Tuke and his contemporaries: asylums, homosexuality, women and degeneration

Daniel Hack Tuke was descended from William Tuke, who founded the Retreat at York in the 1790s. Based on the fundamental Quaker belief in the equality of all human beings, the Retreat aimed to provide more humane treatment for people with mental disorders than that available in the local public asylum. It was funded by donations from Quaker groups around the country, rather than from personal family wealth.

Hack Tuke, like his ancestors, pioneered humane social treatment. He worked for several years at the Retreat, and in 1879 was a founder member of the After-Care Association (today, Together for Mental Wellbeing). This organisation initially aimed to support women to re-establish their lives in the community following an asylum admission.⁴ Tuke co-edited the JMS for around 15 years, and undertook the mammoth task of editing the two-volume Dictionary of Psychological Medicine (1892).^{Reference Tuke5} The Dictionary included articles by leading psychiatrists, psychologists and neurologists. It aimed to be a state-of-the-art scientific and clinical compendium. Relatively little of it directly addressed what today would be considered human rights or equality issues.

When trying to understand attitudes and behaviours of our forebears, we require a degree of scepticism when reading their obituaries, especially when written by colleagues, as these tend to follow the tradition of not speaking ill of the dead.^{Reference Bewley6} It is unusual, however, to find one attributed to a patient, in this case Henry Francis Harding, which extols the virtues of a psychiatrist.^7,8 Harding mentioned some of Tuke's personal attributes, which align with other evidence, to suggest that he maintained a good relationship with his son, the homosexual artist Henry Scott Tuke.^{Reference Broderick9} In late Victorian England, this could not be taken for granted. In the Dictionary, Conolly Norman, medical superintendent of the Richmond District Lunatic Asylum, Dublin, contributed the entry on ‘sexual perversion’,^{Reference Norman and Tuke10} one of the terms then used concerning homosexuality. He wrote empathetically, recognising the development of homosexual identity during childhood rather than it being a disorder that required treatment. Like Tuke, Norman also tried to provide the most humane treatment for his asylum patients. Also, unlike a significant number of their contemporaries, both of them were enthusiastic about supporting the election of women doctors to membership of the Medico-Psychological Association.¹¹

In the second half of the 19th century, biological, hierarchical theories of mental, physical and cultural differences, which often put upper-class White men at the top, gained acceptance. Within the psychiatric literature, Bénédict Morel's degeneration hypothesis (1857)^{Reference Morel12} was prominent. It proposed a downward trajectory of health and well-being of individuals, families and society, if they bore a supposedly inherited taint. The degeneration hypothesis gained ground among novelists, the public, politicians, physicians and scientists, but it was probably less influential than might be expected among British psychiatrists. Although criticised for their lack of academic approach to psychiatry, many held a cautious scepticism towards hypotheses presented to them, a virtue in its own right and one that could protect the interests of their patients. Many were aware that their clinical observations were inconsistent with degeneration. They treated and discharged patients who were labelled as having ‘hereditary insanity’, and noted that their patients’ families did not show patterns of decline compatible with it.^{Reference Hilton13} From the evidence available to us, Tuke and Norman were among those who tried to overcome ideas of biological hierarchies, hereditary predispositions, and inevitable decline and hopelessness associated with insanity. They tried to improve in-patient care and aftercare.^{Reference Nolan14} They reached out beyond stereotypes and theories, and held liberal attitudes towards to people whose lives were affected negatively by social or professional exclusion.

Language, race and weighing up the evidence

All historical sources require careful and contextualised analysis. Many Victorian psychiatrists left few private papers that might directly shed light on their lives as individuals. Their publications require cautious reading if one attempts to use them to infer personal attitudes or motivation for writing. For example, we can consider Havelock Ellis's (1897) writing on homosexuality (‘sexual inversion’). Unlike many of his contemporaries,^{Reference Beccalossi15} he took a non-moralising, non-legalistic approach, explaining that ‘several persons for whom I felt respect and admiration were the congenital subjects of this […] instinct which to those persons who possess it frequently appears natural and normal’. However, to argue his case, some of the comparisons he made, such as with ‘the congenital idiot’ and ‘the man [sic] of genius’,^{Reference Ellis16} and his language of normal and abnormal to stress human variation, make for uncomfortable reading today. Rather than looking at the individual words he used to assist his expected readership to understand his argument, we need to consider the take-home message.

The meaning of many words used by previous generations has shifted. Language with an emotional overlay and associated with stigma changes particularly rapidly. Earlier professional and official terminology, such as cripple, spastic, lunatic and imbecile, have become terms of abuse. ‘Race’ has also changed. In its broadest meaning there is the ‘human race’. In Tuke's time, race often indicated difference or foreign-ness rather than specifically skin colour, such as the ‘Jewish race’, then used in popular literature^{Reference Zangwill17} and in medical parlance.^{Reference Tamburini, Tonnini and Tuke18} Tuke tried to weigh up the evidence presented to him. He wrote of uncivilised, savage or barbarian nations, but associated their lifestyle with good mental health. However, he also acknowledged that his evidence was based on ‘the testimony of travellers’, so interpreting it required ‘extreme caution’. Nevertheless, he wrote that it ‘must not be disregarded, but be accepted as the nearest approach we can make’.^{Reference Tuke19} He also criticised lifestyles and leadership in his own country for conditions that, in his view, increased insanity, such as the ‘curse of civilised pauperism’ and the ‘widespread tippling which disgraces England’.^{Reference Tuke20} Tuke was not one-sided in his interpretation of culture or race as it related to mental well-being. In his view, life in England was more likely to cause mental disorders than life in distant countries. Tuke exemplified a psychiatrist who sought a scientific understanding of mental disorders while recognising limitations and uncertainties of the evidence available to him.

Tuke's ideas contrast with those of his more famous colleague, Henry Maudsley.²¹ Maudsley probably destroyed his private papers,^{Reference Rollin, Berrios and Freeman22} so we know little about him as a person, although his own published writings, and what his contemporaries wrote about him, provide clues. In 1867, in the context of discussing the evolution of brain and mind, Maudsley wrote:

Frederick Tiedemann (Professor of Anatomy and Physiology, Heidelberg) compared orangutan and human brains in the 1830s. He found only minute differences between brains of Black and White people, with any resemblance to those of other primates of dubious significance. He concluded that ‘neither anatomy nor physiology can justify our placing [Black people] beneath the Europeans’ morally or intellectually, and that any differences were the result of oppression and the cruelty of slavery.^{Reference Tiedemann24} However, almost 40 years after Tiedemann published his research, Maudsley misrepresented it, advocating instead a theory affirming racial difference.^{Reference Mitchell, Michael, Thomas and Jackson25} As is common for research that contradicts established theories or cultural, political or economic drivers, Tiedemann's research had little impact. In this case, it conflicted with elitist ideals of Empire, and Maudsley accepted it uncritically.

In 1896, an anonymous review of Maudsley's The Pathology of Mind appeared in the JMS. It criticised both book and author:

Considering that Maudsley was a former editor of the JMS, it is astounding that this, and a string of other criticisms, appeared in the Journal.²¹ His ideas were intolerable to his peers, who regarded them as behind the times and unworthy of debate. According to Trevor Turner, Maudsley's heritage also included ‘the dangers of drawing philosophy from clinical experience, the sterility of pure materialism in the face of human needs, the easy lapse into unscientific thinking’.^{Reference Turner26} Remembered, or perhaps glorified, by his enormous donation to the London County Council to establish the hospital that bears his name, there were other faces to a man we know little about.^{Reference Pantelidou and Demetriades27}