This blog is a small part of my ongoing research into the Garlands lunatic Asylum. Hopefully these examples demonstrate how far we have come in treating these illnesses outside institutions. What were once stigmatized conditions treated away from public gaze, are now topics we can openly discuss to help each other. Continue the conversation, grab a coffee and chat with friends and colleagues, and encourage openness around mental health.
Thursday, 7 February 2019
In line with Time to Talk Day (7th Feb. 2019), this post will explore some of the common reasons people were admitted to a lunatic asylum in the late nineteenth century. Using my research of the Garlands Asylum, a number of patient examples will be presented to illustrate how mental illness was regarded, and open up the conversation around mental health to demonstrate how much has changed, and how much further there is still to go.
In 1872, the medical superintendent in charge of the asylum, Dr Thomas Clouston, commented on the statistics for the admissions of the initial decade that Garlands was open. At the head of the causes was a ‘hereditary predisposition’ to mental illness, which had been found in 29% of cases. Asylum doctors at this time had noticed the clustering of insanity in certain family trees, but had no explanation as to why, and were uncertain of the conditions it occurred most frequently in. Clouston noted the difficulty in getting the true family background of a patient on admission from relatives due to the stigma surrounding mental illness: ‘Its existence is often most difficult to get at from relatives…One would not be far wrong to say that one-half of all the cases had this cause predisposing to or directly producing the malady.’
In a patient's records it often details a mother/father or a more distant relative such as brother on father’s side, or maternal grandfather as suffering with some form of insanity also. An example of hereditary insanity is John M, admitted in September 1887, aged 30. He was a single farm labourer from Kirkby Stephen, and although it was his first time in the asylum, this was his second attack of depression. His two sisters had previously been in the asylum, suggesting that this was a hereditary condition.
Next, Clouston remarked that for the initial decade, 14.8% of admissions had been attributed to intemperance. For almost every patient their state of soberness is stated in the casebooks. A great number were described as being intemperate, addicted to alcohol, or given as a drunk.
One example was Robert H, admitted in March 1898, aged 29. He was a dock labourer from Maryport, and this was his first case of insanity. He was admitted after being struck down by an attack of insanity which had lasted 6 six days. The cause of his illness was given simply as ‘drink’, and no hereditary predisposition to insanity was found in his family. The excess of alcohol had caused Robert to suffer from delusions. These were detailed in his admission notes: ‘[He] said people were taking his bed from under him’, and ‘[He] imagines a man is going to put vitriol in his eyes’. Hayton had also shown suicidal tendencies as he ‘tried to cut his throat’.
Those with insanity caused by intemperance often recovered fairly quickly. This was because they were not allowed any alcohol once in the asylum and would have no way of getting any. Therefore, their confinement was a way of them getting sober and returning to a normal state of mind. About two weeks after admission, Robert was noted as laughing ‘at his former delusions, and...[said] they were the effects of drink.’ On remaining sober, he was discharged as recovered six weeks after admission.
Next, accounting for 8.2% of the admissions, insanity caused by childbirth, whether it be post-natal depression, a traumatic childbirth, the fear of being pregnant, but ultimately a number of different causes of insanity suffered by women only also referred to as
puerperal mania. An example of puerperal mania is found in the case of Sarah F Admitted in Oct 1890, she was diagnosed with ‘pregnancy and domestic troubles’. The problem was that she was afraid to be pregnant, but it seemed she was around 7/8 months pregnant at the time of admission. Only a week later her baby was still born and she remained in the asylum until July 1891.
Also common in the classification of mental illness in the asylum was melancholia. This was characterised by a depressed mood and sometimes accompanied by suicidal thoughts. An example is Ann D, admitted in April 1886, aged 39 from Cockermouth. Her melancholia was her first attack of insanity and had lasted only 14 days. She was recorded as being so down that she ‘begs for a knife to cut her throat’. However, due to quick diagnosis and treatment she recovered and was discharged a few months later on 17 July 1886.
A final reason for admission to the asylum that sometimes occurred was poverty. Lack of success in a persons working life often led to asylum admission. For example, Ellen P was admitted to garlands in February 1893. She was labelled a 'tramp' and her illness was attributed to ‘destitute circumstances’. Her background seems to be a tragic one. Her son had died five years previous to her admission whilst they were in the workhouse, and she would frequently be haunted by her son’s dead spirit. During her illness she had ‘tried to drown her daughter in [the River] Caldew’. However, with effective moral treatment at the asylum, she was discharged as recovered on 7 June 1893.
