Garlands 1906

Garlands 1906

Thursday, 31 May 2018

Emotions and the Asylum


Throughout my research of the patient case notes of the Garlands Asylum, I have been struck by the emotions that emerge from these clinical documents. Although they contain a high amount of biographical and medical information, the circumstances surrounding a patient’s committal can also offer a glimpse into the emotions experienced by those being admitted. This blog post will offer two examples of female patients who were brought to Garlands in its opening few years, who display the emotions acting upon them on committal.

First, Ann R, aged 50, a housekeeper from Whitehaven, was admitted in March 1863 experiencing suicidal thoughts. Before coming to Garlands, it was stated in her notes that she:

made two attempts to destroy herself. Escaped from her home one day last week and was brought back again by a Policeman, who found her upon the sea-shore with part of her clothes off, and was told she had been making an attempt to drown herself. Her daughter also informed me she took a razor from her a short time ago, with which she believed her mother meant to injure herself.

The cause of her melancholia was given as: ‘Heard that her husband who has been in Australia has married another woman.’ It is uncertain whether or not Ann had separated from her husband, or if he had just taken off and the news had made its way back to her. Whatever the circumstances, it is clear that the event caused Ann to break down emotionally, and led her to take steps to end her life. Doctors noted on admission that she was: ‘Very melancholic and dejected. Will not enter into any conversation whatever.’ After six months treatment in Garlands, her spirits seemed to be lifted, and her case notes stated: ‘For a week she has been much more cheerful, quite a different woman in fact, entering into the amusements…with her fellow patients.’ However, she did relapse, and slipped back into a melancholic state. As a result, she remained in Garlands for just under two years, when she was discharged recovered.

Second, Sarah C, aged 18, a weaver from Carlisle, was admitted in June 1862, also suffering from melancholia. The official cause diagnosed in her notes was ‘suppression of menstruation’. Although this was the era of the emergence of psychiatry as a medical area of specialisation, the ancient beliefs regarding women and their reproductive systems still prevailed as a cause of mental illness. Women were considered to be increasingly susceptible to emotional disorder, particularly at certain points of their lives. Puberty, pregnancy, lactation, menstruation, and menopause, were all key events that could ‘shock’ the female body, prompting a mental breakdown.[i]

On admission, there was a lengthy statement of facts indicating the events leading to her melancholia, which includes vast information surrounding the economic circumstances of Sarah and her family:

‘The history of her care taken today from her mother (who is a widow earning only 2/6 a week weaving in Dixon’s Factory and with 5 children younger than our patient) is that the girl has worked hard and tried hard, that she has been well up to six weeks since, that then the catamenia ceased, she having been regular from 15 years old up to that time. The mother considers this to be the cause of her illness and that directly ‘they’ flew to her head…She appears frightened, gets no sleep, is restless, melancholy and of a religious turn of mind. She has been a respectable, steady, moral and industrious girl, has a constant habit of reading religious books. Dr Elliott signs the order for admission and Mr Reeves who signs the medical certificate says ‘that however much questioned she appears vacant and sometimes won’t answer but remains silent, she has religious misconceptions and that she is going to die and that she is lost; she is restless and difficult to keep quiet; the least noise terrifies her and she is painfully nervous – will not keep in bed late gets out creeps under the bed and tries to get out of the window – mothers direction, Sarah C, Duke St Carlisle.’

For us reading this in the twenty-first century, it appears that the ‘suppression of menstruation’ had very little impact on her mental health. The burden of being one of the main wage earners, in the absence of her father, of a large family, would have laid heavily on a young woman. The pressure to survive in such poor and desperate circumstances, clearly led to her worry and caused her restlessness. In the absence of talking therapy in this era, asylum doctors strove to look for physical symptoms of illness (or significant events, as with Ann above), and could overlook the fact that poverty and overwork could contribute to an individual’s melancholia. 

Sarah remained in the asylum for nine months. After showing little improvement, she was removed by her mother in March 1863, presumably has her wage earning capacity was being missed by her family. The realisation that asylum treatment was having no effect, but while in Garlands Sarah was capable of doing needlework, would have been a signal that she could still function in a manual work. I have so far not found any further trace of Sarah in Garlands, but it would be interesting to find if she was able to cope with life on the outside.

These two brief patient examples highlight an additional importance of asylum case books. Primarily intended to be a medical record of a patient’s history, symptoms, diagnosis, physical health, and reaction to treatment whilst in the asylum, these documents can also contain fleeting moments of emotion which the patients experienced. A degree of estimation and ‘reading-between-the-lines’, backed up by cross-referencing these records with census/birth/marriage/death material, can lead to fascinating patient histories emerging. This further humanises these clinical documents, and allows us to empathise with those who experienced mental health care in the nineteenth century asylum.


