The period spanning the end of the nineteenth century and the early years of the twentieth has been relatively neglected in the historiography of the asylum and mental health care in Britain. There has been a widespread consensus that the key developments in the rise and consolidation of ‘asylumdom’ had already occurred and that the workings of the system had become largely ossified. Louise Hide’s meticulously researched book shows that this was far from the full story and that, on the contrary, it was a period of transition when interesting things were taking place even within the large institutions.
Set in its wider social and demographic context, the main evidence on which the study is based emanates from two London County Council lunatic asylums, both opened in the 1890s, at Claybury in Essex and Bexley in Kent, each designed to accommodate some two thousand patients. With class and gender as reference points, and adopting an ethnographic approach, Hide provides in-depth consideration of the three key constituent groups who inhabited the asylums – the patients, the medical officers, and the staff of nurses and attendants. The many individual case vignettes and other illustrative material she deploys, sourced both from patient casebooks and administrative records, heighten the book’s interest and accessibility.
The asylums’ patients, many originating from the more deprived areas of London, are analysed from the perspectives of their socio-economic and occupational backgrounds, the circumstances or ‘causes’ that precipitated their admissions, and the forms of insanity that they manifested. This is an approach that has become relatively familiar in studies of Victorian asylums. However, an exploration of the origins, motivations and experiences of medical staff, including those less senior, is rather more unusual. Aspects of particular interest are the increasing emphasis on scientific methods, the class and status hierarchies that prevailed, the stresses and pressures to which junior doctors were subjected, and the considerable difficulties faced by the ‘lady doctors’ working at Claybury asylum.
The chapter on the attendant staff shows this to have been a significant period in the history of mental health nursing. Clearly, whilst many of the long-standing problems and issues still prevailed, there were some perceptible changes occurring. Interlinked with a growing professional consciousness and organisation, improvements were taking place in pay and conditions, female nurses were being brought in to look after some male patients, and training was becoming more widespread. Hide contends convincingly that the role of attendant was gradually becoming that of mental nurse.
Three chapters examine important aspects of the asylums’ operation, indicating some of the contradictions that were becoming more apparent. The accepted image huge, imposing institution of the late nineteenth century, with its dominant medical superintendent exercising control over a rigid, structured, ordered, routinised and impersonal system, is to some extent confirmed, along with the patients’ lack of privacy or agency. Mechanical restraint is shown to be once again in regular use. Violence appears to be not uncommon between staff and patents, with overworked, pressurised attendants sometimes meting out summary justice and otherwise abusing their powers. Yet, at the same time, beneficial changes were apparent. Annexes for the active treatment of recently admitted acute patients were being established. Treatment methods were becoming more eclectic and sophisticated, with a new emphasis on experimental approaches that included separate provision for convalescence and discharge preparation. All these developments suggest that the turn-of-the-century asylum was no therapeutic desert.
A couple of the topics explored are worthy of special mention. In Chapter 4 the perceptive discussion around work and all its complex meanings, as they affected both staff and patients, is of particular interest. It is shown as an indicator of ability, status and mental state, as well as a means of therapy and a vehicle for achieving both individual reward and economic self-sufficiency in the institution. In the next chapter Hide provides deep and sensitive insights into the processes of admission as experienced by the bewildered new patient, focusing on how apparently practical measures became transformative rituals.
As the book’s title would indicate, issues of social class and gender are addressed and considered critically at several points. However, its overall content is a good deal broader than the limitations of those particular parameters, for it is an incisive and wide-ranging study of the asylum system, and the people within it, at a critical juncture. Louise Hide has demonstrated that the quarter century in question was a time of significant transitions. The lunatic asylum was gradually transforming into the mental hospital, the attendant moving toward being a nurse, and the lunatic becoming a mental patient. This highly recommended book shows conclusively that this was far being a period of stagnation in the development of institutional mental health provision.