This blog is a small part of my ongoing research into the Garlands lunatic Asylum. Hopefully these examples demonstrate how far we have come in treating these illnesses outside institutions. What were once stigmatized conditions treated away from public gaze, are now topics we can openly discuss to help each other. Continue the conversation, grab a coffee and chat with friends and colleagues, and encourage openness around mental health.
For more information go to https://www.time-to-change.org.uk/
Friday, 21 December 2018
Much is documented about the chronic underfunding of the NHS in the modern era, and, in particular, mental health services. The growing number of people diagnosed with mental illness, and a lack of provision to effectively treat them, is not a problem confined to recent times. The optimism of the 1845 Lunacy Act in making compulsory the construction of a lunatic asylum in every county and borough throughout England and Wales, soon proved to be a victim of its own success.
Soon after Cumberland and Westmorland opened its own asylum – Garlands – in 1862, there were calls for an extension to its accommodation. Originally intended to house 200 pauper patients, by 1863 this had been exceeded, as on 31 December of that year, 225 were resident.
This angered many among in the local Poor Law Unions who funded the institution, as they regarded the building of the asylum an extravagant ‘blunder’. The following passage documents a meeting of the Whitehaven Board of Guardians, and focuses on the strain on accommodation so soon after opening. It was published in the Whitehaven News in October 1863.
It was built at a great expense; and yet, in less than two years, we are obliged to go and seek shelter elsewhere for any lunatic patients we may henceforth have…It is with the greatest difficulty that information can be obtained with reference to this costly building…I am told that the asylum cost the two counties £50000, which seems an enormous and startling sum…I cannot reconcile such wholesale expenditure of public money upon an asylum like that, with the fact that before the termination of two years, it is full…
Again in April 1864, the Whitehaven Guardians debated the cost of the asylum when it was built, and the necessity of an extension. They alluded to the fact that they could not see a direct cause for the increase in calls for provision:
From some cause or other lunacy was greatly on the increase. The average number from this union [Whitehaven] used to be 25 to 27: now they had 37…
Garlands underwent several extensions throughout the remainder of the nineteenth-century, taking the capacity to 660 patients. Many cases had to be refused entry. Some were sent to other asylums at a higher cost to the ratepayers. Most were housed in nearby workhouse wards, but the substandard level of care was widely known, and frequently commented on in the annual reports of the Lunacy Commissioners. For instance, they stated in 1860 of the Kendal Workhouse:
The larger of the day-rooms is gloomy and cheerless, dirty, wretchedly furnished, and destitute of every comfort…Two men are, in several instances, placed to sleep in the same bed…There is no paid nurse in any part of the Workhouse, and the porter, assisted by pauper inmates.
An article published in the West Cumberland Times in June 1894 reflected the despair of ratepayers at the unrelenting pressure on mental health provision at Garlands.
The strain on accommodation at Garlands is hardly less than is the case at similar institutions in Northumberland and Durham. The total number of inmates under the charge of Dr Campbell at the end of 1893 was 579…however, as the Committee of Visitors inform us, the number of patients at Garlands has frequently exceeded 600. Thus the County Council are brought face to face with the question of making further provision for the insane…it is clear that the insane at Garlands grow more numerous with each decade.
However, although the tone of the article begins with the Whitehaven Board of Guardians complaining about the increase, they do state the benefit it brings to those who are treated in Garlands, as those in need of provision are more likely to receive it after the asylum is enlarged:
There is a greater desire to have the benefit of skilled treatment such as is afforded at Garlands Asylum to those whose lives have been darkened by mental afflictions. Patients who were formerly dealt with in workhouses are now sent to asylums.
Into the twentieth century, the issue did not abate. After further extensions, the number resident in 1919 had grown to 913. In an article in the Penrith Observer in July 1919, again the pressure on expenditure was being debated in the public arena. However, this time the tone had become much more sympathetic to the work done at Garlands. The Asylum had just, after 58 years, changed its name to the Cumberland and Westmorland Mental Hospital. Rather than stating its unjust expense, the Penrith Observer was much more understanding of the need for mental health provision, and regarded Garlands as a ‘costly necessity’. They also praised the hard work of the staff, and stated how underfunded they were:
The staff – already insufficient – must become larger, work shorter hours, and yet be better paid, while the cost of living will very likely fail to drop for a considerable time.