[i] A. Scull, Hysteria: The disturbing history (Oxford: Oxford University Press, 2011), p. 47.

Thursday, 1 February 2018

Stigma and Mental Illness in Garlands Asylum

In line with Time to Change’s ‘Time to Talk’ day on 1 February, I would like to reflect on the stigma of mental illness in the nineteenth century, as a way of highlighting how far we have come, and how important it is that we conduct open and honest conversations about the topic, in order to end mental health discrimination.

It is clear from previous posts that the way in which those suffering from mental illness in the nineteenth century were considered, was a far cry from how we consider sufferers now. For a start, incarcerating individuals in an asylum that was built on the outskirts of Carlisle, far from the main population (it was described in an article in the Carlisle Journal in 1898 as a ‘little segregated colony’), is an indication that it was something to be treated in a sealed environment. The terms used to classify those in an asylum seem somewhat insensitive and discriminative to the modern eye - ‘lunatic’, ‘imbecile’, ‘idiot’, ‘feeble-minded’ – and the way in which patients were described in the case notes was in a much less than sensitive manner. In addition, friends and relatives on the outside could also be affected by the stigma of being associated with sufferers of mental illness.

After the 1845 County Asylums Act, every county and borough in England and Wales had to provide an asylum to accommodate pauper patients. Increasingly after this date, families became more willing to admit their relatives to these institutions that offered specialist care, and an increased risk of recovery. Despite this, a stigma remained attached to those suffering from mental illness, and the medical superintendents of Garlands in the later nineteenth century continued to state the need for relatives to admit their loved ones at as early a stage as possible in order for a greater chance of recovery. This was reinforced in the 1885 annual report by Dr Campbell:

A mistaken kindness on the part of their relatives allows them to exhaust all the questionable benefits of home treatment often without recourse to special knowledge of the disease, and only when home treatment is found worse than unavailing is the patient sent to an asylum.

However, not all families could be so ‘kind’. Dr Clouston recalled one case that came to Garlands in 1871:

One young woman was sent here in a deplorable state of filth and neglect, who had been for years allowed to remain in a state of nudity in her father’s house, occupying the same sitting apartment as the rest of the family, scorching herself at the fire, looked after chiefly by a brother, nearly grown up; and all this in the middle of a town of considerable size.

Therefore, despite the availability of specialist care in the Garlands Asylum, families were held back by the stigma attached to admitting that a relative was suffering with a mental condition.

One particular example I have come across in my PhD research of the Garlands nineteenth century patients, highlights this stigma. Isabella Y, aged 33 from Carlisle, was admitted in November 1896 suffering from mania. The event that led to her committal was the death of her husband, William. Her case notes stated: ‘Her husband is said to have locked her up in a room and not to have let her outside for years; he was found dead at his home yesterday, he was an old man about 70 years of age.’ Her physical state on admission indicated that she had been kept indoors for some years, as she was described as pale, emaciated, filthy, and in a generally poor condition.

The fact that Garlands had been open since 1862, less than 5 miles from where they lived, meant that specialist care was readily available within a short distance. This then leads us to believe that the stigma of having a wife suffering from a severe mental illness was so prominent, as he saw it necessary to conceal her from the outside world for such a long period. The additional consideration of the large age gap between the two can also be quite telling. Looking back at census material and marriage certificates, I cannot find much about the pair. The only document I can find is the 1891 census which lists them both living in Botcherby, Carlisle, as man and wife. Isabella is not listed as having any mental condition, so no indication of her illness has given to the outside world (on her Garlands admission she was stated as being mentally unwell since 1886). Consultations with family historians have led me to understand that such large age gaps in this period were not very common. Mostly they would occur when an older man would agree to marry his friend’s daughter, in the event of his death, in order to look after her, and guarantee her financial security. On Isabella’s case notes her next of kin is listed as a second cousin, indicating that she had no nearby close relatives. This may have been because her family was originally from overseas. Her entry on the 1891 census gives her place of birth as Brooklyn, USA. Whether this was true or not, I have not been able to verify through other documents. William’s will listed him as a gentleman, and his effects were left to Isabella’s second cousin in Carlisle. Any records stretching further back I have been unable to trace.

Whatever the explanation for Isabella’s incarceration at home, it is apparent that William was so concerned about the stigma of her mental illness, that he took drastic measures to conceal it.

This case, along with many others I have come across, indicates the stigma attached to the association with those suffering from mental illness that was so dominant in the Victorian period. Although this progressively eased throughout the twentieth century, people still feel unable and uncomfortable with speaking about mental health to the present day. I hope that by looking back at such cases we can see how far we have come, and use this as a platform to encourage the discussion around mental health, to see what still needs to be done. For further information about ‘Time to Talk’ follow the links below, and start the conversation.




