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 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.