. For the former, we suggest that any aggrieved patient consider the wider picture. Not working might indicate an inability to live independently outside the asylum. Any patient unable to live independently is unlikely to be considered suitable for discharge and by remaining idle your fate is most determinedly to stay here also.

  However, under no circumstances will we insist that you work. Indeed, we recognise that due to the nature of their illness many patients are simply unable to function in a productive manner. At any one time we estimate that around a third of our patient group falls into this category. The practice of asylums in managing these patients varies considerably. If your case is such then we shall still endeavour to keep you occupied, as even the most demented patient here, unless catatonic and immobile, can most likely be induced towards some mechanical action.

  At its most basic level, this action can be found through the creative use of the waste of asylum life. Thus, old newspapers can be shredded to make stuffing for the bedding of patients liable to wet or soil themselves; horse hair can be combed to fill pillows; rags can be torn into fuel for the boiler. These tasks are inoffensive, undemanding and require no special tools or supervision; they even make productive use of patients who tend to be destructive. At this asylum we consider such activities to be a welcome addition to the daily output.

  Most work performed by patients is unskilled. This is an inevitable consequence of the associated supervision required of any patient who wishes to undertake skilled labour. But there is an abundance of tasks that, while not requiring any exceptional talent, are of the utmost importance in providing an uplifting and healthy environment. They begin inside with the rigorous routine of cleaning required on all the communal places. Upon each ward there is a team of patient cleaners engaged in the washing, scrubbing and polishing of all the fixtures and fittings.

  Around fifty patients, men and women, form these teams. Walk along any part of the asylum in the morning and you will see patients with mops, brushes or cloths in hand. Simple scrubbing can be easily taught and is a job available to the vast majority of patients. In some asylums, a little vinegar in used in the water to clean the floors and windows, though here we prefer to use soft soap or soda, so that the rooms and corridors do not retain the lingering, rather burning, smell of vinegar. Even so, during and after cleaning all available windows will be left open to allow the evaporation of any disagreeable chemicals.

  Furniture and woodwork may be polished using a little oil. And if a patient feels uncomfortable with a bucket at their feet, then they can always pick up a drying cloth and follow on behind the wet work. Rugs from the day-rooms are taken outside and beaten by patients capable of wielding a carpet beater.

  Outside work is also a regular activity for the male patients. Another 50 men work daily in the farm or kitchen garden, while additional seasonal duties may be required if building work is in progress. Work in the farm or gardens follows the same patterns as for the labourer of rational mind. The preparation of the land, the nurturing and harvesting of grains, fruits and vegetables are practised here in traditional fashion. To work in the kitchen garden is to enjoy the trust of using forks, hoes and spades – tools that may not be considered safe in all patients’ hands. There is an element also of independence, for, while the attendants will watch you, there is always such a variety of tasks in hand that it is impossible for their eyes to be fixed on every mixed border. If you are detailed for the kitchen garden, then we suggest you use your privilege wisely, as it is a step along the pathway to discharge.

  Work to the lawns, trees and shrubs is equally vital. A small sum is available each year for planting of new shrubs or other perennials, and we constantly strive to make the gardens a pleasing environment in which patients can recuperate. During the spring and summer months, the grass is kept neat by a team who use the cutting machines and a roller for ground levelling or maintaining the cricket pitch. The use of these tools is another privilege, especially in the less secure gardens to the front of the estate, while those teams who trim the specimen plants and boundary hedging with shears or loppers are also trusted, if rigorously supervised.

  A careful eye is placed too upon those patients who help with the livestock on the farm. Inevitably, the farm bailiff has call only for a handful of workers, and these men must be amongst the most gentle of our patient group. If chosen, you may find yourself shepherding creatures to graze or to milk, or providing a comfortable environment for the pigs, sheep, cows and chickens through clearing old straw or laying fresh. There are daily tasks for the kitchen too, with butter to be churned and eggs to be retrieved from the coops and delivered to the larders.

  Field work is more likely to be undertaken by patients in a small group, working together on a set task of digging, spreading manure, sowing or reaping. We employ seasonal labourers to thresh and undertake more dangerous activities, but there are still many opportunities for patients to help. Wheat, barley and oats are all tended on our wider estate and contribute to the bread we bake and the hot meals we provide, with any excess being sold; a significant quantity of potatoes are also grown to augment the grains in broths and stews.

  At harvest time, you will find a swell in the numbers of patients directed to help in the fields and gather in the crops. There is a sense of community in this work, perhaps as great as you would find in any country parish. The same small group approach is true for the labours of building maintenance or building improvements. All the walkways and pathways around the airing courts, for example, were dug and laid to gravel with a coal tar surface by the patients. Other patients worked to extend these tarred tracks across the whole estate. The grounds between the main building and the river have been terraced, allowing for their better cultivation; the site for the asylum sewage works was levelled; stones have been broken to help provide foundations for building works; and hard landscaping – including a little brickwork – has been provided around some of the buildings. Recently a small group also undertook the arduous and unpleasant task of draining the cess pit.

