Book Reviews by David J. Vaughan

Centres of Lunacy
David J. Vaughan

Perspectives in Economic and Social History: 36

Edited by Thomas Knowles and Serena Trowbridge 2015 (Pickering & Chatto)

256pp: 234x156mm: 2014
HB 978 1 84893 452 8: £60/$99
eBook: £24 (incl. VAT)

This collection of papers - inspired by a one-day conference in May 2011 on the site of the former Birmingham Lunatic Asylum - brings together a broad range of themes and topics from the study of mental health, and its impact on the historiography of the titular subject. Its reach, in both focus and geography, produces a rare collection of otherwise standalone discussions; making for an excellent source of ideas and further reading for those investigating lunacy and its social response in the 19th century.

The three, perhaps loosely defined, sections - Literary, Quantitative and Cultural - allow the eleven separate epistles to be accessed thematically; though, far from being consolidated by common ground, a simpler presentation of ungrouped topics might yet have made the whole more accessible, making each of equal importance. It is a small matter.

The work starts briefly with a re-appraisal of the emerging centres for the insane, the focus of the monograph's aims. From Foucault's edifices of the 'Great Confinement' to the expansive buildings populated by Sarah Wise's inconvenient people, it homes in variously on the diagnosis, institutionalization and treatment of the mad. In so doing, it opens up a fascinating treasure chest of anecdotal and statistical material, with academic rigour and only occasional subjective interpretation that adds both depth and the potential for 'mission creep' in understanding the role of the new public asylum.

For example, the current modern (post-modern?) obsession with analysis by gender, class or other social categorization, presents - and argues for - different perceived experiences of the insane throughout the common era, yet these are interpreted with plausibly modern, retrospective assessment.

From Pinel to Foucault, Scull to Showalter, the introduction shows concurrently changing approaches to both the study, and research context, of contemporary social attitudes toward the insane of the Victorian age. In chapter 1, it revisits the construction of the new county asylums that followed the 1845 Lunacy Act, reading their dramatic appearance against the emergence of a 'moral therapy', the medicalized but oft-ignored mantra of alienist heavyweights like Tuke (at the York Retreat) and John Conolly (Hanwell Lunatic Asylum).

The motivation behind these 'centres for treatment', as postulated in chapter 2, suggests they were, in fact, devised less for the benefit of the inmates and more from the needs of those who had placed them within. While chapter 3, in assessing the presence of the asylum in popular literature, reverberates perhaps more closely than intended with Foucault's commentary on madness and civilization, and laments the loss in living memory of the legacy of these institutions for society's mad - the embarrassing deviants.

Part Two gets underway with a useful introduction to the physical placing and social impact of these new public asylums. Contemporary opinion, about how best to read and understand this new 'social underclass', and where to accommodate their continued existence, is delivered through newsprint and corporate minutes. While the whole is set within the context of an unrelenting industrial revolution, the management of the insane influenced as much by the latter's identity as a by-product of unsustainable population growth, as from any 'cultural' reaction to the increased number considered to exist outside the 'norm'.

An international 'solution', highlighted in chapter 5 with an American response to this universal challenge of housing the mad, is read against its British counterpart, both in terms of the building fabric and the ephemeral social institution. By highlighting the former's labour therapy, it exemplifies the moral and socio-economic backdrop that saw many later commentators dismiss the treatment of the mad, on both sides of the Atlantic, as a thinly-veiled euphemism for social coercion; even suggesting a first step towards the unpalatable eugenics of subsequent eras.

The daily work of the asylum and its staff is subsequently dissected, including the contrasted experiences for both public and private asylums (cf Institutionalizing the Insane in Nineteenth-Century England, reviewed on 24 July 2014). Many of the more common facets of institutionalized care are discussed, including the now anticipated segregation by gender, class or, increasingly, criminal behaviour. The moral and social aspects of each covers the familiar issues of diet, occupation and even sexual proclivities. While emerging therapies and underlying medical attitudes arise from the wider discussion of life for the insane, incarcerated in the constantly under-resourced, often inadequate, institutions, what Scull terms a "warehousing for the poor".