Monday, 22 January 2018

Exercise and the Asylum


As stated in previous posts, lunatic asylums in the latter half of the nineteenth century were operated following a regime of moral treatment. One of the main aspects of this was regular exercise. The importance of keeping active and maintaining good mental health is still reinforced today. Mental health charity Mind is running a month long campaign to raise awareness of the benefits of exercise to both body and mind. Details of their RED – run every day – January campaign can be found at http://www.cemind.org/news/2018/1/red-january-over-halfway-there.aspx

Looking into the past, it is apparent that not much has changed. From the outset Dr Clouston, medical superintendent of Garlands 1863-1873, stated that, ‘regular outdoor exercise strengthen[s] the bodily health, and consequently lessen[s] the mental irritability.’ The Garlands Asylum followed a daily routine that revolved around the different aspects of moral treatment. Time was allotted each day for the exercise of the patients. Each ward had its own adjoining airing court, in which patients were encouraged to spend as much of the day as possible. Even those who were physically unwell were brought into the fresh air as much as possible. Spending time in the open air was thought to provide patients with an environment in which to clear their minds of the unwanted thoughts that had caused their mental conditions.  Patients were regularly taken out of the asylum boundaries to undertake regular exercise. It was believed that a ‘walk on the country roads thrice a week’ was extremely beneficial.[i]

In 1864, Dr Clouston stressed in more detail the importance of exercise, and how it was administered in Garlands:

Since the new walk round half the circumference of the farm has been completed, all the patients who were formerly confined to the airing courts are sent out to walk at least once every day. It is no uncommon occurrence to have the male wards quite empty during the walking hours in the afternoons, and it is only the sick or those who are otherwise employed who are ever in the house at that hour. This has the most beneficial effect on the worst class of patients who cannot employ themselves, and when in the airing court are apt to sit down and get cold.[ii]

Team games were also encouraged. Male patients formed an asylum cricket team, and in the summer months played three evenings a week. Teams would even be brought in from Carlisle to play the patients. For the females, a croquet set was provided, which they ‘enjoyed very much’.[iii]

Regular employment of the patients in tasks to maintain the day-to-day running of the asylum was also considered a form of exercise. Male patients were expected to help with the work on the asylum farm and in the workshops (e.g. carpentry, tailoring and shoemaking). Whereas for the females, they were expected to contribute to the domestic upkeep of the asylum, completing chores, working in the kitchen and carrying out any needlework repairs. Again, these tasks were thought to distract the patients from their conditions, and give them a sense of purpose through a routine that contributed to the economy of the asylum.

In 1876, the medical superintendent Dr Campbell noted:

The farm has proved a healthful and remunerative source of employment for the male patients, and much useful work has been done by the female patients in the wards, the kitchen, and the laundry. Continuous efforts are being made to improve the condition and habits of the chronic female patients. I believe that the want of some suitable occupation of the simplest nature, and which entails mere physical exertion like wheelbarrow work for the same class of male patients, is the principal cause of the greater excitability and noisiness in the female wards of Asylums.[iv]

Therefore because the males were employed in the outdoors, it was having a more beneficial effect on their health than for the females, who completed their employment tasks indoors. This reinforced the need for patients to be active in the fresh air, as it was having a better effect on their mental conditions.

The medical superintendents of county lunatic asylums were presided over by the Commissioners in Lunacy, who would inspect the institution annually and publish their findings in a report. One of the factors upon which the superintendents would be judged was the number of patients partaking in regular exercise and employment, as well as the number and range of activities for them to partake in. For instance, the Commissioners wrote of Garlands in their 1877 annual report:

…altogether 147 men and 120 women are usefully occupied. Of the former 107 are farm labourers and gardeners, 2 carpenters, 14 mat makers and hair pickers, 2 bakers and 3 tailors. Of the latter 25 work in the laundry, 8 in the kitchen, and 59 at knitting and sewing. Great attention is given to ensuring for the patients good and frequent out-door exercise, and we have no doubt of the beneficial results which ensue. Most of the men who are capable of active exercise are employed in some way, but there are 20 allowed to go on parole about the grounds, whilst about 140 of the women walk daily in the grounds, and nearly 100 sometimes go out beyond them. In fact, the men who do not work, but are capable of the exercise, are walked twice round the grounds daily instead of, as before, three times a week.[v]

