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The Connement of the Insane

The rise of the asylum constitutes one of the most profound, and controversial,
events in the history of medicine. Recently, academics around the world have
begun to direct their attention to the origins of the connement of those deemed
insane, exploring patient records in an attempt to understand the rise of the
asylum within the wider context of social and economic change of nations
undergoing modernization.
This edited volume brings together fourteen original research papers to an-
swer key questions in the history of asylums. What forces led to the emergence
of mental hospitals in different national contexts? To what extent did patient
populations vary in terms of their psychiatric prole or their socio-economic
background? What was the role of families, communities and the medical
profession in the connement process? This volume therefore represents a
landmark study in the history of psychiatry by examining asylum connement
in a global context.

r oy p o r t e r was Professor of the Social History of Medicine at the Well-

come Trust Centre for the History of Medicine at University College London.
Recent books included Doctor of Society: Thomas Beddoes and the Sick Trade
in Late Enlightenment England (1991); London: A Social History (1994);
The Greatest Benet to Mankind: A Medical History of Humanity (1997);
Enlightenment: Britain and the Creation of the Modern World (2000) and
Bodies Politic: Disease, Death and the Doctors in Britain: 16501914 (2001).
He was a co-author of The History of Bethlem (1997), and of Gout: The
Patrician Malady (1998). He was widely published in a variety of elds, in-
cluding eighteenth-century medicine, the history of psychiatry and the history
of quackery. The author and editor of over a hundred books, Roy Porter died
on 3 March 2002.

david wright received his doctorate in economic and social history from
the University of Oxford in 1993. In 1999, he returned to Canada, having been
appointed the Jason A. Hannah Chair in the History of Medicine at McMaster
University in Hamilton, Ontario. His books include Mental Disability in
Victorian England: The Earlswood Asylum, 18471901 (2001), and two
edited volumes (with Anne Digby), From Idiocy to Mental Deciency: His-
torical Perspectives on People with Learning Disabilities (1996) and (with
Peter Bartlett) Outside the Walls of the Asylum: The History of Care in the
Community (1999).
The Connement of the Insane
International Perspectives, 18001965

Edited by
Roy Porter and David Wright

Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, So Paulo

Cambridge University Press

The Edinburgh Building, Cambridge , United Kingdom
Published in the United States of America by Cambridge University Press, New York
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Cambridge University Press 2003

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Dedicated to the memory of
Professor Roy Porter, 19462002
 Contents

List of gures page ix

List of tables x
Notes on contributors xii
Acknowledgements xvii

Introduction 1
r oy po r t e r
1 Insanity, institutions and society: the case of the Robben Island
Lunatic Asylum, 18461910 20
harriet deacon
2 The connement of the insane in Switzerland, 19001970: Cery
(Vaud) and Bel-Air (Geneva) asylums 54
jacques gasser and genevi e v e h e l l e r
3 Family strategies and medical power: voluntary committal in a
Parisian asylum, 18761914 79
patricia e. prestwich
4 The connement of the insane in Victorian Canada: the Hamilton
and Toronto asylums, c. 18611891 100
david wright, james moran and sean gouglas
5 Passage to the asylum: the role of the police in committals of the
insane in Victoria, Australia, 18481900 129
catharine coleborne
6 The Wittenauer Heilstatten in Berlin: a case record study of
psychiatric patients in Germany, 19191960 149
a n d r e a d orries and thomas beddies
7 Curative asylum, custodial hospital: the South Carolina Lunatic
Asylum and State Hospital, 18281920 173
p e t e r m C candless

vii
viii Contents

8 The state, family, and the insane in Japan, 19001945 193

akihito suzuki
9 The limits of psychiatric reform in Argentina, 18901946 226
jonathan d. ablard
10 Becoming mad in revolutionary Mexico: mentally ill patients at
the General Insane Asylum, Mexico, 19101930 248
cristina rivera-garza
11 Psychiatry and connement in India 273
sanjeev jain
12 Connement and colonialism in Nigeria 299
jonathan sadowsky
13 Irelands crowded madhouses: the institutional connement of
the insane in nineteenth- and twentieth-century Ireland 315
elizabeth malcolm
14 The administration of insanity in England 1800 to 1870 334
elaine murphy

Index 350
 Figures

1.1 White lunatics resident in the Robben Island Lunatic Asylum

as a percentage of total lunatics resident, by gender,
18571904 page 45
2.1 Number of case les examined 56
2.2 The distribution of case les by sex (percentage) 58
2.3 Length of stay of hospitalization (percentage) 61
2.4 The individual(s) demanding admission (Cery, 18801960) 69
2.5 Number of voluntary patients (percentage) 70
6.1 Number of male and female admissions per year (19191960) 154
6.2 Distribution of diagnoses 159
6.3 Distribution of diagnoses according to gender 162
6.4 Therapies (including occupational therapy and electric shocks)
concerning certain diagnoses (numbers according to Wurzburger
Schlussel) 164
6.5 Annual percentage of patients treated with at least one drug 165
6.6 Number of discharges and deaths per year (19191960) 166
8.1 Number of patients 206
8.2 Patients conned in hospitals and at home 208
8.3 Public and private patients in public, substitute, and private
asylums 214
8.4 Proportion of public and private patients in public and
commercial asylums 216
8.5 Patients at large, 19051927 218
8.6 Patients at large, 19281941 219

ix
 Tables

1.1 The number of lunatics and idiots in the colony in 1891, as

recorded in the 1891 census page 27
1.2 Proportion of rst admissions to the Robben Island Lunatic
Asylum recorded as dangerous, 18461910 31
1.3 First diagnoses of rst admissions to the Robben Island Lunatic
Asylum who were given diagnoses, 18461910 (percentage) 34
1.4 Social prole of rst admissions to the Robben Island Lunatic
Asylum, 18461910 37
1.5 Occupations of rst admissions to the Robben Island Lunatic
Asylum whose occupations are given, 18461910 (percentage) 44
1.6 Outcomes of all rst admissions to the Robben Island Lunatic
Asylum, 18461910 (percentage) 46
1.7 Length of stay of rst admissions to the Robben Island Lunatic
Asylum whose outcome is given, 18461910 (percentage) 47
1.8 Social prole of rst admissions to the Robben Island Lunatic
Asylum by length of stay, 18721890 (percentage) 49
2.1 Number of case les examined 57
2.2 The distribution of case les by sex (percentage) 57
2.3 Number of case les by age and by decade (percentage) 59
2.4 Number of case les by marital status and by
decade (percentage) 60
2.5 Number of admissions/readmissions by decade (percentage) 61
2.6 Duration of hospitalization by decades (percentage) 62
2.7 Number of voluntary patients (percentage) 71
3.1 Occupations of patients 87
3.2 Admission diagnoses 89
3.3 Death rates 90
3.4 Release rate 93
3.5 Transfer rates 95
4.1 First or subsequent admissions to the institution, admissions to
the Toronto and Hamilton asylums, selected years, 18511891 112

x
 List of tables xi

4.2 Age of patients at time of admission, rst admissions to the

Toronto and Hamilton asylums, selected years, 18511891 113
4.3a Previous occupation of male patients at time of admission, rst
admissions to the Toronto and Hamilton asylums, selected years,
18511891 116
4.3b Previous occupation of female patients at time of admission, rst
admissions to the Toronto and Hamilton asylums, selected years,
18511891 119
4.4 Place of birth of patients, rst admissions to the Toronto and
Hamilton asylums, selected years, 18511891 121
4.5 Marital status of patients at time of admission, rst admissions to
the Toronto and Hamilton asylums, selected years, 18511891 122
4.6 Length of stay of patients: rst admission to the Toronto and
Hamilton asylums, selected years, 18511891 123
4.7 Outcome of patients: rst admissions to the Toronto and Hamilton
asylums, selected years, 18511891 124
5.1 Number of lunatics received at Victorian asylums through police,
18751890. 136
5.2 Policing sex of lunatics and passage to the asylum in Victoria,
1885 and 1890. 140
5.3 Passage of lunatics to Victorian asylums, 18751890. 147
7.1 Paying and pauper admissions to South Carolina Lunatic Asylum,
for selected periods, 18281852 179
7.2 Average number of paying and pauper patients resident in South
Carolina Lunatic Asylum, for selected periods, 18301864 179
7.3 Number of patients and number of black patients in South
Carolina Lunatic Asylum/State Hospital, 18401920 184
7.4 Percentage of deaths of patients under treatment, at the South
Carolina State Hospital, at ve year intervals, 18901915 189
8.1 Types of places of custody 210
8.2 Reasons given for home-custody 211
8.3 Admissions of private and substitute patients at Oji Brain
Hospital (1935) 222
8.4 Lengths of stay of the discharged Oji Brain Hospital
patients 222
8.5 Capacities of places other than mental hospitals, 1929 and 1935 223
 Notes on contributors

jonathan d. ablard is Assistant Professor of History at the State Uni-

versity of West Georgia, USA. He received his PhD from the University of
New Mexico in 2000. He is the author of Law, Medicine and Commitment
to Public Psychiatric Hospitals in Twentieth Century Argentina, in Mariano
Ben Plotkin (ed.), Argentina on the Couch: Psychiatry, the State and Society
in Argentina, 18801970 (University of New Mexico Press, 2002).
thomas beddies is currently an historian of medicine and staff member
at the Institute for the History of Medicine at the University of Greifswald
(Germany). His main interests include the history of psychiatry and the
history of medicine in the era of National Socialism.
catharine coleborne lectures in History at the University of Waikato,
New Zealand, and is the co-editor (with Diane Kirkby) of Law, History,
Colonialism: The Reach of Empire (Manchester University Press, 2001) and
the co-editor (with Dolly MacKinnon) of Asylum: History, Heritage and
Madness in Australia (University of Queensland Press, forthcoming). She
has published widely on the history of madness in Australia. Her current
work considers psychiatry in the museum and the construction of psychiatric
histories in Australia and New Zealand.
harriet deacon has been interested in understanding colonial institutions
(prisons, leper and lunatic asylums) since working on her BA Honours thesis
(on the Breakwater Prison in Cape Town, South Africa) at the University
of Cape Town and her PhD thesis at the University of Cambridge (on the
hospitals at Robben Island). Currently at Robben Island Museum in Cape
Town, her publications encompass the history of racism in medicine, medical
knowledge and exchanges between settler, scientist and indigene, cultural
geographies of health and exclusion, and the notion of heritage at Robben
Island.
andrea d orri es received her medical degree from the University of
Freiburg, Germany, with a specialization in paediatrics and human genet-
ics (198393). She has conducted research projects in medical ethics and

xii
 Notes on contributors xiii

medical history at the universities of Freiburg and Berlin (19937). Since

1997, she has been Head of the Centre for Health Care Ethics (Zentrum
fur Gesundheitsethik) in Hanover. Her main interests include ethics in pae-
diatrics and genetics, decision-making in medicine and health politics, and
hospital ethics committees.
sean gouglas is Assistant Professor of Humanities and Computing in the
Department of History and Classics at the University of Alberta, Canada.
He has received numerous prizes for his work on Geographical Information
Systems in the history of agriculture and the history of medicine. He is
currently researching the history of sudden and violent death in Western
Canada and Australia.
sanjeev jain is Additional Professor, Department of Psychiatry, National
Institute of Mental Health and Neurosciences (NIMHANS), Bangalore,
India. He completed his undergraduate medical training in Delhi, and resi-
dency in Psychiatry in Bangalore at the NIMHANS in 1985. He has been
on the faculty since 1986. His clinical responsibilities at the hospital include
the management of fty in-patients, and an out-patient service. His research
focuses on genetics of psychiatric disorders and the history of psychiatry in
India.
cristina rivera-garza is Associate Professor of Mexican History at San
Diego State University, USA. She is the author of the award-winning histori-
cal novel, Nadie me Vera Llorar (Tusquets, 2000). She is currently completing
the manuscript Mad Narratives: Inmates and Psychiatrists Debate Gender,
Class, and the Nation at the General Insane Asylum La Castaneda, Mexico
19101930.
pet er m C candless is Professor of History at the College of Charleston,
Charleston, South Carolina USA. He is author of Moonlight, Magnolias,
and Madness: Insanity in South Carolina from the Colonial Period to the
Progressive Era (1996). Currently, he is working on a history of disease and
medicine in South Carolina from 1670 to 1820 and is an associate editor of
the forthcoming South Carolina Encyclopedia.
e lizabeth malco l m was educated at the universities of New South Wales,
Sydney, Australia and Dublin, Ireland. She has worked in departments of
Irish Studies at Queens University, Belfast, and the University of Liverpool,
and is currently Professor of Irish Studies at the University of Melbourne.
She has published a history of St Patricks Hospital, Dublin, Irelands oldest
psychiatric hospital, as well as a number of articles on the history of mental
illness in Ireland and among the Irish abroad.
xiv Notes on contributors

james moran is currently a Canadian Institutes of Health Research Postdoc-

toral Research Fellow at McMaster Universitys History of Medicine Unit
where he is working on an epidemiological history of madness in nineteenth-
century Ontario. His interests in the history of madness have been recently
published in his book, Committed to the State Asylum: Insanity and Society in
Nineteenth-Century Quebec and Ontario (McGill: Queens University Press,
2000).
elaine murphy is the Chairman of East London and the City Health Au-
thority, London, UK; Visiting Professor in the Department of Psychiatry at
Barts Hospital and the London Hospital, Queen Mary Hospital, University
of London and Honorary Senior Research Fellow at the Wellcome Trust
Centre for History of Medicine at University College, London. She recently
completed her doctorate in medical history, specializing on the Poor Law in
Victorian England.
roy porter was Professor of the Social History of Medicine at the Wellcome
Trust Centre for the History of Medicine, University College, London. The
author and editor of over seventy books, his publications on the history of
psychiatry include Mind-Forgd Manacles: A History of Madness in England
from the Restoration to the Regency and A Social History of Madness. He
was co-editor and co-founder of the journal History of Psychiatry.
patricia prestwich is a Professor of History in the Department of History
and Classics at the University of Alberta, Canada. She has written extensively
on the history of modern France, including Drink and the Politics of Social
Reform: Antialcoholism in France since 1870 (Palo Alto, California: Soci-
ety for the Promotion of Science and Scholarship, 1988). She is currently
completing a book manuscript on the Parisian asylum Saint-Anne, and is
beginning a new project on the reform of psychiatric institutions in interwar
France.
jonathan sadowsky is the Theodore J. Castele Associate Professor of
the History of Medicine at Case Western Reserve University, Cleveland. His
chapter is adapted from his 1999 monograph Imperial Bedlam: Institutions
of Madness and Colonialism in Southwest Nigeria. He is currently working
on the history of electro-convulsive therapy.
akihito suzuki completed his doctorate at the Wellcome Institute for the
History of Medicine, London, UK in 1992. He is now Associate Professor in
History at the School of Economics at Keio University in Tokyo, Japan. He
has published numerous articles on the history of psychiatry in England. He
is now working on the history of psychiatry in Japan in the late nineteenth
and early twentieth century.
 Notes on contributors xv

david wright holds the Jason A. Hannah Chair in the History of Medicine
at McMaster University, and is Associate Professor in the Department of
Psychiatry and Behavioural Neurosciences and the Department of History.
He has published widely on the social history of developmental disability and
psychiatry, including, most recently, a research monograph entitled Mental
Disability in Victorian England (Oxford University Press, 2001). He is cur-
rently the principal investigator on a Canadian Institutes of Health Research
project grant researching the historical epidemiology of mental illness in
Canada, c.18501900.
 Acknowledgements

This edited volume has evolved over several years and is the result of gen-
erous nancial assistance of several foundations. The editors and authors are
grateful for the assistance of Dr David Allen and the History of Medicine Grants
panel of the Wellcome Trust, London, and from Associated Medical Services
(Hannah Institute for the History of Medicine), Toronto. Anonymous referees
of Cambridge University Press provided invaluable constructive criticism in the
early stages of the book. We would also like to acknowledge the comments of
Peter Bartlett, Jonathan Andrews and John Weaver. Editorial and administrative
assistance was provided by Janna Bordonaro, Erika Dyck, Jessa Chupik, Angela
Graham, Steve Bunn and James Moran of McMaster University, Hamilton.
Marnie Houser and Jessa Chupik compiled the index for the book. Three chap-
ters in this collection are partly based on previously published material. The con-
tributors would like to acknowledge the Regents of the University of California,
Alpha Academic, and the editors of the Journal of Social History for permission
to republish the material included in the chapters by Jonathan Sadowsky, Andrea
Dorries, and Patricia Prestwich respectively. The chapter by Gasser and Heller
was translated from the French by David Wright and James Moran. Finally, the
editors are grateful to William Davies and the staff at Cambridge University
Press for their encouragement and support of this book. Special thanks must
go to Maureen Leach for her excellent copy-editing of a challenging interna-
tional collection of essays, and to Neil de Cort and the other members of the
production and design team.

xvii
 Introduction

Roy Porter

The closing decades of the twentieth century brought a rising and sustained
critique of the welfare institutions of the modern state one largely left-wing
in origins but increasingly taken over and voiced by the radical right. Profes-
sions which professed to be enabling were, claimed a rising chorus of critics,
disabling.1 Social services which presented themselves as benign were, in
reality, insidious, serving the interests of providers not consumers, promoting
professional dominance, policing deviance and intensifying the social control
required to ensure the smooth running of multinational capitalist corporations
or, in the right-wing version, such institutions were wasting tax-payers money
on scroungers and so encouraging malingering.2
Unsurprisingly, such political critiques of welfarism (in its widest sense)
spawned histories of their own. Replacing various kinds of Fabian, Whig or
celebratory historical interpretations which had treated the emergence of the
caring professions and social-security institutions as benecial and progres-
sive as shifts from neglect to administrative attention, from cruelty to care,
and from ignorance to expertise a new brand of studies took altogether a more
negative or jaundiced view of such social institutions and policies, and sought
to blow their benevolent ideological cover.3
In no eld were the new and critical histories more critical, indeed more in-
dignantly impassioned, than the history of psychiatry. Traditional in-house
and Whig histories of the care of the insane had never been particularly
triumphalist after all, psychiatry had always been a house divided against
itself, uneasy in its stance towards both the public and the medical profession at

1 I. Illich, Limits to Medicine: The Expropriation of Health (Harmondsworth, 1977) and Disabling
Professions (London, 1977).
2 The literature here is so vast, it would be impossible to begin citing it. Of great importance,
however, in clarifying the issues has been S. Cohen and A. Scull (eds.), Social Control and the
State (New York, 1981).
3 Once again, humanitarianism or control is a topic on which the survey literature is too vast even
to begin to cite, but see M. Micale and R. Porter (eds.), Discovering the History of Psychiatry
(New York and Oxford, 1994), especially N. Dain, Psychiatry and Anti-Psychiatry in the United
States, 41544; G. Grob, The History of the Asylum Revisited: Personal Reections, 26081,
and the substantial introduction.

1
2 Roy Porter

large, and aware of its embarrassing want of magic bullets.4 But from the six-
ties, psychiatry and social policy towards the mad became subjected to intense
historical analysis.
Perhaps most radically, and certainly most doggedly, the American (anti-
psychiatrist) Thomas Szasz deemed mental illness a mythic and monstrous
beast, and proclaimed that mental illness was a ction. Insanity, he has contin-
ued ever since to claim, is not a real disease, whose nature has been progressively
scientically unveiled; mental illness is rather a myth, forged by psychiatrists
for their own greater glory. Over the centuries, medical men and their supporters
have been involved, argues Szasz, in a self-serving manufacture of madness.
In this he indicts both the pretensions of organic psychiatry and the psychody-
namic followers of Freud, whose notion of the unconscious in effect breathed
new life into the obsolete metaphysical Cartesian dualism. For Szasz, any ex-
pectation of nding the aetiology of mental illness in body or mind above
all in some mental underworld must be a lost cause, a dead-end, a linguistic
error, and even an exercise in bad faith. Mental illness or the unconscious are
not realities but at best metaphors. In promoting such ideas psychiatrists have
either been involved in improper cognitive imperialism or have rather naively
pictorialized the psyche reifying the ctive substance behind the substantive.
Properly speaking, contends Szasz, insanity is not a disease with origins to be
excavated, but a behaviour with meanings to be decoded. Social existence is a
rule-governed game-playing ritual in which the mad person bends the rules and
exploits the loopholes. Since the mad person is engaged in social performances
that obey certain expectations so as to defy others, the pertinent questions are
not about the origins, but about the conventions, of insanity. In this light, Szasz
dismisses traditional approaches to the history of madness as questions mal
poses, and aims to reformulate them.5
In some ways reinforcing and complementing Szaszs critique of the episte-
mological status of insanity, Michel Foucaults Madness and Civilization, rst
published in French in 1961, argued that mental illness must be understood
not within the domain of positivist science but as inscribed within discursive
formations. To be precise, madness was a voice that, from Classical through
Medieval times, spoke its truth and was listened to, within a Platonic philosophy

4 J. G. Howells (ed.), World History of Psychiatry (New York, 1968). An important attempt at
European comparative history is L. de Goei and J. Viselaar (eds.), Proceedings: First European
Congress on the History of Psychiatry and Mental Health Care (Rotterdam, 1992). R. Porter,
Madness and its Institutions, in A. Wear (ed.), Medicine in Society (Cambridge, 1992), 277301,
is a brief comparative study of institutions.
5 T. S. Szasz, The Myth of Mental Illness (New York, 1961; London, 1972; revised edn, New York,
1974); and The Manufacture of Madness (New York, 1970; London, 1972). For discussion see R.
E. Vatz and L. S. Weinberg, The Rhetorical Paradigm in Psychiatric History: Thomas Szasz and
the Myth of Mental Illness, in Micale and Porter (eds.), Discovering the History of Psychiatry,
31130.
 Introduction 3

of poetic furor, an Aristotelian assumption of the mad genius, or the Christian

doctrine of divine or demonic possession inspiration. At a later stage as part
of the developments dubbed by Foucault the great connement, madness was
shut up (in both senses of the word), reduced to unreason (a purely negative
attribute), and rendered the object of supposed scientic investigation.6 The cri-
tique of the great connement proved highly inuential. Amongst the more
conspicuous contributions, David Rothman applied the critical interpretation of
the asylum (exposed as an engine of control) to the United States, and Andrew
Scull saw madhouses serving a similar function in Britain, as well as being a
vehicle of professional imperialism.7
The new historians did not have it all their own way. Foucaults provocative
formulations which stood traditional history of psychiatry on its head, taking
the heroes of the standard story and making villains of them have been ro-
bustly rebutted by various professional psychiatrists. In The Reality of Mental
Illness, Martin Roth and Jerome Kroll, for instance, counter-asserted that such
have been the stability of psychiatric symptoms presented in recorded history
that we may condently afrm that madness is more than a label, a device
for scapegoating deviants in the interests of social control: it is a real disease,
probably with a biological basis.8 For their part, traditionalist historians of so-
cial policy have continued to reiterate the progressivist view.9 And historians
of psychiatry of a socio-cultural bent have also taken issue with many of the
empirical particulars of Foucaults reading of the transformations of madness
and its treatment from Medieval times into the nineteenth century. Discover-
ing the History of Psychiatry, edited by Mark S. Micale and Roy Porter, and
Rewriting the History of Madness: Studies in Foucaults Histoire de la Folie,
edited by Arthur Still and Irving Velody, contain many essays offering detailed

6 M. Foucault, La Folie et la Deraison: Histoire de la Folie a lAge Classique (Paris, 1961); trans.
and abridged as Madness and Civilization: A History of Insanity in the Age of Reason, by R.
Howard (New York, 1965; London, 1967). C. Gordon, Histoire de la Folie: An Unknown Book
by Michel Foucault and Rewriting the History of Misreading, in A. Still and I. Velody (eds.),
Rewriting the History of Madness: Studies in Foucaults Histoire de la Folie (London and New
York, 1992), 1943, 16784.
7 D. Rothman, The Discovery of the Asylum: Social Order and Disorder in the New Republic
(Boston, Mass., 1971); A. Scull, Museums of Madness: The Social Organization of Insanity in
Nineteenth-Century England (London and New York, 1979) a much-revised version of this
later appeared as The Most Solitary of Afictions: Madness and Society in Britain, 17001900
(New Haven, Conn., and London, 1993). The Castels pioneering studies of France should also be
mentioned: R. Castel, LOrdre Psychiatrique: LAge dOr dAlienisme (Paris, 1973; and 1976);
English trans. by W. D. Halls, The Regulation of Madness: Origins of Incarceration in France
(Berkeley and Cambridge, 1988); F. and R. Castel and A. Lovell, The Psychiatric Society (New
York, 1981).
8 For instance M. Roth and J. Kroll, The Reality of Mental Illness (Cambridge, 1986).
9 K. Jones: Mental Health and Social Policy, 18451959 (London, 1960); A History of the Mental
Health Services (London, 1972); and Asylums and After: A Revised History of the Mental Health
Services from the Early Eighteenth Century to the 1990s (London, 1993).
4 Roy Porter

critiques rather than mere polemical bouquets or brickbats of Foucaults

views, producing many promising avenues of research.10
Overall it would seem that the Foucault who saw Reason and society as
involved in a joint mission (or even conspiracy) to control and silence mad-
ness did not offer a much more sophisticated historical view than traditional
Whiggish and meliorist interpretations. But his emphasis upon the dialectic
between Reason and Madness is surely valuable to historians. In some ways
that is an insight which has been built upon by Sander Gilman and others who
have examined madness as a particular mode of disease representation. Gilman
had argued that the image of the insane forms part of wider construal of self
and other whereby societies identify themselves by the projection of stigma-
tizing stereotypes. The mad form part of a world of the other also populated
by (for example) blacks, homosexuals, the criminal and other deviants. Such
an approach to the history of perceptions appears to offer a fruitful entry into
the analysis of language, myth and metaphor respecting madness.11
The debates detonated by the works of Szasz, Foucault, Scull and others
have been noisy, polemical and often angry.12 Going beyond ideological, and
sometimes personal, differences, new studies of the institutionalization of the
mad, and the role of the psychiatric profession in it, have increasingly argued
that the bait has been cast far too crudely as if there were, for instance, a
cut-and-dried choice between Whiggism and anti-psychiatry. Closer scrutiny
and more thoughtful analysis of the historical records, younger historians were
claiming, revealed that the asylum was neither just a site for care and cure, nor
just a convenient place for locking up inconvenient people (custodialism).13
It was many things all at once. And far from being a weapon securely under
the control of the profession, or the state, it was a contested site, subject to con-
tinual negotiation amongst different parties, including families and the patients
themselves. Monolithic and conspiratorial accounts are being replaced by ones

10 Micale and Porter (eds.), Discovering the History of Psychiatry; Still and Velody (eds.), Rewriting
the History of Madness.
11 S. L. Gilman: Difference and Pathology (Ithaca and London, 1985); Jewish Self-Hatred, Anti-
Semitism and the Hidden Language of the Jews (Baltimore, 1986); Sexuality: An Illustrated
History (New York, 1989); Inscribing the Other (Lincoln, NE, 1991); The Jews Body (New
York and London, 1991); and Health and Illness: Images of Difference (London, 1995). See
also related themes J. Hubert (ed.), Madness, Disability and Social Exclusion: The Archaeology
and Anthropology of Difference (London, 2000).
12 For polemics see for instance J. L. Crammer, English Asylums and English Doctors: Where
Scull is Wrong, History of Psychiatry 5 (1994), 10315; K. Jones, Sculls Dilemma, British
Journal of Psychiatry 141 (1982), 2216. Scull has not been slow to hit back: Humanitarianism
or Control? Some Observations on the Historiography of Anglo-American Psychiatry, Rice
University Studies 67 (1981), 357; Psychiatry and its Historians, History of Psychiatry 2
(1991), 23950; Psychiatrists and Historical Facts. Part one: The Historiography of Somatic
Treatments, History of Psychiatry 6 (1995), 22542; and Psychiatrists and Historical Facts.
Part two: Re-Writing the History of Asylumdom, History of Psychiatry 6 (1995), 38794.
13 A. Scull, A Convenient Place to Get Rid of Inconvenient People: The Victorian Lunatic Asylum,
in A. D. King (ed.), Buildings and Society (London, 1980), 3760.
 Introduction 5

which emphasize the role of consumers (purchasers) as well as suppliers,

which highlight the market model, and give due weight to bottom up as well
as top down history, histories of use as well as abuse, of resistance as well as
domination or which acknowledge (as in the later thinking of Foucault) the
sheer complexity of the constitution of power.14
Different scholars have brought out different features of this more complex
reading. Some, such as Peter Bartlett and James Moran, have emphasized how
far the management of the mad remained outside psychiatric control.15 Others,
notably Len Smith, Elaine Murphy, and Andre Cellard stress that the handling
of the insane should be seen not as monolithic and monopolistic but as a mixed
economy of care provision, with inputs from the private sector, charity and
the state.16 Other scholars question the model of professional dominance and
further argue that the active agency of the family in mediating forms of treatment
and custody for a difcult relative was far more important than has hitherto been
recognized.17
These debates provide the launching-point and the focus of inquiry for several
of the studies in this book. Before teasing out some of their implications, it might
be helpful at this point briey to address each of the papers in this volume, to
underscore key themes and potential points of comparison.
Cathy Coleborne, as part of a wider scholarly interest in gender and conne-
ment, considers the role played by police in the institutionalization of insane
persons in lunatic asylums in Victoria, Australia. From the earliest days of the
asylum in the colony, the police were involved in the detection, seizure and