These sentiments echo those of the national media today. Underfunded and understaffed, in this respect, not much has changed in the 100 years since this was penned. What is apparent is that mental health has become much less stigmatised since the Victorian institutions have closed. Reflecting on the provision of mental health in the past helps create a lasting conversation. This is to encourage the increased openness and understanding of the invisible conditions suffered by so many of us.
This post is part of my ongoing research into the Garlands Lunatic Asylum, and the history of mental illness. If you want to contact me about this post, or my work, please do so at firstname.lastname@example.org or on Twitter @caradobbing
Wednesday, 10 October 2018
To coincide with World Mental Health Day, and as the focus this year is on the wellbeing of children and young people, this post examines some of those admitted to Garlands under 14 in the late nineteenth and early twentieth centuries. What is written here is an extension of the research I have already undertaken for my PhD, and something I wish to explore further in the future. From the beginning, the Garlands annual reports stated that it was not an institution for children. As I did more research, more children kept emerging from the records, and through this post I want to share some snippets of their stories. When beginning to look at the case notes of these patients, although intended to be clinical documents, the emotions acting upon them and their families in seeking institutional committal, is immediately clear.
‘Insanity’ in this period was the catch-all, legal term that referred to mental health conditions and disabilities. ‘Lunacy’ was the umbrella term for conditions regarded as temporary, and curable. These included illnesses such as mania and melancholia. ‘Idiocy’ and ‘Imbecility’ were the terms used to denote chronic, life-long conditions. These would be understood today as mental or learning disabilities, which were present from birth. It is these terms which feature most prominently in the children who will be explored in this post.
Using the admission registers for the period 1862-1914, the number of children 14 and under admitted only stood at 0.5% - 38 children. The mere presence of these patients is fascinating in itself, as it was constantly reiterated that this was an adult institution. For instance in 1883, the superintendent noted: ‘An imbecile child of eight years…was sent here and appeared to me so unsuitable for treatment in this institution…He was afterwards removed by his parent. Lunatic asylums are not proper places for the treatment of imbeciles of tender years’.
This was not uncommon, as the asylums constructed in response to the 1845 Lunacy Act were given no age restrictions for the patients they were built to treat. As a result, children can be found in the admission records of institutions which were only equipped to deal with adult patients. Specialist provision, in the form of idiot and imbecile asylums, began to be erected after the county institutions, but often these were not as great in number, and as was the case for Cumbria, were situated some distance away, and had to cater for a larger population – leading to a demand on their resources. For instance, the nearest to Garlands, the Royal Albert Asylum for Idiots was built to provide specialist provision for children classed as idiots and imbeciles in Lancaster in 1870. It was also known as the Northern Counties Idiot Asylum, as it was intended to cater for such patients from Lancashire, Cumberland, Westmorland, Durham and Northumberland. As such, the cases in the sample should have been sent there to receive care, and some did, but this was not always true.
In the first instance, the response was to board the child out to local workhouse wards, but if patients were displaying violent behaviour, they were reluctant to receive them. Alternatively, if the case was that the child’s family could not cope with their illness, and it was clear that they could not be ‘cured’, then a more suitable place would be sought. For instance, Christopher G, aged 11, was brought to Garlands in October 1890 suffering with ‘epileptic imbecility’, his father stated in his admission documents that he was ‘difficult to manage’ due to his violent outbursts. When examining Christopher, the doctors recorded: ‘At present crying and saying he wants to go home’. These emotions demonstrate the attachment to his family, and show how difficult it must’ve been for them to make the decision to admit him to Garlands.
Christopher was only in Garlands for one week before the superintendent recorded in his notes: ‘…So far has behaved well, and from his tender years he appears to me a very unsuitable case to be associated with adult lunatics. He might have done outside boarded with someone who had no young children…’ And that is what happened. Three weeks later he was discharged from the asylum and was boarded out to a child-less couple in Kendal. However, when he turned 17, in 1897, he was readmitted to Garlands, where he remained until his death two years later.