The recovery of patients would also be judged, among other things, by their participation in regular exercise and in useful employment.  For instance, Ann F, admitted in May 1889 was suffering from melancholia, and was described as considerably depressed. In her initial few weeks of treatment Ann was in weak health and struggled to get out of bed. Her case notes stated that she seemed dazed and confused, and gave little trouble. Two to three months into her stay at Garlands she began to take some exercise in the airing court, despite being very shaky on her legs. Her progression continued, and in August 1889 was described in her notes by doctors: Is brightening up. Takes more interest in things around her. Helps a little in cleaning the ward…answers questions more readily than she did. Finally, on the entry just before her discharge at the end of September 1889, it was stated: She takes a greater interest in what is going on in the ward. Helps to dust up and keep the ward tidy…seems to be in her usual mental state.[vi]

Taking all this information into consideration, it is evident that exercise and useful employment was essential to the treatment utilised at the Garlands Asylum in the latter half of the nineteenth century. This links perfectly to Mind’s RED January campaign, reinforcing the health benefits of exercise. Nineteenth century doctors may not have understood why keeping active had such remedial benefits, but they observed its impact in the county asylums, and in absence of any medical treatments, it offered one of the main facets of their regimes of care.

Thank you for taking the time to read this snippet from my research conducted on the Garlands Lunatic Asylum, which forms the basis of the PhD thesis I am currently writing up. My aim is to write the history of such a fascinating institution through the experience of its pauper patients. If you have any stories relating to the asylum, or would like help in tracing your ancestors that were in this particular institution, please don’t hesitate to contact me at caradobbing@gmail.com



[i] Cumbria Archive Centre Carlisle – henceforth CACC, Annual Report 1863, THOS 8/1/3/1/1, p. 14, quoted in C. Dobbing, ‘An Undiscovered Victorian Institution of Care: A Short Introduction to the Cumberland and Westmorland Joint Lunatic Asylum’, Family and Community History (2016), Vol. 19, No. 1, p. 9.
[ii] CACC, Annual Report 1865, THOS 8/1/3/1/3, p. 12.
[iii] CACC, Annual Report 1863, THOS 8/1/3/1/1, p. 13.
[iv] CACC, Annual Report 1876, THOS 8/1/3/1/14, p. 16.
[v] CACC, Annual Report 1877, THOS 8/1/3/1/15, pp. 9-10.
[vi] CACC, Female Casebook 1888-1892, THOS 8/4/40/2, p. 48.

Monday, 13 November 2017

Garlands Project Launch: 8 Nov. 2017


Wednesday 8th November saw the launch of our exciting project surrounding the Garlands Asylum. Along with Cumbria County Council, Cumbria Partnership Trust, and Carlisle Eden Mind, I presented some of my research, which focused on the history of this fascinating institution. The aim of the project is to break down the stigma surrounding mental health by opening up the discussion around the treatment, as it was in the early days of the asylum, and as it stands now, and the help people can access in the event of mental illness. The value of reflection lies within the lessons we can learn from the progression in terminology, treatment and the way we consider mental health. Through this post I will outline the main points I made at the launch, and hope you will join the discussion surrounding mental health.
 


My focus, of course, is on the history of the Garlands Asylum, and how mental conditions were treated in the period from its opening in 1862, until the outbreak of war in 1914. Placing the patients’ stories and experiences at the heart of my research has caused me to regard the institution with a human aspect. When people ask about my research, and I mention the phrase ‘lunatic asylum’, they have a large misconception about the brutality of treatment received, and regard the institution with a degree of horror. Through my research I aim to breakdown these misconceptions and retell its history through the patients who experienced treatment in the institution.

My talk began with giving a short background of the asylum: when it was constructed, why, what kind of treatments were offered, and the effect this had on the patients. I then set out the regime of care from the inception of the asylum in 1862, and continued throughout the initial decades.

Moral Treatment

Moral treatment, was advocated in all county asylums in the period after 1845. The main facets of this regime were not dissimilar to some of the recommended treatments today: a good diet, regular exercise, recreational activities, religion and useful employment. This treatment was outlined in the 1863 Garlands annual report by the medical superintendent, Dr Clouston:

To treat the patients kindly, to maintain good order and discipline in the house, to provide healthy and suitable employments for all who can employ themselves, to endeavour to get those to work who do not do so, to provide suitable entertainments for their leisure hours, to endeavour to get them all roused into taking an interest in something, thus exercising and strengthening the mental faculties they have left, and to keep up the bodily health and strength in all of them.

He placed great emphasis on the employment of the patients to act as a diversion from the thoughts and circumstances causing their conditions: regular work for both mind and body will do much to counteract the ill effects of the associations of the persons, places, and circumstances that were connected with the original outbreak of the malady.

Around three quarters of the asylum population were regularly employed. Tasks in the workshops, on the farm, and in the asylum itself were largely carried out by the patients. The result was noted in the 1869 annual report as ‘pleasing and amusing’ the patients to a great extent.