14 For one contribution amongst many see C. Jones and R. Porter (eds.), Reassessing Foucault:
Power, Medicine and the Body (London, 1994).
15 P. Bartlett, The Poor Law of Lunacy: Administration of Pauper Lunatics in Nineteenth-Century
England (London, 1998); J. Moran, Committed to the State Asylum: Madness and Society in
Nineteenth-Century Ontario and Quebec (Montreal, 2000). See also the studies in P. Bartlett
and D. Wright (eds.), Outside the Walls of the Asylum: The History of Care in the Community
17502000 (London and New Brunswick, NJ, 1999).
16 L. D. Smith, Cure, Comfort and Safe Custody: Public Lunatic Asylums in Early Nineteenth-
Century England (London, 1999); E. Murphy, The Administration of Insanity in East London
18001870, PhD thesis, University of London (2000). Pioneering was W. Llewellyn Parry-
Jones, The Trade in Lunacy: A Study of Private Madhouses in England in the Eighteenth and
Nineteenth Centuries (London, 1971).
17 A. Suzuki, Lunacy in Seventeenth- and Eighteenth-Century England: Analysis of Quarter Ses-
sions Records. Part one, History of Psychiatry 2 (1991), 43756. Part two, History of Psychiatry
3 (1992), 2944; and see his Closing and Disclosing Lunatics within the Family Walls: Domes-
tic Psychiatric Regime and the Public Sphere in Early Nineteenth-Century England, in Bartlett
and Wright (eds.), Outside the Walls of the Asylum, 11531; Framing Psychiatric Subjectiv-
ity: Doctor, Patient and Record-keeping at Bethlem in the Nineteenth Century, in B. Forsythe
and J. Melling (eds.), New Research in the Social History of Madness (London, 1999); and
his forthcoming book on family psychiatry in nineteenth-century Britain, provisionally entitled
Insanity at our Own Doors: Family, Patient and Psychiatry in Early Victorian London. See also
B. Forsythe and J. Melling (eds.), Insanity, Institutions and Society: New Research in the Social
History of Madness, 18001914 (London, 1999); Bartlett and Wright (eds.), Outside the Walls
of the Asylum.
6 Roy Porter

sequestration of women and men deemed to be insane. As the nineteenth

century progressed, the numbers of asylum inmates dramatically multiplied
and the asylum system expanded rapidly. In order to cope with the spiralling
patient numbers, a series of legal, medical and administrative measures was
instituted in the latter part of the century, which shaped the meanings of both
madness and the asylum.
Towards the end of the century, further legislation detailed the methods police
were to follow in the committal of lunatics. They were asked to perform a role
that was both medical and legal in nature, and were thus intimately involved in
the forging of the asylum population. This has been taken as an indication that
control of the insane was not primarily achieved through medicalization. Yet,
Coleborne argues, police were indeed central to the medicalization of madness,
since they were asked to amass medical particulars of lunatics, and were also,
in a variety of practical ways, the adjudicators of the boundary between sanity
and insanity. Central to her chapter is the conviction that families, police, asylum
authorities and the alleged insane all negotiated with each other, in the process
producing denitions and experiences of both insanity and the asylum.18
In Irelands crowded madhouses, Elizabeth Malcolm builds on the rather
startling fact that Ireland was one of the rst nations to construct a national
asylum system.19 The rst purpose-built asylum was inaugurated in Dublin
in 1814; a further nine were erected throughout the country in the 1820s and
1830s; and twelve more during the 1850s and 1860s. Subsequently, all these
asylums were considerably enlarged or augmented with supplementary hospi-
tals. Between 1851 and 1901, the asylum population rocketed by 337 per cent,
to an astonishing 63.4 per 100,000. The United Kingdom and other European
and colonial societies no doubt experienced enormous increases in their asylum
populations during the latter part of the nineteenth century, but perhaps none
on such a scale as Ireland.
Malcolm investigates this phenomenon through a meticulous study of the
Irish asylum system. She shows that Irish asylums should not be seen as geriatric
institutions, nor were their inmates the socially maladjusted or economically
redundant mists supposed by certain historians to have been characteristic
of late-Victorian asylums in England. A majority of the inmates at that time
were ordinary members of Irish society: persons under fty and many,
particularly men, only in their twenties and thirties. The largest group among
these men were rural labourers and farmers sons. What, Malcolm asks, were the
socio-economic origins of these patients? What conicts within struggling rural
Irish families led to institutional connement?

18 See also K. C. Kirkby, History of Psychiatry in Australia, pre-1960, History of Psychiatry 10

(1999), 191204.
19 For her earlier work see E. Malcolm, Swifts Hospital: A History of St Patricks, Dublin (Dublin,
1988). See also P. M. Prior, Mad, not Bad: Crime, Mental Disorder and Gender in Nineteenth-
Century Ireland, History of Psychiatry 8 (1997), 50116.
 Introduction 7

Patricia Prestwich takes up the question of the dynamics of incarceration.

Nineteenth-century psychiatrists, she notes, were fond of portraying their pa-
tients as fresh off the streets, without a medical identity until they came
under the clinical gaze and therapeutic control of the asylum physician a
professional view curiously echoed in Foucaults and Szaszs own formula-
tions. Recent research in the history of institutional psychiatry, however, has
been suggesting that the journey to the asylum may be no less important
than the clinical gaze for understanding the social composition and function
of this contested institution indeed scholars have recently been maintaining
that admitting psychiatrists merely conrmed the diagnosis of insanity made by
families, by neighbours, or by non-medical authorities. Such possibilities make
it therefore essential to go beyond the concept of the asylum as an instrument of
medical power and to examine the demands made on the asylum and its doctors
by the community.
As examined in Patricia Prestwichs chapter, the records of the Parisian asy-
lum of Sainte-Anne provide an opportunity to explore the complexities of the
process of committal in France. Constructed in 1867 as the rst of ve new
model asylums in the Paris region, Sainte-Anne represented the hopes of
Parisian psychiatrists for the scientic yet humane handling of the insane. It
was specied as the teaching hospital for Paris, and its courses in psychiatric
medicine were conducted by the most celebrated physicians of the period, in-
cluding Valentin Magnan. The grounds of Sainte-Anne also housed the admis-
sions ofce for all ve asylums in the department of the Seine. There, from 1867
to 1912, Magnan examined and certied from 3,000 to 4,000 patients a year.
Sainte-Anne was also the only public asylum situated within Paris itself, and was
therefore the most convenient of these institutions for the Parisian population.
On the basis of quantitative and qualitative analysis of the admission records
for over 7,000 patients treated at Sainte-Anne from 1873 to 1914, Prestwich
examines three key questions of institutional connement: rst, how did in-
mates arrive at the asylum? Second, what kinds of people were committed?
And third, what sorts of behaviour resulted in their connement? Although
the role of committal in maintaining public order is discussed, the accent is
on what this committal process reveals about the motives and requirements of
families. Prestwich then proceeds to examine the types of patients admitted to
Sainte-Anne. Recent research on nineteenth-century asylums has established
that they did not serve, as has often been suggested, as a dumping ground for
undesirables. But it remains vital to analyse the diversity of the asylum pop-
ulation, in terms both of standard social characteristics (e.g. age, marital status
and occupation) and of the types of behaviour leading to committal. Prestwich
stresses the variety of medical and social problems faced by the community
and, in consequence, the multiple demands for care and treatment placed on the
asylum and its physicians. Gender, she suggests, was more important than the
type of insanity in distinguishing patients: women and men were frequently
8 Roy Porter

diagnosed as suffering from different afictions and, as a result, had different

experiences of the asylum.
In certain ways resembling one of the hopitaux generaux delineated by
Foucault, Robben Island, off the southern coast of South Africa, accommo-
dated lunatics, lepers and the chronic sick in a General Inrmary for nearly a
century after 1846. As Harriet Deacon shows in her chapter, the institution was
established soon after the emancipation of slaves, at a time when the colonial
government and a nascent Cape Town middle class were trying to impose a
new order on the undisciplined urban underclass in preparation for self-rule.
The Capes most threatening insane were sent to the island asylum, which, until
1875, was the only such institution in the colony. Although it grew steadily
after 1846, the total of insane isolated in the island asylum at any one time
was relatively small, exceeding 200 only in the 1890s. The aggregate insti-
tutionalized population in the colony numbered only 645 in 1891; twice that
sum of lunatics and idiots were kept in private houses. There was thus no
great connement, though the same pressures for institutionalization oper-
ated at the Cape as in Europe: the interruption of social networks of care, and
a dominant-class horror of uncontrolled behaviour.
Deacons analysis of the admissions registers for the asylum suggests how
and why some of the Cape insane were conned at Robben Island. The selection
and treatment of asylum inmates were related to social and economic patterns
of change in society at large. At the time when the asylum was established,
it took from country gaols and the overcrowded Cape Town hospital those
regarded as disruptive to an institutional order on the mainland, which placed
a new stress on the discharge of labour by gaol inmates and the rapid cure of
patients in the hospital. Most of these patients were male, in a proportion which
remained fairly steady throughout the century and demonstrated the primacy
of gaol admissions and the overwhelming focus on detention rather than cure.
During the rst fteen years, nearly half of the admissions were convicts.
In the 1860s and 1870s, however, the proportion of white paying patients
rose vefold, as the asylum underwent reforms along moral management
lines. New asylums were opened to take these middle-class patients (more of
them being women) as pessimism over the curability of black lunatics coincided
with a growing racism in colonial society. By the early twentieth century, four
fths of the island inmates were black (most of them deemed dangerous) and
a third were convicts. The patient prole had come full circle, its function once
again being to eject the most dangerous and threatening members of society
from overcrowded prisons that made their black prisoners work at public works
to prepare them for re-entry as disciplined labourers in a booming colonial
economy resting on gold and diamonds.
Comparative history forms the analytic framework in two chapters The
Connement of the insane in Switzerland, 19001970: Cery and Bel-Air
 Introduction 9

Asylums, by Jacques Gasser and Genevieve Heller, and The connement

of the insane in Victorian Canada by David Wright, James Moran and Sean
E. Gouglas. Both form part of larger interdisciplinary projects on the history
of nineteenth-century Swiss and Canadian psychiatry. Cery and Bel-Air in
Switzerland, and the Toronto and Hamilton asylums in Canada, were public
asylums designed to receive both pauper and middle-class lunatics. Because
these Swiss institutions were responsible to two separate cantons of the Swiss
confederation (Geneva and Lausanne), they operated under distinct legislation
governing the practice of connement. The two Ontario asylums, by contrast,
operated within the same provincial legislative framework. On the basis of
a sample of patient records and other archival material, a socio-demographic
analysis of inmates of both sets of asylums is offered, providing substantial new
material on the social and medical data (diagnoses, length of stay, number of
stays) of patients.
Gasser and Heller provide a study of admission criteria to the Swiss asylums.
They discuss the evolution of legislation which gave a relatively settled legal
framework to each period, dening the type of admissions, those authorized to
admit patients, and the reasons for connement. In the canton of Geneva, until
1936, jurisdiction over the internment of the insane fell to the Department of
Justice and Police; in the canton of Lausanne, by contrast, such jurisdiction lay
under the control of the Department of the Interior (health and public welfare).
Gasser and Heller also quantitatively analyse admission procedures during the
whole period under consideration. They show the uctuating proportions of
patients who requested admission, were accepted on the request of others,
or by civic authorities (generally by the intervention of a doctor outside the
institution), or who were conned by judicial order. Finally, Gasser and Heller
discuss the circumstances and processes of admission in specic situations,
looking in particular at a handful of patient records, chosen from around 1930,
which give some indication of the interweaving of medical and social criteria
in the admission process.
Wright, Moran and Gouglas present detailed socio-demographic analyses
that further question an older revisionist portrayal of the asylum as a dustbin
for the useless and unwanted of industrial society. The Toronto and Hamilton
asylums were not, according to them, populated by the fringe elements of
industrial society, at least certainly not from a socio-demographic standpoint.
Patients were admitted across the adult age spectrum. Men and women became
patients in accordance with their representation in the general population.20

20 The major studies suggesting women were disproportionately conned in asylums are: P.
Chesler, Women and Madness (New York, 1973); E. Showalter, The Female Malady: Women,
Madness and English Culture, 18301980 (New York, 1985); Y. Ripa, Women and Madness:
The Incarceration of Women In Nineteenth-Century France (Minnesota, 1990). For excellent
summaries of feminist critiques of psychiatry and the history of psychiatry, see J. Buseld,
10 Roy Porter

Indeed, the absence of sex as an important socio-demographic variable (when

cross-referenced with age, occupation, length of stay, religion and geographical
background) is striking. Wright, Moran and Gouglas use their statistical ndings
as a base upon which to reconsider the relationship between asylum admissions
and wider patterns of employment, kinship networks, immigration and socio-
economic growth in Victorian Ontario.
Andrea Dorries surveys the strengths and shortcomings for the historian
of German psychiatry of surviving archival material. Founded in 1880, the
Wittenauer Heilstatten psychiatric hospital in Berlin has preserved nearly all its
patient records. In addition to an exhaustive run of patient les, documentation
can be found on special treatments (e.g., malaria therapy for progressive paral-
ysis due to tertiary syphilis) as well as material concerning hospital employees.
Aided by a computer-based analysis of patient records from the hospital,
Dorries builds her paper with a view to describing patients lives in the period
from 1919 to 1960. Her database includes personal, medical, social, postmortem
and admission data, as well as data on sterilizations performed during the 1930s
and 40s. Using a random sample of 4,000 records (8 per cent of all surviving
ones), the paper focuses on three topics: rst, the social and demographic char-
acteristics of admissions; second, the treatment and discharge of patients based
on diagnosis, year and gender and the effect of the patients social circum-
stances on their lengths-of-stay; and, third, the care and treatment of children
who stayed at the hospital. Dorries takes particular account of changing politi-
cal circumstances: the Weimar Republic, with its tremendous implications for
most patients with physical disorders: and the post-war period in Germany, with
the emerging new political systems in East and West Berlin. Her paper demon-
strates continuities and discontinuities in the daily life of patients admitted to a
municipal psychiatric hospital during the period of the rst four decades in the
twentieth century.
The records of the South Carolina Department of Mental Health form the
foundation of Peter McCandlesss chapter, an investigation of how an asylum
in the southern United States changed as a result of radical changes in its patient
population, and how those mutations were in turn related to major shifts in the
society at large. Opened in 1828, the South Carolina Lunatic Asylum is the
third-oldest state mental institution in the United States. American historians of
mental illness have argued that it (and other early Southern asylums) began as
custodial institutions caring for pauper lunatics. Its founders, however, hoped
to create a curative establishment, grounded on moral treatment, for patients of

Sexism and Psychiatry, Sociology 23 (1989), 34364 and N. Tomes, Feminist Histories of
Psychiatry, in Micale and Porter (eds.), Discovering the History of Psychiatry, 34883. For a
more recent discussion of the role gender played in the history of psychiatry, see the collected
papers in J. Andrews and A. Digby (eds.), Sex and Seclusion, Class and Custody: Perspectives
on Gender and Class in the History of British and Irish Psychiatry (Amsterdam, 2002).
 Introduction 11

all classes, and for several decades its ofcers struggled to achieve this goal.
Before the 1860s, the number of patients remained small, never exceeding 200,
and the total of paying patients (some from the wealthy planter elite) nearly
equalled the number of pauper patients, whose care was funded largely by local
governments. The patients were nearly all white in a state which had a black
majority population. Although the asylum could legally accept blacks after
1849, only ve were resident when the Civil War ended in 1865.
After the Civil War, McCandless goes on to show, the nature of the asylum
changed radically. Without explicitly abandoning its curative goals indeed
in 1895 it was renamed the South Carolina State Hospital for the Insane it
insensibly accepted a custodial function, handling large numbers of patients now
deemed primarily chronic and incurable. The patient headcount grew rapidly,
reaching 2,200 by 1920, and the social and racial nature of the patient population
also changed markedly, as a result of signicant changes in the situation of the
state. One of the richest states in the 1820s, by the late nineteenth century South
Carolina descended to become one of the poorest. Paying patients virtually
disappeared, and the institution was inundated by impoverished beneciary
patients whose costs were now paid by the state.
Emancipation fully opened the asylum to the black majority and the number
of black patients skyrocketed to over 1,000 in 1920, ironically creating a biracial
institution in a state increasingly devoted to rigid segregation. The changes in
the institutions role and patient population accompanied a marked deterioration
in its internal conditions, the result of grossly inadequate funding. To a large
extent this development resulted from the states steep economic decline and
internecine political struggles. But inadequate funding also reected changes
in the institutions clientele. As a result, its ofcers were unable to provide even
basic custodial care to patients increasingly marginalized by chronic disease,
poverty and race.
The question of gender is central to Jonathan Ablards examination of
connement in Argentina. As Ablard shows, by the early twentieth century
Argentina had one of the most extensive and modern systems of public psy-
chiatric care in Latin America. Despite the promise of these institutions and of
plans to build new asylums in the interior of the country, however, by the 1930s
all of Argentinas public facilities were in crisis, plagued by overcrowding,
physical breakdown, legal irregularities, and impossible doctor-and-staff-to-
patient ratios. Addressing one hospital in the city of Buenos Aires, the Hospital
Nacional de Alienadas (National Hospital for the Female Insane), Ablard ex-
plores the decline of that hospital from two viewpoints. First he considers how
the structural and ideological contradictions of public health policy condemned
the National Hospital to overcrowding. From the 1870s to the 1930s, Argentina
was a major destination for European immigrants. Argentine elites viewed those
newcomers with ambivalence, believing that their presence disrupted the social
12 Roy Porter

and political order and that many were defective, and hence likely to require
help from the state. Accordingly, public health, and particularly psychiatric
hospitals, received paltry state subsidies.
As a further cost-saving device, hospitals for women such as the National
Hospital were entrusted to charitable and religious organizations which per-
formed the work for little or no recompense. The National Hospital was further
burdened by the fact that it was Argentinas only psychiatric facility dedicated
entirely to female patients. As a result, it received patients from all over the
country. Many arrived with no identication, and often without the proper legal
paperwork. Ablard also examines the hospitals relationship to everyday citizens
and to public authorities. Despite conditions which were often harsh, families
were the principal source of commitments until 1933. Thereafter the adminis-
tration of the National Hospital, forced by overcrowding to refuse additional
patients, established new admissions rules which led to a sharp increase in pub-
lic authority commitments. This shift further undermined what many doctors
had hoped was a trend towards a growing public condence in the hospital.
The National Hospital, however, viewed its relationship to the general public
with great ambivalence. On one hand, throughout the rst half of the century,
doctors continued to hope that commitments by family members would even-
tually lead to a growth in voluntary self-admissions. On the other hand, the
hospital was constantly trying to restrict frivolous, inappropriate and medically
unnecessary admissions. Yet its attempt to become a strictly medical institution
was further impeded by socially grounded medical concepts that called for the
protection and attentive control over women at large. As a result, doctors were
ultra-vigilant for signs of mental illness in women who violated social norms,
and also tended to be reluctant to release such women from the hospitals care.
The historiography of psychiatry in Argentina had relied hitherto almost
exclusively on published medical literature. Ablard breaks new ground by ex-
amining previously untapped sources, including insanity proceedings, hospital
annual reports, and the archive of the elite womens Society of Benecence
which ran the hospital from the 1850s until 1947. Much of the earlier literature
assumed that Argentina followed European, and particularly French, models of
hospital care. A careful study of primary documents reveals, however, that the
Argentine psychiatric network reected the peculiarities of national social and
economic development, and particularly the relative weakness of the national
state when it came to the implementation of health and social control policies.
Another Latin American nation here investigated in a parallel study is Mexico.
Cristina Rivera-Garza traces the history of the General Insane Asylum, inau-
gurated in 1910 by General Porrio Diaz the agship welfare institution
devoted to the care of the mentally ill in early twentieth-century Mexico. One
of the largest and most monumental projects of the modernizing agenda of
the Porrian regime, the asylum soon faced serious nancial limitations as a
 Introduction 13

result of the Mexican revolution, whose armed phase commenced just three
months after the asylums opening. Plagued by overcrowding, poor stafng
and physical deterioration, the asylum authorities nevertheless kept detailed
patient records. Using admission registers and medical les from 1910 through
to 1930 a year after the institution underwent medical and administrative
reform Rivera-Garza explores the continuities and discontinuities between
the Porrian strategies of connement as set out in asylum regulations, and the
actual procedures through which men and women became asylum inmates. In
examining the social and demographic proles of inmates, Rivera-Garza ad-
dresses the various ways in which both police and families used concepts of
gender and class to detect mental illness in a rapidly changing social milieu. It
is a kind of analysis especially important in an institution which, while serving
a range of social classes, admitted great numbers of patients as free and indigent
(100 per cent of women and 86 per cent of men in 1910) and on the strength of
a government order (86 per cent of women and 68 per cent of men).
Drawing upon institutional reports and patient testimonies, she then exam-
ines the dynamic of life within the asylum grounds, paying special attention
to the ways in which the layout and routine of the institution replicated and
reinforced distinctive class and gender understandings of mental illness. In be-
coming mad, Rivera-Garza concludes, asylum inmate characterizations shed
light on the negotiation through which state agents and family members distin-
guished mental illness, something of growing relevance in the context of the
emergent revolutionary regimes concerned with the reconstruction of the nation.
This social history of connement in revolutionary Mexico City shows the con-
tested origin of public health policies, variously interpreted as either a vertical
imposition of an increasingly centralized state or the success of revolutionary
welfare policies.21
In a welcome contribution to the history of colonial policy towards the mad
in British Africa, Jonathan Sadowsky illustrates how the history of that colonys
asylums re-enacted developments common in the comparative history of psy-
chiatric institutions, while also illustrating themes peculiar to the politics and
priorities of colonialism. Initially the institutions were, like many colonial im-
ports, already obsolete by metropolitan standards, replicating virtually all the
shortcomings British psychiatry had come to pride itself in overcoming. For
most of the early twentieth century, administrators of the Nigerian colonial state
ventilated a rhetoric of scandal and the need for reform, but when reform was
at last achieved in the late 1950s and early 1960s, it was contemporary with
Nigerias gradual shift to independence, and the reform was largely accom-
plished through the initiatives of Nigerians.

21 C. Rivera-Garza, Mad Encounters: Psychiatrists and Inmates Debate Gender, Class, and the
Nation in Mexico, 19101930 (Lincoln, NE, forthcoming).
14 Roy Porter

Sadowsky appraises Nigerias asylums under colonialism, by examining

the material conditions in the asylum, the social processes of admission and
discharge, the ideological conicts raised by debates over asylum reform and,
nally, the process of reform itself. Colonial asylum policy was driven by the
theory of indirect rule, which held that interference in local practices should be
kept to a minimum. It was a policy which, in the name of cultural preservation,
justied parsimony, and which assailed reform of the institutions as an impo-
sition on the native way of life. Supporting this platform was the curious but
common belief that one could, somehow, have colonialism without making any
impositions. Westminster avoided a signicant investment in treatment, and, at
the same time, a strict hands-off policy. By consequence Nigeria ended up with
institutions which had none of the potential benets of asylum care, and many
of its most coercive traits. Colonial policies for the incarceration of the insane
may thus be said to reect in microcosm the contradictions of indirect rule.
Examining provision for the insane in East London, Elaine Murphy em-
phasizes the gradual nature in the transition from private to public care. The
capacity of an earlier private trade in lunacy to both adapt to market changes,
and to impress the Lunacy Commissioners during their inspections, left the old
mixed economy system of care intact right to the end of the nineteenth century.
Murphy notes that it was the force of state preference for public providers which
ultimately placed them in a position of dominance. According to Murphy, the
ultimate success of the public system thus lay more in the inuence of families
in the committal process and in the ability of the central government to control
capital expenditure, than in the medical capture of madness by an incipient
alienist profession or by the Lunacy Commission.
The relationship between (British) colonial psychiatry and indigenous prac-
tices of mental health services forms the backdrop to Sanjeev Jains chapter on
the history of psychiatry in India. Building on a burgeoning literature on the
history of madness in the Subcontinent, Jain documents the inuence of British
psychiatric practice and the slow steps towards institutional treatment in colo-
nial and later independence India. As Jain documents, rates of incarceration (as
a percentage of the huge Indian population) were relatively speaking low, and
thus Indian psychiatrists had to resort to a variety of techniques in providing
mental-health services. Unique among these was the practice of the Amritsar
Mental Hospital which invited patients families to live on the grounds of the
hospital in order to aid in the recovery of kin. Side-by-side with the continuance
of traditional Ayurvedic and Unani medical practices, one is struck by the ra-
pidity with which the few institutional based Indian psychiatrists employed the
latest (European) treatments. Shock therapies, for instance, were reported to be
used in Indian mental hospitals within months of being reported in European-
based psychiatric journals. This internationalizing aspect of psychiatry has
only recently received serious historical attention.
 Introduction 15