  Routine decoration is something you might help with, if you have the requisite neatness required for painting. Because of the accumulated effects of burning the stoves and the gas lamps, each year we try to whitewash the ceilings throughout the entire main building. Usually, at least one of the male or female sides is also repainted with the appropriate colour wash, while a smaller programme attempts to refresh the exterior wood and metalwork. That is recoated with an oil-based paint within a period of three to four years.

  The same limitations are true of assisting in the workshops, which is perhaps the most exacting work that we can offer. Every good asylum is able to supply and look after its own clothing and fixtures, and we take pride in our own output. As a result, those patients with sufficient dexterity may find themselves invited to take up employment with one of our artisan attendants.

  Our capacity is such that around twenty working men might join our permanent artisans – the shoemaker, tailor, upholsterer and carpenter – while one or two more might be invited to help the baker or the engineer, or assist the farrier should he visit. The workshops are equipped with stools and benches at comfortable heights, with tra
ys of instruments always to be returned to their homes. In the shoemakers’ shop there is the strong, sweet smell of leather, untempered by the usual odours of a tanner’s shop, while cloth and wood bring a fresh aroma to the other workrooms.

  Aside from cleaning, we prefer that female patients perform indoor work and they can bring their domestic skills to bear in three sections of the asylum: the laundry, the sewing room, and, to a lesser extent, the kitchens. As you may surmise, only our convalescent women are trusted with a needle. Within their pretty day-room, the casual visitor will happen upon a group of ladies, tastefully attired and engaged in needlework, as one might see in a domestic drawing room.

  Altogether, we have space to accommodate around thirty seamstresses in the sewing room. It is like a small cottage industry, interrupted only by the healthy conversation of improving minds. Of course, much of the work comprises basic necessities: repairs to asylum garments, bed linen or washing materials. The women’s own garments are also made here, but the cloth is first cut by an attendant and then sewn under her direction into patterns. The women patients who sew are also encouraged to work on their own items of clothing, as the crocheting of lace trimmings for a dress can help boost feminine esteem, as can the sewing of a dress with gay pattern from a non-standard cloth. These dresses can be made for themselves or for their patient friends, assuming such a gift is also beneficial to the other patients’ health.

  Laundry work is rather different, as it is far more oppressive to the senses. When the laundry is in operation there is much noise from both the hand and mechanised washing, the powerful (though not unpleasant) smell of tar from the carbolic soap, as well as a great heat and humidity created by the ironing and the drying cabinets. You will also deduce that wet clothes gain weight in excess of their dry poundage, and so a suitable candidate for the laundry will be of a robust nature, with physical strength and stamina, rather than one of our more delicate females. Nevertheless, we must always endeavour to find some thirty candidates so that we can rotate their duties, and also on occasions dispense with the need for the machines.

  The laborious nature of washing, rinsing and drying so many clothes means that it is not possible for the laundry to be in operation every day. Washing occurs on three days of the week, with the fallow periods allowing for the clothes to be aired, collected and returned to store, ready for the rotation of the patients’ linen. Thus, if you work in the laundry, you will find that your work has a routine varying between wet days and dry days.

  Finally, a small number of our female patients help in the kitchen. Kitchen work carries many risks, as there is a constant need for boiling water and feeding the fire in the stoves, as well as ready access to a surfeit of knives and other tools that can cause much harm in the wrong hands. In consequence, female help here is best used in the scullery, where plates, dishes and cutlery are washed and stored, or in the dining hall as servers; only the most trusted patient may assist with the preparation of food.

  For Those Who Cannot Work, or for Working Patients in Possession of Some Idle Time

  An asylum is a unique public institution in that the recreation of the patients is of as great importance as their work or custody. Those unable to enjoy the fruits of performing labour still join with the workers to engage in activities which do not necessarily have a purpose other than to stimulate and occupy. That is not to say that recreation is aimless, but rather that it need not lead to any immediate, visible product. As recreation is both healthy and good for the treatment of patients, we encourage it, and provide a wide range of amusements for all to enjoy.

  Fresh Air Recreations

  Let us begin with a simple perambulation in the enclosed airing courts, where paths frame the lawns and seats. Walks within the airing courts are suitable even for the infirm or for those at risk of becoming excitable. There is also a wider series of pleasant strolls available via the walkways around the estate. Of course, the necessary strength and behaviour to complete the walk is required, but around two-thirds of our patients take advantage of this latter option. Daily you will see groups of four or five taking the air along the river meadows or through the fields, each group accompanied by an attendant. Male and female groups always walk in opposite directions so that they do not meet.

