The History of Asylums

1. The History of Asylums Jennifer VanCleave PSYC 5060

2. Asylum Apart From Asylums • Asylums were originally designed to provide refuse to those unable to care for themselves, such as the poor, frail, physically/mentally ill • Similar to a halfway house • Generally experienced population influx during times of political unrest or war

3. 1st Known Psychiatric Hospital • London: 1247 – Bethlem Royal Hospital • Got it’s name from Bethlehem (meaning “house of bread”) • Priory for the sisters and brethren of St. Mary of Bethlehem • Shortened to Bedlam in popular speech • 1330 – mentioned as a hospital • 1377 – began admitting mentally ill

4. 1405 – Royal Commission that stated lunatics would be confined there • Noise of the 31 patients was described as “so hideous, so great; that they are more able to drive a man that hath his wits rather out of them” • 1547 – King Henry VIII formally gives control of the hospital to the city of London

5. Treatment at Bedlam • Conditions were terrible and treatment often consisted of restraint/confinement of “lunatics” • Some patients were allowed to leave as licensed beggars • 1700 – lunatics called “patients” • Label as either “curable or incurable”

6. Treatment at Bedlam • Patients deemed violent/dangerous were manacled and chained to the floor or wall

7. Bedlam • Referred to as “house of confusion” which led to the bedlam meaning a state of chaos • Infamous for it’s brutal ill-treatment • Beginning in the 18th century, Bedlam became a tourist attraction as a freak show

8. Bedlam • Entrance fee for visitors was a penny • Visitors would look into cells & laugh at the “antics” which were generally violent or sexual in nature • Visitors were allowed to bring sticks to poke patients • 1814: Approximately 96,000 visits • Free admission on 1st Tuesday of every month

9. A Rake’s Progress – by William Hogarth

10. Famous Patients of Bedlam • Hannah Chaplin (mother of Charlie Chaplin) • James Tilly Matthews (subject of 1st book-length psychiatric case study) • Daniel M’Naghten (M’Naghten Rules – insanity defense in British Legal System) • Admitted after the attempted murder of Prime Minister Robert Peel • Many Artists

11. Yesterday & Today • Bethlem Royal Hospital: 1830 • Bethlem Royal Hospital: 2005

12. Increased Strain on Asylums • Great Britain: 1788-89 King George III becomes physically and mentally ill • It is hypothesized that his “crisis” was very public, and in turn caused an influx of mentally ill patients in asylums • At the time, it was thought that asylums were one of the last places to allow the expression of passions

13. Victorian Era Practicum Placement:Hill End Asylum (early 1900s) • Your Supervisor: Medical Superintendents (later known as psychiatrists) • £ 680/year • Almost no patient contact • Your Job: Attendant • £ 28/year (no reimbursements) • Direct contact with patients (day & night shifts) • Majority were females in their 20s • Low retention rates (big shocker)

14. Your Clients: over 600 patients • Variety of diagnoses • 42% mania (11% of which were seen as “acute”) • 26% dementia • 16% melancholia • 16% mental deficiency • 69% discharged in 6 months or less • Your Training • First Aid • Your Risks • Death • Pay docked for patients acting up • “Asked to resign” if you got married

15. Job Description in Asylum News • Fourteen hours daily duty, very moderate pay and emoluments…isolation from outside interests, heavy responsibility in detail, very offensive duties, great mental strain, no chance of rising to superior position, the knowledge that an accident will probably mean dismissal, and no assurance of a pension.

16. Reformers • 1793: Phillipe Pinel (superintendent at Asylum de Biĉetre – Paris) • Credited as 1st to use humane treatment methods for the mentally ill • Influenced by Jean-Baptiste Pussin (hospital attendant who removed patient restraints) • Dorothea Dix • Advocate for humane/progressive treatment • Set up state hospitals throughout US

17. References Brimblecombe, N. (2005). Asylum nursing in the UK at the end of the Victorian era: Hill End Asylum. Journal of Psychiatric and Mental Health Nursing, 12, 57-63. Rovang, D. (2006). When reason reigns: madness, passion and sovereignty in late 18th-century England. History of Psychiatry, 17, 23-44. Talbott, J.A. (2004). The need for asylum, not asylums. Psychiatric Services, 55, 1127. Walsh, J.J. (2003). Bedlam. Retrieved on 8/4/06 from www.newadvent.org/cathen/02387b.htm. No Author. (2006). Bethlem Royal Hospital. Retrieved on 8/5/06 from http://en.wikipedia.org/wiki/Bethlem_Royal_Hospital. No Author. (2006). Psychiatric Hospital. Retrieved on 8/5/06 from http://en.wikipedia.org/wiki/Psychiatric_hospital.