In the other contribution focusing on Asia, Akihito Suzuki demonstrates how

the development of psychiatric institutions in Japan from the Meiji Restoration
(1868) to the Second World War presents a number of similarities to the ex-
perience of many European countries. These notably include the enactment of
national legislation (from 1900) for regulating institutional provision for the
insane, a series of exposes of glaring abuses in metropolitan asylums (1903),
tensions between central and local government over psychiatric policy, and the
involvement of police in the incarceration process.
His paper, however, spotlights one key difference. Before the Second World
War, Japan did not witness the establishment of a publicly funded, nationwide
network of large-scale asylums. As late as 1950, only 19,000 patients (from
a national population of over 50 million) were institutionalized in about 150
psychiatric hospitals. Thus, instead of that dominance of vast long-stay mental
hospitals which became prevalent in the west, a mixed economy of the care
for the insane persisted. Within this set-up, the style of psychiatric provision
varied enormously.
Publicly funded psychiatric hospitals, modelled after English asylums, were
outnumbered by private Noh Byoin (brain hospitals), many of which had
origins in, and were situated on the sites of, Buddhist temples and Shintoist
shrines. Psychiatric colonies ourished in two cities (Kyoto and Kanazawa),
both crystallized around ancient religious and philanthropic lore. A large num-
ber of certied patients (2,400 in 1950) remained within the household, and
still more led their own troubled and dependent lives without being certied, let
alone institutionalized. Thus, the history of Japanese psychiatry in the pre-1945
era provides a unique opportunity to examine some of the fundamental ques-
tions in the use of the asylum, and the Japanese experience of psychiatric pro-
vision must no longer be seen merely as a failure to catch up with the West.
Deploying a comparative perspective, Suzuki analyses the social history of
connement from around 1900 to 1945. In particular, using archival sources,
he examines two different types of institutions: Matsuzawa Hospital in a Tokyo
suburb, which was (and still is) a University-afliated public psychiatric hospi-
tal with 1,000 beds; and Iwakura Hospital, a for-prot enterprise situated outside
Kyoto, with its numerous satellite boarding-out houses for the insane. As well as
adopting different therapeutic and managerial strategies, those two institutions
catered for patients from different classes or social groups who came to the asy-
lums through different paths and with different rationales: Matsuzawa pursued
highly Westernized regimens on poorer patients from the metropolis who had
usually been committed to the hospital by the police, while Iwakura provided
self-consciously eclectic treatment for those from wealthier families from all
over the country who sought refuge in the asylum. By examining these con-
trasts in the dynamics of institutionalization of the two facilities, and by putting
them into the context of contemporary Japanese society, Suzuki illuminates
16 Roy Porter

the factors which shaped Japanese psychiatric provision into a system that was
distinctively mixed and varied.
As will be evident, individually and collectively these studies address major
questions in the history of psychiatry. Several seek to uncover the impulses
behind the mighty movement accelerating in the nineteenth century and con-
tinuing in the twentieth to certify and incarcerate large populations of people
(as Malcolm observes, a stunning one-in-a-hundred of the whole population in
Ireland!). In some cases Germany for instance the movement seems to have
been, as Scull classically argued, in part a response to capitalism, industrial-
ism and urbanization.22 But elsewhere the asylum grew in nations or regions
(Ireland for instance, but also South Carolina) which were not only primarily
rural but actually undergoing economic retrogression.
What were the forces behind the drive to conne the insane and to consolidate
the procedures of incarceration? How important were doctors? Alternatively,
were high-level political decisions and changing proles of ofcial public pol-
icy preponderant? This seems to have been the case in Mexico and Argentina.
Elsewhere, the practice of street-sweeping, as described in Colebornes study,
indicates the prime role of the police in the committal of the insane in Victorian
Australia. Or was the push to conne largely family-driven a desire to get
difcult relatives out of the domestic sphere? Malcolm intriguingly suggests
that, although a nineteenth-century Foucauldian model of the great conne-
ment might seem attractive to some, in the early comprehensive system of state
asylums which developed in Ireland, the urge to put people away actually came
in large measure not from the agents of the state but from families and commu-
nities who were glad to have economic burdens shifted off domestic shoulders
in circumstances of drastic economic crisis.23 Prestwich for her part underlines
the role of the bourgeois family in securing connements in nineteenth-century
Paris.
None of the authors in this book subscribes to the Foucauldian great con-
nement model tout court. But that does not mean that they renounce the
notion that institutionalization and the asylum served the ends of social control,
of disciplining and punishing, however dened. Indeed several of the essays
emphasize how the asylum particularly targeted certain groups. In Australia,
Coleborne nds, women were disproportionately likely to be the victims of
psychiatric labelling, stigmatization and asylumdom.24 Moran and Wrights
22 A. Scull, The Most Solitary of Afictions. See also C.-R. Prull, City and Country in German
Psychiatry in the Nineteenth and Twentieth Centuries, History of Psychiatry 10 (1999), 43974.
23 M. Finnane, Insanity and the Insane in Post-Famine Ireland (London, 1981).
24 See also C. Siobhan Coleborne, Reading Madness: Bodily Difference and the Female Lunatic
Patient in the History of the Asylum in Colonial Victoria 18481888, PhD thesis, La Trobe
University, Melbourne (1997); for women as victims in Britain, Showalter, The Female Malady;
and see also N. Tomes, Feminist Histories of Psychiatry, in Micale and Porter (eds.), Discov-
ering the History of Psychiatry, 34883.
 Introduction 17

study of lunatic asylums in Ontario by contrast nds that there it was the
large oating population of young unmarried men who were often scooped
up by the asylum. In antebellum South Carolina, lunatic slaves remained the
problem of their masters, but after the Civil War, the asylums in that state in-
creasingly were reduced to serving as custodial institutions for free blacks.25
Conditions for black patients were worse in every way than for whites. Similar
racial discrimination may be seen in Deacons analysis of institutionalization
in South Africa. Blacks formed the chief population of the Robben Island insti-
tution, while white South Africans were largely cared for in private facilities.26
What all these studies point to is the need to specify, in their unique historical
context, the distinctive range of factors which gave the psychiatry establish-
ment its point; nor must we forget that these may have changed dramatically
over time.
The new history of psychiatry which emerged form the 1960s was, not
surprisingly, centred on North America and western Europe.27 Studies of other
nations, regions and continents have followed, promoting the same or similar
inquiries. We now know, for instance, much more about the development of
psychiatry in Greece after its independence, in Central and South America, and
in Russia.28 This academic development inevitably led to the formulation of
the question: what power role did psychiatry and the institutionalization of the
insane play in colonial and quasi-imperial contexts? This is a matter particu-
larly important in the light of the commonly held view that medicine and
by implication, psychiatry are intrinsically colonial pursuits: they colonize
the body, colonize the patient. If that is the nature of medicine, then must not
psychiatry itself have served to promote the imperial mission? Indeed Megan
Vaughan and other scholars have shown beyond doubt how the importation of
western psychiatry into imperial contexts did not merely provide rationales for
locking up troublesome indigenous individuals but supplied supposed psycho-
logical proles of the native at large, construed, for instance, as savage, or
backward or childlike, thereby rationalizing colonial rule.29

25 See also P. McCandless, Moonlight, Magnolias and Madness: Insanity in South Carolina from
the Colonial Period to the Progressive Era (Chapel Hill, NC, 1995).
26 See also H. Jane Deacon, Madness, Race and Moral Treatment: Robben Island Lunatic Asylum,
Cape Colony, 18461890, History of Psychiatry 7 (1996), 28798; S. Swartz, Changing Di-
agnoses in Valkenberg Asylum, Cape Colony, 18911920: A Longitudinal View, History of
Psychiatry 6 (1995), 43152.
27 Mention should also be made here of the comparative study: K. Doerner, Madmen and the
Bourgeoisie: A Social History of Insanity and Psychiatry (Oxford, 1981).
28 D. Ploumpidis, An Outline of the Development of Psychiatry in Greece, History of Psychiatry
4 (1992), 23944; J. Brown, Heroes and Non-Heroes: Recurring Themes in the History of
Russian-Soviet Psychiatry, in Micale and Porter (eds.), Discovering the History of Psychiatry,
297307;
29 See notably M. Vaughan, Curing Their Ills: Colonial Power and African Illness (Stanford, Calif.,
1991).
18 Roy Porter

These are lines of inquiry further explored in this book. What seems clear,
however, is the sheer complexity of the colonial structures themselves. As is
evident from the examples of Australia and South Africa, there was some
bad feeling from settler groups in the colonies towards the mother country.
Australians were never allowed to forget their convict origins and, partly for
that reason, the handling of the insane in that colonial milieu was never di-
vorced from police business. In both places, the heavy arm of psychiatry fell
disproportionately upon the disadvantaged native population.30
But once again the story proves more complex than it might seem. At rst
sight it might be expected that West Africa would provide a case in which
psychiatrization would serve as an instrument of the rule of White over Black.
But in fact Britain invested little faith or money in asylums in the biggest
West African colony, Nigeria. Sadowsky shows why: Britain paradoxically,
hypocritically but characteristically wanted to have its imperial cake and eat it
it wanted colonial rule, but chose to improve the colonized as little as possible.31
As is so often the case, the empire can offer a mirror for what was going on
in the metropolitan domains. How far were the mad poor and other disadvan-
taged groups in London, Paris or New York being treated as colonized people?
Certainly, as studies have shown, there was a very different psychiatry for the
poor than the psychiatry for the rich.32
The case of Nigeria suggests that institutionalization and psychiatrization
were less the bold and clear instruments of policy than the foci of uncertainties,
muddles, conicts and indecisions. As is revealed by the studies of European
and American psychiatry contained in this book, much might be hoped and
expected of the psychiatric enterprise, but in practice neither the bricks-and-
mortar, nor the diagnostics, nor the therapeutics ever delivered the goods, and
psychiatry never won the unambiguous respect of the politicians, the press, the
pundits or the people.
Till recently, the history of psychiatry has had various obvious weaknesses.
One relates to evidence. In many cases, important archives have been inacces-
sible to historians, or their astonishing richness of case material and documen-
tation has overwhelmed the scholar. As the article below by Andrea Dorries
in particular suggests, computer software is making it possible to overcome

30 See also S. Garton, Medicine and Madness: A Social History of Insanity in New South Wales,
18801940 (Kensington, Australia, 1988); M. James Lewis, Managing Madness: Psychiatry
and Society in Australia 17881980 (Canberra, 1988).
31 See also J. Sadowsky: The Connements of Isaac O.: A Case of Acute Mania in Colonial
Nigeria, History of Psychiatry 7 (1996), 91112; Psychiatry and Colonial Ideology in Nigeria,
Bulletin of the History of Medicine 71 (1997), 94111; and Imperial Bedlam: Institutions of
Madness in Colonial Southwest Nigeria (Berkeley, 1999).
32 R. Hunter and I. Macalpine, Psychiatry for the Poor, 1851. Colney Hatch Asylum, Friern Hospital
1973: A Medical and Social History (London, 1974); C. MacKenzie, Psychiatry for the Rich:
A History of Ticehurst Private Asylum, 17921917 (London and New York, 1993).
 Introduction 19

such obstacles.33 Another is a consequence of parochialism. There have been

too few comparative studies, and such worldwide accounts that we have are
mainly antiquated compilations.34 Bringing together studies from all the con-
tinents, this book addresses differences and similarities in a variety of differ-
ent societies, and hopefully points the way towards pioneering comparative
studies.
33 Valuable has been M. MacDonald, Madness, Suicide, and the Computer, in R. Porter and A.
Wear (eds.), Problems and Methods in the History of Medicine (London, 1987), 20729.
34 See note 4, above.
1 Insanity, institutions and society: the case of the
Robben Island Lunatic Asylum, 18461910

Harriet Deacon

Introduction
Robben Island, an island off the southern coast of South Africa barely six miles
from Cape Town, the capital city of the Cape Colony in the nineteenth century,
accommodated lunatics, lepers and the chronic sick for nearly a century
after 1846. The General Inrmary was established just eight years after the
emancipation of slaves was nalized, at a time when the colonial government
and a nascent middle class in Cape Town were trying to impose a new order
on the undisciplined urban underclass in preparation for self-rule. The Capes
most dangerous insane were sent to the island asylum from 1846, that, until
1875, was the only asylum in the colony. By 1921, there were a number of
other asylums established: Grahamstown (1875), Port Alfred (1889), and Fort
Beaufort (1894) in the Eastern Cape, and Valkenberg (1891) near Cape Town.1
While Britain and some of her colonies provided extensive provision for
the insane, the Cape did not. Most of the colonial insane were cared for at
home or through private boarding arrangements: only the most desperate re-
sorted to the asylum. In 1890, the proportion of registered white insane to the
white population at the Cape was 1:1,180, about three times lower than that in
Ireland, New Zealand, New South Wales, Victoria and Britain (from 1:294 to
The research on which this chapter is based was supported at Cambridge University by the Sir
Henry Strakosch Memorial Scholarship, and the Patrick and Margaret Flanagan Scholarship.
Completion of the chapter was supported by the Robben Island Museum.
1 Current scholarship on Cape asylums includes H. J. Deacon: Racial Categories and Psychiatry
in Africa: The Asylum on Robben Island in the Nineteenth Century, in W. Ernst and B. Harris
(eds.), Race, Science and Medicine (London, 2000); and Madness, Race and Moral Treatment
at Robben Island Lunatic Asylum, 18461910, History of Psychiatry 7 (1996), 28797; S.
Marks, Every Facility that Modern Science and Enlightened Humanity have Devised: Race
and Progress in a Colonial Hospital, Valkenberg Mental Asylum, Cape Colony, 18941910,
in J. Melling and W. Forsythe (eds.), Insanity, Institutions and Society: A Social History of
Madness in Comparative Perspective (London, 1999); S. Swartz: The Black Insane at the Cape,
18911920, Journal of Southern African Studies 21 (1995), 399415; Changing Diagnoses in
Valkenberg Asylum, Cape Colony, 18911920: A Longitudinal View, History of Psychiatry 6
(1995), 43152; and Colonialism and the Production of Psychiatric Knowledge in the Cape,
18911920, PhD thesis, University of Cape Town (1996); F. Swanson, Colonial Madness: The
Construction of Gender in the Grahamstown Lunatic Asylum, 18751905, BA (Hons.) thesis,
University of Cape Town (1994).

20
 Robben Island Lunatic Asylum, South Africa, 18461910 21

1:380).2 There was also a much larger proportion of people classied as crim-
inal insane in the Cape than in Britain or New South Wales, although in New
South Wales and elsewhere, police were still responsible for a large proportion
of asylum committals before 1900.3 Although it rose steadily after 1846, the
number of insane conned in the Robben Island asylum at any one time was
relatively small, only exceeding 200 in the 1890s. The total asylum population
in the colony numbered only 645 in 1891; double the number of lunatics and
idiots were kept in private houses. There was thus no Great Connement of
the insane in the Cape Colony during the nineteenth century. Yet some of the
same pressures for institutionalization operated at the Cape as in Europe: the
disruption of social networks of care and a dominant-class fear of uncontrolled
behaviour within an increasingly ordered urban society.
An analysis of admissions to the Robben Island asylum can illustrate the
social dimensions of psychiatric practice at the Cape. Fox has suggested that pa-
tients committed to the San Francisco asylum in the early twentieth century were
a strikingly heterogeneous [group, sharing] neither a common social background, a
similar mental condition, nor even a customary route to the asylum . . . What united
them, instead, was a type of relationship to other people. The insane were disturbing,
peculiar, or incomprehensible. They were in many cases out of touch with reality and in
a small number of cases violent or destructive. But they became insane not when they
crossed some well-dened boundary between health and sickness, between normality
and abnormality. They became insane when other individuals decided they could no
longer be tolerated.4
It is clear from the Robben Island records that the Cape asylum, unlike the San
Francisco asylum,5 was catering mainly for the dangerous insane. This was
partly a feature of the minimal institutional provision for the insane at the Cape
and partly due to the legal strictures on admitting ordinary lunatics before
1891. And yet within this framework the island admission records highlight
interesting gender and racial variations in institutional use as well as changing
patterns of admission and treatment that can be related to social and economic
changes in the society at large.
Throughout the nineteenth century and into the twentieth, most of the patients
in Cape asylums, including Robben Island, were male6 and disproportionally
many were white. When the Robben Island asylum was established, it took
from country gaols and the overcrowded Cape Town hospital those who were
2 Report of the Inspector of Asylums for 1890, Cape Parliamentary Papers (CPP), G371891,
14.
3 S. Garton cited in C. Coleborne, Passage to the asylum, below.
4 R. W. Fox, So Far Disordered in Mind: Insanity in California, 18701930 (London and Berkeley,
1978), 79.
5 Ibid., 1378.
6 Swartz, Colonialism and the Production of Psychiatric Knowledge, 132; Valkenberg was an
exception in having more women than men, 133.
22 Harriet Deacon

considered most disruptive to an institutional order on the mainland that placed

a new stress on the performance of work by gaol inmates and the speedy cure
of patients in the hospital. It took time to develop a curative ethos on the island,
however. During the rst fteen years three out of ve asylum inmates were
black, nearly half of whom had come through the criminal justice system. Dur-
ing the 1860s and 1870s, the proportion of white paying patients rose vefold as
the asylum underwent reforms along humanitarian moral management lines.
After 1875, new asylums were opened on the mainland to take these middle-
class patients, more of whom were women than before. Greater pessimism over
the curability of black lunatics now coincided with increasing racism in colo-
nial society.7 Within the system of colonial asylums, Robben Island was marked
for the most dangerous and threatening members of society. By the early twen-
tieth century, four out of ve of the island asylum inmates were black and a
third were convicts. The asylum had come full circle, its function once again
to remove troublesome black male prisoners from overcrowded prisons.

The process of admission

In order to analyse the process of admission to the asylum at Robben Island,
a database was compiled from patient admission records. It is important to
treat the statistical data with care, however. The records are incomplete before
1872, and systematically favour long-stay cases and those admitted through the
Somerset Hospital, founded in 1818 as the rst civilian hospital at the Cape.
Early admission data have been gleaned from Old Somerset Hospital admission
registers and correspondence les. Using the admissions database, the average
admission rate for the period 184652 is 19.3 admissions per annum, while
ofcial statistics for the same period record 29.2 admissions per annum. It
should be remembered too that categories such as nationality changed over
time, as did diagnostic terms and procedures.
The asylum population at Robben Island must be treated as a historically
specic subset of those people who would today be dened as mentally ill
rather than as representative of the distribution of madness in the colony. Except
possibly for middle-class British settlers after 1860, the major pressures for in-
stitutionalization at the Cape were poverty and fear of violence rather than
the hope of a cure. There is little evidence that the establishment of an asy-
lum in 1846 produced or reected a change from home care to the use of
the asylum as a therapeutic resource. Africans,8 Dutch-Afrikaans settlers9 and
7 On racism in colonial psychiatry see Swartz, The Black Insane.
8 Although people who have been born in Africa, or lived most of their lives there, and certainly
those who lived there before 1652, could all be termed Africans, in this paper I have used the
term African specically to refer to those black indigenous inhabitants of the Cape who were
probably not identied as Khoisan, Malay or coloured.
9 The Dutch-speaking white settler community at the Cape came from a range of continental
European countries, but predominantly from the Netherlands and Germany. Most immigrated
to the Cape before 1806. Although there was considerable intermixing with the local slave and
 Robben Island Lunatic Asylum, South Africa, 18461910 23

Muslims10 all continued to be reluctant to use the asylum. Admissions were

dominated by those considered dangerous, by the friendless and the poor. I
shall therefore start by examining the pressures for institutionalization and the
alternatives to the asylum before exploring the processes through which the
insane were identied and admitted to the asylum. Then I shall examine the
social constitution of the asylum population.

The making of an asylum population

When the Robben Island asylum was opened in 1846 it provided an extra seventy
hospital beds for lunatics in addition to the thirty or more in the Somerset
Hospital in Cape Town. These places were soon lled by patients who had
been in gaols, in the pauper asylum at Port Elizabeth and in home care. Few
of these people had any alternative source of care. In 1861 the asylum keeper
commented that if the lunatic men had any one to come for them . . . they would
be sent away.11
Ex-slaves, indigenous Khoisan12 and Africans made up nearly 60 per cent
(n = 87) of all rst admissions given nationalities who were admitted to the
Robben Island asylum in the period 184661.13 Annual reports give a break-
down of lunatic numbers by race and nationality after 1859. In that year
there were 156 lunatics, of whom 70 per cent (n = 110) were described as
Hottentot,14 African (some of these were probably Dutch colonials) or
Kar,15 and 23 per cent (n = 37) were from the United Kingdom.16 Recent
European immigrants, ex-slaves, African refugees from the frontier wars, and
others without strong family networks were more likely to require state aid

Khoisan population, by the end of the nineteenth century those who saw themselves as white
had developed a strong racialized identity as Afrikaners.
10 In Cape Town at this time, Muslims were what nineteenth-century settlers called Malays,
black descendants of slaves who had come from East Asia and parts of Africa, many of whom
converted to Islam after their arrival at the Cape and intermarried with local settler and indigenous
populations. A number of Cape Town Muslims were able to rise above the extreme poverty of
the urban underclass.
11 Pierce, minutes of evidence, Report of the Commission of Inquiry into the General Inrmary
and Lunatic Asylum on Robben Island, CPP, G311862, 109.
12 Some of the indigenous people who lived off the land around Cape Town and in the interior,
mainly to the west and north, were hunter-gatherers and others were pastoralists. The Dutch
called the former Bushmen and the latter Hottentots. Although later scholars have attempted
to get away from the pejorative uses of these words by inventing new terms (San and Khoi or
Khoekhoe respectively), which I have used in this paper, the distinction between the two is not
always sustainable (hence the use of the term Khoisan).
13 The sample is small, and the large number of ex-slaves listed in the registers may be partly
because they were admitted on government order. However, the general picture from ofcial
statistics is similar.
14 See explanation of the term Khoisan.
15 A term used by settlers in the nineteenth century to refer to Xhosa-speaking Africans from the
eastern Cape.
16 Report on the General Inrmary, Robben Island for the year 1859, CPP, G111860, 4.
24 Harriet Deacon

in times of distress. Emancipation and the transition to a market economy be-

fore mid-century, which reduced traditional family and employers support for
the mentally ill, and encouraged the use of the asylum in Britain,17 may have
increased the pressure on poor families to send cases to Cape Town for institu-
tional care. Most of the Africans entering the Robben Island asylum were men
unemployed or migrant workers referred by employers or the criminal jus-
tice system rather than their own communities.18 Similarly, Victorian asylums
in Australia admitted few aboriginal patients.19 In twentieth-century colonial
Africa, governments still considered the care of the African insane to be the
concern of their communities rather than the state.20
There were options outside the asylum that even the poor could utilize
in the absence of family care. The Dutch Reformed Church, to which most
Dutch-Afrikaans settlers belonged, provided boarding-out care for non-violent
lunatics. There were Cape Dutch home remedies for hysteria and epilepsy21 and
some patent medicines, very popular among the Dutch-Afrikaans community,
like Dr Forsyths Chemic Health Restorer, were said to cure nervousness.22
For those without church or nancial resources there were other options. The
insane orphan Maggie K was kept at the Salvation Army Rescue Home for
some time before being taken to the police by a friend of the family.23 In 1883
a Woodstock resident called a Malay doctor to attend to her servant girl who
had gone mad or was in a t. Brutus, the doctor, chanted and sang in the
vernacular to ward off the presence of the Devil who, he said, had been in the
room the previous night.24 Vertical charity thus assisted some of the mad just
as it assisted the poor in general.
Institutional provision for the insane in the Cape Colony was limited and in
demand. The Robben Island Surgeon-Superintendent, Dr Edmunds, attested in
1871 to the numerous applications for admission.25 Even in the 1880s, the
asylums at Robben Island and Grahamstown were usually so full that cases had
to be kept in gaols for many months where they were aggravated by becoming
the butt and amusement of the prisoners.26 These cases included convicts who
17 A. Scull, The Most Solitary of Afictions: Madness and Society in Britain 17001900 (London,
1993), 2632.
18 On the paths of black people into asylums see Swartz, The Black Insane, 408.
19 Coleborne, Passage to the asylum, below.
20 M. Vaughan, Curing their Ills: Colonial Power and African Illness (Cambridge, 1991), 120.
21 D. G. Steyn et. al. (eds.), Volksgeneeskuns in Suid-Afrika:  n Kultuurhistoriese Oorsig, Benewens
 n Uitgebreide Versameling Boererate (Pretoria, 1966), 258; L. Pappe, Florae Capensis Medicae
Prodromus: An Enumeration of South African Plants used as Remedies by the Colonists of the
Cape of Good Hope (Cape Town, 1868), 16, 46.
22 The Lantern, 18 May 1878.
23 Sub-Inspector Barnes to Resident Magistrate of Cape Town, 10 July 1898, Cape Town Munici-
pality Papers: Lunacy 18781910, 1/CT 12/53, Cape Archives, Cape Town (CA).
24 The Lantern, 25 August 1883.
25 Report on the General Inrmary, Robben Island for the year 1871, CPP, G181872, 8.
26 Reports of the Civil Commissioners, Resident Magistrates and District Surgeons for 1882,
East London, CPP, G911883.
 Robben Island Lunatic Asylum, South Africa, 18461910 25

had become insane as well as non-criminal cases.27 Dangerous or violent cases

usually got precedence for admission to the island because of the shortage of
asylum provision. The Old and the New Somerset Hospitals in Cape Town
were also used to house lunatics. One Jan du P, from the country town of Paarl,
having threatened his family with a knife, thinking that he was being poisoned,
was kept in the Old Somerset Hospital for twelve years with chronic mania
before his transfer to Valkenberg in 1891.28 The more modern New Somerset
Hospital was used for patients like Miss S, who in 1864 was transferred from
the Old Somerset Hospital where it was deemed quite impossible . . . to pay
proper attention to lunatic females of her class.29
The wealthy insane had a wider choice of options than the poor: home care,
boarding-out, private asylums and state institutions. Initially, however, the island
asylum had a poor public image that discouraged all but the most desperate
applicants. There was also a general aversion to hospitals among the middle
classes at the Cape. Growth in middle-class use of asylums abroad and their in-
creasing association with cure made the institutional option more popular during
the latter half of the nineteenth century. Walter E, a colonial-born Englishman
who worked as a clerk in the attorney generals ofce, was sent to Robben
Island in 1855 and again in 1880. He was described as an imbecile . . . harm-
less and quite childish, but had delusions of persecution by Malays. After
Walter Es discharge from the island, Dr Beck suggested a complete change to
cure his loss of memory and general nerve depression. But when he returned
from his holiday abusive, threatening suicide and sexual assault, he was sent to
Robben Island again before being transferred to Valkenberg in 1891.30
Private care of the wealthier insane continued to play an important role even
after middle-class facilities were made available in Cape asylums. Most of the
propertied insane were admitted to the Valkenberg and Grahamstown asylums,
who cultivated a more elitist image than the Robben Island asylum.31 During
the 1880s some private practitioners dissuaded relatives from sending patients
to Robben Island or the Somerset Hospital.32 Cape Town doctors continued
to treat some better class lunatics privately in 1879, patients for whom the
existing arrangements on Robben Island were said to be quite unt.33 As

27 R. Southey to Edmunds, 19 Feb. 1868, letters despatched by Colonial Ofce, CO 6861, CA.
28 Valkenberg Asylum casebook 1, 18914, University of Cape Town (UCT) Manuscripts Collec-
tion, Cape Town.
29 J. Laing to Colonial Secretary, 23 Dec. 1864, letters received by Colonial Ofce, CO 827, CA.
30 Valkenberg Asylum casebook 1, 18914, UCT Manuscripts Collection, Cape Town.
31 Report on Robben Island in Reports on the Government-aided Hospitals and Asylums and
Report of the Inspector of Asylums for 1892, CPP, G171893, 135.
32 D. Moyle, Laying down the Line: The Emergence of a Racial Psychiatric Practice in the Cape
Colony During the Nineteenth Century, unpublished paper, Psychology Department, UCT,
1988, 10.
33 Dr J. F. Manikus, Minutes of Evidence, Report of the Commission appointed to inquire into
and report upon the best means of moving the asylum at Robben Island to the mainland, CPP,
G641880, 21.
26 Harriet Deacon

late as 1898, the Cape Argus reported that poorer patients were sent to the
asylum sooner, as rich families will do anything rather than send [their insane
relatives] to a hospital.34 In 1890, only thirteen of the thirty-nine propertied
insane placed under curatorship by the Supreme Court were accommodated in
asylums the rest were kept in private homes.35
Although most of those recognized as insane were not sent to asylums, private
asylums never loomed as large at the Cape as they did in England.36 In 1845,
Harriet O complained that there were no private houses for the treatment of the
insane in Cape Town. Her father was forced to go either to the Somerset Hospital
or to Robben Island.37 In 1905, only a Miss Durrs in Mowbray was licensed
under the 1897 Act as a private lunatic asylum. It housed three uncertied
European women patients as voluntary boarders.38 Informal boarding houses
were more common. Thomas McS, an English hotel keeper in Caledon, was
boarded with a family after the death of his mother in 1890, three years after
he began to get violent. He was admitted to Valkenberg in 1891. Ebenezer K,
declared of unsound mind in the Supreme Court in 1843, was boarded out
for ten months before going to England where he was in fact certied sane.39
Sending the insane home to England was not general practice. In 1889, Robben
Island surgeon-superintendent Ross had to make a special case of C, a dipso-
manic with strong leading delusions, whom he wanted to send to relatives in
England at government expense.40
The 1891 census provides the rst accurate estimates of the relative balance
between different forms of provision for lunatics. It shows that 1,281 lunatics
were being maintained in private dwellings, as opposed to 120 in jails and ap-
proximately 645 in Cape asylums.41 Males were signicantly over-represented
among those certied as insane, but whites were only slightly over-represented.
While the malefemale ratio approached unity in the colony,42 men represented
nearly two-thirds of the insane. While whites represented about a third of the

