Diane Carpenter University of Southampton University of Portsmouth

1. ‘Above All a Patient Should Never Be Terrified’: Moral Treatment and Management in Hampshire, U.K. 1845-1914. Diane Carpenter University of Southampton University of Portsmouth 1

2. Hampshire, England, UK c.1851 2

3. METHODOLOGY • DRAMAS OF • MEDICAL • HISTORY • THE HEALER • THE SICK PERSON • DISEASES • DISCOVERING & • COMMUNICATING • KNOWLEDGE • MEDICINE & HEALTH • INTERACTING WITH • SOCIETY DE- MEDICALIZATION MEDICALIZATION ANNALES ALLTAGSGESCHICHTE HCLA and BPLA NARRATIVE OF THE PATIENT JOURNEY 5

4. CASE STUDIES Hampshire County Lunatic Asylum (HCLA) Borough of Portsmouth Lunatic Asylum (BPLA) 6

5. SOURCES • Reception Orders, Case Books, Administrative records (daily running including accounts and staffing), Maps, Plans, Photographs, Quarter Session Reports, Censuses, Newspapers, Original textbooks and journals, Personal letters, Contemporary fiction. 7

6. ETHICS • 100 – Year restriction re Medical Records • Permission sought and gained from the Local Research Ethics Committee (NHS Research Ethics Service) June 2008. 8

7. Historiography • Focus on control and order (moral management) • Other determinants of moral treatment involved improved diet, fresh air, exercise, entertainment, meaningful occupation – in an aesthetically pleasing environment. • These have been the specific province of local historians

8. Focus of this Paper • To what extent did the quality of asylum life compare with the main alternatives for pauper lunatics? • To what degree was the quality of life consistent in all asylums nationally? • Is there evidence to suggest that the quality of moral treatment improved or deteriorated between 1845 and 1914?

9. Figure 1: BPLA DIETARY, 1879. Source: C.I.L. Report, 1880

10. Comparison of the Weekly Dietary for Male Patients at Five Asylums fluid /oz Sources: Crammer, Asylum History, p.110; P.C.R.O. PR/H8/1/7/1, BPLA, 1880, A.R.M.S., p. 34; H.R.O. 48M94/A9/1, HCLA, A.R.M.S., 1853, p.11; Cherry, Mental Health, p77; Gardner, Sweet Bells, p.51. Precise details were not available in all categories for the NLA. Butter and tea were more frequently given to female patients.

11. Occupations of Patients Admitted to the HCLA, 1854.

12. RESULTS: MORAL TREATMENT – THE QUALITY OF ASYLUM LIFE • The basic determinants of the quality of life for the local asylum population appeared preferable to its alternatives • Asylum diet was better than at the Workhouse, and often to what could be afforded at home • Accidents and contagious diseases occurred, but probably, because of the precautions taken, less often than in the industrial or agricultural workplace • Asylum provided safer environment than patients’ homes • Standard of cleanliness was variable, but frequently checked • High standards of personal cleanliness 14

13. THE QUALITY OF ASYLUM LIFEContinued. • Clothing was institutional, but of very good quality – providing warmth. All patients were given shoes, boots and winter coats • Opportunity for exercise (in the fresh air) was better in Portsmouth than in Hampshire. (In both cases this was better than it is today). • Employment was aimed at developing skills or preventing de-skilling with the aim of rehabilitation and discharge • A wide variety of amusements and entertainments was provided in both Asylums.

14. RESULTS: MORAL TREATMENT – CONTROL AND ORDER (MORAL MANAGEMENT) • States of quietude were considered desirable by most (Medical Superintendents, Asylum Visitors and Commissioners in Lunacy) • Physical control was achieved largely by secluding patients for short periods of time • Occasional authorized mechanical restraint e.g. ‘strong dresses’ • More evidence of psychological control (than physical or chemical) e.g. daily routine 16

15. Figure 2: BPLA DAILY REGIME, 1879 Source: PCRO, PR/H8/1/8/1 Rules for the Government of the Borough of Portsmouth Lunatic Asylum,1879.

16. MORAL MANAGEMENT – SOCIAL CONTROL • Social control in both asylums - encouragement of patients to conform to social mores e.g. chapel attendance, • strict segregation of sexes (except for organized entertainment such as asylum dances) • Visiting by patients’ relatives was limited, yet encouraged once the ‘acute phase’ had passed • Reliance on institution as surrogate family appears to have been encouraged

17. The offices of religion have a soothing and favourable effect on many: - I have found the use of evening service, and the calm and sober strain of piety which pervades the Liturgy, to be well adapted to these unfortunate beings. Religious excitement of the feelings is always bad and has brought a great number of patients to this, as well as to every other Asylum. A patient should never be terrified.

18. CONCLUSIONS • In conclusion, despite criticism by many of the quality of care for the mentally ill during the period 1845-1914, the local evidence would suggest that • Asylum life was preferable to its alternatives • Generalizations should not be made, and, • in Hampshire, England, the quality of moral treatment did not deteriorate between 1845 and 1914 although it was poised for a considerable change.