  Recently, we have been able to extend the scope of the walking parties to some of the lanes bordering the asylum and even the main road outside the gates, as it is infrequently traversed by carts and carriages. The female patients also enjoy these routes, as modern society no longer considers it quite so shocking to see a group of women walking, unaccompanied by a male chaperone, along the public roads.

  For those patients who are unable to move beyond their wards, some assistance is given so that they may exercise through physical support or even a repetitive stretching and relaxing of the muscles. No patient is permitted to spend his or her time entirely at rest in the day-room or the ward corridor, lest this inactivity become a disagreeable habit.

  More complex outdoor amusements tend to be the preserve of summer months. For the men, a cricket pitch was laid out in our inaugural summer, a year that also saw the asylum’s first victory over the local village team. In due course we were able to create a permanent pitch complete with its own small pavilion, where patients may change their clothes in comfort. Now that the game of cricket has also been codified by the Marylebone Club, regulation equipment is quite easy to procure and cricket is played on every fine evening in the warmer seasons.

  Umpires and scorers are found from amongst the convalescents, while the boundary line is replete with those too frail to participate, but who live out each triumph and disaster as if it were their own. To see cricket played as the sun gently slips beneath the summer sky, and a golden evening turns copper pink, is a true pleasure and no better picture of a harmonious assembly might be witnessed in any English village.

  We act as hosts for cricket games against various local teams – including the asylums nearest to us – and are occasionally able to play return fixtures. The staff, of course, join in too, and each team has a mix of staff and patients. The patients enjoy the equal status that sport gives them with their warders and matches are keenly fought. One patient, who suffers from delusions of grandeur, is determined to maintain his status as the best bowler here (if not in the world), while our poor chaplain was struck by the ball during one innings last July and then was absent for several days.

  In the winter months, we have found that the men enjoy the somewhat rougher pursuit of association football. Asylum football has its own rules, which consider excessive physical contact a disagreeable element to the game. Patients are therefore encouraged to play the ball and to leave the other players well alone, lest collision proves an unfortunate provocation to violence. It is for this reason that the rugby style of football is never practised in asylums.

  While the women do not engage in team sports, the provision of a lawn tennis court has been of considerable benefit to them. We have a level site and it is a simple matter each year to mark out the lines of a court with twine and pegs, before painting them; a basic net of wooden posts and wire mesh lasts the season. As one might expect, there is less interest in sport on the female side, and it is easy to accommodate all the ladies who wish to play – using doubles where necessary – and still avoid playing during the heat of the day.

  A growing number of less rigorous games are also finding their way into asylum life. Outdoor croquet, for example, is most suited to the restrictions of an airing court and can be played by a number of convalescing patients in less hospitable weather than is required for cricket or for tennis. A set of lawn bowls has been purchased for more elderly residents, and the creation of a bowling area is under active consideration.

  Recreations Enjoyed Indoors

  While activities outdoors are, of necessity, determined by the weather, activities inside the wards are offered daily as a staple way to occupy the irrational mind when it is not at work. On the convalescent wards so
me of these activities are available for patients to undertake by themselves; on the acute or refractory wards, the offer is more restricted.

  Reading is perhaps the most common pursuit and every ward receives a daily supply of newspapers and an occasional supply of periodicals, so that any patient with an interest in reading can keep up their habit. The appropriation of newspapers for individual use is considered unacceptable, and the attendants will make sure that the day’s stock remains accessible to all. There is no censorship of news, nor have we found any evidence that the editorial rigour of certain publications causes distress to patients. Newspapers and magazines are happily also disposable, so that should an accident befall a copy it creates no unforeseen dent in the institution budget.

  Each ward is additionally supplied with three standard texts: a Bible, prayer and hymn books. Other reading matter is available from the asylum library; this collection is kept secured, but can be open to any patient upon application to the chaplain. The chaplain uses his discretion over how the library is stocked, and he procures volumes of general literature with advice from the Society for Promoting Christian Knowledge, who also supply the books. Their preference is for light fiction with moral tales, or factual works on matters of natural, scientific or historical interest. This year we have added the Waverley novels of Sir Walter Scott and a collection of Lord Bulwer-Lytton’s popular stories. Books are issued on a monthly basis and a strict record is kept of each volume loaned. Each ward also has a bookcase where volumes can be kept safely when not required.

  The other principal ward activity is the playing of indoor games. Cards are freely available, because like newspapers they are innocuous and easy to replace. In wards where it is safe to do so, sets of draughts, dominoes, bagatelle boards and chess are provided, though these are locked away when not in use. They may be issued under the supervision of an attendant, who can also supply a copy of the rules of each game to prevent controversy. During inclement seasons we bring out an indoor croquet set, as games may be played within the ward corridors. Finally, after many years of saving, we have recently been able to purchase a billiard table for use in the entertainments hall.