34 Quoted in the South African Medical Journal (1898), 48.

35 Report of the Inspector of Asylums in Reports of the Medical Committee . . . for 1890, CPP,
G371891, 10.
36 See W. L. Parry-Jones, The Trade in Lunacy: A Study of Private Madhouses in England in the
Eighteenth and Nineteenth Centuries (London, 1971).
37 Memorial from Harriet O, 6 Dec. 1845, memorials received by Colonial Ofce, CO 4026,
doc.468, CA.
38 Report of the Inspector of Asylums in Reports on the Government-aided Hospitals . . . for 1905,
CPP, G321906, 54.
39 Valkenberg Asylum casebook 1, 18914, UCT Manuscripts Collection, Cape Town; and
Supreme Court, Cape Town Mail, 28 February 1846.
40 W. Ross to Under Colonial Secretary, 11 March 1889, Colonial Ofce, letters received, CO
1438, CA.
41 Report of the Inspector of Asylums in Reports on the Government-aided Hospitals and Asylums
and Report of the Inspector of Asylums for 1892, CPP, G171893, 126, 134.
42 Census of 1891, CPP, G61892, 22.
 Robben Island Lunatic Asylum, South Africa, 18461910 27

Table 1.1 The number of lunatics and idiots in the

colony in 1891, as recorded in the 1891 census

Asylums Outdoor lunatics Outdoor idiots Gaols

Male 396 244 450

Female 249 253 334
White 350 131 266
Black 295 366 518
Total 645 497 784 120

colonial population in 1891,43 they comprised two-fths of the insane. In a

situation of scarcity of asylum accommodation, admission was granted more
often to white men (whose insanity threatened white supremacy and raised the
spectre of degeneration and hereditary insanity) and black men (whose insanity
threatened white society by disrupting employment relations or the taboo on
sexual contact with white women).44
Cape asylums were also admitting only a small proportion of those who were
recognized by their communities and the authorities as insane, and admitting
these patients very selectively (see Table 1.1). Although the number of asy-
lum patients had nearly doubled in the previous decade,45 it still represented
only about half of the number outside asylums and gaols. Nearly two thirds
of certied mental patients in private dwellings (outdoor lunatics and idiots)
were classied as idiots cases who were probably considered less violent or
dangerous than lunatics. This trend was reversed within the asylums, where
most inmates were certied as lunatics. Yet more of the black and slightly
more of the female insane were outdoor lunatics and more of the white and
male insane were institutionalized.46

Admission procedures
Dening someone as insane was a necessary condition for admission into the
asylum. The doctor was only called to ratify the denition if the person had
already been labelled as insane in social terms and had also become socially or

43 Census of 1891, CPP, G61892, 15 (in that section of the colony dened by the 1875 census,
and thus excluding recently annexed territories).
44 H. J. Deacon, A History of the Medical Institutions on Robben Island, 18461910, PhD
thesis, University of Cambridge (1994), chapter ve; Swartz, Colonialism and the Production
of Psychiatric Knowledge, 11316.
45 Report of the Inspector of Asylums in Reports on the Government-aided Hospitals and Asylums
and Report of the Inspector of Asylums for 1892, CPP, G171893, 126.
46 Moyle, Laying Down the Line, 11.
28 Harriet Deacon

economically problematic.47 The relative scarcity of complaints about wrongful

detention at the Cape testies to the use of the asylum mainly for those cases
who were seriously mentally ill, for whom there were few viable alternatives or
whose families approved of their detention. The Lunacy Panic about wrongful
detention of alleged lunatics in England during the 1850s,48 which caused a
urry of legislation in India,49 hardly touched the Cape.
At the nineteenth-century Cape, where in legal terms until 1891 all lunatic
admissions had to be either criminal or potentially so, the boundaries between
the lunatic and the criminal lunatic were vague. Because gaols were used to
accommodate paupers and the insane as well as the criminal, and to police
vagrancy too, there was little pressure to sharpen the boundaries between
the various groups. A prisoner called Rachel N in the House of Correction in
Cape Town in the mid-1870s became too violent to control and was sent to the
Somerset Hospital lunatic wards on the order of the Under-Colonial Secretary.
Convalescent, she was returned to the House of Correction six months later
to complete her sentence of imprisonment.50
Not all lunatic cases stood trial: brought to the gaols for some offence or
nuisance, some were certied insane by the local doctor or district surgeon
and sent to the asylum when there was a vacancy. Michael P, reportedly a source
of annoyance and violence to his friends in Cape Town, was several times
imprisoned in the Cape Town gaol, where he forced conversation upon other
prisoners of the most beastly and unnatural description. A medical board asked
to determine whether he was insane, decided that as a temporary measure he
should be sent to the Robben Island pauper wards.51 Henry I, a similar case,
had run after the young women in his masters house, lit a re in the stable
and scribbled nonsense on the fence. He was sent to Grahamstown Asylum
in 1880 as a criminal lunatic without trial.52 The separation of criminal and
ordinary lunatics only became an issue in the 1890s, when numbers of the latter
increased, and a large proportion were sent to Robben Island from where, it
was argued, they could not easily escape.

47 See Swartz, Colonialism and the Production of Psychiatric Knowledge, 7697 for a discus-
sion of the certicates required by the committal process at the Cape during this period. See
Coleborne, Passage to the asylum, below, for a discussion of New South Wales certicates.
48 T. Turner, Not Worth Powder and Shot: The Public Prole of the Medico-Psychological
Association, c.18511914, in G. Berrios and H. Freeman (eds.), One Hundred and Fifty Years
of British Psychiatry 18411991 (London, 1991), 3.
49 W. Ernst, Mad Tales from the Raj: The European Insane in British India, 18001858 (London,
1991), 456.
50 Under-Colonial Secretary to Surgeon of Old Somerset Hospital, 16 Dec. 1876, Old Somerset
Hospital Papers, letters received: 18761888, HOS 1, CA.
51 Report by the Superintendent of Police, memorial of P, March/April 1859, memorials received
by Colonial Ofce, CO 4110, doc. P36, CA.
52 Case of Henry I, n.d., Health Branch: Criminal lunatics 18939, CO 8050, CA.
 Robben Island Lunatic Asylum, South Africa, 18461910 29

Until the rst quarter of the nineteenth century in England, notions of cul-
pability were centred around obvious signs of behavioural disturbance (e.g.
violence), and required proof that the insane did not know wrong from right,
for if they did they were not insane and could control their actions. After 1825,
the defence of partial insanity, or monomania (delusion), began to be accepted
in English courts and was accompanied by a far greater amount of medical
testimony because the signs of insanity were only discernible by expert eyes.53
In the colony, these ideas took root as well. Elliot, a lunatic on Robben Island
in 1848, had been accused of stealing clothing in Cape Town and had subse-
quently destroyed the clothing given to him in the asylum. Although he had
been rejected by the legal system as insane, his lack of violence and his apparent
consciousness of his misdeeds were commented on by Dr Hall, who said, we
cannot avoid thinking that some degree of knavery is mixed up with his lunacy,
which a little gentle discipline would in all probability correct.54 The idea of
partial insanity was also clumsily suggested in evidence before the Robben
Island Commission in 1861. The assistant lunatic keeper, appropriately named
Mr Nutt, complained that the lunatics who refused to work, fought each other
and stole from the boat, knew that they were doing wrong: They are not quite
right [he said], but some are only a little wrong.55
Psychiatric assessment of dangerousness and the use of the diminished re-
sponsibility defence are now crucial in the sentencing of those who are deemed
mentally disordered in South Africa.56 In dealing with the forensic patient, the
relevance of the crime to sentencing and duration of asylum care remains a
serious issue today.57 Dangerousness played an important role in justifying
asylum admission during the nineteenth century. Besides family applications,
the courts and police networks were the major screening mechanisms for asy-
lum admissions during the nineteenth century, and often invoked the notion of
dangerousness. Whether criminal or not, a large proportion of the patients sent
to Robben Island were perceived as dangerous. In the period 18461910, 406
out of 1,141 rst admissions (36 per cent) entered in the database are listed as
dangerous. Suicidal cases made up about 9 per cent of rst admissions in this
period.

53 J. P. Eigen, Delusion in the Courtroom: The Role of Partial Insanity in Early Forensic Testi-
mony, Medical History 35 (1991), 27, 29.
54 Report by J. Hall on Robben Island, 19 April 1848, minutes of evidence, Report of the Com-
mission of Inquiry, CPP, G311862, 1334.
55 Nutt, minutes of evidence, Report of the Commission of Inquiry, CPP, G311862, 16970.
56 Henning cited in A. Cohen, The Psychiatric Assessment of Dangerousness at Valkenberg
Hospital, MA thesis, UCT (1991), 27, suggests that in South Africa today, although most
Attorneys General feel that the duration of a patients detention in an asylum should be directly
related to the seriousness of their crime, the therapeutic policy of the Department of Health
relates length of detention to cure.
57 Cohen, The Psychiatric Assessment of Dangerousness, 28.
30 Harriet Deacon

Because of the bias towards long-stay patients in the pre-1872 records, and the
scarcity of accommodation for the mentally ill in this period, one might expect
that dangerousness would be a major criterion for admission to Robben Island
before 1872. Indeed, fourteen (nearly a third) of the forty-nine patients sent
from Somerset Hospital to Robben Island in 1846, the year the latter hospital
opened, were described as violent or treacherous.58 The cases of Joseph O
and Cornelia S, both held in the lunatic wards of the Old Somerset Hospital in
1845, and earmarked by the authorities for transfer to Robben Island, illustrate
the inuence of assessments of dangerousness in sending patients to the Island.
The relatives of both cases did not want them transferred, as Robben Island was
too far away, and was already stigmatized. Joseph O was an epileptic who had
been cared for at home by his daughter for six years until he became violent,
when he was put into the Old Somerset Hospital. Cornelia S was a peaceful
lunatic who had been kept in the Old Somerset Hospital for fteen years, visited
by her sister whose husband could not afford to keep Cornelia at their home.
Cornelia was allowed to remain in the Old Somerset Hospital while Joseph,
who was considered too disruptive for the pauper wards, was transferred to the
island.59
For the whole period before 1872, however, only a tenth of rst admissions
to Robben Island were described as dangerous in the Somerset Hospital regis-
ters (see Table 1.2). On the Island in 1848, the surgeon-superintendent reported
that with two or three exceptions the lunatics [were] tranquil.60 In 1861 the
chaplain, Revd J. A. Kuster complained that he visited the lunatics only once
a month, as [s]peaking with them affects my nerves very much, there being
much disturbance from the noisy ones.61 Noisy or disruptive behaviour, in the
wards, at work, or in church, was reported as the major disciplinary problem
in the asylum, although every year there were a few cases of violent assault.62
This suggests that, although always important as a justication for admission or
transfer, the notion of dangerousness was used far less before 1872 than there-
after in admission registers for the island asylum. This may have been because
in 1879,63 the rst mental health legislation concerned with institutionalization

58 H. Bickersteth to Acting Secretary to Government, 23 June 1852, in Report of the Select Com-
mittee on and documents connected with, the Robben Island Establishment, CPP, A371855,
41.
59 Memorial of H.O., 6 Dec. 1845, memorials received by Colonial Ofce, CO 4026, doc.468, CA;
memorial of J.S., 3 Dec. 1845, memorials received by Colonial Ofce, CO 4024, doc.127, CA.
60 Report on Robben Island, 19 April 1848, minutes of evidence, Report of the Commission of
Inquiry, CPP, G311862, 133.
61 Revd J. A. Kuster, Minutes of evidence, Report of the Commission of Inquiry, CPP, G311862,
49.
62 For example, J. Verreaux, minutes of evidence, Report of the Commission of Inquiry, CPP,
G311862, 191.
63 See A. Kruger, Mental Health Law in South Africa (Durban, 1980), pp. 1213 for a discussion
of the Act.
 Robben Island Lunatic Asylum, South Africa, 18461910 31

Table 1.2 Proportion of rst admissions

to the Robben Island Lunatic Asylum
recorded as dangerous, 18461910

Date Dangerous lunatics

18461871 10% (n = 45)

18721890 61% (n = 234)
18951910 41% (n = 127)

at the Cape was passed to provide a legal basis for the detention of criminal
and dangerous lunatics.
By the time the detention of ordinary lunatics was provided for in the 1891
Act,64 Robben Island was earmarked for dangerous and criminal lunatics any-
way. As more mainland asylums opened, a greater proportion of dangerous
and criminal patients were sent to the island asylum. By 1881, Grahamstown
asylum accommodated a signicantly smaller proportion of maniacal and dan-
gerous cases than did Robben Island.65 In the period 187290, two-thirds of
rst admissions to the Robben Island asylum were characterized as dangerous.
This proportion dropped to two-fths in the period 18951910 (see Table 1.2).
By this time more of the Robben Island patients were criminal lunatics (34 per
cent rather than 28 per cent) whose detention was already justied by the court
and legislative changes that had increased the range of patients who could be ad-
mitted, including ordinary and voluntary patients, which reduced the burden
on dangerousness as a justication for admission.
Men were consistently more likely than women to be designated dangerous
in the Robben Island registers, in line with contemporary gender stereotypes.
Although there was a long association in colonial discourse between black-
ness and dangerousness too, and black mental patients are perceived as espe-
cially dangerous in Britain and America today,66 dangerous admissions at the
Robben Island asylum were not disproportionately black. This may have been
because far more of the black admissions came through the criminal justice
system, and their detention was already justied on those grounds (see above).

The denitions of insanity

The process of dening madness was not uniform. Disagreement over who was
insane illustrates the uid nature of boundaries of deviance. There were cases
64 Ibid., p. 14. 65 Cape of Good Hope Blue Book for 1881, 228.
66 P. Moodley and G. Thornycroft, Ethnic Group and Compulsory Detention, Medicine, Science
and Law 28 (1988), 32428; M. Sabshin, H. Diesenhaus and R. Wilkison, Dimensions of
Institutional Racism in Psychiatry, American Journal of Psychiatry 127 (1970), 78793.
32 Harriet Deacon

at Robben Island thought not to be insane, either by their families or by the

staff. In 1860, for example, the attendant Pierce felt that the violent actions of a
Mr S, employed in the colonial auditing department in Grahamstown, towards
a fellow lodger who had stolen something from him, were used against him in
some foul play resulting in his admission to Robben Island.67 S had no trial,
and was apparently sent to the island without being told what had happened.68
He was not considered insane, but nevertheless spent some time on the island.
There were more fundamental debates about the meaning of insanity, how-
ever. In 1873, the island chaplain, Baker, commented on a case of religious
mania as follows:
[De V is now] quite sane, may be a little eccentric, and doubtless too practically
religious to be regarded as quite right by ordinary people. I counselled him not to bring
religion openly to bear on triing matters of daily routine or domestic life. I wish many
were like him.69

He admitted nevertheless that the Bible could be misused, commenting in 1869

that
From conversations . . . with one or two of the patients, I have been convinced that it would
be better not to give the Bible generally to them, but a book of suitable readings from
the Scriptures, with forms of prayer. They morbidly turn to unprotable expressions,
and nd food for their diseased minds [in the full Bible text].70

Baker was tolerant of eccentricities, as long as they coincided with his moral
viewpoint. His emphasis on religious instruction and morality as the only good
way of living gave his psychological counselling a particular emphasis. He
recognized the need to speak less plainly to a sensitive Lunatic,71 but did
not agree with the surgeon-superintendent, Dr Biccard, who quoted, in 1876,
a medical man of 12 years experience who made it a rule never to discuss
or allow to be spoken of, matters of Religion and Politics in his Asylum.
Only convalescents should be allowed to attend church, said Biccard.72 In other
ways, Bakers view of the insane was more inclusive than the medical denition,
possibly due to the fact that he was more concerned with the content of utterances
than with the pathological form.
In general, Baker and the other island chaplains seem to have relied on the
usual visual and audible indications of the ordinary features of insanity, such

67 Pierce, minutes of evidence, Report of the Commission of Inquiry, CPP, G311862, 108.
68 G. M. S., minutes of evidence, Report of the Commission of Inquiry, CPP, G311862, 224.
69 Baker, 11 Nov. 1873, Chaplains Diaries, AB 1162/G2, University of the Witwatersrand
Manuscripts Collection (UWMC), Johannesburg.
70 Baker, 10 Sept. 1869, Chaplains Diaries, UWMC, AB 1162/G2.
71 Baker, 30 April 1877, Chaplains Diaries, UWMC, AB 1162/G3.
72 F. L. C. Biccard to Under-Colonial Secretary, 6 July 1876, letters received by Colonial Ofce,
CO 1027, CA.
 Robben Island Lunatic Asylum, South Africa, 18461910 33

as a lack of rational conversation, over-excitement, and strange appearance

or lack of composure.73 In 1870 he urged a Miss P to be calm, in spite of her
excitement at being discharged, in order that this not be interpreted as insanity.74
In 1874, using a popular etiology, he linked the violence of some of the lunatics
on a Sunday to the presence of a new moon.75 In 1876, he was concerned
about the over-hasty discharge of a certain Mrs S, who he felt ought to be
removed from the society of insane people but that from her expressions
about her husband and her feeling towards myself, etc., I fear she should not
retake the full status of a wife.76 Baker supported the asylum doctors decisions
regarding institutionalization, however. For example, Baker wrote to the brother
of a patient, Dr P. J. van B, whose family was agitating for his release on the
grounds of temporary insanity, noting that the patient had conducted himself as
a gentleman. But Baker then wrote in his journal that he had made no remark
as to mental disease nothing to be used as proof of sanity in their attempts
to free the patient against medical advice.77

Medical diagnoses
Nineteenth-century doctors denitions of who was insane tallied closely with
social denitions. Almost all they added to the process was a medical diagno-
sis. During the early nineteenth century in Europe, doctors classications of
the insane centred around gross behavioural signs, and simple putative causes:
major categories were mania, melancholia, phrenzy, dementia and lethargy.78
The Robben Island doctors used a similar classication, centred around mania,
dementia, melancholia and idiocy or imbecility. More detailed diagnoses were
given as the century wore on. S. Swartz has suggested that nineteenth-century
medical certicates for the insane in the Cape were legal documents justifying
institutionalization, rather than medical diagnoses with implications for treat-
ment. She indicates that in the latter part of the century, these justications
hinged on evidence that the patient was becoming childish (dementing); that a
patient was passive (lazy, lethargic, mute, withdrawn) or violent and hyperac-
tive; and/or that patients were immoral (including all sexual behaviour such as
masturbation).79
Many asylum patients in Britain before mid-century suffered serious bouts
of psychosis, were suicidal or suffered from serious mental disability. By the
73 Baker, 28 Dec. 1869, Chaplains Diaries, UWMC, AB 1162/G2.
74 Baker, 29 July 1870, Chaplains Diaries, UWMC, AB 1162/G2.
75 Baker, 20 Oct. 1874, Chaplains Diaries, UWMC, AB 1162/G3.
76 Baker, 11 Aug. 1876, Chaplains Diaries, UWMC, AB 1162/G3.
77 Baker, 5 July 1872, Chaplains Diaries, UWMC, AB 1162/G2.
78 G. E. Berrios, Historical Background to Abnormal Psychology, in F. Miller and P. J. Cooper
(eds.), Adult Abnormal Psychology (Cambridge, 1988), 30.
79 Swartz, Colonialism and the Production of Psychiatric Knowledge, 789.
34 Harriet Deacon

Table 1.3 First diagnoses of rst admissions to the Robben Island Lunatic
Asylum who were given diagnoses, 18461910 (percentage)

Idiocy
Date Mania Dementia Imb.a Melancholia Generalb Other Total

184661 52.7 19.6 1.6 0.4 24.6 1.2 100

(n = 137) (n = 51) (n = 4) (n = 1) (n = 64) (n = 3) (n = 260)
186271 28.0 30.6 6.5 3.2 30.6 1.1 100
(n = 52) (n = 57) (n = 12) (n = 6) (n = 57) (n = 2) (n = 186)
187290 53.5 26.8 9.7 6.6 2.4 1.0 100
(n = 204) (n = 102) (n = 37) (n = 25) (n = 9) (n = 4) (n = 381)
18951910 52.8 13.4 7.2 13.8 9.5 3.3 100
(n = 161) (n = 41) (n = 22) (n = 42) (n = 29) (n = 10) (n = 305)

a Idiocy and imbecility were not formally distinguished although the general trend was towards

dening more severe cases as idiots.

b I have invented this category to describe non-specic diagnoses such as insanity or lunacy .

mid- to late nineteenth century, British alienists admitted more patients with
less serious disorders.80 It is difcult to ascertain reliably the extent of severe
dysfunctional behaviour from the diagnoses in the Robben Island admission
registers, however, as there are no surviving case books detailing behaviour.81
The frequency of the appellation dangerous (see above) does perhaps indicate
that aggression and behavioural dysfunction were very common. Throughout
the period, the most common diagnoses for the Robben Island admissions were
mania of various types, and dementia (see Table 1.3). The less disruptive
forms of insanity (idiocy, imbecility and melancholia) were diagnosed
slightly more frequently as the century wore on, perhaps indicating a greater
willingness among doctors to venture out of general descriptions such as in-
sanity or a greater preponderance of mental deciency and depression among
patients. As diagnoses became more sophisticated and scientic, general de-
scriptions like insanity or lunacy were used less often. Diagnoses of epilepsy
remained constant, representing about 10 per cent of rst admissions throughout
the period 18461910, often coupled with other diagnoses.
Delusions were a clear identier of the insane, by doctors and lay people alike.
It has been argued that delusions cannot tell us much about the social fabric of
life for the population at large, but delusional content may nevertheless reect

80 See L. Smith, Cure, Comfort and Safe Custody: Public Lunatic Asylums in Early Nineteenth-
Century England (London, 1999).
81 Swartz, Changing Diagnoses in Valkenberg Asylum, 451 has suggested that because diagnoses
and descriptions of symptoms changed so often in asylum records, information about rst
diagnoses in admission registers does not represent the complexity of the system of psychiatric
diagnosis. This means that while we can compare diagnostic patterns to social prejudices, we
cannot simply translate nineteenth-century diagnoses into modern ones.
 Robben Island Lunatic Asylum, South Africa, 18461910 35

general social tensions.82 The 1880s was a time of increasing concern about the
Malay (Muslim) threat in Cape Town, as the white middle classes believed
that the smallpox epidemic of 1882 was exacerbated by the burial practices of
the Muslim community. Muslims were associated with magic, poisoning and
dirtiness.83 One man who was sent to Robben Island in 1886 complained that
he could not sh because the Malay men hid under the water and took the
sh off his line.84 Another patient refused to apologize for beating his wife and
children because he said a Malay had bewitched him.85 The idea of being
Malay tricked was also a feature of delusional content among Valkenberg
patients.86

Causes of insanity
Lay and medical explanations of insanity commonly emphasized the inability
of the insane person to cope with the trials and temptations of life, or the ad-
verse effects of excess. This social explanation of insanity was older than,
and existed alongside, physical explanations (referring to brain lesions) and
later physiological ones (referring to brain function) advanced by alienists in
Europe and America.87 But the assignation of etiology was not a priority for
the asylum doctor. Only just over a quarter of admissions to the Robben Island
asylum between 1872 and 1890 are given etiologies, while the register is com-
plete in most other respects. Of the cases given etiologies, 37 per cent (n = 39)
were deemed hereditary, 31 per cent (n = 33) due to physical causes and 26
per cent (n = 28) to moral causes. The latter included adverse circumstances,
disappointed affections, religious enthusiasm and temper.88 Physical eti-
ologies, that also had moral or social dimensions, included climate, deviant
sexual behaviour such as masturbation or promiscuity, and alcohol abuse.89
By the late nineteenth century, doctors saw heredity as the primary etiology.
Dodds suggested in 1891 that female insanity was due mostly to hereditary
factors or other bodily diseases.90 Dr Greenlees of the Grahamstown Asylum
82 J. C. Burnham, Psychotic Delusions as a Key to Historical Cultures: Tasmania, 18301940,
Journal of Social History 13 (1980), 373.
83 J. V. Bickford-Smith, Ethnic Pride and Racial Prejudice in Victorian Cape Town: Group Identity
and Social Practice, 18751902 (Cambridge, 1995), 714.
84 Case of Jan, n.d., Health Branch, Criminal lunatics 18931899, CO 8050, CA.
85 Case of Bekker, 25 Nov. 1895, Attorney Generals Papers, Lunatics 18945, AG 1932, CA.
86 Swartz, The Black Insane, 4045.
87 Berrios, Historical Background, 29.
88 These etiological terms were not invented by colonial doctors (see Sankey cited in R. Russell,
Mental Physicians and their Patients: Psychological Medicine in the English Pauper Lunatic
Asylums of the later Nineteenth Century, PhD thesis, University of Shefeld (1983), 41).
89 For an example of self-diagnosis see A. Simons to W. J. Dodds, 22 December 1894, Valkenberg
Asylum casebook 1, 18914, UCT Manuscripts Collection, Cape Town.
90 Report of Inspector of Asylums in Reports of the Medical Committee . . . for 1891, CPP,
G361892, 10.
36 Harriet Deacon

argued that heredity was a more important cause of insanity among whites in
the Colony than in England.91 There was a marked drop in diagnostic interest
at Robben Island after 1890, due probably to the large number of supposedly
incurable black and criminal cases. Etiologies were given to only 11 per cent
(n = 34) of rst admissions in the period 18951910, compared to 28 per cent
(n = 106) in the period 18721890.
Throughout the period 1846 to 1910, alcoholism was advanced as a cause
of insanity in just over a tenth (n = 18) of all cases given etiologies. This is the
second largest category after heredity. In evidence from the 1850s, it is clear
that although addiction to drink was seen as a cause of insanity, being drunk
was not conated with being insane, and the insane alcoholic could be cured by
abstinence. K was said by his brother to have destroyed his mental faculties
through drink in 1849;92 Birtwhistle suggested in 1850 that Hugh G be sent
on a sea voyage to avoid temptation from drink.93 In 1855 Birtwhistle said
that Mr V, admitted to Robben Island with mania, had merely been suffering
from the effects of drink when examined by Dr Frankel on the mainland,
and was not therefore showing further signs of insanity.94 Epileptic cases, said
the chaplain in 1876, would be improved by the withholding of intoxicating
drinks.95 Alcohol was nevertheless provided for patients as part of their asylum
diet because it was a central part of nineteenth-century medical treatments.96 In
the 1860s, a patient with delirium tremens was turned away from the Somerset
Hospital with the advice to go home and drink some whisky.97

The social prole of the Robben Island patient

This section examines the social prole of rst admissions to the Robben Island
asylum between 1846 and 1910, focusing on the period 18721890, for which
there is most information. This period differs from earlier and later periods
at the asylum because non-criminal cases make up a large proportion of the
intake, and white lunatics predominate. The gures in Table 1.4 show that the
Robben Island admissions were disproportionately likely to be middle-aged

91 Quoted in R. C. Warwick, Mental Health Care at Valkenberg Asylum 18911909, BA (Hons.)

thesis, UCT (1989), 57.
92 Memorial of K, 29 October 1849, memorials received by Colonial Ofce, CO 4047, doc., 3, CA.
93 J. Birtwhistle to Colonial Secretary, 23 Oct. 1850, Robben Island Letterbook, RI 1, CA. See
also Birtwhistle to Colonial Secretary, 2 Nov. 1854, Robben Island Letterbook, RI 1, CA.
94 Birtwhistle to Colonial Secretary, 18 March 1855, Robben Island Letterbook, RI 1, CA.
95 Chaplains Report in Report on the General Inrmary, Robben Island for the year 1876, CPP,
G201877, 6.
96 W. Edmunds in P. E. Wodehouse to the Duke of Newcastle, 7 Aug. 1863 in Correspondence
between the Colonial Government and the Authorities at Home Relative to the Robben Island
Institution 18631865, CPP, A91865, 18.
97 P. Landsberg, minutes of evidence, Report of the Select Committee appointed to take into
consideration the papers laid on the table referring to Somerset Hospital, CPP, A271865, 20.
 Robben Island Lunatic Asylum, South Africa, 18461910 37

