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‘No “Sane” Person Would Have Any Idea’: Patients’ Involvement in Late Nineteenth-century British Asylum Psychiatry

  • Sarah Chaney


In his 1895 textbook, Mental Physiology, Bethlem Royal Hospital physician Theo Hyslop acknowledged the assistance of three fellow hospital residents. One was a junior colleague. The other two were both patients: Walter Abraham Haigh and Henry Francis Harding. Haigh was also thanked in former superintendent George Savage’s book Insanity and Allied Neuroses (1884). In neither instance were the patients identified as such. This begs the question: what role did Haigh and Harding play in asylum theory and practice? And how did these two men interpret their experiences, both within and outside the asylum? By focusing on Haigh and Harding’s unusual status, this paper argues that the notion of nineteenth-century ‘asylum patient’ needs to be investigated by paying close attention to specific national and institutional circumstances. Exploring Haigh and Harding’s active engagement with their physicians provides insight into this lesser-known aspect of psychiatry’s history. Their experience suggests that, in some instances, representations of madness at that period were the product of a two-way process of negotiation between alienist and patient. Patients, in other words, were not always mere victims of ‘psychiatric power’; they participated in the construction and circulation of medical notions by serving as active intermediaries between medical and lay perceptions of madness.

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1. ‘Henry Francis Harding’, Under the Dome, 5, 19 (1896), 94–5: 94. The obituary may have been written by assistant physician Theo Hyslop, who used similar language in official reports, for example ‘Mr H Harding VB has died of natural causes & his loss will be much felt.’ BRHA, Physician-Superintendents’ Weekly Reports, BWR-02, 1887–1907, entry for 21 August 1896.

2. Bethlem Royal Hospital Archives (BRHA), Patient Casebook (Voluntary Boarders), CB/131, 19.

3. Percy Smith, R., ‘Voluntary Boarders in English Asylums’, Journal of Mental Science, 42, 176 (1896), 7273.

4. Porter, Roy, ‘The Patient’s View: Doing Medical History From Below’, Theory and Society, 14, 2 (1985), 175198; L. Stephen Jacyna and Stephen T. Casper (eds), The Neurological Patient in History (Rochester, NY: University of Rochester Press, 2012), 6.

5. Condrau, Flurin, ‘The Patient’s View Meets the Clinical Gaze’, Social History of Medicine, 20, 3 (2007), 526.

6. Condrau, op. cit. (note 5), 528–9; Michel Foucault, Psychiatric Power: Lectures at the Collège de France, 1973–74, Jacques Lagrange (trans.) (Basingstoke: Palgrave Macmillan, 2006).

7. Jacyna and Casper’s recent edited volume, The Neurological Patient in History, is a rare exception, drawing together essays that offer a wide variety of perspectives on the medical encounter. Jacyna and Casper, op. cit. (note 4); see also Elizabeth Lunbeck, The Psychiatric Persuasion: Knowledge, Gender, and Power in Modern America (Princeton, NJ: Princeton University Press, 1994); Leonard Smith, “‘Your very thankful inmate”: Discovering the Patients of an Early County Lunatic Asylum,’ Social History of Medicine, 21, 2 (2008), 237–252. Similar close studies of the role of doctor and patient in mutually collaborating to shape a patient’s role have been carried out in the history of psychotherapy. See for instance: Mikkel Borch-Jacobsen, ‘Making Psychiatric History: Madness as folie à plusieurs’, History of the Human Sciences, 14:2 (2001), 19–38; Mikkel Borch-Jacobsen and Sonu Shamdasani, The Freud Files, (Cambridge: Cambridge University Press, 2012), ch. 3.

