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

by Mark Stevens

  The increasing gloom around asylums was only lifted after 1945. The reasons for this were partly social and economic: the post-war boom found employment for many people previously considered surplus, and that group included those whose mental illness affected their capacity for work. These people were now needed, so the wider community gave them a chance to help in whatever way they could. Coincidentally, the employment boom arrived at the same time as the last vestiges of the poor law were swept away. No more were the restrictions of indoor relief to be central to treatment; patients could instead be offered a broader range of care, away from a central institution. The new National Health Service provided services in surgeries and clinics as well as hospitals.

  Moulsford joined the NHS in 1948 and was asked to find a new name that would be free of stigma. It chose to become Fair Mile, a suitably anonymous title that turned it into just another institution. This one act of re-branding wiped the asylum off the map, though if the motive was to remove the negative connotations of the Victorian word, the plan was also to restore the Victorian idea of hope. It was part of a rediscovery that patients were people too, and an even greater change in that direction came about in 1959, when the landmark Mental Health Act first gave patients a voice to challenge their detention.

  Around the same time, another important development arrived: the prospect of new treatments. For many years, the moral regime had prevailed in public asylums, and the visitor to the ward would have noticed little development from the nineteenth century. The first radical fresh ideas were introduced just before the Second World War, when electro convulsive therapy and insulin comas made their way into public asylums with mixed success. Then, in the late 1950s and early 1960s, modern pharmaceuticals followed, offering if not cures, the alleviation of symptoms and allowing patients to reclaim their former lives. For the clinicians this was a big moment, promising the possibility that most patients could live free of constant care. Vast institutions no longer seemed quite so necessary.

  As places like Fair Mile entered a decade of social revolution, the received view of life inside the Victorian asylum was that it too required reappraisal. Living standards outside the asylum had raised immeasurably since Queen Victoria had died, while those inside enjoyed a quality of bed and board unchanged since the turn of the century. In the chronic wards patients had become institutionalised and hopeless, yet new drugs on the admissions wards offered the opportunity of turning even previously static lives around. It was an era of technical fixes, when prescribing pills was in vogue and the old values of interaction and occupation were generally derided.

  It took some time for this shift in medical attitudes to manifest in public policy. Health Minister Enoch Powell had predicted a world free of asylum ‘water towers’ in 1960, but the gradual move towards discharging long-term patients, begun in the 1950s, continued at a slow pace. When the increase in speed came, it was because the politicians had latched onto a reversal of the old poor law maxim: outdoor relief had now become cheaper to provide than indoor. Asylum buildings were expensive to maintain, as were staff salaries; drugs for out-patients were not. The better option was to dispense with bed and board, to place a welfare payment in one hand and some tablets in the other, and let patients make their own luck instead. Unfortunately, this professional enthusiasm for community-based treatments provided cover for what became savage cuts in mental health services.

  The economics of mental health care cannot be dismissed. As the British economy slowed in the 1970s and 1980s, it became harder to discharge people successfully into society. Unemployment became a fact of life for many working people, and those who were already marginalised found a return of hard times. Opportunities for integration shrank, and while the concerted drive to discharge long-term patients continued, it did so without the same results. A new breed of ‘revolving door’ mental health patient was created, as people found themselves spending shorter, but more regular periods in care. When specialist services were reduced, many patients were admitted to general hospitals instead.

  By the time growth improved in the latter 1980s, it had become politically acknowledged that in-patient care was financially undesirable. The preferred option was known as ‘care in the community’, whereby family and volunteers might provide resources to support the patient alongside the state. This was the moment when the great period of asylum closures was implemented. The end was rapid; nearly forty hospitals shut their doors in the first half of the 1990s and virtually all the Victorian wards were swept away. Fair Mile hung on longer than most, finally discharging its last patient in 2003.

  In theory, care in the community could have provided a positive future, where patients were free to make their own choices and were welcomed into society. In some cases this did happen, particularly in the more affluent parts of the country. However, in others, community care offered the risk of what John Talbott, a prominent American psychiatrist, described as replacing ‘a single lousy institution with multiple wretched ones’. Studies have estimated that up to 100,000 patients were discharged from Victorian asylums in the second half of the twentieth century. Only 4,000 of those hospital beds were replaced with mattresses in NHS hostels. Other hostels housed the mentally ill who joined the homeless; and where once asylums received patients direct from the prisons and the workhouses, now those patients remain in custody, particularly if they are young; while if they are old, they may be found instead in that most twenty-first century of institutions: the care home.