For the children who remained in Garlands, they would stay in adult wards, and would be placed under the care of fellow patients. Asylums of this era believed in morally treating patients, and useful employment was a major part of this. Therefore, caring for children was a form of employment, and was utilised to keep patients occupied and diverted from their conditions.
One instance is the youngest patient to be admitted, Richard B, aged 4, who was brought from Cockermouth Workhouse in 1862. He was noted from the outset as being an unsuitable case for the asylum. He was noted as causing a ‘great deal of trouble’ as he ‘takes up the entire time almost of one nurse’ – usually one nurse would be responsible for up to 14 patients. He was put in the care of Elizabeth R, a 29 year old female. From her case notes, it doesn’t look as though she cared for Richard for a prolonged period, and when children got slightly older, for males, they were removed to the male adult wards.
A couple more cases have shown that when in adult wards, children could form bonds, particularly of a parental nature, with other patients. For instance, Thomas F, aged 10, was noted shortly after admission: ‘Calls one of the other patients Daddy and goes about with him as if he was his father’. This could also work the other way, as in the case notes of Robert B, a 9 year old admitted in 1862, it was stated that: ‘James M, another patient, has taken the delusion that the boy is his and consequently takes great care of him’.
As mentioned, the Royal Albert Asylum for Idiots was an important consideration for the asylum doctors when planning on what care was best for children. But, only 26% of the children who came to Garlands were either sent there, or arrived having spent time there. It wasn’t a definite that Royal Albert would accept all cases, as it catered for 5 counties, and in the 1880s could accommodate around 500 patients. From the outset it was intended to be training centre. If patients did not show the slightest chance of improvement, or ability to be trained in a certain area, they would not be sent there.
A report on ‘How Imbeciles Are Educated’ from 1884, stated that the ‘primary object of the place is to make it a school for the education of the dormant faculties of imbecile children; they are admitted between the ages of six and fifteen, for a term of seven years. It is not a life refuge…the education of these children is, therefore the special object set before them by the staff of the institution. To discover, to draw out, and to develop any faculty possessed by their defective intellects is the great aim of all persons employed’.[i]
There are instances of children arriving at Garlands having been removed from Royal Albert due to their behaviour or lack of improvement. For example, Edith P, aged 14 was admitted in 1903 having spent 2 years and 9 months in Royal Albert. A letter attached to her admission documents stated that: ‘The poor girl has much deteriorated, and is now most violent. We fear that she will do serious mischief to other patients, and even to the nurses. We must therefore ask you to make arrangements for her immediate removal as we have no proper accommodation for such cases in this institution, such as provided in lunatic asylums.’ Edith remained in Garlands until her death aged 19.
Children sent to Royal Albert often came back once they reached their late teens, and when their treatment ended. One example, Eleanor B aged 17, was admitted to Garlands in 1887 following 7 years treatment in Royal Albert. She did stay for some time at home, but she was ‘beyond the control of her mother’, so she was sent to Garlands. She remained until her death in 1925.
Family breakdown was a major factor which triggered an institutional response to insanity, in patients of any age, but more so for children. For instance, James D was admitted to Garlands following the suicide of his father, in October 1889. His mother had died some years previous, and he was the oldest at 14 of 3 children. He was described as always being of weak intellect, and it seems that his father’s death triggered his admission, due to a lack of adult relatives. Once institutionalised, cases such as James were rarely discharged home, in the absence of supportive relatives, and he died in an asylum, aged 20.
The prevalence of hereditary degeneration, and the eugenic school of thought, is extremely apparent when reading the case notes of these children. A lack of awareness of how to deal such cases led to a constant farming out, and a focus on training them in whatever way possible. As stated by the superintendent in 1888: ‘Imbecile children are out of place in a lunatic asylum, and yet if allowed to grow up without training, as the majority do in these counties, they in time become the most expensive and troublesome patients met with in lunatic asylums.’
Going forward, to echo the sentiments of World Mental Health day, we can use these snippets of the past to learn from, and to encourage conversation around mental wellbeing, particularly among children and young adults.
Thursday, 31 May 2018
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.
Thursday, 1 February 2018
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
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 email@example.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
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, 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
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.
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