8. For more on this wider context, see eg., David Wright, ‘Getting out of the Asylum: Understanding the Confinement of the Insane in the Nineteenth Century’, Social History of Medicine,10, 1 (1997), 137–155; Akihito Suzuki, Madness at Home: The Psychiatrist, the Patient and the Family in England, 1820–60 (Berkeley, CA: University of California Press, 2006); Louise Wannell, ‘Patients’ Relatives and Psychiatric Doctors: Letter Writing in the York Retreat, 1875–1910’, Social History of Medicine, 20, 2 (2007), 297–313; and Hilary Marland, Dangerous Motherhood: Insanity and Childbirth in Victorian Britain (Basingstoke and New York: Palgrave Macmillan, 2004). Ian Hacking’s idea of the ‘looping effect’ is also interesting in relation to this topic. Ian Hacking, ‘Kinds of People: Moving Targets’, Proceedings of the British Academy, 151 (2007), 285–318.

9. Michael Barfoot and Allan Beveridge, ‘Madness at the crossroads: John Home’s letters from the Royal Edinburgh Asylum, 1886–87’, Psychological Medicine, 20 (1990), 263–84; Michael Barfoot and Allan Beveridge, “‘Our most notable inmate”: John Willis Mason at the Royal Edinburgh Asylum, 1864–1901’, History of Psychiatry, iv (1993), 159–208. The social history of medicine has also seen a number of monographs and articles that cover the nuanced complexities of asylum life, including Anne Digby, Madness, Morality, and Medicine: A Study of the York Retreat, 1796–1914 (Cambridge; New York: Cambridge University Press, 1985); Charlotte MacKenzie, Psychiatry for the Rich: A History of Ticehurst Private Asylum, 1792–1917 (London: Routledge, 1992); Joseph Melling and Bill Forsythe, Insanity, Institutions and Society, 1800–1914 (London and New York: Routledge, 1999).

10. As far as we know, Britain was indeed the country with the largest number of asylum magazines in the nineteenth century. See Aude Fauvel, ‘Psychiatrie et (des)obéissance: écrire à l’asile au XIXe siècle, l’expérience écossaise’, in Falk Bretschneider, Julie Claustre and Isabelle Heullant-Donat (eds), Règles et dérèglements en milieux clos, VIe-XIXe siècles (Paris: Presses Universitaire de la Sorbonne, 2015).

11. Heinz-Peter Schmiedebach, ‘Inspecting Great Britain: German psychiatrists’ views of British asylums in the second half of the nineteenth century’, in Volker Roelcke, Paul J. Weindling and Louise Westwood (eds), International Relations in Psychiatry. Britain, Germany, and the United States to World War II (Rochester, NY: University of Rochester Press, 2010), 12–29.

12. Fauvel, op. cit. (note 10).

13. This approach also sits between the ‘professionalisation’ thesis of asylum psychiatry advanced by Andrew Scull and more recent work on the relationship of the asylum to community. See Peter Bartlett and David Wright, Outside the Walls of the Asylum: On ‘Care and Community’ in Modern Britain and Ireland (New Brunswick; London: Athlone Press, 1999); Andrew Scull, The Most Solitary of Afflictions: Madness and Society in Britain, 1700–1900 (New Haven: Yale University Press, 1993); Wright, op. cit. (note 8).

14. Digby, op. cit. (note 9), 206.

15. Many voluntary admissions at Ticehurst were readmissions or convalescent patients (who had presumably previously been certified), while one in twenty new admissions from 1895 were voluntary boarders. Charlotte MacKenzie, Psychiatry for the Rich: A History of Ticehurst Private Asylum, 1792–1917 (London: Routledge, 1992), 206. Wellcome Library London (WLL), Manor House Asylum: Case notes, male and female voluntary boarders, 1896–1911, MS5725/6222/6227; WLL, Ticehurst House Hospital: Certificates and Notices of Voluntary Boarders: Admission dates 1895–1901, MS6245/6326/6341/6341/1.

16. Holloway also allowed friends of patients to board in the hospital, as well as ‘companions’ of both sexes, whose ‘musical or artistic tastes …are of advantage in promoting the comfort of the patients and boarders.’ WLL, Third Annual Report of Holloway Sanatorium, Registered Hospital for the Insane for the year 1888 (London: 1891), 13–19.