Table 1.4 Social prole of rst admissions to the Robben Island

Lunatic Asylum, 18461910

Total in White Male Paying Mean Median

Date sample % % % age age

184661 261 37.8 61.8 0.8 33.5 30.0

186271 186 56.5 68.5 4.8 33.8 32.0
187290 384 60.8 65.0 24.0 35.2 34.5
18951910 310 19.4 63.9 7.1 34.9 32.0

males between 1862 and 1890. Paying patients represented about a quarter of
rst admissions between 1872 and 1890.
Different admission or diagnostic patterns for racial and gender-dened
groups at the Robben Island asylum could be caused by the race or gender-
bias of colonial ofcials or doctors, or by systematic differences between these
groups in terms of family circumstance, culture and incentives or opportunities
for seeking care. The relative role of these factors in diagnosis could be estab-
lished by looking at individual case records. These are however absent from the
Robben Island archive, the only detailed case records coming from records of
those transferred to Valkenberg or Grahamstown or the Old Somerset Hospital.
An analysis of the patient prole can nevertheless inform our understanding of
the way in which the asylum was used by psychiatrists, their clients and the
community.
Fox shows that admissions to the San Francisco Asylum (190629) were
mostly lower-class, single adult males.98 Black admissions to Robben Island
were largely single adult males but among white admissions there was an in-
creasing tendency to use the asylum for middle-class, married white females
in the period from 1860 to 1890. Both black and white women continued to be
underrepresented at Robben Island compared to the colonial population, how-
ever, possibly for different reasons. Black women, especially Africans, were not
fully urbanized and therefore avoided contact with white employers or agents
of the state. More white families could afford private care to avoid the stigma
of institutionalization, and they were more likely to keep mentally ill women
at home.
Recent historians of gender and psychiatry have argued that women have
suffered the brunt of psychiatric intervention as they are represented in greater
numbers both in Victorian asylums and in the more diffuse psychiatric patient
population today.99 This feminization of psychiatry is not evident in South

98 Fox, So Far Disordered in Mind, 105.

99 E. Showalter, Victorian Women and Insanity, Victorian Studies 23 (1980), 161.
38 Harriet Deacon

Africa: neither at Robben Island during the nineteenth century, nor today.100
During the nineteenth century the gender ratio in Cape asylums remained stub-
bornly favourable to men. In the early twentieth century, the preponderance of
male patients at Robben Island can be partly ascribed to the increasing propor-
tion of criminal insane patients (largely men), and possibly also to the increasing
proportion of black patients, for which group there may have been some gen-
der specic recruitment because of the initial predominance of males among
African migrant labourers in the urban areas. By the 1890s only Valkenberg
Asylum attracted a signicant proportion of long-stay female patients whose
middle-class families found the asylum acceptable.101
External factors and the allocation of institutional beds in segregated asylums
can also inuence gender ratios, however. The dominant use of the Victorian
asylum for pauper cases (women were more likely to be recipients of poor
relief), and the provision of more ward space for women in asylums built after
the 1830s were important factors in creating the consistently high ratios of
women to men in Victorian asylums.102 And although admission ratios are
valuable in detecting inequalities, they do not tell the whole story. As Fox has
pointed out, inequalities in admission ratios, or the lack of such inequalities, does
not automatically imply the absence of gendered inequalities associated with
psychiatric care.103 In fact, he shows that in San Francisco between 1906 and
1930, although gender ratios on admission approached unity, women admitted
to the state asylums suffered from longer attacks, were more likely to have
had previous commitments and attacks, and were overrepresented in the age
group sixty-ve and over, compared to men.104 Both variation in length of stay
(women stayed longer) and allocation of bed spaces (men had more bed spaces)
played a role in the gendering of psychiatric provision at Robben Island.
Compared to the general population, proportionally fewer black people
than white were admitted to Robben Island asylum. As in the past, black
South Africans today have different admission gures for certain psychiatric
conditions,105 there are racial differences in the type and form of some men-
tal diseases,106 and some have argued that there are different intra-racial pro-
les depending on experiences of urbanization and what has been termed
transculturation.107 In modern South Africa where racial differences are
bound closely to class and cultural divides, different patterns of aid-seeking,108
100 Swartz, Colonialism and the Production of Psychiatric Knowledge, 21.
101 Ibid., 35, 45, 46. 102 Showalter, Victorian Women and Insanity, 162, 164.
103 Fox, So Far Disordered in Mind, 105, 124. 104 Ibid., 12729, 131.
105 Freed and Bishop cited in L. Swartz, Aspects of Culture in South African Psychiatry, PhD
thesis, UCT (1989), 39.
106 Bartocci cited in Swartz, Aspects of Culture, 41.
107 Cheetham et al. cited in Swartz, Aspects of Culture, 47.
108 Swartz, Aspects of Culture, 40.
 Robben Island Lunatic Asylum, South Africa, 18461910 39

different cosmologies,109 complex culturally based communication failures be-

tween psychiatrist and patient and other variables can systematically inuence
psychiatric proles of the various racial categories. Leslie Swartz argues that
different incentives and opportunities for admission may by themselves produce
different psychiatric proles for various racial groups in South Africa today.110
He has also criticized modern cross-cultural studies in South African psychia-
try for treating black and white patients as culturally separate.111 In assessing
degree and amount of mental illness among Xhosa speakers in South Africa
using the Present State Examination (PSE) in translation as a standard diagnos-
tic tool may be problematic.112 Many studies continue, explicitly or implicitly,
to use racial stereotypes (e.g. the African personality), or a passive, static rep-
resentation of African culture, in order to explain the extent and type of mental
illnesses among black people.113 Similar patterns of racism within psychiatry
have been documented in Britain, where schizophrenia, for example, is more
commonly diagnosed among blacks and the Irish.114
Cultural factors would certainly have affected the admission process at
Robben Island. Fox argues that in early twentieth-century San Francisco, in-
sane foreigners were relatively unlikely to have family in the area who could
refer them to the asylum and were therefore more likely to be picked up by
police. But by comparing police referrals for foreigners and for locally born
cases without family in the area, Fox can conclude that cultural factors played
a large role in determining which people were taken in by police. Foreigners
wandering about the city in inappropriate areas would be picked up and, if
unable to give a good account of themselves in English, appearing confused
or hostile, would often be sent to the courts on a charge of insanity.115 In
the nineteenth-century Cape, recent arrivals to urban areas, especially those
who did not speak English, sometimes ended up in the asylum.116 Recent ar-
rivals from rural African communities in the eastern Cape may have experi-
enced similar problems, as they did in Argentina and Australia.117 Cultural
boundaries were not always contiguous with nineteenth-century racial cat-
egories, however. Cultural similarities between rural Cape coloured and
109 H. Ngubane cited in Swartz, Aspects of Culture, 22.
110 Swartz, Aspects of Culture, 40. 111 Ibid., 52.
112 Gillis et al. cited in Swartz, Aspects of Culture, 36.
113 Swartz, Aspects of Culture, 17, 23.
114 M. Lipsedge and R. Littlewood, Aliens and Alienists: Ethnic Minorities in Psychiatry (London,
1989).
115 Fox, So Far Disordered in Mind, 8789.
116 For example, see the report of a Russian detained at Robben Island who could not speak any
English, Health Branch Correspondence, 1901, CO 7258, CA.
117 J. Ablard, The limits of psychiatric reform in Argentina, 18901946, below, notes a similar
pattern for long-distance peasant admissions to asylums in Buenos Aires; see also Coleborne,
Passage to the asylum, below, on Chinese immigrants to Australia.
40 Harriet Deacon

Dutch-Afrikaans white populations (especially in the eyes of British-born po-

licemen) may sometimes have outweighed racial difference between the two
groups.
Although admission processes favoured the admission of new arrivals to
the city, they also reected general patterns in an already racialized social
order. In the colony as a whole, blacks were more likely to be poor and non-
Christian than whites. Common-law marriages were also more common among
blacks. These patterns were echoed in the Robben Island intake. Between 1872
and 1890 there were only four black paying lunatic patients at Robben Island
(3 per cent of 150 black rst admissions), all mixed-race, while paying pa-
tients made up 37 per cent (n = 79) of white admissions. Blacks were more
likely than white admissions to be non-Christian or Dutch Reformed than from
Anglican, Catholic or other Christian denominations. A greater proportion of
white admissions were married and more of the black admissions were single.
Black admissions to Robben Island were also more likely to have come from
the eastern Cape and western Cape hinterland, although not from outside the
colony, than whites. This is not surprising far more Africans lived in the
eastern Cape and far fewer Africans were urbanized, even in 1904.118
One would expect that racialized theories about insanity would produce
racialized etiologies and diagnoses, but this was less marked in the analysis
of admission registers than expected. Black patients admitted to Robben Island
were given substantially fewer etiologies than whites, an indication of greater
medical concern about white insanity and the perception that black insanity was
less complex.119 There was also a disproportionate number of blacks among
idiotic and imbecile admissions and fewer blacks among those given general
diagnoses like insanity. This may reect a different patient prole (due to
different pressures for admission) rather than racism in diagnosis, however.
Diagnoses of melancholia (then based partly on considerations of mood) cer-
tainly had a racial connotation. This diagnosis was restricted to twenty white
patients before 1888, of whom fteen were paying, and thirteen were either
married or widowed. A disproportionate number of white, married and paying
patients were thus given diagnoses of melancholia. The diagnostic category
may have been used to decrease the stigma attached to institutionalization for
better-class white patients with family attachments. Racial differentiation is also
evident in the diagnosis of melancholia at other asylums. Black patients were
believed to be unable to experience depression because they had insufciently

118 The 1904 census shows that 8 per cent of Africans, 48 per cent of coloureds and 52 per cent of
whites were urbanized; C. Simkins and E. van Heyningen, Fertility, Mortality and Migration in
the Cape Colony, 18911904, International Journal of African Historical Studies 22 (1989),
94.
119 For the same pattern in other Cape asylums see Swartz, Colonialism and the Production of
Psychiatric Knowledge, 102.
 Robben Island Lunatic Asylum, South Africa, 18461910 41

evolved nervous systems. Even today, it is often assumed that black patients
suffer less from melancholia than whites.120
Admission patterns are associated with a complex set of inuences, which
are difcult to disaggregate. This can be demonstrated with regard to age of rst
admissions. For the entire period 18461910, the mean age at rst admission
was 34.5 years, with the median at 32.0 years (n = 1114). In the rst seventeen
years of the asylum, the median age of rst admissions was 30.0 (n = 260),
but between 1872 and 1890, the median age was 34.5 (n = 362). The data
before 1872 is skewed towards long-stay cases who would have been younger
on admission. The increase in median age was probably due to an increase
in recording of admissions in the forty to fty-nine age group. By the 1870s,
psychiatric services were expanding to take in more demented and mentally
retarded patients (diagnoses of dementia, idiocy and imbecility had increased)
but these were concentrated in the younger age groups rather than in the age-
bracket providing senile cases today.121 When Robben Island accommodated
more criminal cases, the median age decreased again (to 32.0 years, n = 307),
as the penal system mainly accommodated and referred younger men.
Throughout the period, the Robben Island rst admissions cluster around the
twenty to thirty-nine age group, that represents over 60 per cent (n = 686) of
all rst admissions, although this age group represented only about 20 per cent
in the general population (and 40 per cent of the population aged over twenty)
in 1875.122 Most nineteenth-century asylums in Britain also accommodated
mainly young adults and those in early middle age.123 The middle-age range of
the Robben Island admissions illustrates its use as a place of detention for those
cases who could be expected to work but did not, or for those who presented
a particularly dangerous aspect if violent, but it may also be a product of the
asylums use by immigrants. There are very few rst Robben Island admissions
under twenty years (6 per cent, n = 70) and over sixty years (7 per cent, n = 64).
Comparing these proportions to those in the colonial population in 1875 (about
50 per cent and 5 per cent respectively),124 one can see that very young people
were grossly underrepresented but old people were not. Local communities
may have been more reluctant to use the asylum for the very young, who might
have been more economically useful and easier to control than the very old. A
slightly greater proportion of older people was admitted later in the century, but
this is probably a product of sample bias. Without much institutional provision
120 Swartz, Changing Diagnoses in Valkenberg Asylum, 4413.
121 Before Kraepelins work in the late nineteenth century, no distinction was made between
dementia due to dementia praecox (later called schizophrenia) and senile dementia. Many of
the dementia cases were therefore under sixty.
122 Census of 1891, CPP, G61892, 48.
123 A. Digby, Madness, Morality and Medicine: A Study of the York Retreat 17961914 (Cambridge,
1985), 1767.
124 Census of 1891, CPP, G61892, 48.
42 Harriet Deacon

for the elderly at the Cape, it is not surprising that the old were not under-
represented.
In a contemporary American study, sociologists have found that married
people have consistently lower incidence of mental illness.125 For those who
suffer mental illness before marriage, marriage may not be an option. Also,
families are able to provide some care for the insane. In asylums in nineteenth-
century Britain, more patients were single than married.126 One would therefore
expect to have fewer married admissions to Robben Island than married people
in the general population. In the years 187290, of those Robben Island lunatic
admissions whose marital status was listed, 40 per cent (n = 129) were listed as
married and 54 per cent as single (n = 175). By contrast, in 1875 about 56
per cent of the colonial urban population aged twenty and over were married.127
The assumption thus holds true. There was a gender dimension to this pattern,
however. Proportionally more of the female and white admissions to Robben
Island were married. Between 1872 and 1890 half (n = 60) of female rst
admissions at the Robben Island asylum given marital status were married
while only a third (n = 69) of male rst admissions were married. Just over
half (n = 65) of female rst admissions were single or widowed compared to
two-thirds (n = 141) of male rst admissions. Fox suggests that women in early
twentieth-century San Francisco were more likely than men to be perceived
as insane within the family, and more likely to be sent to an asylum through
family intervention. If subject to a dementing process, women had fewer socially
acceptable options than men for care outside the home.128 The Robben Island
case may indicate a similar pattern in the Cape.

The increase in better class patients

When the rst better-class patient arrived at Robben Island in a whale boat
from the Old Somerset Hospital in 1850, surgeon-superintendent Dr Birtwhistle
failed to treat him better than the others and was berated by the Colonial
Secretary for this.129 Most of the lunatics during the 1840s and 1850s were
paupers, leaving little behind them when they died, with a few exceptions.130
The favoured patient V earned 7 2s. 6d. from selling property in King Williams
Town in 1851.131 D, admitted as a paying patient in April 1854, had exhausted

125 D. R. Williams, D. T. Takeuchi and R. K. Adair, Marital Status and Psychiatric Disorders
among Blacks and Whites, Journal of Health and Social Behaviour 33 (1992), 1401.
126 Digby, Madness, Morality and Medicine, 175.
127 Census of 1875, CPP, G421876, 15. 128 Fox, So Far Disordered in Mind, 97, 131.
129 Birtwhistle to Secretary to Government, 12 Sept. 1850, CA, Robben Island Letterbook,
RI 1.
130 Birtwhistle to Colonial Secretary, 21 April 1851 and 14 March 1853, CA, Robben Island
Letterbook, RI 1.
131 Birtwhistle to Secretary to Government, 21 April 1851, CA, Robben Island Letterbook, RI 1.
 Robben Island Lunatic Asylum, South Africa, 18461910 43

his deposit by August and was demoted to non-paying status.132 By 1855, just
over a tenth of the lunatics were better-class, but not all of these were pay-
ing patients.133 In 1861 surgeon-superintendent Minto differentiated between
better-class lunatics (one third of the patients) and educated lunatics (very
few).134 The standard rate for paying patients (the same as at Old Somerset
Hospital) was two shillings per day135 four times the bare minimum needed
to maintain oneself in Cape Town during the 1830s, and beyond the reach of
all but the skilled worker or subsidized employee.136
The reform of the asylum in the 1860s attracted more middle-class patients
to the Robben Island asylum in search of a socially acceptable therapeutic and
custodial solution. Between 1872 and 1890, a quarter (n = 92) of rst admissions
were paying, in contrast to less than 5 per cent (n = 11) before 1872. Between
1846 and 1890, the proportion of white patients (who would probably have
been wealthier) increased from about two-fths to nearly three-fths. British
immigrants and other immigrant Europeans made up a much higher proportion
of rst admissions than colonial-born whites in the period before 1872. But by
the 1870s, a growing number of colonial-born whites were admitted, including
some from respectable colonial families. By 1880 half of the approximately
200 Robben Island lunatics were white, compared to a third of the 100 patients
at Somerset Hospital.137 Edmundss success in improving the public image
of the Robben Island asylum attracted more paying patients, some with well-
respected colonial names, although even in the 1870s better-class families still
sent relatives reluctantly to Robben Island.138 During the 1890s, when more
mainland asylums opened, however, the proportion of white, non-earning and
paying patients at the Robben Island asylum declined dramatically.
Although more wealthy patients entered the asylum in the 1860s the percent-
age of rst admissions from the professional, self-employed or skilled classes
remained fairly stable (at 1113 per cent) before 1890 (see Table 1.5) be-
cause many of the new middle-class admissions were non-earning women. The
proportion of non-earners (mainly housewives) admitted to Robben Island had
tripled by the 1860s and 1870s, but declined thereafter. As convict and unskilled

132 Ibid., 15 Aug. 1854, CA, Robben Island Letterbook, RI 1.

133 Return of Chronic Sick, Lunatics and Lepers in the General Inrmary, in Report of the
Select Committee Appointed to take into Consideration the Papers Laid on the Table Referring
to Somerset Hospital, CPP, A91855, 17.
134 J. C. Minto, Minutes of evidence, Report of the Commission of Inquiry, CPP, G311862, 15.
135 Reports on the Somerset Hospital and the General Inrmary, Robben Island, for the Year
1855, CPP, G121856, 2.
136 S. Judges, Poverty, Living Conditions and Social Relations: Aspects of Life in Cape Town in
the 1830s, MA thesis, UCT (1977), 3.
137 Captain Mills, minutes of evidence, Report of the Commission, CPP, G641880, 1.
138 Robben Island Lunatic register 18461904, RI 181, CA; Ebden, minutes of evidence, Report
of the Select Committee . . . on Removing the Lunatics and Lepers from Robben Island, CPP,
A31871, 3.
44 Harriet Deacon

Table 1.5 Occupations of rst admissions to the Robben Island Lunatic

Asylum whose occupations are given, 18461910 (percentage)

Middle Artisans/ Semi- Not N/A

Date class skilled skilled Unskilled earning (Convict) Total

184661 11.4 5.7 17.1 14.3 5.7 45.7 100

(n = 4) (n = 2) (n = 6) (n = 5) (n = 2) (n = 16) (n = 35)
186271 14.7 12.0 17.3 14.7 17.3 24.0 100
(n = 11) (n = 9) (n = 13) (n = 11) (n = 13) (n = 18) (n = 75)
187290 12.9 9.9 9.6 19.8 20.1 27.8 100
(n = 43) (n = 33) (n = 32) (n = 66) (n = 67) (n = 93) (n = 334)
18951910 1.0 4.1 8.1 36.9 15.9 33.9 100
(n = 3) (n = 12) (n = 24) (n = 109) (n = 47) (n = 100) (n = 295)

admissions (mainly black men) increased again in the 1890s, middle-class ad-
missions declined in general.
The increase in paying patients admitted to Robben Island during the 1870s
was most dramatic among white females (see Figure 1.1). The percentage of
white admissions among the female insane is a particularly sensitive indicator of
the use of the asylum for those who were not just poor or considered dangerous.
White families were generally wealthier and therefore able to choose whether
to admit their relatives to the asylum or keep them at home. Black families,
by contrast, seem to have played only a minor role in selecting the asylum
as a place of custody for insane relatives. The colonys penal system, that
tended to target blacks in any case, was the major referral agent for black
admissions to the lunatic asylum. In the period 187290 nearly 40 per cent
(n = 17) of African rst admissions were convict lunatics as opposed to 13
per cent (n = 12) of British-born rst admissions and 24 per cent (n = 20)
of white colonials. But although middle-class whites of European extraction
were perhaps more willing to resort to an asylum for insane relatives, this
willingness was tempered by considerations of gender. They were less likely to
see female lunatics as dangerous than men. The stigma of institutionalization
also rested more heavily on women, who were traditionally seen as occupying
the private sphere of the home. The admission of greater proportions of white
females to an asylum therefore indicates a reduction in the stigma attached to
institutionalization and a recognition of the asylums therapeutic role. (It was
only after this shift in perception that married women would be more likely
than married men to enter the asylum, as Fox has observed above.)
In 1859 there were as many white as black men in the Robben Island lunatic
asylum, but more black women than white.139 The gap between the proportions
139 Report on the General Inrmary, Robben Island for the Year 1859, CPP, G111860, 4.
 Robben Island Lunatic Asylum, South Africa, 18461910 45

60 Male
Female
50

40

% 30

20

10

0
1857 1863 1867 1869 1873 1880 1891 1897 1904
Year
Figure 1.1 White lunatics resident in the Robben Island Lunatic Asylum as a
percentage of total lunatics resident, by gender, 18571904

of white and black female lunatics narrowed gradually during the 1860s (see
Figure 1.1 above). By 1873 there were sixty-eight male and thirty-four female
white lunatics and sixty male and forty female black lunatics in the asylum.140
Segregated accommodation at Robben Island was used to reserve places for
better-class patients and encourage applications. But white female admissions
were encouraged even more actively than white male admissions. A new build-
ing was constructed for the female asylum in 1867, a separate wing was set
aside for better-class female patients on the island by 1873141 and paying fe-
male patients had their own ward by 1880.142 In 1871, surgeon-superintendent
Edmunds claimed that although arrangements for the males were incomplete,
better-class female patients were well enough catered for.143 Female inmates
formed a disproportionate number of the paying patients, most of whom were
admitted between 1870 and 1890. They were overrepresented in the non-earning
category, mainly as housewives, and underrepresented in the employed petty
bourgeois and semi-skilled categories. Grahamstown asylum admitted some
better-class women when it opened in 1875, but the long distance from
Cape Town may have encouraged some families to use Robben Island instead.
Disproportionally more women than men were admitted to Robben Island from
140 Report on the General Inrmary, Robben Island for the Year 1873, CPP, G231874, 3.
141 Ibid., 6.
142 Lunacy Inspectors Report in Report on the General Inrmary, Robben Island for the Year
1880, CPP, G221881, 9.
143 Edmunds, minutes of evidence, Report of the Select Committee, CPP, A31871, 3.
46 Harriet Deacon

Table 1.6 Outcomes of all rst admissions to the Robben Island Lunatic
Asylum, 18461910 (percentage)

Date Discharged Died Transferred Escaped Not given Total

184661 3.4 20.7 9.6 66.3 100

(n = 9) (n = 54) (n = 25) (n = 173) (n = 261)
186271 12.4 41.4 16.1 30.1 100
(n = 23) (n = 77) (n = 30) (n = 56) (n = 186)
187290 25.0 39.3 32.6 0.3 2.9 100
(n = 96) (n = 151) (n = 125) (n = 1) (n = 11) (n = 384)
18951910 31.6 32.3 20.3 15.8 100
(n = 98) (n = 100) (n = 63) (n = 49) (n = 310)

the Boland,144 and slightly fewer from the more distant western Cape hinter-
land. Families were possibly less willing to send their female relatives too far
from home.

Leaving the asylum

In order to assess the functioning of the institution, some indication has to be
given of length of stay and therefore the composition of the resident population
as opposed to admissions. An analysis of length of stay and outcome can reveal
much about the social prole of patients and the reasons for their institutional-
ization. For this purpose the data from the years 187290 is the most reliable.
Of those given discharge dates before 1872, only one case stayed less than
eleven years in the asylum. This is because most early cases in the database are
gleaned from the Old Somerset Hospital register that does not list outcome after
the patients stay at Robben Island. Tables 1.6 and 1.7 show how the admissions
database is skewed towards patients who were not given outcomes in the years
before 1861 and those who remained in the asylum in 1872 and died there. A
signicant number of cases admitted in the period after 1895 were not given
outcomes.
There has been some debate as to whether British asylums lled up with
chronic cases during the last third of the nineteenth century.145 This did not
happen at Robben Island in the long term, although there were a number of
long-stay patients, especially before 1891. Of rst admissions to the asylum
in the period 187290,146 only 16 per cent stayed a year or less. About two-
144 The Boland, or uplands, refers to an area encompassing the wine- and wheat-farming towns in
the immediate vicinity of Cape Town such as Stellenbosch and Paarl.
145 G. N. Grob, Marxian Analysis and Mental Illness, History of Psychiatry 1 (1990), 22930.
146 That is, all those who were given outcomes, or dates and reasons why they left the asylum. The
earlier cases in the database either have no outcome listed (those from the Somerset Hospital
 Robben Island Lunatic Asylum, South Africa, 18461910 47

Table 1.7 Length of stay of rst admissions to the Robben Island Lunatic
Asylum whose outcome is given, 18461910 (percentage)

Date <1 year 12 years 24 years 49 years 918 years >18 years Total

184661 1.1 13.6 85.2 100

(n = 1) (n = 12) (n = 75) (n = 88)
186271 4.6 6.9 3.8 22.3 23.1 39.2 100
(n = 6) (n = 9) (n = 5) (n = 29) (n = 30) (n = 51) (n = 130)
187290 15.8 18.8 22.7 21.2 18.0 7.8 100
(n = 59) (n = 70) (n = 59) (n = 55) (n = 67) (n = 29) (n = 339)
18951910 25.0 27.3 22.7 21.2 3.8 100
(n = 65) (n = 71) (n = 59) (n = 55) (n = 10) (n = 260)

thirds of the cases stayed over two years, and a quarter stayed longer than
nine years (see Table 1.7). This indicates the relative severity of the Robben
Island cases or the slow discharge process. In two state asylums in Harrisburg
in America between 1880 and 1910, about half of the patients were discharged
after one year, and this proportion rose to 60 per cent in private asylums.147
With the establishment of other mainland asylums in the 1890s, the number of
patients who were transferred or discharged from the Robben Island asylum
increased,148 and the number of long-stay patients at Robben Island decreased
accordingly.
Outcomes varied according to length of stay. Of all rst admissions in the
period 187290 who were given outcomes, a quarter (n = 96) were nally
discharged, two-fths (n = 151) died in the asylum and a third (n = 125) were
transferred to other asylums. But these outcomes were unevenly distributed
between long- and short-stay patients. Over half of the discharges (56 per cent,
n = 54) occurred within the rst two years of admission. Discharge became very
unlikely after four years in the asylum (82 per cent (n = 79) of all discharged
cases had left by then). This was similar to the pattern at the Retreat asylum in
York (17961910) although discharge happened even more rapidly at York.149
Death rates at Robben Island were higher than discharge rates for every length-
of-stay group, except for those staying between one and two years in the asylum,
when the weak and debilitated cases had already perished. Naturally, the longer
a patient stayed in the asylum, the more likely s/he was to die there. But the high
death rate in the initial intake can be contrasted with the pattern at York, where

registers) or are the long-stay cases that were in the asylum in 1872 when the register was
started. The best data on length of stay thus exists for admissions after 1872.
147 C. McGovern, The Myths of Social Control and Custodial Oppression: Patterns of Psychiatric
Medicine in Late Nineteenth-Century Institutions, Journal of Social History 20 (1986), 6, 19.
148 This is evident from the ofcial reports rather than the database gures as outcomes were not
reported as often after 1890.
149 Digby, Madness, Morality and Medicine, 227.
48 Harriet Deacon

death rates only exceeded discharge rates for those staying over two years in the
asylum.150 This indicates the more extensive use of the island asylum for patients
who were seriously ill or debilitated from poverty. As more asylums were
opened during the course of the century, the reorganization of asylum provision
on the basis of race, violence and chronicity necessitated some movement of
patients between asylums. At Robben Island, therefore, long-stay patients were
very likely to be transferred. Indeed, after four years in the asylum, patients
were more likely to be transferred than to die. The most common reasons for
transfer or non-transfer were difculty of control or suitability for work. After
1891, difcult cases were increasingly transferred out of Grahamstown and
Valkenberg asylums to Robben Island or Fort Beaufort, the asylum for chronic
cases. In 1896, for example, a patient admitted to Grahamstown and described
there as not dangerous but a voluble, spiteful fussy little Irishwoman who,
from the violent use she makes of her tongue, is always getting into trouble,
was transferred not improved to Robben Island.151 The use of black patients
as manual labourers within asylums affected transfer patterns.152 When the
Grahamstown Asylum became solely for whites in 1908 the withdrawal of the
native labour supply was rather severely felt and black male patients were again
housed nearby two years later.153 In 1916 Valkenberg admitted its rst black
patients (housed in a separate building) for similar purposes.154 Manual labour
provided by black patients was essential in reducing the expense of running
asylums at the Cape.155
A closer analysis of length-of-stay and outcome can provide some ideas as
to social and economic factors prompting a resort to the asylum. The data can
be usefully disaggregated by diagnosis, area of origin, socio-economic group,
gender and race (see Table 1.8). The severity of a patients illness affected the
length of time s/he stayed in the asylum. The few melancholic cases (this was
the socially acceptable face of insanity for the middle classes),156 showed a