  Mental health services, meanwhile, largely became providers of crisis care. The current NHS offers around 15,000 beds for the mentally ill, and a patient has to present an immediate and serious risk to themselves or others to have a chance of admission. Beds are taken wherever they can be, and it is not unusual for patients to be treated hundreds of miles away from home. Ironically, a modern in-patient ward is full of people who are far more distressed than those who inhabited a Victorian dormitory; the atmosphere is not conducive to respite care. These crisis services have also lost the many peripherals to the old institutions – there have been no systematic replacements for the asylum day-room, its gardens, farm or workshops. Our mental health offer to patients has diminished.

  It was not supposed to be this way. Patients were intended to become customers, at liberty to shop around for their health care, with the freedom to consider options rather than to stand alone. But the result has been a social compact far removed from that offered by the Victorians. They guaranteed limited treatment in exchange for your control; we offer whatever you want, but cannot provide it.

  This is not to suggest that the Victorian asylums were a panacea. If they were, we would not have wanted other options. In hindsight, though, they failed because our expectations changed. The public asylums were born of a belief that they could be benevolent places, providing a possible cure; they tried to grant a good life for those within them; and even in their darkest days as warehouses, they never meant to be cruel or inhumane.

  But we asked too much of them. If they were at fault, it was simply through dealing with the problems that society imposed. Closing the asylums has not brought us any closer to working out how we should respond to mental illness. We still prefer to think that out of mind should mean out of sight.

  Chapter 4

  Become a Friend of the Victorian Asylum: Researching Archives and Visiting Remaining Sites

  Though the great nineteenth century asylums have closed, their presence still looms large in modern memory. Many generations grew up with them and they provide a reference point for debates about mental health care today. They are difficult for medical practitioners or for social historians to ignore.

  This book takes a particular approach to the Victorian asylum, striving to note the good intentions behind the institution while also recognising its imperfections. It does not wholeheartedly condemn but attempts to laud the asylum’s genuine and heartfelt compassion, even if today we may find such compassion misdirected. I do not pretend tha
t mine is the only valid approach to asylum history. Many people argue passionately that the Victorian asylums were created as merely another instrument of poor law oppression, and that they became places of imprisonment and degradation. Reconciliation with such feelings is not easy.

  However if, like me, you do feel that there is something worth commemorating about the Victorian network of public mental health care, then there is good news. For these places have left behind a remarkable, physical legacy, far more so than the other poor law institutions, and this legacy can be glimpsed in virtually every county in the British Isles.

  Asylum Buildings

  The concrete manifestation of asylum fabric is part of the Victorian contribution to our architectural heritage. Although a number of asylums are no longer standing, they have a far higher survival rate than those other welfare bastions, the workhouses.

  This is, in part, due to their very different settings, as workhouses were built typically on the edge of towns and subsequently became surrounded by twentieth century urban sprawl. Most workhouses also joined the NHS as general hospitals and were then converted or replaced as demands required. Yet the asylums were built on those ‘airy and healthy situations’ that the legislators ordered. These were mostly in parkland and well away from the centres of Victorian population, and post-war redevelopment was not necessary, as there was space enough to build additional structures in the grounds. As a result, not only was an asylum less likely to be altered during its working life, but it was also less likely to fall foul of schemes for town planning after its closure.

  The standard of architecture in asylums was invariably far higher than that of workhouses. While the workhouses were designed with a minimum of decoration and adornments, asylum exteriors were almost palatial, as contemporary commentators avowed. Similarly, the workhouse wards had meaner windows, and an absence of the sturdy and spacious interiors praised by the champions of the moral regime. Workhouses reflected their poor law purpose in a way that asylums did not, and this has produced the unforeseen consequence that asylum buildings are more desirable to modern purchasers. Several former Victorian asylums have now been converted into residential use.

  In their new form, once public spaces have become private, often gated developments that still keep the outside world out, if perhaps no longer keep the inhabitants shut away. This has been the fate of Fair Mile, which is now a housing project known as Cholsey Meadows. Happily, it has managed to maintain some social housing and community space amongst the ‘dramatic, spacious family homes’. You can visit what once was Moulsford and see its restored main block, now largely cleansed of twentieth century infill. You can enter the recreation hall, where the patients once danced to the asylum band, or book the cricket pitch where so many patients played.

  Some Victorian asylums are still open as working hospitals. Around ten survived the period of the great closures, including Hanwell – now called St Bernard’s Hospital – where John Conolly destroyed every instrument of restraint at the beginning of the Victorian age. The other notable survivor is Broadmoor, though even that will move shortly from its original bricks and mortar to a new hospital next door.

  The architecture of Hanwell, Broadmoor and these other grand therapeutic fortresses is still a marvel to behold. Even when derelict they radiate a certain beauty, something that has acquired a cult following amongst those dedicated to abandoned places. Groups of trespassing explorers make it their mission to infiltrate such desolate spaces and take pictures of them. The results are then posted online to illustrate urban decay. It is an unexpected interpretation, and one that is testament to our enduring fascination with asylums.