17. Bethlem Royal Hospital, General report of the Royal Hospitals of Bridewell and Bethlem, and of King Edward’s Schools (London & Witley), for the year ending 31st December, 1881 (London: Batten and Davies, 1882), 37. For more on this topic see Jonathan Andrews et al., The History of Bethlem (London: Routledge, 1997), in particular, ch. 27.

18. The shift in Bethlem’s legal status was one of the outcomes of an investigation of 1852, reported in Parliament of Great Britain, Report of the Commissioners in Lunacy on Bethlehem Hospital, Irish University Press Series of British Parliamentary Papers: Health Mental, 6, Sessions 1837–53 (Shannon: Irish University Press, 1969).

19. Lunacy Act, 1890, 53 Vict. ch. 5, Section 229 (London: H.M.S.O., 1890), 110.

20. WLL, Fourth Annual Report of Holloway Sanatorium, Registered Hospital for the Insane for the year 1889 (London: 1891), 14.

21. BRHA, Patient Casebook (Voluntary Boarders), CB/155, 21.

22. Ibid., CB/155, 21.

23. Digby, op. cit. (note 9), 206.

24. See, for example, Emma Pinch, op. cit. (note 21), CB/155, 51 or Annie Mills Green, idem., 48. The exception to the rule was one patient who consented to being force-fed while a boarder. When he withdrew his consent, he was certified. William Luther Leeman, idem., CB/162, 14.

25. This is often referred to in the Journal of Mental Science, for example in a report of a discussion taking place at the British Medical Association. ‘The British Medical Association’, Journal of Mental Science, 37, 159, (1891), 658–668, 666. One example of the Commissioners’ concerns can be found in WLL, Third Annual Report of Holloway Sanatorium, 9.

26. Op. cit. (note 17), 1886 (London: Batten and Davies, 1887), 41–2.

27. Digby, op. cit. (note 9), 206.

28. Henry Francis Harding, op. cit. (note 1), 94.

29. This is all the more pertinent given that admission interviews could be lengthy. When 25-year-old teacher Alice Morison was admitted as a boarder in 1895, for example, a few paragraphs of background describing several years of experiences of multiple personality was noted to have ‘many details wanting’ due to being ‘picked out of 2 hours conversation’ with Alice and her friend, Miss Kennedy (BRHA, Voluntary Boarder Book, 1893–6 (CB/147–26).

30. Op. cit. (note 21), CB/131, 19.

31. Ibid., 73.

32. Ibid., 73–4.

33. Smith probably also had other reasons for these claims: fears of wrongful incarceration had risen in the run-up to the 1890 Lunacy Act, and an emphasis on protection served to counter these claims by insisting that it was the patient, and not the doctor or the patient’s family, who called for admission. Louisa Lowe, The Bastilles of England: Or, the Lunacy Laws at Work (London: Crookenden, 1883); Scull, op. cit. (note 13), 307–8.

34. Barfoot and Beveridge, ‘Our Most Notable Inmate’, op. cit. (note 9), 161.

35. Harding, Henry Francis, ‘Notes Apropos’, Under the Dome, 2, 7 (1893), 6875: 68.

36. Henry Francis Harding, handwritten note (undated) in op. cit. (note 21), CB/131, 19.

37. Harding, ‘Notes Apropos’, Under the Dome, 2, 7 (1893), 68–75: 68. John Willis Mason also played on the term ‘patient’ in his magazine articles in Edinburgh. Barfoot and Beveridge, ‘Our Most Notable Inmate’, op. cit. (note 9), 184.