150 Ibid., 228. The statistics Digby gives in Table 9.6 have been used to get a gure of 43.2 per cent
for deaths in the group staying two to ten years and 35.4 per cent for those discharged recovered
or improved. The discharge rate would in fact exceed the death rate if one included the cases
discharged unimproved, but this would perhaps be more comparable to the transfer gures for
Robben Island than the discharge gures as York did not transfer cases to other asylums.
151 Admissions for 1896, Grahamstown Asylum Papers, casebook 187593, HGM 16, CA.
152 Work was a common theme of institutional conditions for working-class patients. See Ablard,
The Limits of Psychiatric Reform in Argentina, 18901946, below, for a discussion of manual
labour in Argentinean institutions.
153 Report of the Commissioner of mentally deranged and defective persons in Report of the
Department of the Interior for 19161918, Union of South Africa Parliamentary Papers (UPP),
UG311920, 21.
154 Ibid., 19. 155 Swartz, The Black Insane, 412.
156 Melancholia was presumably acceptable to the middle class because it involved introversion,
a return to privacy, rather than orid extroversion. The same romantic idea that associated
middle-class depression with civilization and creativity played out in the arena of tuberculosis,
the wasting disease.
 Robben Island Lunatic Asylum, South Africa, 18461910 49

Table 1.8 Social prole of rst admissions to the Robben Island Lunatic
Asylum by length of stay, 18721890a (percentage)

Cases in Maleb White Marriedc Paying Convicts

Length of stay Sample % % % % %

< 1 year 59 67.8 72.9 55.6 28.8 8.5

(n = 40) (n = 43) (n = 30) (n = 17) (n = 5)
12 years 70 62.9 75.4 47.5 37.1 7.1
(n = 44) (n = 52) (n = 28) (n = 26) (n = 5)
24 years 75 56.0 58.7 34.9 28.0 9.3
(n = 42) (n = 44) (n = 22) (n = 21) (n = 7)
49 years 73 79.5 42.5 30.5 15.1 20.5
(n = 58) (n = 31) (n = 18) (n = 11) (n = 15)
918 years 67 59.7 52.2 41.4 13.4 52.2
(n = 40) (n = 35) (n = 24) (n = 9) (n = 35)
Over 18 years 29 58.6 62.1 23.1 27.6 75.9
(n = 17) (n = 18) (n = 6) (n = 8) (n = 22)
All lengths 373 64.6 59.9 40.1 24.7 23.9
(n = 241) (n = 223) (n = 128) (n = 92) (n = 89)

a Because there are no data on sex, race, marital status, etc. for some cases within the length-of-stay
group, the percentages listed here are valid percentages, excluding missing data.
b One missing case: total valid cases 372 of 373.
c Fifty-four missing cases: total valid cases 319 of 373.

high turnover, as 52 per cent (n = 13) of rst admissions with this diagnosis
left the asylum within two years. Over a third of rst admissions between 1872
and 1890 with diagnoses of general insanity, idiocy or imbecility tended to
leave the asylum within two years of admission, in contrast to a fth of those
with diagnoses of mania and dementia. The latter cases formed the bulk of
long-stay patients. Long-stay cases had mostly been legally detained as crimi-
nal insane. Three-quarters (n = 22) of those cases staying over eighteen years
were committed under Act 20 of 1879 (which was until 1891 the only legal
means of detention, but was not used for the majority of admissions). While
about 10 per cent of cases in most occupational groups stayed for over ten
years, 64 per cent (n = 57) of convicts stayed for over ten years. Dangerous-
ness (as recorded in the asylum admission registers) does not seem to have
implied long-term detention, however. Its primary role was to justify initial
detention.
But the accessibility and viability of alternatives to asylum care also affected
the length of stay. Those coming from the Boland or Greater Cape Town were,
not surprisingly, more likely to leave the asylum within less than two years than
cases from the eastern Cape or the western Cape hinterland. Cases with some
chance of recovery and with family or friends in contact, were often transferred
50 Harriet Deacon

from Robben Island to mainland asylums.157 The declining public image of

the Island asylum after 1880 also encouraged middle-class patient mobility.
The patient T asked to be transferred from Robben Island to Grahamstown in
1906, as I am mixed up with all kinds of criminal patients here whereas in
Grahamstown I shall be among my own class.158 Married, white or paying
patients were more likely than single, black or non-paying patients to leave the
asylum in the rst two years, perhaps partly because of the greater number of
melancholia diagnoses among the former group.
Gender differences in length of stay can be partly explained by gendered
notions of the necessity for institutional care. In the rst two years of their
stay in the asylum, men and women were equally likely to leave it by death,
transfer or discharge. But later rates of leaving varied somewhat by gender. In
the period 187290, a third (n = 39) of the female rst admissions with outcome
given stayed over nine years at the Robben Island asylum, compared to only a
quarter of the men (n = 57). This was not due to differential outcomes. Men and
women died, were transferred and discharged in similar proportions, although
more men than women were admitted overall. Disproportionally more men
than women were admitted to Robben Island with imbecility and dementia,
which diagnoses tended to produce longer length of stays. There was also
a group of long-stay women patients in the Valkenberg asylum after 1891.
Swartz has argued that women admitted to Valkenberg were often represented,
both before and after admission, as violent and troublesome as a sign of their
insanity (it is interesting to note they were not more likely to be marked as
dangerous however). She attributes this partly to the cultural expectation that
women should be more passive and sedentary than men.159 Certain kinds of
disruptive or violent behaviour by women in the asylum may thus have been
more of a barrier to discharge than among men.
Patterns of asylum use also differed along racial lines. Black patients in
general were more likely than white admissions to stay longer than three years
in the asylum. They were slightly more likely to die in the asylum rather than
be discharged or transferred. It is therefore unlikely that black families were
using the asylum for the temporary detention of insane relatives. The black
admissions to Robben Island were usually there under coercion rather than by
relatives request. The situation at the Cape parallels that in India where, with
growing pressure on accommodation after legislation enforcing the detention
of criminal lunatics in asylums in 1851, the basic criterion for the admission
of Indians was to become their danger to the community at large rather than

157 Robben Island Commissioner to Under Colonial Secretary, 12 March 1901, Robben Island
Letterbook, RI 61, CA.
158 W. H. T. to Colonial Secretary, 21 April 1906, Health Branch, letters received, CO 7810, CA.
159 Swartz, Colonialism and the Production of Psychiatric Knowledge, 46, 1979.
 Robben Island Lunatic Asylum, South Africa, 18461910 51

their state of mind.160 In colonial Malawi too, the main motivation behind the
establishment of an asylum in 1910 was the need to take criminal lunatics out
of prisons, where they were disruptive of the institutional order.161

Conclusions
How and why lunatics entered mental institutions is related closely to the
social function of the institutions and the class, race or gender-specic mean-
ings attached to insanity. The asylum was established in 1846 primarily as a
dumping ground for those who were clogging up the colonial gaols and hos-
pitals as chronic, disruptive or disabled cases. It was no coincidence that the
establishment of the Robben Island asylum coincided with a programme to uti-
lize convict labour on public works. During the 1860s and 1870s, middle-class
white families began to use the asylum more, especially for female relatives. The
reformed asylum was an icon of civilization at a time when the colonial middle
class was attempting to establish itself on both the colonial and the international
stage.162 More dangerous and criminal cases (mainly black men) were sent to
the island asylum after two new mainland asylums for white middle-class pa-
tients were opened in 1875 and 1891. By the beginning of the twentieth century,
when the colonys newly exploited mineral riches relied heavily on the control
of black migrant labour, Robben Island inmates were again mainly poor, black,
male and criminal.
The social prole of the Robben Island patient was determined by a variety
of complex factors. In the Cape Colony, where there was no great connement
of the insane, facilities for institutionalization were minimal. These scarce re-
sources were allocated and used in specic ways by the state, the medical pro-
fession, communities and families to create an asylum population dominated
by single, urbanized men of working age. White patients were overrepresented
in Cape asylum populations as a whole, but at Robben Island they dominated
numerically only between 1862 and 1891. Black women were strongly under-
represented. This differential allocation of bed-space was related to patterns of
mental illness, availability of alternative sources of medical care for the insane,
community denitions of mental illness, community attitudes towards western
medical care, colonial state priorities, medical practices and medical prejudices.
Although the asylum inmates at Robben Island, like those in the San Francisco
asylum, had all been dened by society as inconvenient or intolerable, they
160 Ernst, Mad Tales from the Raj, 50.
161 M. Vaughan, Idioms of Madness: Zomba Lunatic Asylum, Nyasaland, in the Colonial Period,
Journal of Southern African Studies 9 (1983), 220.
162 See H. J. Deacon, Remembering Tragedy, Constructing Modernity: Robben Island as a
National Monument in C. Coetzee and S. Nuttall (eds.), Negotiating the Past: the Making
of Memory in South Africa (Oxford, 1998) and Ablard, The Limits of Psychiatric Reform in
Argentina, 18901946, below.
52 Harriet Deacon

formed a specic subset of the colonial population who had travelled several
well-worn paths to the asylum door. Patients admitted to Robben Island from
1846 to 1910 were disproportionally single, as are mental patients today. Almost
all were in the middle-age range, over twenty and under sixty years, indicating
the importance of inability to work or conduct family life in encouraging insti-
tutionalization. Most of the patients in Cape asylums, including Robben Island,
were male. This was partly because of the legal emphasis on dangerousness as
a criterion (more often applied to men) for admission to scarce asylum beds,
and the way in which asylums were used by the state to empty gaols of dis-
ruptive criminals (who were predominantly men), especially at Robben Island.
Married people were less likely to enter the asylum in general, as they had
support networks at home, but married and well-off white women were more
likely to enter the asylum than similarly placed men, probably because of their
lower status and power within the household. While women were in general
less likely to be institutionalized than men, they were more likely to become
long-stay patients.
Robben Island asylum was at the custodial end of the psychiatric spectrum,
except for a brief interlude in the 1860s and 1870s, and housed numerically
more black than white patients for most of the period 18461921. But even
at Robben Island, white patients were overrepresented in asylum admissions
compared to the general population. This was explained at the time by racist
theories that represented the white brain as more evolved and civilized, and
therefore more susceptible to, and requiring more protection from, insanity
than the black brain.163 Better explanations can be found, however. White in-
sanity was feared within the colonial order because it connoted degeneration
and threatened hereditary insanity. Black insanity was feared mainly in its con-
tact with white communities potentially disrupting employment relations or
breaking the taboo on sexual contact with white women. The black insane se-
questered in relatively independent or isolated communities were thus not a
major concern of the colonial state. Africans and Khoisan communities contin-
ued to use indigenous healing methods and to resist western medical treatment
systems for mental illness well into the twentieth century. African women were
particularly underrepresented among admissions because of their limited expo-
sure to white employment and the criminal justice system, the major admission
route of their male counterparts.164 Many black male admissions were either
seriously physically ill or debilitated on admission, suggesting both poorer gen-
eral health, possibly due to distance from community networks of assistance,
and a long route to the asylum through the criminal justice system.

163 Swartz, Colonialism and the Production of Psychiatric Knowledge, 11316.

164 Swartz, The Black Insane, 409.
 Robben Island Lunatic Asylum, South Africa, 18461910 53

Those without family networks who could not afford home care were most
likely to depend on the asylum, but cultural factors and alternative sources of aid
kept many out of the asylum. This included recent immigrants (mainly British),
ex-slaves and poor black inhabitants of Cape Town and the surrounding area.
British settlers, mainly recent immigrants without other options, at least before
the asylum became respectable in the 1870s, formed the majority of the volun-
tary patients in Cape asylums. Christian churches and associated organizations
seem to have provided an asylum entry route for some poor mixed-race people
and ex-slaves, but not, it seems for those from poor white Dutch-Afrikaans
communities. Community attitudes towards institutionalization and western
medicine played an important role in determining admission patterns, even
among relatively poor communities. Like Africans, Dutch-Afrikaans settlers
and Muslims in Cape Town were reluctant to use the asylum. Well-organized
religious charity and community assistance programmes in urban areas gave
them more options outside the asylum. Besides the western treatment approach,
inexibility regarding diet, the lack of proper provision for Muslim burials and
the association of the island asylum with Christianity probably discouraged
black Cape Town Muslims from using the asylum extensively.
2 The connement of the insane in Switzerland,
19001970: Cery (Vaud) and Bel-Air (Geneva)
asylums

Jacques Gasser and Genevieve Heller

Introduction
The two asylums upon which this comparative study of patient records is based
share many similarities. Situated only sixty kilometres apart, both are public
teaching hospitals of two neighbouring cantons Vaud and Geneva in the
French region of Switzerland, the Swiss Romande. In Switzerland, which is a
confederation of states (cantons), there is little centralization of power. Thus, the
responsibility for the mentally ill lies under cantonal jurisdiction. This explains
the fact that there were different laws for different cantons, and that there were
no massive national mental hospitals. Over the course of the nineteenth and
beginning of the twentieth century, most of the cantons established one or two
public asylums for a variable, though not numerous population. In 1930,1 the
largest of the twenty-ve public institutions of Switzerland, Zurichs Rheinau,
had 1,200 beds. The principal private institutions numbered twenty-one and
catered mostly to members of the domestic and foreign middle class.
The cantonal asylum of Vaud, named Cery, was established in 1873. It was
an imposing building, corresponding to the type, popular in that era, of mon-
umental u-shaped structures. It succeeded the rst public asylum which began
welcoming pauper lunatics in 1811. The asylum of Bel-Air, in the canton of
Geneva, was established in 1900, replacing the rst cantonal asylum, which
had been constructed in 1838. Its composition of several pavilions represented
a break from the u-system of buildings. Both Cery and Bel-Air were situated
outside of town, surrounded by a park and a farm or market garden. For most
of the twentieth century, these institutions were under the direction of resident
medical ofcers who were also, simultaneously, professors of psychiatry in their
respective medical faculties of the University of Lausanne and the University
of Geneva.
Translated from French by David Wright and James Moran.
1 There is, however, a comparative study of the 1930s, that of H. Bersot, Que fait-on en Suisse pour
les malades nerveux et mentaux?(Berne, 1936, collection Contributions a letude des problemes
hospitaliers, chapter nine).

54
 Switzerland, 19001970 Cery and Bel-Air asylums 55

In 1900, the canton of Vaud (whose capital is Lausanne) was a farming

and, to a lesser degree, an industrial region, numbering 280,000 habitants in
an area of 2,000 square kilometres. For this population, Cery had 500 beds.
The canton of Geneva, by contrast, constituted an urban and tertiary sector
economy boasting 130,000 inhabitants for an area of 100 square kilometres.
Bel-Air was correspondingly smaller than its sister institution, with 300 beds.
This comparative study examines the period from 1900 to 1970. During this
epoch, the buildings were modied, enlarged and modernized. By 1970, there
were 570 beds in Cery (the highest density in Cery exceeded 800 beds in 1960)
and 725 beds in Bel-Air (which reached a maximum density, then diminished to
657 beds in 1975). These remain, to this day, the principal public and teaching
mental hospitals of the two Swiss cantons.
It is necessary to consider the period before the establishment of each of the
institutions to understand their development. This question will be considered
later in a discussion of legislative matters. As public institutions, the asylums
of Cery and Bel-Air prioritized the admission of les malades assistes and les
malades internes by administrative and judicial request, without excluding com-
pletely the admission of a less unfortunate and less restricted population.

Social and medical characteristics of patients

This project examined the records of nearly 50,000 individuals in order to study
the criteria for connement of psychiatric patients in the Swiss Romande, from
the beginning of the twentieth century to 1970. This gure corresponds to the
number of case les which were preserved in the archives of the two mental
hospitals. From this group of records, we selected a 10 per cent random sample
for each decade in order to conduct a statistical analysis.2 We have thus retained
1,865 case les from Bel-Air and 2,844 case les from Cery (see Table 2.1).
One-third of the total number of les analysed concern the 1960s, and half
(47.8 per cent from Bel-Air and 51.5 per cent from Cery) relate to the last two
decades (195069), reecting a net increase in psychiatric admissions since the
1950s.
Moreover, the population that we studied was distributed nearly equally by
sex. At Bel-Air, one sees slightly more women than men (itself a reection of
the general population). At Cery, by contrast, one observes a surplus of men

2 The collection of data and a preliminary analysis was conducted by George Klein in Evolution des
modalites dadmission non volontaire en hopital psychiatrique; Lexemple de Cery: 18731949,
thesis of the Faculty of Medicine, University of Lausanne (1996). Jacques Caspary and Philippe
Rossignon also contributed to this project within the framework of research nanced by the Projets
de developpement de lAssociation Vaud-Geneve, directed by Jacques Gasser and entitled Le
passe dans le present de la psychiatrie.
900
800
700
600
GE
500
VD
400
300
200
100
0
19001909 19101919 19201929 19301939 19401949 19501959 19601969

Figure 2.1 Number of case les examined

 Switzerland, 19001970 Cery and Bel-Air asylums 57

Table 2.1 Number of case les examined

Years GEa VD

19009 197 191

191019 239 259
19209 193 308
19309 165 254
19409 180 368
19509 294 629
19609 597 835
Total 1,865 2,844

a In all the tables and gures in this chapter, the

cantonal asylum of Geneva, Bel-Air, is indicated
by the initials GE, and that of Vaud, Cery, by the
initials VD.

Table 2.2 The distribution of case les by

sex (percentage)

GE VD

Years Female Male Female Male

19009 46.7 53.3 41.1 58.6

191019 53.6 46.4 43.2 56.8
19209 48.7 51.3 46.1 53.9
19309 55.8 44.2 37.4 62.6
19409 55.6 44.4 40.8 59.2
19509 53.4 46.6 43.9 56.1
19609 52.8 47.2 48.0 52.0

(about 60 per cent until the 1960s) during the entire period under study (see
Table 2.2). This disparity can be explained by a differing attitude amongst psy-
chiatrists and local authorities as to the question of inebriety. In effect, in the
canton of Vaud, individuals suffering from alcoholism were mostly incarcerated
in a psychiatric institution; in Geneva, they were often accepted into a general
hospital. In addition, we were able to calculate that 90 per cent of those indi-
viduals hospitalized in the psychiatric institution for alcohol-abuse problems
were men. Thus, in our group of patients at Cery, if one subtracts alcoholics,
we nd a distribution of the sexes reective of their composition in the general
population.
The distribution of patients studied by age reects that of the general popu-
lation, with an increase in aged patients (those over sixty) over several decades
65.0 Female
60.0 Male

55.0
50.0
GE
45.0
40.0
35.0
19001909 19101919 19201929 19301939 19401949 19501959 19601969

65.0 Female
60.0 Male

55.0
50.0
VD
45.0
40.0
35.0
19001909 19101919 19201929 19301939 19401949 19501959 19601969

Figure 2.2 The distribution of case les by sex (%)

 Switzerland, 19001970 Cery and Bel-Air asylums 59

Table 2.3 Number of case les by age and by decade (percentage)

19009 191019 19209 19309 19409 19509 19609

GE VD GE VD GE VD GE VD GE VD GE VD GE VD

<20 6.6 6.8 6.3 9.0 6.7 8.8 3.7 8.7 7.2 5.4 4.4 4.3 4.5 5.1
2029 13.7 17.4 18.4 17.6 16.6 15.9 11.0 14.2 10.6 16.3 12.6 16.4 14.9 18.0
3039 18.8 23.7 21.3 26.6 22.3 17.2 20.1 22.4 17.8 19.0 12.6 18.1 14.3 15.1
4049 23.9 16.3 20.9 17.2 18.1 19.5 21.3 20.1 17.2 17.4 11.6 20.2 11.7 14.9
5059 13.2 20.0 12.1 11.7 11.4 17.5 20.1 15.0 12.2 16.6 13.9 15.1 10.4 13.3
>59 23.9 15.8 20.9 18.0 24.9 21.1 23.8 19.7 35.0 25.3 44.9 25.9 44.1 33.7

(this increase is most pronounced in Bel-Air from 1940 onwards: between

35 and 45 per cent of patients were over sixty years); the modest number of
those under the age of twenty (between 4 per cent and 9 per cent) illustrates
a presence of this age-group clearly underrepresented in the asylum compared
to the general population. For the remainder of the patients, we see a relatively
homogeneous and stable distribution across the age groups (see Table 2.3).
The evolution of the marital status of patients demonstrates that unmarried
people were in the majority until the 1930s, in both Cery and in Bel-Air, even
if, compared to the general population, this majority was underrepresented
(approximately 10 per cent fewer unmarried persons in the asylum). This un-
derrepresentation is probably explained by the fact that those under the age
of twenty were seemingly absent from the asylum and were for the most part
unmarried.3 Next, there are the married patients who are more important nu-
merically after 1930 (see Table 2.4). Those divorced and widowed are relatively
stable during the different decades and form together about one-quarter of the
entire asylum population. For those who were married, the rates are comparable
to the general population; as for those divorced and widowed, they are strongly
overrepresented in the asylum (as many as ve times for those divorced and
two times for those widowed).
There is further evidence that the vast majority of those hospitalized during
this period under study were institutionalized only once (see Table 2.5). In ef-
fect, in an average of all of the decades in our study, more than three-quarters
(76.8 per cent) of patients were in this situation, and the level was relatively
stable, with the exception of Cery in the 1950s where the proportion of admis-
sions who were rst admissions dropped to 59.4 per cent before rebounding to
70 per cent in the 1970s. These numbers are explained partly by the appearance
of new neuroleptic therapies which began to be used widely, in Cery at least,
from the middle of the 1950s, and which permitted psychotic patients to leave
hospital (but which did not avoid more numerous relapses in the community).
3 The authors would like to thank David Wright for alerting us to this point.
Table 2.4 Number of case les by marital status and by decade (percentage)

19009 191019 19209 19309 19409 19509 19609

GE VD GE VD GE VD GE VD GE VD GE VD GE VD

Unmarried 47.9 42.9 42.2 48.6 45.1 44.5 30.9 39.0 37.2 38.6 32.3 40.9 31.2 36.1
Married 29.9 42.4 33.8 34.4 32.1 34.4 44.8 40.2 37.8 41.0 37.1 42.6 37.4 40.5
Divorced 4.6 2.6 3.8 3.9 8.3 5.5 12.1 9.8 7.2 9.8 12.2 7.8 9.7 9.4
Widowed 17.5 12.0 20.3 13.1 14.5 14.6 12.1 11.0 17.8 10.6 18.4 8.7 21.6 14.0
 Switzerland, 19001970 Cery and Bel-Air asylums 61

Table 2.5 Number of admissions/readmissions by decade (percentage)

19009 191019 19209 19309 19409 19509 19609

GE VD GE VD GE VD GE VD GE VD GE VD GE VD

1 81.7 75.4 79.1 85.7 78.8 74.0 75.8 81.5 75.6 76.1 79.3 59.4 83.2 69.9
2 13.2 16.8 14.6 10.4 10.9 15.9 18.8 13.8 14.4 16.3 11.6 18.2 10.4 17.2
3 2.0 5.2 4.2 2.3 5.7 4.9 4.2 3.5 5.6 4.1 4.1 9.6 3.9 6.5
4 0.5 1.0 0.4 1.2 2.1 1.0 0.6 0.4 2.8 1.1 1.7 3.2 1.7 2.4
5 0.5 0.0 0.8 0.0 1.0 1.3 0.6 0.8 0.6 1.1 1.0 2.6 0.3 1.7
>5 2.0 1.6 0.8 0.4 1.6 2.9 0.0 0.0 1.1 1.4 2.4 7.0 0.5 2.3

4
12%

1
3 37%
21%

1 = <1 month
2 = 1 month3 months
3 = 3 months1 year 2
4 = >1 year 30%
Figure 2.3 Length of stay of hospitalization

We also conclude that, on average, more than 90 per cent of patients of our
group were hospitalized one or two times and only about 4 per cent more
than four times (we also note the exception of Cery during the 1950s when
7 per cent of patients forty-four people in the group studied were hospitalized
more than ve times). What should not be forgotten in the various quantitative
results is the constant rate over seventy years of psychiatric hospitalization;
in effect, if we except the Lausanne situation from the 1950s, the number of
hospitalizations per patient only varied by a few per cent.
The last variable that we analysed is that of the duration of hospitalization.
On average, one third of patients (37 per cent) were hospitalized for less than a
month, with Bel-Air having a relatively constant rate across the seven decades
Table 2.6 Duration of hospitalization by decades (percentage)

19009 191019 19209 19309 19409 19509 19609

GE VD GE VD GE VD GE VD GE VD GE VD GE VD

<one week 8.2 4.2 9.7 4.2 13.1 7.8 5.5 6.3 5.1 6.8 8.8 7.0 10.4 11.0
1 to 2 weeks 12.8 6.8 14.7 7.3 12.0 9.7 7.3 8.7 7.3 9.5 9.5 12.6 10.2 9.1
2 to 3 weeks 5.1 5.8 11.3 6.2 6.8 4.9 5.5 8.7 7.9 9.5 7.5 11.1 8.9 10.4
3 weeks to 1 month 11.2 13.6 9.7 12.4 11.5 11.0 9.1 12.6 9.0 12.8 11.6 13.5 10.7 16.6
1 to 2 months 12.8 10.5 15.1 24.3 17.3 23.1 20.6 22.4 17.4 23.4 22.4 22.9 20.8 26.5
2 to 3 months 9.7 8.9 8.4 7.3 7.3 8.1 8.5 8.3 10.7 12.8 8.8 11.3 11.4 10.2
3 months to 1 year 25.5 27.7 19.7 25.1 16.8 17.2 24.2 18.1 23.6 18.5 17.3 15.3 18.6 11.4
1 to 5 years 7.1 15.7 7.1 10.0 8.9 12.3 10.3 10.2 12.4 4.1 12.6 4.9 7.4 3.8
>5 years 7.7 6.8 4.2 3.1 6.3 5.8 9.1 4.7 6.7 2.7 1.4 1.3 1.5 1.0
 Switzerland, 19001970 Cery and Bel-Air asylums 63

(except during the two decades of the 1930s and the 1940s, when one sees a
decline to 27 per cent and 29 per cent) and Cery showing a progressive increase
(from 30 per cent in 190019 to 47 per cent in 19609).
Two-thirds (67 per cent) of the patients in our group stayed in the asylum
for less than three months and the remaining third can be divided into stays of
longer duration (about 20 per cent additional patients stayed less than one year
and another 10 per cent patients more than one year). Finally, on average, 5 per
cent of the patients stayed hospitalized more than ve years, with a progressive
decline during the decades, reaching a rate of about 1.5 per cent from the 1950s
onwards at Cery and at Bel-Air. In absolute numbers, a small number of people
(ten to fteen in our group per decade) since the beginning of the century spent
a very long time in the asylum or psychiatric hospital. We may ask ourselves
whether the relatively stable but small number of very long stays reects an
institutional reality in psychiatry.