Patients, that were able, were allowed to walk in the asylum grounds, with supervision from the asylum attendants, in order to get regular exercise. This was said to have had a soothing effect on the patient’s behaviour as they got the opportunity to clear their thoughts in the fresh air. Similar to this were the recreational pursuits offered to the patients to keep them usefully occupied whilst in the asylum. A large supply of books and periodicals were available. Knitting, needlework, domestic chores, work on the asylum farm, were all undertaken by the patients to encourage productivity and recovery, as well as contributing to the upkeep of the asylum. Regular events would be held to keep the patients occupied. Weekly dances and balls would be held. Sports events, such as cricket, would occur, with teams being brought in to compete with the patients. Choral groups, ventriloquists, and lecturers would be invited in to the asylum to give performances.

Patients who were otherwise unruly could respond well to these events. For instance, Catherine B, who was admitted in February 1885 suffering with mania and suicidal tendencies, seemed to forget all this and react well to the asylum dances. As described in her case notes in April 1885:

Wanders about the ward moaning and groaning wretchedly. The only occasion in which she appears to forget her troubles is at the weekly dance, when she brightens up wonderfully. Laughs heartily and industriously goes round the hall... Labouring hard often to teach others the steps and educate her fellow patients who require it.

There are many instances of patients responding well to the moral regime of the asylum. This was noted in the 1887 annual report: the disinclination many patients have shown to leave the asylum, shows that the efforts made to treat the inmates justly and kindly, and to render their life here pleasant and enjoyable, have been successful.

For more background on Moral Treatment, see my previous post - http://garlandshospital.blogspot.co.uk/2015/09/the-moral-treatment-of-patients.html

Misconceptions

The main focus on my talk was to break down some of the common misconceptions of the Asylum. These are the main three I have come across. First: once patients were admitted, they were incarcerated for life. Overcrowding of the asylum, and the pressure on accommodation in the institution was a constant problem. As early as 1863, one year after opening, the Committee of Visitors stated of Garlands: ‘they are unable to provide sufficient accommodation therein for the number of lunatics who are chargeable to the two counties.’ The asylum underwent several extensions in its initial decades, taking the available capacity from 200 in 1862, to 660 patients in 1902. Taking this into account, the unnecessary incarceration of patients simply was not feasible. Doctors were driven by statistics, and were judged on their rates of recovery. So when a patient came to the asylum, they did their utmost to affect a quick recovery, to maintain a high rate of cure. As we saw in the Garlands recovery rates, they managed to do this. Therefore, it was in the doctor’s interests to keep the patients for as little time as possible in order to free up any available beds, and so that they maintained their professional reputation among the relatively new field of psychiatry. How well this quick-turnaround actually worked is doubtful, as many patients were readmitted to the asylum at a later date, often in a worse condition than when they were first treated.

The second biggest myth is that the patients were subjected to frequent brutality. The common belief is that asylums kept patients constantly in chains or strait jackets. However, as I have shown previous, the regime of moral treatment completely disregarded this practice. Patients were treated with kindness and given the opportunity to adhere to the moral therapy offered. When patients rebelled against this kindness, the doctors only sought to use methods of restraint as a last resort. Violent patients would firstly be placed in a single room on their own and given the opportunity to calm down: Sedatives would also be administered. If the violence continued, and they posed a risk to themselves or others, methods of restraint would be sought. All patients who were placed in mechanical restraints had to be recorded in a specific register, and this would be inspected by the lunacy commissioners on their annual visits.


 


For instance, in 1891, it was recorded that eleven patients had been put in seclusion for a total of 257 hours across the whole year, and that one man had been restrained for 8 hours using sheets, and one woman using the strait jacket for 15 hours, across the whole year. Therefore, although mechanical restraint was used, it was only done so as a last resort, and was not the common mode of treatment.

The last biggest myth is that patients, in particular females, were admitted to the asylum against their will and without suffering from mental illness. I often get people asking me if there are lots of women put in there because they annoyed their husbands and such, but so far I have found no evidence of this. I think that this practice may have occurred in earlier decades and centuries among the wealthier classes who could afford to pay doctors to take their wives into private asylums. But Garlands was a public asylum that provided treatment for pauper patients, and was paid for by local Poor Law Unions. The 1845 Lunacy Act stated that to be admitted to a county asylum, the testimonies of two individuals that had witnessed the person’s insanity had to be recorded on a document called a reception order. These testimonies had to come from an examination from a doctor or medical officer at the local workhouse, and from a relative/neighbour/fellow workhouse inmate who had lived closely with the patient. The form then had to be signed by a local magistrate warranting the person’s removal to an asylum. There are instances of paper work being filled out incorrectly and patients being discharged as a result. Therefore the method of entry to an asylum was much more rigid than many people believe.

Next Steps

From the discussions began at the launch, it is clear that more is required to really address the stigma surrounding mental health. By using the past as a way of reflecting on how much (or how little) treatments have changed, we hope to continue debating what is required in future to treat mental illness.