In chapter 7, the 'body politic' of insanity is assessed within the broader development of nineteenth century society; cementing, perhaps, a long-held connection between urban expansion and the growth in the number of asylum inmates. At its heart lay a new awareness, of GPI, or General Paralysis of the Insane, first defined at the beginning of the century. In Victorian minds, it was primarily the disease of the urban male, with all its attendant abuses in particular alcohol and sex.

As the medical profession read more from the dissected human body, so a connection between immoral living and mental decay developed. Asylums became centres for human experiment - in life and death - and characteristics such as a "staggering gait, muscular weakness, [and] disturbed reflexes" became accepted as outward signs of mental degeneration. Post-mortem examination of the skull and its brain located further 'evidence' of an underlying moral decrepitude.

The equivalent for nineteenth century females lay in the assumed cynosure of the reproductive organs. Hysteria was named after an earlier belief in the 'wandering womb', while menstruation and post-natal responses were increasingly cited as causes of mental atrophy. An intriguing, emergent connection between the brain, the physical workings of the body and 'free will' led to strident claims, both for and against leniency, toward the Victorian female.

Mitigation of criminal behaviour increasingly used 'reflex', irresistible and 'moral' insanity as grounds for defence,. Yet, in many cases, hysteria - and GPI especially - was cited as evidence of a low morality in the sufferer. As such, men and women were unhealthily 'diagnosed' according to the perceived immoral lifestyles of their respective genders.

Towards the end of this monograph, in what many will consider is its strongest chapter, Helen Goodman readdresses previous, popularly received perspectives on the masculine experience of institutionalized madness. In removing gender barriers, for example within the hysteria condition, she agreeably blurs the lines of both gender weakness and the corresponding definitions of insanity the condition. In this, she invites us to re-visit our own perceptions of madness in the human condition, and not only as it might have been in the last century but one.

In conclusion there are, perhaps, issues to be taken with some of the deductive reasoning, particularly in the final section. But, as a collection of thought on the heavily nuanced subject of insanity and its place in - or, more accurately, beyond - nineteenth century society, it delivers with alacrity and aplomb. It was a pleasure to read.

©2014 David J. Vaughan

Other sources
Foucault, M. 1967, Madness and civilization: A history of insanity in the age of reason, London: Routledge
Wise, S. 2012, Inconvenient People: Lunacy, Liberty and the Mad-Doctors in Victorian England, London: Bodley Head


Proving the Rule or Squaring the Circle?
David J. Vaughan

Science and Culture in the Nineteenth Century: 12

Ian Hesketh 2011 (Pickering & Chatto)

240pp: 234x156mm: 2011
HB 978 1 84893 126 8: £60/$99
eBook: £24 (incl. VAT)