Conditions of admission
The social process of admission to the psychiatric hospital in Switzerland will be
examined in three ways. First, we will analyse the legal requirements concerning
the motives and the methods of admission,4 as well as their evolution in the
two cantons of Geneva and of Vaud over the course of the last century. The
legal conditions of admission specied, on the one hand, the type of person
vulnerable to being institutionalized and the motives behind their connement,
and, on the other hand, they distinguished the types of connement. Further they
indicated which people were liable to request the connement and under what
circumstances people were empowered to authorize or to impose it. Second,
we will analyse statistically certain general data relating to the admission of
patients. This takes into account most notably, whether or not the individual
was considered dangerous, and the type of authority (medical, administrative,
judicial) under which admission was requested. Finally, we will examine several
case les with close attention to detail. Such a reading will lead to a greater and
more nuanced understanding of concrete situations. We will examine, above
all, why individuals pleaded for the connement of a particular person.

Legislation
The rst lunatic asylums of the cantons of Vaud and of Geneva, created in
the rst half of the nineteenth century, responded both to the phenomenon of
asylum construction during this era, and to political, administrative and medical
imperatives. The reorganization of the administration of a number of Swiss

4 In order to protect lunatics property, the laws also governed other aspects concerning the man-
agement of institutions and modes of surveillance found therein.
64 Jacques Gasser and Genevieve Heller

cantons including Vaud (to this date a dependent territory of the canton of
Berne) and Geneva (which had been temporarily annexed to France) reected a
concern for better management of services and the need for public order. These
new institutions also represented a wish on behalf of authorities to distinguish
those whom one could simply care for (incurables), those persons guilty of
crimes and/or of begging (thereby necessitating punishment or rehabilitation),
and those persons who were victims of physical or mental malady (necessitating
care, protection, but also, for certain lunatics, connement). Thus, whereas
the mentally ill were previously found intermixed with other categories of
the assisted (beggars, the disabled, and prisoners) in institutions created in the
seventeenth and eighteenth centuries (such as the Grand Hopital or at the Prison
de lEveche in Lausanne, at the Petite Maison des alienes in Berne, or at the
Maison de Discipline de lHopital general in Geneva), the creation of institutions
reserved specically for lunatics became oriented little by little to a distinct and
specic responsibility separate from those of prisons and the physically ill.
The authorities of the Canton of Vaud (a new Swiss canton from 1803) advo-
cated by decree in 1910, the creation, in addition to the existing cantonal hos-
pice for physical illness, the building of an establishment for incurables and of
a House of Lunatics (Maison des alienes). All three institutions were supported
by public funds. This decree specied the criteria for connement: In the House
of Lunatics, lunatics of both sexes are received, whose existence in their families
and in society have become painful and dangerous, or who have a probable hope
of recovery.5 These criteria were formulated later on with more precision, but
the principles upon which they were based remained: distress (penibilite an
interesting notion which was later abandoned), dangerousness, and curability.
The House of Lunatics was instituted in 1811 in an existing building for an
expected forty patients. Sixty years later, there were 170 inmates. The number of
patients continued to increase because of the conuence of several phenomena:
the increase in the general population, the organisation of public assistance,
public order control, and the more effective identication of mental pathologies.
The construction of a new building was thus thrust upon the authorities. The
style of architecture of the lunatic asylums, which was largely disseminated and
discussed at the international level, drove the conceptions and the compromises
that the authorities and doctors made in asylum construction. The asylum of
Cery, and thirty years later, the asylum of Bel-Air, did not escape this pattern.6
The canton of Geneva adopted its rst lunacy law (Loi sur le placement et la
surveillance des alienes) on 5 February 1838,7 a piece of legislation which was

5 Canton de Vaud, decree of 18 May 1810, art. 2.

6 C. Fussinger, D. Tevaearai, Lieux de folie. Monuments de raison. Architecture et psychiatrie en
Suisse romande 18301930 (Lausanne, 1998).
7 Completed by the law of 7 April 1838, this legislation revisited elements of a provisionary rule
on the goverance of lunatics of 11 November 1829 and adopted, word for word, certain articles
of the French law.
 Switzerland, 19001970 Cery and Bel-Air asylums 65

inspired by the French law of 1837 (in effect from 30 June 1838). The Geneva
law was contemporaneous with the creation of the cantonal House of Lunatics,
Les Vernets, and concerned all those lunatics who were sequestered in public
or private institutions. Considerably more comprehensive than the legislation
regarding the protection of lunatics for the canton of Vaud, it nevertheless did
not specify the reasons for committal. Whereas connement depended on the
welfare and health authorities in the canton of Vaud, it was the perogative
of the authorities of justice and police in the canton of Geneva. This notable
difference in authority over connement has been criticized. The obligation
of Geneva to request a connement from the police appears to have been a
humiliating procedure, treating lunatics as if they were accused criminals. This
practice, however, did not disappear until 1936. The admission of the mentally
ill to asylums was at that time authorized by the Department of Hygiene and
Public Assistance, a procedure consistent with the other hospitals. One cannot
conclude, however, that this had an effect on the hospitalized population. The
admissions in the asylum were submitted for authorization by the executive
authorities of each canton (the Welfare Department or the Police Department
in these cases) because it was a type of connement that could infringe upon
the penal code.
Partial modications occurred at different times during the nineteenth and
twentieth centuries. To simplify, we are going to discuss here the principal laws.
For the canton of Vaud, there was a law of 14 February 1901 (concerning the
administration of persons suffering from mental illness) and a law of 23 May
1939 (concerning mental illness and other psychopathies) which would be re-
placed by a new law in 1985. For the canton of Geneva, there was the law
concerning the administration of lunatics from 25 May 1895, and the law con-
cerning the administration of persons suffering from mental disorder from 14
March 1936 which would be replaced by a new law in 1979. There was not
any fundamental difference between the new laws of the two cantons. We note
rather a parallel evolution concerning the three areas considered here, namely,
the categories of lunatics, the types of admission and the causes of admission.

Categories of lunatics These laws concerned lunatics (alienes is the

only term used in the text of the rst generation of laws), a global category in
the nineteenth century to which was added, little by little, other patient groups,
such as epileptics, alcoholics, the mentally disabled, and addicts. The asylums,
however, already welcomed these categories of patients before the terminology
became diversied. In effect, the diagnostic statistics in the annual reports or the
examination of the case les indicate that these types of patients were already
hospitalized in the asylum during the nineteenth century. This modication in
the laws signies a clearer differentiation in patients mental pathologies. The
epileptic or alcoholic was not conated with the lunatic, although it was con-
venient, in certain circumstances, to intern them in lunatic asylums. We note,
66 Jacques Gasser and Genevieve Heller

however, that at the same time (at the end of the nineteenth and the begin-
ning of the twentieth century), specic institutions were created for epileptics,
alcoholics, and persons suffering from mental disability.
In Geneva, the law of 1895 concerned the resident lunatics in the canton of
Geneva and the lunatics of Genevan nationality (art. 1) and the epileptics, al-
coholics, and in general, all the other patients whose mental state compromises
public security (art. 2). In the canton of Vaud, the law of 1901 was extended in
1921 to persons suffering from addictions (morphine addiction, cocaine addic-
tion, alcoholism, etc.), and further, in 1928, to persons suffering from mental
inrmity (inrmite mentale). We note that this modication is tied to the legal-
ization of sterilization in the canton of Vaud (a unique situation in Switzerland
at this time). Persons suffering from mental inrmity were vulnerable to being
sterilized rather than incarcerated.8 Certain admissions were made for an expert
evaluation of such cases. In the law of 1939 (Vaud), all of these categories were
subsumed under the categories, the mentally ill and other psychopaths.
One is able also to remark that the term lunatic aliene was abandoned;
the limits of madness were far from being always clearly demarcated . . . we
wish to try to lessen the stigma that results from a stay in a maison de sante: we
propose to eliminate the term alienes from the title of the law.9 A less pejorative
formulation, more nuanced, and suggesting a gradation and diversity of mental
pathologies, was adopted. Thus the legislation on lunatics aliene became a law
on the government of persons suffering from mental illness (Vaud, 1901) and
the law on the government of persons suffering from mental afictions (Geneva,
1936). It is interesting to note that the transition from the notion of the lunatic
to that of the mentally ill occurred in the rst third of the twentieth century in
the Romande legislation, whereas one is able to situate this medicalization of
madness in the 1850s in psychiatric texts.10

Admission types The principal distinctions between different types of

admission over the two centuries are, respectively, requests for asylum required
by different people and, secondly, connements ordered by an administrative
or judicial ofcial. The terminology was changeable and was thus ripe for
confusion. One must note in particular that the admission volontaire of the
nineteenth century was not the same as voluntary admission in the twentieth
century. Thus, according to the Geneva law of 1895, voluntary admissions
8 G. Jeanmonod, G. Heller, J. Gasser, Decience mentale et sexualite. La sterilisation legale
dans le canton de Vaud entre 1928 et 1985, Medecine et Hygiene 57 (1999), 20504. This
article gives the rst results of a research project, nanced by the National Swiss Foundation
for Scientic Research, on Eugenics in the Swiss Romande: A study of the sterilization of the
sick and developmentally disabled at the end of the 19th century to the present.
9 E. Grandjean, Considerations sur la Loi genevoise du 25 mai 1895 sur le regime des alienes
(Yverdon, 1902), 10.
10 See G. Lanteri-Laura, Psychiatrie et connaissance (Paris, 1991).
 Switzerland, 19001970 Cery and Bel-Air asylums 67

included all admissions requested by anybody (with the exception of ordered

admissions), although now they are only concerned with admissions requested
by the patient him/herself.11 The notion of an emergency admission (admission
durgence),12 and that of a provisional admission (already in the law of 1862
in the canton of Vaud), were introduced at the end of the nineteenth century. In
certain cases this facilitated the preliminary procedure of connement.
The requests for admission could be made by different people, a list of whom
would be too copious to detail. Requests were made not only by the parents or
the authorities, but by such persons who, in the circumstances, could authorise
a similar request,13 by the sick person himself, by his legal representative,
[and] by all the members of his family who agree to such a procedure;14 one
could also have a request ordered in the interest of public safety and the safety
of the person himself by the authorities of the commune, the district, or the
canton. The admission requested by the patient did not yet have a specic
status. In the law of 193615 as with that of 1939,16 the admissions requested by
the patient, called free admissions (admissions libres), are distinct from the
admissions requested by other people to the Departement. The procedure for
free admissions was simplied, and discharge was made easy. Free admission
had an autonomous and entirely medical status. Thus, the expressed wish by the
psychiatrists since the beginning of the century to free the care of the mentally
ill from the double humiliation of administrative interference and dependence
on the authorities, was realized in the case of the consenting patient.
The medical certicate, an optional requirement in the rst laws of the nine-
teenth century, became obligatory for all admissions.17 This was not the case
for the admissions by judicial authority in the law of 1901,18 nor for the free
admissions.19 It seemed to be required in all the cases in Geneva. The modalities
of establishing a medical certicate were often specied (doctors, skilfulness in
completing them, delays in their availability, direct observation of the patient,
content of the certicate) and were of various degrees of urgency.

Motives behind admission The motives for admission were formu-

lated in a very simple manner in the laws of the nineteenth century. It was the
patients whose existence in their families and in society became painful and
dangerous, or who had a probable hope of recovery20 and the institutions were
destinations for the treatment and the supervision of lunatics.21 The mental
illness itself, care, danger and protection were the grounds for connement. One
nds these elements (which did not necessarily have to be all present at one time)
in the Vaud law of 1901: The present law applies to all those persons suffering

11 Geneva law of 1979. 12 Geneva, 1895, art. 22. 13 Geneva, 1895, art. 25.
14 Vaud, 1901, arts. 10 and 11. 15 Geneva, art. 21. 16 Vaud, art. 18.
17 Vaud, from the rules of 1862, Geneva, with the law of 1895. 18 Vaud, art. 35.
19 Vaud, 1939, art. 18. 20 Vaud, 1810. 21 Geneva, 1838.
68 Jacques Gasser and Genevieve Heller

from mental illness found in the Canton of Vaud, for all whose state necessitates
care or threatens danger to others.22 Note that there was no specic mention
of danger to the lunatic him/herself. However, the medical certicate had to
attest to the existence of a mental illness and the necessity for treatment in an
institution.23 With the law of 1939, one loses the priority accorded until then
to care and treatment; the emphasis is shifted to dangerousness. This shift is ev-
idenced in legal texts relating to the authority of police (public order and public
safety): The present law applies to the mentally ill and other psychopaths (the
mentally inrm, drug addicts, alcoholics, etc.) whose state presents a danger
to themselves, to others, to the public order, or public morals.24 The dominant
tone of the law given by this rst section was that of better social control rather
than that of assistance and care. One thus returns to the priorities of the Geneva
legislation on lunatics during the nineteenth century owing to its connection to
the Department of Justice and Police. However, the medical certicate did have
to mention the necessity for treatment or supervision.25
From the law of 1895 in Geneva, the category of dangerousness as grounds
for committal was diversied. There was a distinction between dangerousness
(of a varied nature) with respect to others, and danger to the patient him/herself.
In effect, the law concerned all those patients whose mental state was of a na-
ture that compromises security, decency, or public tranquillity or their proper
security.26 The need for treatment was not made explicit, neither in the law
of 1895 nor in the law of 1936, but the medical certicate had to establish
the sickness or the necessity for connement27 and, reveal the symptoms of
the sickness and the reasons necessitating admission.28 By contrast, in the
law of 1979, the notion of dangerousness disappeared in the explicit motives,
giving way to a need for treatment: The present law applies to persons . . .
suffering from mental illness and whose mental state requires care in a psychi-
atric institution.29 The notion of dangerousness was resumed for involuntary
admissions; it even became an indispensable condition. In effect the request for
admission formulated by a doctor had to attest to mental troubles, to a grave
danger to themselves or others, and to the necessity for treatment and care in
a psychiatric hospital.30 Dangerousness was no longer mentioned in the rst
section of article 1, but lower in article 24. It is necessary to note still that the
motive for admitting the accused was generally that of putting them under the
observation of experts.31
The examination of the evolution of the different laws allows us to observe
changes wrought by experience, using more precise, or more exact formulations,
and occasionally more liberal and realistic formulations. Except for the often
22 Vaud, 1901, art. 1. 23 Vaud, 1901, art. 12b. 24 Vaud, 1939, art. 1.
25 Vaud, 1939, art. 16. 26 Geneva, 1895, art. 2, Geneva, 1936.
27 Geneva, 1895, art. 25. 28 Geneva, 1936, art. 22. 29 Geneva, 1979, art. 1.
30 Geneva, 1979, art. 24. 31 Vaud, 1901, art. 35 and Geneva, 1936, art. 21.
 Switzerland, 19001970 Cery and Bel-Air asylums 69

100%

90
80
70
60
50
40
30
Doctor
20
Judicial authority
10
0 Doctor and authority
188089 189099
190009 191019 Voluntary
192029 193039
194049
195059

Figure 2.4 The individual(s) demanding admission (Cery, 18801960)

very detailed and complex dispositions (relating to the protection of the sick
and the security of society), we are able to remark that a new formulation is
often precipitated by a change in the spirit of this law echoing a change in
the evolution of practice: the accentuation of the role of doctors relevant to
the administration, the desire to reassure public opinion, and to dedramatize
admission.

Quantitative results on the admission of patients

At Cery, we are able to distinguish who requested admission quite easily from
the case les, be it a doctor (with a medical certicate), a representative of
political, administrative, or judicial authority (with a document written on the
letterhead of one of the authorities), or, conjointly between the two (a medical
certicate and an ofcial document). It is possible, moreover, to discover if the
patient requested his own admission.
All through our period, one can observe that in the majority of case les
and, conforming to the law of 1901 (Vaud), a doctor wrote a medical certicate
of admission. However, in the 1920s, there was a rise in admissions supported
by an ofcial and a doctor, and in the 1930s, a rise in admissions demanded by
a judicial authority alone. Both decline in the 1940s. That corresponds, in the
causes of admission, to an increase and then a decrease in expert requests.
This uctuation suggests that the 1920s and 1930s saw a hardening of the social
 %
18.0
16.0
14.0
12.0
GE
10.0 VD
8.0
6.0
4.0
2.0
0.0
19001909 19101919 19201929 19301939 19401949 19501959 19601969

Figure 2.5 Number of voluntary patients (in percentage)

 Switzerland, 19001970 Cery and Bel-Air asylums 71

Table 2.7 Number of voluntary

patients (percentage)

GE VD

19009 3.0 1.0

191019 4.6 0
19209 4.1 1.9
19309 4.2 2.0
19409 7.2 2.7
19509 11.2 7.8
19609 16.2 6.1

order, which declined in Switzerland during the war. In confronting the results
concerning the (juridical) requests and the sex of patients, one is able to remark
that 70 per cent to 100 per cent (according to the year concerned) of admissions
requested by juridical entreaties concerned men.
The admissions requested by the sick persons themselves are, so to speak,
non-existent until the end of the 1950s (see Table 2.7/Figure 2.5), when we see a
rise, however modest (about 10 per cent) in this category. Today, they represent
fully half of total admissions. It is necessary to point out however, that the results
of a quantitative analysis are not very trustworthy when the numbers are quite
small. We note however that in our research which concerns one case le in
every ten, we analysed forty-nine admissions cases requested by a sick person
himself amongst 629 case les examined between 1950 and 1959, and that there
were only twenty such cases admitted to the institution in the entire rst half of
the twentieth century. Some printed forms, signed by the patients themselves
were recovered after 1935. It is important here to put into perspective the notion
of patient-driven admissions. A qualitative analysis makes it appear that certain
patients presented themselves (in a state of delirium) at the asylum for refuge,
and that others came under the pressure of others, still others self-admitted
because they asked (with complete lucidity) for help, notably in the case of
depression or drug dependence.
One must recall here that the Vaud law of 1901 recognized the admission by
the patients themselves and the law of 1939 dispensed with the need to present
a medical certicate and facilitated their discharge. The law of 1901 already
authorized admission without medical certicate, whilst it was still required by
a judicial authority.
The categories utilized in the case les were not identical at Cery and Bel-Air.
Whereas the specicity of the laws which did not require medical certicates for
admissions by juridical authority (Vaud, 1901) or by the patient himself (Vaud,
1939) facilitated, in the quantitative analysis, the discovery of such instances
72 Jacques Gasser and Genevieve Heller

at Cery; at Bel-Air such a distinction was not easily identiable. All of the
admissions had to be accompanied by a medical certicate and, until the law
of 1936 (Geneva), were picked up by the Department of Justice and Police
which introduced a certain confusion between the admissions authorized by it
or requested by it.

Qualitative analysis concerning social and medical motivations

behind admission
Certain indications concerning the motives behind admission were easily re-
trievable in the case les; others more entangled or scattered. Due to the gaps
in evidence, one can not usefully or comprehensively determine motivation be-
cause one can not fully evaluate or speculate on missing information. Indeed,
the motivations behind admission are often not explicitly articulated. One must
specify that the indications furnished in the case les offer only a very imperfect
conclusion in individual cases. However, one is able to nd some mention of
ofcial motivation for admission (mental affection, danger, supervision, place-
ment under observation, request for expert opinion), and often mention of the
recent circumstances which precipitated the demand for admission. Besides,
older events and circumstances were reported by one or other of the testiers,
parents or witnesses, or by the sick person himself. One also nds mention
of the actual person making the request, and occasionally one can identify the
name of the person who made the request. What can be elucidated here, thanks
to different parts of the case les, is at what point the threshold of tolerance was
passed and what recent events, added to other circumstances, led eventually for
a request for admission.
This research focuses on several case les chosen in an arbitrary manner
concerning the admissions made in the 1930s. The individual situations were
inscribed in the personal history of the patient but also in the social history of
the era.

Betty: schizophrenic At the age of twenty-nine, Betty was brought

by taxi to the asylum at Cery. She had escaped from her parents house during
the night in a t of anger, and, the next day, had caused a scandal in the street
as her father tried to take Betty home; but she escaped him. She then escaped a
policeman who had come to help out, but he ultimately detained her. Examined
by a doctor, at the request of the local police, she was admitted as an emergency
case. Betty spent close to two months in Cery before being transferred to another
asylum. Over the course of the previous years, there had been several troubling
incidents because of Bettys strange behaviour. The last scandal, a most violent
 Switzerland, 19001970 Cery and Bel-Air asylums 73

act against her father in the street, seemed to push the family to seek this solution
of connement rst suggested by the general practitioner.
However, she and her parents had endured the effects of her sickness for a
long time. She was anxious, crying, hardly eating anything, becoming thin, tired,
and frightening others; she was not able to get by, did not work and could not
stand people speaking in her presence. According to her parents, they witnessed
the troubled life of their daughter; her suffering added to the daily difculties
of living. They had her cared for by a private doctor and accompanied her to
her consultations. They did not spare time or their money. It was the public
manifestation of the sickness, rather than its domestic face, which led to her
connement in an asylum. The rst scandals, which did not have the intensity
of the last ones, had been surmounted because her parents managed to supervise
and control her at home.

Bertrand: chronic alcoholism, psycopathy A forty-seven-year-old

doctor, Bertrand spent ve months at Cery for observation and detoxication.
Following a complaint against Bertrand over a serious professional mistake, and
after several warnings, the cantonal health service forced its appointed physician
to take him to the Cery asylum because his state of health must be considered
a public danger. The health service physician asked for an emergency conne-
ment for chronic alcoholism, and attempted suicide and Bertrand was taken
away by a policeman. Two days after admission, the council of the state took
away Bertrands licence to practise medicine. One week later the Justice of the
Peace gave the divorce demanded by his wife; at the end of three months, the
Justice of the Peace asked for an expert in psychiatry because Bertrand made a
lawsuit for false imprisonment. He left Cery to present himself for judgement
relative to his lawsuit. Kept in prison during the night preceding the judgement
against the recommendations of a psychiatrist, Bertrand committed suicide.
Thus, professional fault aggravated by a lapse in judgement, precipitated
his admission. Alcoholism and the attempt of suicide were the explicit reasons
(following an order to pay, one month before his connement, he had attempted
suicide). The situation worsened progressively, one source suggesting that the
sickness had lasted ten years, others indicating only two or three years. From all
sides grief followed him: from lawsuits over his debts, from the bank, from his
wife for ill-considered spending, and from drunkenness. Successive criminal
offences, inadequate behaviour in the practice of medicine, and failure in the
nancial domain led nally to his admission and the request for psychiatric
expertise. Connement was a measure of protection both against new suicide
attempts, and against the public danger that his mental state represented in his
professional capacity. The connement also allowed for administrative, civil,
and penal measures (professional interdiction, divorce, court proceedings) to be
74 Jacques Gasser and Genevieve Heller

taken against Bertrand. The only available therapy in such cases was a regimen
of abstinence.

Louis: constitutional psychopathy, opiomania A man of thirty-one

years, without employment and a resident of Berlin, Louis was admitted to
Cery for observation. He was there a month. He was taken by a policeman to
the prison by order of a judge who requested a medical examination to see if
the young man was an insane person, or if he demonstrated an incomplete
mental development that would diminish his responsibility for what he had
been accused of doing. He was arrested following a complaint and risked a
penalty of ten years for several swindles. The complaint was lifted thanks to
the inuence of his father, a high level German bureaucrat working in Berne,
who promised to ask the Justice of the Peace in Switzerland for the control of
his son. As soon as this was established, the father drove his son to the border.

Charles: not a lunatic but an antisocial character Charles, a fty-

seven-year-old clockmaker, without a regular job, spent eight months in Cery.
Transported by the Prefect in person to be placed under observation, Charles
came from the prison where he had nished his term. He was imprisoned for
not paying a ne for poaching. The Prefect did not want to release Charles at the
end of his prison term because the police feared him. Charles was an avid hunter
who possessed weapons and who promised revenge on those who imprisoned
him. He was a man who lived a solitary life in a cabin, raised dogs, doing small
work tasks to maintain his existence. One week after the admission of Charles
to Cery, the prefecture, on the advice of the sanitary service, requested from
Cery a report, which was not made until seven months later. On the basis of
this report, the sanitary service, under the advice of the council of health which
held authority over psychiatric institutions, ordered the immediate release of
Charles.

Alain: paranoid schizophrenic At the age of thirty-three Alain, in a

very distressed state, was brought to Cery by his father and his maternal uncle.
His condition worsened irremediably and he died after a very painful three-year
stay at Cery. Entries relating to Alains critical mental state were frequent (in
contrast to the le of Charles), and included references to his medical treatment
as well as descriptions of the disruptions to asylum life caused by his behaviour.
His admission to Cery came at a critical moment when Alains life had
become too painful with the aggravation of his condition. Difculties during
childhood, during adolescence, from the death of his mother, the remarriage of
his father, were cumulative steps in his worsening mental state. Hallucinations,
growing anguish, and increasing attempts at suicide for several days made
matters urgent. His family seemed to have used up much of their patience and
 Switzerland, 19001970 Cery and Bel-Air asylums 75

attempted other avenues before connement, including successive consultations

with different physicians. As Alains suffering grew, so did that of his family,
and the danger level increased. The treatment of a similar case like this could
only be done at a specialized clinic. It was in these terms that the medical
certicate for admission justied the need for connement.

Lydie: erotic pubescent reaction A young woman of fteen years,

Lydie was brought to Cery by a parent. Her mother did not know what to do
and worried about the consequences resulting from the liberties that Lydie was
taking with the boys. Lydie had quit school one year before graduation for
indiscipline, stayed at home without occupation and did not learn a trade. Lydie
spent forty-one days at Cery after which she was released on her own. It appears
that the lesson served her well. Her le does not indicate whether the medical
certicate leading to her committal was made as the result of a specic incident
relating to her condition. Mental troubles characterized by an exaltation of
mood, a tendency to linguistic excess, excitation of the senses, the risk of
fugue and indecency. She reacts against all authority, whether scholastic or
familial . . . I request her placement under observation at the asylum of Cery. It
was probably the mother of Lydia who appealed to the doctor.

Daisy: non-alienated intellectual retard Daisy, aged sixteen years,

was admitted to Cery upon the order of the Sanitary Service after requests
for abortion and sterilization were made by her guardian and by a general
physician. These measures were considered necessary because of heredity
from her mother, and because the child resulting from her pregnancy would
be a burden to the community. After twenty-ve days, she was released on her
own without the requests having been carried out.