The exhibition of the some of the Garlands archival materials will be shown at several venues around the county. Full details and dates will be confirmed shortly, and we hope as many of you as possible will be able to view it.

For full information of the launch see


Any feedback of the event, and any comments you may have for suggestions of where we could take the project, please don’t hesitate to get in touch. Caradobbing@gmail.com

Wednesday, 18 October 2017

Garlands Project Launch, November 2017


As a follow on from my last post, I would like to share some photographs from the Time to Change event in Carlisle on World Mental Health Day 2017. A huge thank you to Caroline Robinson for creating such an amazing display and providing the pictures! Some of the Garlands records were digitised and transcribed for visitors to see how mental illness was regarded and treated in the late nineteenth century. Alongside this was also some detail surrounding the context of the records, most notably the 1890 Lunacy Act.










Central to the display were two patient records from the 1890s and 1900s. The first, Tom M, was admitted to Garlands in September 1900 suffering from mania caused by his intemperate habits. What was interesting about Tom's case, is that a newspaper article was attached to his case notes denoting his attempt to take his own life prior to admission:


Clippings from newspapers relating to the patient and their condition were often attached to the case notes during this period. Anything to assist the doctors in creating a picture of their behaviour prior to admission was considered valuable in keeping with their medical records. On admission, Tom seemed to be somewhat confused and could not recall attempting to hang himself: “Patient has a childish vacant expression: Did not know why he was in custody: On being asked why he had attempted to finish himself in that way, he replied ‘What way?’ He has been drinking heavily for a long time and attempted to hang himself. There is no one to take charge of him and in his present condition is not fit to be at large.” It seemed that some time away from his surroundings, and the temptation of alcohol, was enough to fully recover Tom, as one month after admission he was discharged as recovered and never returned for treatment in Garlands.



The second case displayed was that of James G, who was admitted to Garlands in September 1898 also suffering from mania. James was brought to Garlands with little known about him, as he had been found wandering at large: 'Been curious in behaviour and frightening people in district'. He seemed to be very confused at the beginning of treatment as to where he had come from and what had occurred prior to admission. What is most interesting to note from his case notes is that he displayed a desire to remain in the asylum. For instance on 2 October 1898, the doctors noted: "says he is quite content to remain here." Similarly on 2 November 1898: "Says he likes better being up here because there are books here." However, once James began to recover, his desire to return home became clear. Eleven months after admission it was noted: “Rather unsettled and restless. Very anxious to go home or he says he wants a change.” James was discharged recovered in September 1899, and, like Tom above, never returned to Garlands.

These two patient stories are a snippet of the research I have been conducting for my PhD thesis on the history of the Garlands Asylum. The full launch of the Garlands Project will be on 8 November, where I, among many others, shall be giving a talk detailing the history of this fascinating institution. If you would like to attend, please see the below picture. It is also expected for there to be an ongoing exhibition from the event which will be toured around the county, details to follow.