"The question is often asked’, he said, ‘whether History is a science or an art. You might as well ask whether the sea is blue or green. It is sometimes the one and sometimes the other." (The Science of History in Victorian Britain)
Ian Hesketh's pursuit of history as a discipline is readable, engaging and, for the most part, balanced. Where it leans more toward the scientistic over the poetic, it simply fulfils its title. This is a work of Hesketh's personal quest for the origins of his obviously beloved subject - history - and its new status as a bona fide academic discipline in the mid- to late-nineteenth century.
The work of Henry Thomas Buckle, "popular historian" and author of a controversial new science of history, kick-starts the search with his own narrative of history as a series of predetermined givens. Buckle's dismissal of 'free will' - such a dominant theme of this blog - led not to a lamentable summary of humankind's unavoidable and self-destructive passage of missed opportunity through the eons, but as a preordained series of experiences, a predetermined path which proved surmountable only by those who 'broke the mould'. Buckle claims the strongest factor to be the average of everything, that evolution (this marginally pre-dated Origin of Species) which provided human development with the few great and good who rose above the mundane and became, in hindsight at least, exceptions that proved the rule.
Underpinning Buckle's approach was his strident belief in ideas. Not religious doctrines, nor rigid facts, but notions, conjecture, interpretation of what the increasingly available archive could provide in the way of facts, figures and statistics.
Poppycock, cried those of a more scientific bent. Despite Buckle's attempt at moving history into science, a more strident revolt against Romantic and personal histories quickly found its voice - and its power - in the colleges of Oxford and Cambridge. Academic behemoths, like Stubbs, Freeman and Seeley, as well as Lord Acton, dispelled the imagined accounts of man's (sic) sorry past in favour of a valueless, archive-led series of facts, devoid of interpretation and, in consequence, recognising the order of things. Its product, some might argue, dehumanized history.
Yet its nineteenth century supporters felt more confident to have pieced together an empirical account of history. When this crossed into a racialism that many since have seen to culminate in the abhorrent writings of Gustav Kossinna, the German archaeologist considered responsible for the growth of Nazism, certain Victorian minds saw it as just another tool for studying - and 'proving' - history.
But back to the present. The current work grows to deliver the twin, bi-polar positions of those who saw history as science...or history as art. But, in Chapter 3, it finds middle ground, specifically in the Victorian writers of historical fiction. Charles Kingsley, Walter Scott, writer of the Waverley novels, and T. B. Macaulay are all presented as exponents of history as art in its worst form. Despised by the more scientific historians, who saw their imagination and popularism overshadowing fact, feared their self-imposed authority to give the world a clinical understanding of its own past was dangerously under threat.
Yet for Kingsley, in dismissing Stubbs and his Oxford contemporaries (Kingsley was Regius Professor of Modern History at Cambridge), favoured a more liberal, inclusive reading of the subject; neither overtly inductive nor wholly deductive (see below); neither blindly religious nor openly Romantic. While, at the same time, rejecting Buckle's belief in his historical 'heroes' as exceptions to the rule, and seeing them instead as makers of history itself.
How religion has played, and continues to play, a dominant role in the history of humankind, is presented here clearly as a central difference between the two sides. Writing now, it is perhaps easy to see how the two would become such enemies. What is perhaps more surprising is how nineteenth century scientific historians accepted and even used the omnipresence of religion to, at times, underpin their claims. Unravelling human history, it seemed, could only begin with a belief in the Supreme Maker, while the rest was down to man. For them, there was no history without God's Creation - whatever date one put on it.
 How did they square this particular circle? By accepting God's natural order - a fundamental principle in Victorian England - and labelling man's (and woman's) actions as a series of independent, fact-based events. Where Buckle might have highlighted the great and the good in his version of a pre-determined past, Freeman, Seeley, Acton and Stubbs would see the development of the human world in isolation from the Creator's vision of life - having the 'free will' which Buckle rejected with such force. Little surprise, perhaps, that many of the scientific historians subsequently moved into senior clerical positions (Bishops of Oxford, Chester and London) and the taking of holy orders.
At the heart of the struggle of fact over fiction, empiricism over ideas, there sat the archive. Newly available in the nineteenth century, accessible as dusty tomes whose secrets waited to be unlocked, their contents were quickly assailed by the scientific historian to underpin their self-proclaimed objective study. Yet even they were aware of the need to consider subjectivity inherent within the record. What facts had been documented, how and why -  compiled into a new narrative, as full of personal agenda as the archive itself. (Added to today by the problem of 'distantiation', the great chasm between what the writer meant and what the reader sees - or interprets.)
These things aside, as a biographical piece, Hesketh has obviously excelled. His research is exhaustive and his use of text, from both the main characters and their observers, beautifully illustrates the thought behind the arguments. The vying theoretical approaches referenced throughout, inherent in any discipline, are perhaps a touch laboured. In recounting the debates, it repeatedly asserts the deductive imaginings of Buckle, the inductive discoveries of the scientific historians, normative worlds, Rankean thought, an argument for determinism - giving the reader either a much needed context for the present study, and/or highlighting their need to reach for a dictionary of philosophy.
Toward the closing chapters, mini-obituaries of the key protagonists bring to life their past endeavours and how others saw them in human terms. This is somewhat ironic. For while they did much to rid history of emotion (critics labelled them 'Dryasdust' - eg p. 15), they were, according to these latter chapters at least, best remembered for their human idiosyncrasies if not overt humanity.
Such is the space given over to these closing words, the volume occasionally feels more like a collection of biographies and less a search for the origins of the discipline. In so doing, it presents perhaps a more poetic, Romantic view of history and less a "dryasdust" record of chronological events and objective fact.
Nonetheless, the entire monograph certainly delivers on its account of the battles fought between proponents on both sides of the divide - as well as the many others that erupted within the separate factions.
In the end, I cannot decide whether Hesketh's excellent volume is a piece of hero worship for the scientific historian, or a successful attempt to present two opposing views and their heroic exponents.
Overall, it is perhaps as much a critical analysis of the subject at hand, as a life history of the debate itself. Whether this involves inductive reasoning, or deductive supposition, is for the reader to decide.

