Garlands 1906

Garlands 1906

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

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