Monday, 9 October 2017

Suicide in the Asylum

In line with world mental health day (10th October), I wish to share with you a fascinating case from the Garlands records which highlights the change in attitude (and vocabulary) surrounding those suffering from mental health issues, and in particular how suicide was dealt with. Time to Change are holding an event in the centre of Carlisle to help take the stigma away from mental illness. Part of the event will include two examples of patients that were in Garlands in the late nineteenth century, to highlight how attitudes, and terminology, have changed with regard to the treatment of mental illness. Incorporated into this will be a discussion around suicide, and how it was regarded in the 1890s. To fit in with this, I have discovered a patient who took her own life whilst resident in Garlands.
Mary W was admitted in May 1885 suffering from melancholia. She had previously suffered with mental illness, and had had a short stay in Garlands in 1880 for five months. Mary was from Whitehaven, a widow who was in her 50s. On admission she was described as industrious and active, but had been feeling anxious due to her thoughts around harming herself and her children. Prior to her previous admission she had attempted to hang herself, and these thoughts had begun to resurface. Looking at her family background on the census, it would suggest that the death of her husband in 1880 led to her first committal in Garlands. Learning from her previous attack of mental illness, it was noted on admission in 1885 that she: ‘Expressed a desire to come here herself’. This was often the case for patients fearing that they were unwell in some way, and certainly for those aware of the irrational feelings they were experiencing towards harming themselves or their loved ones. Quite often in the Garlands records patients are noted as wanting to be admitted for their own safety.
            Throughout her stay in Garlands (four years in total), Mary was described as behaving perfectly well, but continually complaining of a feeling of a great weight bearing down upon her head. She was described as quite withdrawn, listless, dazed and feeling slightly lost. Five days after admission, the following was written in her case notes after an examination by the medical superintendent: “She labours under melancholia. She is dull and nervous. Told me today that she had a bad pain in her head, that she could not sleep at night, that she had such awful feelings and such a dread of something fearful impending, that she wished she was put out of her way and that she feared she might try to kill herself. She is in average bodily health. No marks.”
            A month later, her depressed feelings and thoughts of suicide led to an incident observed by an asylum attendant: “Has been keeping well up to this date, but yesterday she was noticed to be unusually dull and…instructions were given that she was to be well looked after. This afternoon while the attendant’s back was turned she disappeared down the cellar stairs and, with a piece [of] tape, attempted to strangle herself. She was seen shortly after and no serious injury was observed, but she was noisy, listless, acutely depressed and struggled a great deal. Is sleeping close to attendant in observation dormitory.” Unfortunately her suicidal thoughts and attempts continued, as described in this entry for August 1885: “She has had several transient outbursts of excitement recently lasting only for a few hours each time during which however she is to be most carefully looked after as she is actively suicidal and is continually saying she is dead and asking to be killed. Sleeping badly. Takes food.”
As her treatment continued into 1886, the doctors began to see an improvement in her, noting that she had become much more cheerful, and even herself admitting she felt better. This led to the proposal of Mary being discharged, and the result was noted in July 1886: “Last month she looked so well that it was proposed to discharge her, but when she was told she said she did not feel well enough and had not sufficient confidence in herself and asked to be allowed to remain here a little longer. She is quiet, nervous and very industrious in habits.” Her nervousness and anxiety became a common factor in her condition as her stay in Garlands progressed. It seems that Mary lacked the confidence in her ability to remain well when discharged back home. The anxious feelings remained, and on more than one occasion prevented her being discharged. For instance, one entry in her case notes stated: “Says she still feels nervous and has not sufficient confidence in her own ability to face the world.”
It was this anxiety at being released from the confines of the asylum, and specialist care, which led to her taking her own life in Garlands. The entry dated 17 December 1889 described the incident:

“This patient has seemed so well in mind for a long time that last week Dr Campbell discussed with her the subject of her being discharged. She said she did not yet feel sufficiently well and was anxious to be allowed to remain in the asylum a little longer. On Saturday and Sunday (14th and 15th December) she complained of headache and stayed in bed. Yesterday and this forenoon she went about her work as usual and was quite cheerful. She was seen and spoken to by Miss Fraser about 4 o’clock this afternoon and nothing peculiar in her manner was then noticed. A little before 6 pm this evening the medical officers were summoned to the coal cellar of the female infirmary where the dead body of this patient had just been discovered by an attendant. The body lay on its back on the coals, the arms laid across the body. A cut across the throat and liquid and clotted blood on the clothing and on the coals beside the body clearly indicated the cause of death. There was an ordinary attendant’s table knife lying on the coals at the side of the body. The body was not cold, the muscles were flaccid. The cut is across the upper part of the throat, severing wind pipe and important vessels and death must have necessarily been rapid.”

This sad case was unfortunately only one of many that took place in Garlands. Precautionary measures were taken to prevent such events occurring, but sometimes they were not enough.

In line with world mental health day, it is important to highlight that mental illness can occur to any of us, at any time. Reflecting on stories such as this one reasserts the importance of talking about our feelings, and helping each other when we may be particularly struggling.

Thank you for taking the time to read this snippet from my research conducted on the Garlands Lunatic Asylum, which forms the basis of the PhD thesis I am currently working on. My aim is to write the history of such a fascinating institution through the experience of its pauper patients. If you have any stories relating to the asylum, or would like help in tracing your ancestors that were in this particular institution, please don’t hesitate to contact me at caradobbing@gmail.com