©2014 David J. Vaughan


An anecdotal and statistical meander through nineteenth century lunacy
David J. Vaughan

Studies for the Society for the Social History of Medicine: 20

Anna Shepherd 2014 (Pickering & Chatto)

240pp: 234x156mm: April 2014
HB 978 1 84893 431 3: £60/$99
eBook: £24 (incl. VAT)

When Anna Shepherd sat down and compiled this worthwhile contribution to studies in 19th century institutionalized lunacy, she must have felt, yes the despair, but also the great hope of those she has made the subject of her modern musings. In a little over 200 pages, she has laid bare Victorian medical and social reform and moreover what it meant, in real terms, to be treated for insanity during the second half of the century. By focussing on the precariously surviving archives of two separate Surrey institutions - one a private sanatorium, the other a public asylum for paupers - she has attempted to dispel a received wisdom, that to be resident in one was far better than to languish in the other. In fact, both institutions experienced very similar personal and historical trajectories.

The presumed differences between the two, typically in terms of fiscal means or gender stereotypes, have been increasingly rejected for some time. Brookwood pauper asylum, for example, held non-pauper patients, while Holloway sanatorium for the 'middling classes' increasingly treated members of the poorer classes, particularly in relation to the After Care Association. Yet what does this prove? If nothing else, that a neat, sanitized demarcation of lunacy care in (later) Victorian England was, in reality, nothing of the kind.

In analyzing 19th century patient care, one of the new central tenets rejects the notion that the 'modern' asylum of the post-Bethlem era had become a convenient 'dumping ground' for embarrassing relatives: in particular those unable to bring in a living wage (related to class)  or 'uncontrollable' females from within the home (gender).  According to Shepherd's statistical analysis, as many men as women were incarcerated at both institutions; and these by loving, caring relatives who wanted only the best for those they considered defective. It goes some way to countering the arguments put forward by Showalter for systemic abuses of the "female malady"; and flies in the face of Wise's "inconvenient people", which saw institutionalization as the proverbial carpet beneath which troublesome wives and husbands could be swept. At the same time, Andrew Scull's assertion that the pressures brought about by the Industrial Revolution led many to 'offload' troublesome relations at the earliest opportunity are stridently refuted.

Instead, the universal albeit nuanced nature of admissions are seen here to contain expressions of real concern from family and friends regardless of social class or personal gender so that there is, it seems, the need for a reclassification of the assumed class and gender divides which have traditionally been ascribed to caring for the insane. Nevertheless, there remains in contemporary literature at least, the impact of the Lunacy Acts (1845), which set the procedures for certification; the Lunacy Regulation Act of 1853, which saw the increased prevalence of Chancery "lunatics" with their wealthy estates placed in trust;  and the emerging role of the Alleged Lunatic's Friend Society, campaigning against wrongful incarcerations since the first half of the century.

What is perhaps more revealing are the personal letters written (though not always sent) between patients and their families beyond the institution walls - surprisingly more frequent at Brookwood (where greater illiteracy is assumed) than at Holloway (where Shepherd's explanation for this apparent anomaly is enlightening).

Such patient testimonies all too often disappear from the material available for academic study (seldom, if ever, sought at the time): allowing inherent legal and societal subjectivity to distort the historical picture in ways seldom corrected. Yet when these patients are allowed at last to repopulate history, their very personal experiences repay an intense scrutiny that justifies the means by which their existence is revealed. For example, with the criminal asylum at Broadmoor recently completed, criminal lunatics were perhaps surprisingly institutionalized in both Holloway and Brookwood; and Voluntary Boarders - those prepared to pay the going rate to secure their own place in the institution - only now exemplifies the attraction of incarceration as an alternative to a precarious position in the world and frequent misery in life outside the institution.