  Asylum Archives

  This fascination finds full expression in something even more remarkable than the architectural bequest: the written heritage that these institutions left behind. Here is the phenomenon of asylum archives, a vast resource for the Victorian period, which allows us to see for ourselves, at first-hand, how mental health care developed in our country. Anyone can conduct their own research into these places and the people who lived within them.

  We have the Commissioners in Lunacy to thank for this. As well as their rules about ward construction, staff discipline and patient care, the Commissioners produced rules about record-keeping. The result was that recording information was not seen as ephemeral, but as an integral part of life in the Victorian asylum. Every important detail was written into books so that it would not be forgotten.

  What the Commissioners could not have predicted is that this paperwork would outlast the institutions that they oversaw, and even the poor laws themselves. The lunacy statutes did not prescribe permanence for asylum records, but, as it has turned out, permanence is the judgement that has been passed on many of them. In part this must be seen as another benefit of those large, sprawling estates, where accumulating records did not necessarily create a storage problem. It was easier to leave them alone than bother to destroy them. In consequence, asylum archives have an even higher survival rate than asylum buildings.

  These archives are rarely still on site, but are mostly to be found in the wide network of heritage services run by local councils. Housed once more at the ratepayers’ expense, they sit neatly in boxes or on shelves in county repositories, next to other books and papers containing other histories. Lists of them are created and made available to browse. From time to time, members of the public come into the reading room and quote a reference to the staff, whereupon a request is made for the documents to be brought into the light once more.

  It is a wonderful thing that so much asylum history is freely available to everyone. There is no requirement for visitors to be learned scholars, and only a little acclimatisation is necessary to decipher the arcane language and unfamiliar handwriting. Persevere and you will be able to unwrap the stories of the past neatly packaged up inside the records. The stories within are very powerful, and every individual has a tale to tell.

  That tale begins first in Victorian society, before it draws you into the asylum and its routine. In an asylum archive you can seek out the documents created by the justices and the medical officers – the admissions registers and case books, monthly minutes and annual reports, wages books and ledgers.

  While researching this book I drew on various management records from the senior men (and they always were men) at Moulsford and Broadmoor. The superintendent’s annual reports to his committee, which are augmented with a dazzling array of what might loosely be termed performance statistics, provide an insight into not just the regime but also its motives. Superintendents’ characters betray themselves as they write these summaries, and the same is true for their monthly reports or journals, while the committee minute books provide the key source for decision-making. Thus a picture of day-to-day life emerges and you can begin to place the people of the asylum within it.

  Those people existed on two sides of a practical divide. The staff, though they were closely tied to their work, were not confined as the patients were. Neither was their employment subjected to observation and note-taking. The asylum’s main record-keeping interest in its employees was twofold: in paying their wages, and punishing their misdemeanours. Part One of this book made use of wages books to list employees, while rules, orders and disciplinary records illustrated how staff were expected to behave. No life stories are to be found here, but there are anecdotes and incidents aplenty.

  The other side of the divide is well catered for with source material. Patient records were the main focus of the Commissioners’ guidance. I find these records very humbling, as within them is proof of the omnipresence of mental illness in any society at any time. Here are people who are no longer in control of their own lives, the responsibility for which is given over to someone else. The records are a cenotaph for those buried deep within them; an undeclared monument for thousands of Victorian people.

  For me this is probably the most interesting facet of asylum archives. It is very rare to find in one source so much
about the life of the ordinary person. These patients did not possess swathes of land or titles, they did not hold high office; they worked as so many of us do in offices, factories or farms, or else they raised families – as husbands, wives, fathers, mothers. Theirs are the voices that history finds it easiest to ignore, and yet if you look within the records of a public asylum you will find so many of them.

  Patients’ names are listed in the registers of admission and the registers of discharges, removals and deaths. Names, ages, places of abode and occupation are recorded alongside the dates of their asylum stay. This is where you first try to find a patient and their identifying number. From here, if you are lucky, you may be able to go elsewhere to discover more beyond the barest comings and goings. All asylums kept series of casebooks and case files, which reflect the distinction made between the administrative papers for each patient and the medical observations carried out during their stay.

  To call the case files an administrative bundle is perhaps an injustice. Although they include the necessary paperwork that authorised detention, they might also feature correspondence from family or friends or even from the patient, and they are by no means as dry as the title might suggest. For Broadmoor, these files are often the only place to find the patient’s own voice. Frustratingly, a filing cabinet full of Moulsford’s papers was lost to the skip shortly before the other archives could be secured.