Monday, 25 September 2017

“As Mad as she is Bad”: The Garlands first Criminal Lunatic, 1862

Looking at previous posts, and the title of this current one, it is apparent that the terminology surrounding mental illness, and those that suffered from it, has altered dramatically in the 150 years since Garlands opened. This post shall explore one fascinating case which highlights just how different this was. My current research into the patients of the Garlands lunatic Asylum, Carlisle, part of my wider PhD thesis, has focused on the movement of pauper patients between different institutions in the initial years of its opening. In the Garlands first month of opening (January 1862), 146 patients were transferred directly from nearby asylums and workhouses. The overwhelming majority (121) of these came from Dunston Lodge private asylum near Gateshead, which was the official receptacle for Cumberland and Westmorland’s mentally ill population prior to the opening of their own institution (Garlands in 1862). Whilst studying this transferal of care, I came across the first Criminal lunatic to be admitted to Garlands, and her case notes make for interesting reading.
Elizabeth R was among those first 146 patients admitted in January 1862 to the new Garlands Asylum. She was transferred, along with the majority of the female patients, from Dunston Lodge on 10 January 1862, where she had resided since 14 June 1861. Prior to her committal to Dunston, Elizabeth had been sentenced to three months in Carlisle Gaol for being a ‘disorderly prostitute’, and her occupation was given in her records as prostitute. On admission to Garlands she was aged 27, described as being both suicidal and dangerous, listed as suffering from mania, and was in weak physical health. What is immediately interesting from her admission records is the cause given for her mental illness: ‘remorse of conscience’. The theme of immorality is constant throughout Elizabeth’s case record. On admission she was described as follows: ‘Intelligent face but made impudent by the use of evil deeds’. This is unsurprising given her stated occupation, but I doubt she would have disclosed this as her job, rather, it was imposed on her – further increasing the stigma surrounding her committal – on admission following her arrest. The remorse she was feeling is indicative of the desperation of her situation, as she, more than likely, was forced to resort to prostitution to survive. Further evidence of her depressed mental state is given by the fact that she was suicidal. Prior to being removed from Carlisle gaol to Dunston Lodge, she undertook a period of starvation, and due to her weakened state, her transferal had to be delayed, as the authorities feared that she would not survive the journey.
Once in Garlands, shortly after arriving, the following passage was written in Elizabeth’s case notes, describing her and her behaviour:

‘As bad as she is mad – one of the worst cases we have to deal with in lunatic asylums. For the simplest offence as a sharp word from another patient, delay in granting a request, a slight verbal rebuke for bad conduct, she will go off into the most violent passions imaginable – screaming, fighting, breaking windows, attacks upon attendants and patients abuse in the extreme, most threatening in her language and will sometimes last for 3 or 4 days; when at the climax she refuses food – lashing at attendants faces, tears up her clothing and bedding. Doing all the mischief she can conceive of and frequently will keep nothing on herself…makes constant and determined attempts at self-destruction…the very great forbearance and kindness which have been shown her by all parties – everyone has lost all sympathy for her. She is most decidedly (although insane) to a very great extent responsible for her actions. Her conversation is beastly and as profane as that of the commonest Haymarket prostitute. Has haemorrhoids – acne on face – Brown hair, sleepy eyes and has had 2 or 3 children.’

We gain some understanding of the behaviour described when reading the last sentence of this entry. The fact that Elizabeth had children, which were clearly illegitimate, may go some way to explain her suicidal thoughts and tendencies, and her feelings of remorse. We can assume that she was not in contact with these children at the time of her admission, as the doctors did not know for certain how many she had given birth to. It may also have been likely that her family wouldn’t have been in contact with her, as they would have disclosed further personal information to the asylum doctors.
            Throughout her stay, Elizabeth was violent, frequently tore up her clothes and broke items in the wards. On several occasions she was described as feigning illness. For instance, on 24 October 1862, she faked a ‘spasm of the stomach so well that she deceived all the nurses but one who thought she was ill indeed. They were much surprised to see her quickly recover under a shower bath of half a minute’s duration only.’ Also on several occasions she attempted to take her own life. It was noted on 4 November 1862 that she: ‘Has been secluded all yesterday and today owing to her extreme state of maniacal excitement, and intense suicidal propensity – 3 times in my presence attempted to strangle herself – her neck is marked with the ligature.’ In an incident on 25 July 1863, she demonstrated how far she was willing to go to attempt to kill herself. After a particularly violent episode, Elizabeth was removed to a padded room in order to calm her down and prevent injury to herself or others. However, on a previous occasion in the room, she had smuggled a pair of scissors in with her and secreted them in between two of the padded sections of the wall. Luckily, an attendant spotted her recovering them from her hiding place, and could intervene before she was successful.
Elizabeth continued to flit intermittently between behaving well, and behaving in a violent, disruptive, unpleasant manner. During her calmer periods, it was noted that she was able to work well in the asylum laundry, and even assisted with the care of a child who had been a patient in the asylum since 1863, admitted when he was only 4 years old. Having been given this responsible role, it seems that she began to see some purpose in living, as the suicide attempts diminished. However, her illness did still continue, as her violent outbursts were still documented in her notes, but were far fewer than before. Elizabeth remained in Garlands until February 1873, when she was discharged recovered. This would have been relatively rare, as the chance of a patient recovering considerably lowered if they had been resident in an asylum for longer than two years – with the majority of recoveries taking place within one year.


Thank you for taking the time to read this snippet from my research conducted on the Garlands Lunatic Asylum, which forms the basis of the PhD thesis I am currently working on. My aim is to write the history of such a fascinating institution through the experience of its pauper patients. If you have any stories relating to the asylum, or would like help in tracing your ancestors that were in this particular institution, please don’t hesitate to contact me at caradobbing@gmail.com