38. Harding, Henry Francis, op. cit. (note 35), 8 (1893), 114–21: 114.

39. One bitterly sarcastic missive from Alice Eliot to congratulate Dr Hyslop on his promotion to superintendent in 1898, declared that ‘Dr Smith …is now busy pronouncing humankind insane. …If only he could follow up his diagnosis with an efficient remedy, he might revolutionize the world!’ (Letter from Alice Eliot to Theo Hyslop (undated), BRHA, Patient Casebook (Female) 1898, CB/159, 52.) Yet Alice, although formerly a voluntary boarder, was by this time a certified patient, soon to be discharged uncured, and her words do not appear to have been acknowledged.

40. Henry Francis Harding, ‘Notes Apropos’, Under the Dome 3, 9 (1894), 17–24. John Home apparently fulfilled a similar role in the Royal Edinburgh Asylum. Barfoot and Beveridge, ‘Madness at the Crossroads’, op. cit. (note 9), 276.

41. Both the patients whose extensive letters and poetry were explored by Barfoot and Beveridge were male. There were a few exceptions, of course: these tended to be those who drew attention to their cases for political reasons, and were often wealthy feminists, such as Louisa Lowe, op. cit. (note 33). For more on female cases, see Judith R Walkowitz, City of Dreadful Delight: Narratives of Sexual Danger in Late-Victorian London (London: Virago, 1992), ch. 6.

42. ‘Obituary: Kentish Scribbler’ Under the Dome, 11, 42 (1902), 58.

43. While the article does not date the drawing, the identities of the members of staff included mean that the picture must be from 1872–78.

44. O’Donoghue, Edward Geoffrey, ‘Chaplain’s Column’, Under the Dome, 8, 30 (1899), 6981: 77–8.

45. Scull, Andrew, ‘The Domestication of Madness’, Medical History, 27 (1983), 233248.

46. M3, ‘Ours and Others’, Under the Dome, 1, 3 (1892), 22–26: 23.

47. Z. ‘Our Departed Feathered Friend’, Under the Dome, 4, 15 (1895), 103–4.

48. Such as Alia Stringer, BRHA, Patient Casebook (Female), 1890, CB/139, 112, Emily Barker, BRHA, Patient Casebook (Female) 1898, CB/159, 51.

49. BRHA, Patient Casebook (Male) 1882, CB/120, 102.

50. BRHA, General Admission Register, ARA-31.

51. Op. cit. (note 49), entry for March 12 1885.

52. Savage, George, Insanity and Allied Neuroses: Practical and Clinical, vol. 1 (London, New York: Cassell, 1884), vi.

53. Hyslop, Theo, Mental Physiology: Especially in Its Relations to Mental Disorders (London: J. & A. Churchill, 1895) frontispiece.

54. Barfoot and Beveridge, ‘Our Most Notable Inmate’, op. cit. (note 9), 185.

55. Letter from Alia Stringer to Theo Hyslop, 13 September 1896 in BRHA, Patient Casebook (Female), 1890, CB/139, 112.

56. A number of ‘children of artisans’ also attended the party. WLL, Adam Diaries, MSS.5517 (1880), entry for 31 December 1880. See also 11 January and 25 July.

57. ‘Master Harold’ Savage also helped in distributing presents. ‘Local Notes’, Under the Dome, 3, 9 (1894), 36; BRHA, Resident Physician’s Weekly Reports, BWR-02, 1887–1907, entry for October 20 1897.

58. O’Donoghue, Edward Geoffrey, op. cit. (note 44), 6, 24 (1897), 174–81: 175.

59. Op. cit. (note 49), 102.

60. Unfortunately I have been unable to find a copy of the volume.

61. Letter from Walter Haigh to Theo Hyslop, August 24 (no year, c. 1890–4), op. cit. (note 49), 102.

62. Op. cit. (note 21), CB/147, 48.

63. Casebooks also include mentions of staff encountering former patients in the street. For example, two months after Charles Godfrey was discharged, it was noted that he ‘was seen in the street by Mr Davis (head attendant) walking with his wife & apparently very cheerful, expressing himself as feeling much better than he had done for a long time.’ BRHA, Patient Casebook (Male), 1884, CB/124, 152.