Understanding this full array of personal routes to institutionalization, in the present context at least, best illuminates the central actors (and actresses) in lunacy care - the patients. Going beyond a mere collection of numbers and admissions data, personal histories reveal much about life before institutionalization: in particular, society, family and state law which all affected change in numerous, very personal tragedies.

Assessments of the treatments and therapies for the institutionalized insane reveals an innate contradiction - that they were, at the same time, both unexceptional and advanced. For example, the greater role of 'moral management', even in public institutions like Brookwood, had permeated 19th century asylums since the days of Pinel and Conolly. While the use of entertainments and the so-called Lunatics' Balls have come to be recognized by modern day students as part of the standard institutional care curriculum (for example, Charles Dickens's Christmas at St Luke's or W. S. Gilbert's visit to Fisherton House, Salisbury). A bias towards manual work (gardening, needlework etc) at public Brookwood versus occasional attempts at meaningful 'employment' at private Holloway further exemplifies the nuanced, often dichotomous nature of institutionalized patient 'care'.

More revealing were the advancements in science, in particular medico-psychological therapies. These included the early use of electrotherapy at Holloway and - genuinely  surprising - trepanning (literally, perforating the skull to relieve inflammation) at Brookwood. Chemical interventions remained, if not scarce, then uncommon. What remained was a pessimistic view of the incurability of insanity so that, by the fin de si√®cle, a return to physical, eugenic-related treatments was inevitable.

Regardless of such treatments, or perhaps because of them, suicide became an increasingly common curse. Some, such as Durkheim, saw a cause in the century's greater industrialization (a not unfamiliar theme). While Forbes Winslow, one of his generation's most proactive alienists, wrote at length on the subject (eg The anatomy of suicide, 1840), arguing critically that suicide, far from its popular perception 'in novel and drama as either mortal sin or heroic option', was due to irrational behaviour that could be addressed by medicine". Treatments remained far from the enlightened or the moral: cutting a woman's hair, seclusion, use of the barbaric dry- or wet-packs (which removed all conceivable means of movement) - all were employed, with doubtless damaging effects. However, it was on being discharged that many patients took their own lives - free at last from institutional restraint.

Thus, Shepherd has encountered several nuances of the institutionalized 'care' of the insane. By choosing a topic with its English florescence in the 19th century, the subject lends itself to a wide-ranging critique: from the class and gender stereotypes of the incarcerated few; to the scope and manner of the treatment they experienced; to the revealing way in which the many they left behind viewed and reacted to their institutionalization. Shepherd has delivered on all fronts, at least in the accumulation and reporting of the surviving 'facts' that emerge from an inconsistently surviving archive. 

In relating so many elements, though, it is difficult to locate the work's 'golden thread'. Instead, it is a somewhat disjointed collection of thoughts and arguments brought together under a simple, convenient heading; unlike the complex, "inconvenient people" it attempts to reveal. In many ways, the work reads more like a 'popular' article (or blog post) than an academic treatise - a collection of facts and anecdotes lacking interpretation or a tangible, discursive heart.

Undermining the comparative analysis of these two Surrey institutions is its ignoring an eighteen year gap in their respective foundations - a length of time some may argue represents at least one paradigm shift in the fast-paced development of lunacy care in Victorian England.

An over-zealous introductory analysis of the county of Surrey, with no real linkage to the likely numbers of lunatic population, provides little constructive insight. A similar, almost obsessive description of the building programmes at both Brookwood and Holloway further obstructs the reader's progress to the work's intended purpose: to illustrate the type and nature of lunacy care in the period. (Earlier work by Isaac Ray and John Conolly are arguably more revealing, written several decades before and no doubt an influence on the construction of both institutions.)

That said, its value to future research is to be lauded providing, as it does, so much empirical and anecdotal evidence on the subject.

©2014 David J. Vaughan

David J. Vaughan is owner and author of Mad, Bad and Desperate,  and has published The Secret Life of Celestina Sommer - a very Victorian murder: a true account of one woman's descent from middle-class London into institutionalized insanity. Available as eBook here.


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