64. Letter from Emily Barker to Theo Hyslop, 23 June 1899, BRHA, Patient Casebook (Female) 1898, CB/159, 51.

65. Smith, op. cit. (note 3), 74.

66. WLL, Third Annual Report of Holloway Sanatorium, 9.

67. For more on the role of the Commissioners, see David J. Mellett, ‘Bureaucracy and Mental Illness: The Commissioners in Lunacy 1845–90’, Medical History, 25 (1981), 221–50.

68. WLL, Fourth Annual Report of Holloway Sanatorium, 14.

69. Op. cit. (note 49), 102, entry for March 12 1885.

70. Indeed, there is no mention of the use of setons in an 1890s text on counter-irritation: Hugh Cameron Gillies, The Theory and Practice of Counter-Irritation (New York: Macmillan, 1895). For more on fever therapy, see Magda Whitrow, ‘Wagner-Jauregg and Fever Therapy,’ Medical History, 34, 03 (2012), 294–310.

71. Kent County Archives, West Malling Place Asylum – Case Histories (Visitors), 1877–93, Ch84/Mc3, 201.

72. Op. cit. (note 21), CB/159, 19.

73. Op. cit. (note 49), 102, notes on admission.

74. Op. cit. (note 21), CB/147, 48.

75. Letter from W.A. Haigh to T.B. Hyslop, 24 August (no year, c. 1890–4), in op. cit. (note 49), 102.

76. Hyslop, op. cit. (note 53) , 227.

77. Letter from W.A. Haigh to R.P. Smith, 2 December (no year, c. 1890–4), in op. cit. (note 49), 102.

78. George Savage, ‘The Lettsomian Lecture on Functional Mental Disorders,’ The Lancet, 165, 4251 (1905), 411; George Savage, ‘The Influence of Surroundings on the Production of Insanity,’ Journal of Mental Science, 37, 159 (1891), 529–35.

79. George Savage, ‘The Presidential Address Delivered at the Opening Meeting of the Section of Psychiatry of the Royal Society of Medicine on October 22nd, 1912,’ Journal of Mental Science, 59, 244 (1913), 19.

80. Savage, George, ‘An Address on the Borderland of Insanity’, British Medical Journal, 1, 2357 (1906), 491.

81. Hyslop, op. cit. (note 53), 469.

82. Savage, George and Mercier, Charles, ‘Insanity of Conduct’, Journal of Mental Science, 42, 176 (1896), 2.

83. with their doctors. For more on this wider context, see note 8. The doctor–patient relationship remained important to asylum medicine in this era, even if the sheer number of letters that patients often wrote to their physicians suggests that they did not necessarily see each other that regularly. See Barfoot and Beveridge, ‘Madness at the Crossroads’, op. cit. (note 9), 272. Similarly, patient letters at Bethlem often incorporate requests for a doctor’s time, or complaints about not seeing the physician. This, in itself, is testament to the importance that patients themselves placed on the encounters that they did have.

84. Examples include Amy Saunders, BRHA, Patient Casebook (Female), 1898, CB/159, 2; Emily Freebody, BRHA, Patient Casebook (Female), 1888, CB/135, 130.

85. Hyslop, op. cit. (note 53), frontispiece.

86. Patricia Rosselet, ‘The Quest for Objectivity in Textbooks of Diseases of the Nervous System (1850s–1920s),’ PhD dissertation, University of Lausanne, 2015.

87. This case was made famous by novelist Simon Winchester in The Surgeon of Crowthorne: A Tale of Murder, Madness and the Love of Words (London: Viking, 1998; American title: The Professor and the Madman).

I wish to thank my former PhD supervisor, Sonu Shamdasani, for his ongoing support. I would also like to thank the editors of this volume, and the two anonymous reviewers, for their suggestions for improvement. Many thanks are also due to Colin Gale, archivist at Bethlem Museum of the Mind.

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