Assessing the case les

The les that we have examined enable us to observe in concrete fashion the
different modalities of admission. Individual les also make evident the extent
to which institutionalized psychiatry was inextricably linked with, and even
indistinguishable from, medical, social and penal contexts. It is difcult to
appreciate the role of different actors in the unfolding of the process which
led to an institutional admission. For example, in the case of Daisy, if it was
her guardian who seemed to make the request for sterilization, the patient le
nevertheless does not allow us to appreciate the role of each intermediary,
between the family physician, the physician of the inrmary where Daisys
pregnancy was discovered, the guardian, the Justice of the Peace and the Sanitary
Service.
76 Jacques Gasser and Genevieve Heller

In most of the les, we encountered the polymorphic idea of danger

(present/future, physical/moral, private/public). We see this overriding theme
in attempts at suicide (Alain), great loneliness (Betty), crumbling family for-
tune, compromised reputation of family members, dupery (Louis), attempted
suicide, professional mistakes endangering the health of others, debts, false-
hoods (Bertrand), threats to a policeman by an armed individual (Charles), risk
of falling pregnant (Lydie), risk of bringing one or more children into the world
at the expense of public assistance (Daisy).
To explicit danger can be added motives, ephemeral or lasting, like amorality,
asocial behaviour, and disruption to public order. These are evidenced by the
young man who did not work and who knew nothing but enjoyment as the
sole goal of life (Louis), the doctor for whom alcoholism brought about moral
decay (Bertrand), the hunter with no regular employment and no proper home,
who lived like a savage (Charles), the young woman who fought and roused
the curiosity of onlookers (Betty), another young woman who refused to go to
school, or to work (Lydie), a third woman who was behind at school (Daisy).
In each case we can uncover issues relating to a lack of social integration, to a
threat, real or felt, like that related to the autonomy and the capacity to provide
for their needs, producing dependence or a disturbance in the relations with
others. Finally, it is worth noting in a minority of the admissions examined, a
great suffering, which was not however the pivotal event leading to committal.
This could be seen in the distressing nature of the situation for the individual
in question, and for his/her social contacts who witnessed the suffering, who
were impotent to alleviate the situation, and who were exhausted by it (Betty,
Alain, Bertrand).
No single argument seems to sufce in explaining requests for asylum com-
mittal, and in deciding on prophylactic (sterilization), protective (connement)
and therapeutic (hospitalization and treatment) measures. The mental illness
itself, it seems, does not sufce if it does not encroach on the public sphere,
exhaust relatives, manifest itself in attempted suicide, etc. Betty and Alain were
ill long before they were admitted to Cery. The possibility of consultations in
private ofces or in policlinique (public out-patient clinics) with specialists
permitted the delay in their connement. These two examples suggest that the
public psychiatric institution was one aspect of a multi-faceted network. The
uctuations and the development of this network offered alternative solutions
to that of admission to a public asylum. Thus, for example, we can imagine
that twenty years later Lydies situation could be resolved through a specialized
consultation for adolescents. Many examples make manifest the role of buffer
played by temporary connement which offered a respite for the presumed
patient or for his/her social circle, permitting a crisis situation to dissipate.
Certainly, the public psychiatric institution was destined to treat the mental
pathologies of the individual, but we cannot fail to observe that in many cases
 Switzerland, 19001970 Cery and Bel-Air asylums 77

it served foremost in the temporary separation and protection of one of the

partners in a public or private conict. This role was well recognized by August
Forel, the eminent psychiatrist and fervent supporter of mental hygiene: Our
asylums have . . . become kinds of public dispensaries of great urgency.32

Conclusion
The quantitative and qualitative evidence that we have been able to collect
from the casebooks of the hospitalized patients in the two Swiss psychiatric
institutions, in conjunction with the evolution of legislation concerning indi-
viduals suffering from mental troubles, allows us to understand a little better
the evolution of the demand for admission to a psychiatric institution during the
rst seventy years of the twentieth century. In summary, and to generalize, we
can try to dene the average type of person who was admitted to the asylum
during our period of study. It was a single man with a psychiatric pathology in
which alcohol played an important role or, if it was a woman, she was also sin-
gle, coming from a humble background with little education and with a poorly
dened psychiatric condition. These persons were hospitalized only once or
twice and for a relatively short period of time; their admission was involuntary
and requested by a doctor. The motivations behind their committal included a
complex mixture of reasons, from the strictly psychiatric to social problems in
a larger sense. Of course, these average situations do not really exist in reality,
but they are conrmed by the analysis of individual cases where the complexity
of situations is characterized best by case study. Central to our understanding
of this process is the notion of dangerousness, which is constantly evoked as
a reason for committal and which remains a very poorly dened concept.
We have also argued that, if the asylum played an important role in the
maintenance of public order, this role was above all that of diffusing a certain
number of conictual social situations (public or familial) for a short period
of time, and less for conning individuals for a long period of time. We have
already noted that two thirds of those who were hospitalized remained for fewer
than three months, and if long hospitalizations (more than a year) existed, they
were rare. However, these long-stay patients played a very important role in the
stigmatization of the asylum.
We have also been struck by the relative continuity of our data over the
decades under study. The changes in personnel and the type of care for persons
suffering from psychiatric problems between 1900 and 1970, the development
of an effective psychopharmacology in the 1950s, and even the parallel devel-
opment of out-patient psychiatry, had little impact on our results: it is as if the
32 Auguste Forel, Pourquoi, quand, comment doit-on interner des personnes dans les asiles
dalienes? (Lausanne, 1904), 11 (translation of an excerpt from the ninth annual report of
the Societe zurichoise de patronage des alienes, 1885).
78 Jacques Gasser and Genevieve Heller

mental hospital had an internal logic which was little inuenced by external
factors. On the other hand, certain social factors undeniably played a role in the
context of involuntary hospitalization. For example, in the 1920s and 1930s, a
period during which social control was strong, the demand for hospitalization
from non-medical individuals was higher than average. One can also see the
profound changes that occurred after the great discoveries of the 1950s (the in-
crease in the number of admissions, the emergence of voluntary admissions, the
shortening of length of stay, and the rehospitalizations). It would probably have
been necessary to lengthen our study to the 1980s, the decade during which these
changes became most evident, to explore these issues fully. Today, more than
half of the patients enter psychiatric hospitals as voluntary patients, their stays
are very short (an average of twenty-ve days in 1998), and re-hospitalization is
more common than ever. The factors that have changed in the last twenty years
necessitate, of course, an entirely new research project. It would be protable
to study on the one hand, the modication of the doctor-patient relationship
(from a paternalistic to a contractual relationship): one of the examples most
characteristic of recent years is the development of patients groups; another is
the demystication of the image of mental illness more generally. On the other
hand, economic constraints and, more specically, the political determination
to nd a way to control the growth of health spending, have also become central
to new models of care.
3 Family strategies and medical power: voluntary
committal in a Parisian asylum, 18761914

Patricia E. Prestwich

Recent research in the history of nineteenth-century psychiatry has explored

the expanding powers of the medical profession and the proliferation of the asy-
lum, that magic machine1 for curing insanity. This medicalization of madness
has usually been portrayed as a top-down process: social control imposed
from above with greater or lesser success on a population now the unwitting
object of medical encadrement.2 But as historians have begun to study in-
dividual asylums and the complexities of committal, more emphasis is being
placed on the role played by families in the process. Asylum doctors, it has
been suggested, merely conrmed a diagnosis of insanity already made by
families, by neighbours, or by non-medical authorities.3 Consequently, as the
American historian Nancy Tomes has argued, the composition of a nineteenth-
century asylum population tells more about the familys response to insanity
than the incidence or denition of the condition itself.4 Such arguments imply

Research for this project was funded in part by the Hannah Institute for the History of Medicine,
the Medical Research Council of Canada, the Social Sciences and Humanities Research Council
of Canada, and the University of Alberta. I am grateful for their support. I also wish to thank Chuck
Humphrey for all his help with the computer analysis of the data. This chapter was originally
published in the Journal of Social History and has been reprinted by permission.
1 Introduction in W. F. Bynum, R. Porter and M. Shepherd (eds.), The Anatomy of Madness:
Essays in the History of Psychiatry, 3 vols. (London, 1988), vol. III, 3. For an introduction to
recent work in the history of psychiatry, see the three volumes of The Anatomy of Madness
(London, 19858). The most recent works on French psychiatry are: J. Goldstein, Console and
Classify: The French Psychiatric Profession in the Nineteenth Century (Cambridge, 1987), I.
Dowbiggin, Inheriting Madness: Professionalization and Psychiatric Knowledge in Nineteenth-
Century France (Berkeley, 1991) and Y. Ripa, Women and Madness: The Incarceration of Women
in Nineteenth-Century France (Minnesota, 1990).
2 C. Jones, Montpellier Medical Students and Medicalisation in Eighteenth Century France, in
R. Porter and A. Wear (eds.), Problems and Methods in the History of Medicine (London, 1987),
58.
3 M. MacDonald, Madness, Suicide and the Computer, in Porter and Wear (eds.), Problems and
Methods, 210.
4 N. Tomes, The Anglo-American Asylum in Historical Perspective, in C. J. Smith and J. A
Giggs (eds.), Location and Stigma: Contemporary Perspectives on Mental Health and Mental
Health Care (Boston, Mass., 1988), 14.

79
80 Patricia E. Prestwich

a more dynamic and dialectical5 interpretation of the process of medical-

ization, one that requires a careful assessment of family demands for medi-
cal services and the degree to which these demands were met, willingly or
unwillingly, by the emerging psychiatric profession.6 Asylum records, although
difcult to interpret, can shed some light on family decisions to take the road
to the asylum;7 this is particularly true in the case of so-called voluntary com-
mittal, where families could avoid the involvement of the police or judicial
authorities.
In France, the law of 1838 established placement dofce, or ofcial commit-
tal, as the normal means of connement; it was, in the words of the law, restricted
to those who endanger public order or the safety of individuals.8 Implemen-
tation of the law of 1838 was the responsibility of departmental ofcials, and
conditions varied widely. In Paris, the procedures for ofcial committal were
complicated and a source of continued controversy. Local police sent those who
appeared to be both unbalanced and dangerous to the Inrmerie speciale, situ-
ated alongside the central police detention cells (the depot).9 At the Inrmerie,
potential patients (referred to as presumes) underwent a psychiatric examination
and, if certied as insane (aliene), were taken by a police van to the Admissions
Ofce of the department of the Seine. This was located in the grounds of the
Sainte-Anne asylum, the most important of the public asylums of the Seine,
and the only one situated within Paris itself. At the Admissions Ofce, patients
were again examined by a psychiatrist, most likely by the eminent Valentin
Magnan, were again certied as insane, and nally, were transported to one of
the ve asylums in the department of the Seine.10

5 Jones, Montpellier Medical Students, 58.

6 The term psychiatrist only began to be used after 1860, and for most of the nineteenth century
French psychiatrists referred to themselves as alienists (Grand dictionnaire de la psycholo-
gie (Paris, 1991), 610). In this chapter, I have used the term psychiatrist and asylum doctor
interchangeably.
7 Prefecture de la Seine, Direction des affaires departementales, Rapport sur le service des alienes
de la Seine (1890), 205.
8 This was article 18 of the law of 1838. On admission certicates the usual phrase was the
patient is a danger to him/herself or to others.
9 Both the central detention cells and the psychiatric service were located at 3 quai de IHorloge,
just near the Palais de Justice or central courts. In 1871, the General Council of the Seine voted
to separate the police psychiatric service from the prison and name it the Inrmerie speciale du
depot in order, as the Prefect said, that it not be confused with the depot, where prisoners are
kept. In 1970 the service was nally transferred to the grounds of Sainte-Anne. J. P. Soubrier
and M. Gourevitch, Recherches aux archives de la prefecture sur les origines de lInrmerie
speciale, Perspectives psychiatriques 96 (1984), 1334; Archives of the Prefecture de Police,
DB 218, letter of the Prefect, 28 February 1872.
10 Valentin Magnan served as the chief examining psychiatrist of the admissions ofce from 1867
until his retirement in 1912 and also gave weekly clinical lessons there. After patients had been
certied by Magnan, the fortunate ones were taken across the grounds to Sainte-Anne itself.
Others had to endure a longer trip to the more distant asylums of Vaucluse, Ville-Evrard, Villejuif
and, after 1896, Maison Blanche, all of which were outside the city limits of Paris.
 Voluntary committal in a Parisian asylum, 18761914 81

For nearly a century, Parisian psychiatrists denounced the continued exis-

tence of the Inrmerie speciale and sought to have patients in police custody
transferred directly to the Admissions Ofce at Sainte-Anne. With considerable
justication, and a certain self-interest, they maintained that police control of
ofcial admissions implied a punitive, rather than therapeutic, approach to the
insane. The prison-like atmosphere of the Inrmerie speciale and the claustro-
phobic cages of the police van imposed, they argued, an unnecessary hardship
on both families and patients. As one doctor described the transfer of patients:
The lunatic is conned to a narrow cage, with the only light coming from a
barred opening overhead; he hears the bolt slam shut and the van starts off
without his having any idea, in his confused state, where he is going or why
he has been locked up.11 Patients, noted Magnan, arrived at the Admissions
Ofce feeling that they have been imprisoned12 and, consequently, were more
difcult to treat.
In 1876, Parisian psychiatrists were inuential in having a second, more
humanitarian, type of admission procedure, placement volontaire, re-
established in the department of the Seine.13 This form of committal was in-
tended for the mentally disturbed who did not threaten public order but who
required treatment. Relatives (or even friends) could place such a person in any
public asylum of their choice without police intervention; they could also with-
draw the patient at any time, even if the asylum doctor objected. (This so-called
voluntary committal did not, of course, involve the consent of the patient: under
the law of 1838 the patient was an aliene and therefore incapable of informed
consent.)
When this form of admission was re-introduced in 1876, psychiatrists por-
trayed it as an enlightened reform that circumvented the horrors of the Inrmerie
speciale and assured the speedy treatment (i.e. committal) of mentally disturbed
but harmless patients. It also, as one doctor observed, avoided any formality
that could suggest the idea of coercion.14 From a medical point of view, this
was a distinct advantage at a time when a strong anti-psychiatry movement
in the press and among politicians accused doctors of sequestration arbitraire,
the illegal connement of people with no signs of mental illness.15 At rst,

11 Annales medico-psychologiques 1 (1877), 428.

12 Proces-verbaux de la Commission de surveillance des asiles publics dalienes de la Seine,
19 March 1907, 105.
13 This type of committal was also authorized under the law of 1838 but had been forbidden in
the 1840s because of overcrowded conditions in Parisian asylums. Members of the Societe
medico-psychologique began to study the question of voluntary admissions in 1868. In 1875, a
commission of the society recommended the re-establishment of the process as a humanitarian
reform that would allow families to avoid police procedures. Annales medico-psychologiques 1
(1877), 99ff.
14 Annales medico-psychologiques 1 (1877), 428.
15 For details of this anti-psychiatric movement, see Dowbiggin, Inheriting Madness, chapter ve.
82 Patricia E. Prestwich

asylum doctors did not foresee any great demand for this new type of admis-
sion and paid little attention to it.16 Nevertheless the demand for this service
grew steadily. By the mid-1890s, voluntary patients accounted for 21 per cent
of all admissions; by 1905 they had risen to nearly 30 per cent and in 1912
they reached 32 per cent.17 Sainte-Anne, the most prestigious of the asylums
of the Seine18 and the only one situated within Paris itself, attracted the largest
number. By the 1890s, nearly half of its annual admissions, male and female,
were voluntary. Sainte-Anne continued to receive a disproportionately high
number of such patients right up to the First World War.19
By 1890, this unanticipated growth in voluntary admissions had attracted
the attention and enthusiasm of asylum doctors. For the next twenty-ve years,
in their annual administrative reports and in their congresses, they welcomed
every increase in voluntary patients, complained of their unequal distribution
among the ve departmental asylums, and urged that more effort be made to
attract such admissions. They argued, for example, that because families were
offended by the promiscuity of the asylum, that is, the intermingling of classes
and medical conditions, separate rooms and better food should be provided for
voluntary patients.20 At a time when asylum budgets were increasingly re-
stricted, there were, as one doctor admitted, both economic and humanitarian
reasons to facilitate such admissions:21 at least half of all voluntary com-
mittals were paying patients, at a rate of nearly 3 francs per day. But doctors
were equally eager to attract non-paying voluntary patients. They complained
that neither families nor their physicians were aware of this form of medi-
cal assistance and that the procedures for free voluntary admission were too
bureaucratic. Marandon de Montyel, the senior psychiatrist at the Ville-Evrard
asylum, always informed his patients of these procedures when they were being
released, so that in case of a relapse, they could be speedily readmitted.22
This enthusiasm for one particular form of admission to public asylums is best
understood within the context of the professional ambitions and insecurities of

16 Annales medico-psychologiques 1 (1877), 106.

17 Rapport sur le service des alienes (1905), 4; (1912), 49.
18 Sainte-Anne housed both the Admissions Ofce, where Valentin Magnan worked and taught,
and the teaching clinic of the Faculty of Medicine, established in 1877. For psychiatrists of the
period, a position at Sainte-Anne was the pinnacle of their career.
19 No overall statistics for Sainte-Anne were reported in administrative documents. These estima-
tions have been calculated from the annual reports of asylum doctors. In 1895 for example 58 per
cent of male patients admitted to Sainte-Anne were voluntary. By 1903 the gure was 53.6 per
cent. Female voluntary admissions for the same years were 64.6 per cent and 60 per cent. Rap-
port sur le service des alienes (1895), 193, 197; (1903), 146, 151. Since voluntary placement
did not imply the patients consent, I have used the term in single quotations throughout.
20 Rapport sur le service des alienes (1890), 93 and (1896), 172. In fact, voluntary patients
received no special treatment in terms of accommodation or diet.
21 Rapport sur le service des alienes (1889), 234.
22 Rapport sur le service des alienes (1891), 139.
 Voluntary committal in a Parisian asylum, 18761914 83

belle-epoque psychiatrists. By the 1890s, the overcrowding in Parisian asylums

had become a constant problem. On the one hand, this ever-increasing asylum
population and the scant evidence of successful treatment encouraged the anti-
psychiatric movement to brand asylums as modern Bastilles and psychiatrists
as panalienists, self-appointed experts who saw madness everywhere except
in their own mirrors.23 On the other hand, psychiatrists now found themselves
responsible for up to 500 patients each, with the result that they could treat
only the most urgent or interesting cases. Moreover, there were few such in-
teresting cases because asylums had also become silted up with chronic and
incurable patients, such as the aged and the mentally handicapped, who, psychi-
atrists charged, were responsible for the professions embarrassingly low rate
of cure.24 Increasingly, asylum doctors denounced the large Parisian asylums as
barracks, depots, and lock-ups, places of connement, not of treatment.25
Rather than physicians, psychiatrists had become, in the words of one frustrated
practitioner, the head custodian of a population that was, from the medical
point of view, uninteresting.26
The unforeseen growth of voluntary admissions provided psychiatrists with
the opportunity to defend their medical expertise and to escape a professional
cul-de-sac.27 As early as 1877, an inspector-general of asylums, L. Lunier,
greeted the increase in the number of voluntary patients as evidence that
families had more and more condence in public asylums.28 In 1890, a young
Parisian psychiatrist, Marcel Briand, suggested that the popularity of volun-
tary admissions was a reection of medical progress: medical science was now
able to diagnose and treat madness at an earlier stage. The result, he argued, was
a change in attitudes, thanks to which families are more familiar with the road
to the asylum, which no longer horries them.29 In 1912, as Magnans succes-
sor at the Admissions Ofce, Briand repeated this claim, welcoming the more
and more numerous voluntary admissions as an indication that Parisians,

23 Dr Paul Garnier, LInternement des alienes (Therapeutique et 1egislation) (Paris, 1898), 118.
24 Dowbiggin, Inheriting Madness, 141. The cure rate was calculated either on the number of
releases in a year or the number of released patients certied as cured. With the most generous
calculations, the cure rate in the asylums of the Seine was about 18 per cent (22 per cent for
men and 14.5 per cent for women) in 1889 and 16 per cent (20 per cent for men, 12 per cent
for women) in 1907. Rapport sur le service des alienes (1889), 25 and (1907), 18. Sainte-Anne
had by far the highest cure rate of the asylums of the Seine.
25 See, for example, Garnier, Internement des alienes, 67.
26 In French, agent surveillant des surveillants. Rapport sur le service des alienes (1897), 172.
Falret, at the Salpetriere, complained that his service got no acute and curable patients, the only
ones of medical interest. Rapport sur le service des alienes (1894), 301.
27 In a perceptive analysis of recent trends in the history of psychiatry, Nancy Tomes has referred
to psychiatry as a discipline trapped by its own medical entrepreneurship in the therapeutic
and administrative cul-de-sac of the mental hospital. N. Tomes, The Anatomy of Madness:
New Directions in the History of Psychiatry, Social Studies of Science 17 (1987), 360.
28 Annales medico-psychologiques 1 (1877), 87.
29 Rapport sur le service des alienes (1890), 205.
84 Patricia E. Prestwich

better informed about the benevolent aspects of the law of 1838, increasingly
appreciate the nature of the care in our asylums.30
But to psychiatrists this growth of voluntary committals symbolized more
than the triumph of science and reason over ignorance and fear. It represented
a new denition of the asylum and, by implication, a new role for its doctors.
When referring to voluntary admissions, psychiatrists increasingly used the
term hospital, or occasionally hospice and maison de sante, rather than
asylum. For example, in 1890 Briand praised the comfort and luxury of
Parisian public asylums and concluded that The Parisian people today consider
them almost like ordinary hospitals, where you can enter or leave whenever you
want.31 In contrast, by the 1890s, asylum doctors frequently associated ofcial
or police admissions with imprisonment. As Rouillard, the head of the teaching
clinic of the Faculty of Medicine at Sainte-Anne, argued, more voluntary
patients were needed in order to show that the clinic was a true hospital and
not a prison.32
Asylum doctors argued that the two admission procedures resulted in two
different types of patients. Those who passed through the Inrmerie speciale
were, they believed, inevitably chronic or incurable patients. Although earlier
psychiatrists had praised ofcial committal because it forced families to treat
the mentally ill,33 their successors now argued that the horrors of the Inrmerie
so appalled families that they delayed admission until they had lost all hope.34
Since it was psychiatric dogma that any delay in admission resulted in the
manufacture of chronic cases,35 it was not difcult to associate chronic or
incurable patients with the Inrmerie speciale, which psychiatrists increasingly
referred to as the depot, the term for the police detention cells. On the other hand,
because voluntary patients could be taken directly to the asylum, psychiatrists
maintained that they were admitted at the acute, rather than chronic, stages of
their illnesses and were, consequently, curable. Only the lack of information
about free care, it was assumed, could account for any delay in the admission
of voluntary patients.
For asylum doctors, frustrated with the state of their institutions and subject
to continued public hostility, the growth of voluntary admissions readily be-
came a symbol of their hopes and a refutation of their critics: asylums could be
transformed into hospitals where an inux of acute patients would result in rep-
utable cure rates, expanded medical knowledge, and greater professional status.

30 Rapport sur le service des alienes (1912), 49.

31 Rapport sur le service des alienes (1890), 2056.
32 Rapport sur le service des alienes (1891), 75. He also argued that voluntary admission avoided
the depot (Inrmerie speciale) and the police van.
33 Rapport sur le service des alienes (1879), 7.
34 Rapport sur le service des alienes (1898), 92.
35 Congres des medecins alienistes et neurologistes de France, Rapports 1 (1897), 298.
 Voluntary committal in a Parisian asylum, 18761914 85

But this medical interpretation of the increasing popularity of voluntary pro-

cedures is too self-serving to explain why families chose to take the road to the
asylum. It assumes that family and psychiatric interests were identical and that
families accepted the medical denition of the asylum as a place to treat men-
tal illness through total isolation. It also ignores the fact that Parisian families
had already demonstrated their reluctance to submit to psychiatric regulation.
Voluntary admissions were reintroduced in the department of the Seine in
1876 not simply because psychiatrists argued for them, but because families
were circumventing the law. Either they tried to bypass the Inrmerie speciale
and take their relatives directly to the asylum, or they used ofcial admissions for
non-dangerous family members, to the detriment of the departmental budget.36
Moreover, comments by psychiatrists themselves suggest that it was not
administrative procedures but psychiatric power that most disturbed families.
Paul Garnier, the examining physician at the Inrmerie, admitted that it was
difcult to persuade families to commit a relative because they feared that the
patient will be mistreated, that it will make him hate his family and will drive
him completely mad.37 Febvre, a psychiatrist at Ville-Evrard, noted that ofcial
procedures offended families and made them fear the impossibility of ever
getting their patients back.38 The regulations for voluntary committal, which
allowed families to reclaim their relatives without the consent of the asylum
doctor, altered the balance of power between the family and the asylum, a
fact that psychiatrists rarely acknowledged and never explored in their medical
writings.
The tangled motives that led Parisian families to knock on the door39 of the
asylum will continue to elude historians, just as they eluded nineteenth-century
psychiatrists. Family decisions were complicated, never fully articulated, and
often unrecorded. But asylum records provide some useful indications of family
attitudes, particularly when the asylum is Sainte-Anne, the most convenient of
the Parisian asylums and, in terms of voluntary admissions, the most popular.
An analysis of the records of voluntary patients at Sainte-Anne from 1876
to 191340 suggests that families had their own denitions of the asylum and
of medical treatment, denitions that did not always accord with the hopes or
interests of the psychiatric profession.
36 Archives de la Prefecture de police, DB 218, letters of 27 September 1871 and 14 July 1877
from the Prefect.
37 Garnier, Internement des alienes, 64.
38 Rapport sur le service des alienes (1893), 177. 39 Ibid., 219.
40 The statistics in this chapter are based on an analysis of every second year of the admissions
records (registres de la loi) of Sainte-Anne from 1873 to 1913, a total of 7,100 cases (4,488 men
and 2,616 women). The admissions records normally give information on the age, marital status,
occupation, type of admission, and, for voluntary admissions, the person who committed the
patient. These records also give three diagnostic certicates and the result of admission, i.e.
release, transfer or death. Not all information was available for all patients, so the number of
cases for each statistical table varies slightly.
86 Patricia E. Prestwich

Although asylum doctors sought to make sharp distinctions between vol-

untary patients and those admitted under police procedures, asylum records
indicate that it was not the method of admission that most clearly distinguished
patients, but rather their gender. Men and women had a different experience of
the asylum. Both at Sainte-Anne and generally in the department of the Seine,
men were most often admitted for alcoholism or for general paralysis, the ter-
tiary and fatal stage of syphilis. At Sainte-Anne, for example, 25 per cent of
all male patients were diagnosed as alcoholic and another 20 per cent as suffer-
ing from general paralysis.41 Male patients, if alcoholic, were quickly released
after a brief period of detoxication; if paralytic, they died, usually within a
year. Women were more likely to be admitted for depression: at Sainte-Anne,
depression accounted for 32 per cent of all diagnoses among female patients.42
Depression was, in medical terms, a less serious condition, but one that did
not respond quickly to treatment. Consequently, women stayed longer in the
asylum and ran a higher risk of being transferred to other asylums. Therefore,
although admission rates for men were higher, at any given moment there were
more women than men in Parisian asylums. This pattern was familiar to psy-
chiatrists of the period: as one explained, If you exclude general paralysis and
alcoholism, women are more predisposed to madness than men.43
Although gender remained the determining factor in patterns of admission,
voluntary patients did differ in certain respects from their fellow patients
admitted under ofcial procedures. Voluntary committal was, not surprisingly,
a family matter and these patients were more likely to be married, although
there was little difference in the number of widowed.44 Nearly 40 per cent of
voluntary patients were admitted by their spouses and, in a rare instance of
gender equality, wives and husbands committed each other in roughly equal
proportions. If not a spouse, it was usually a parent or a child who made the
formal committal, although occasionally it was a more distant relative, a friend,

41 Seven per cent of women were diagnosed as alcoholic and 6 per cent as suffering from general
paralysis.
42 Among male patients, the rate of depression was 13 per cent.
43 Rapport sur le service des alienes (1896), 68.
44 The statistics for marital status are:

Male Female
Ofcial Voluntary Ofcial Voluntary
% % % %

Single 38.0 27.4 38.0 27.7

Married 53.8 66.1 42.0 53.9
Widowed 7.4 5.9 18.6 17.6
 Voluntary committal in a Parisian asylum, 18761914 87

Table 3.1 Occupations of patients

Male Female

Ofcial Voluntary Ofcial Voluntary

% % % %

Unskilled 13.9 8.8 18.7 7.3

Skilled 45.3 37.1 39.3 29.2
Petty bourgeois 22.0 32.8 5.6 5.6
Bourgeois 5.6 6.8 2.6 2.6
No occupation 5.6 9.4 31.1 52.6
Vagabonds 3.8 1.2
Wine trade 2.9 3.9 0.3 1.6
Concierge 0.9 1.2 1.2 1.1

Number of cases: men 4,478, women 2,408. (In all tables, percentages
are rounded to one decimal place.)

or even an employer.45 The decision was usually taken by the immediate family
either because, as doctors alleged, families sought to keep mental illness a secret
or because, in the late nineteenth century, many Parisians were recent arrivals
with no other relatives in the city. The immediate family also took responsibility
for patients who were released, although there was a slightly greater tendency
for mothers to assume the responsibility for such care.
Voluntary patients were also drawn from a somewhat higher social group
(see Table 3.1). Among such male patients, 32.8 per cent came from the petty
bourgeois or artisan class of shopkeepers, clerks, civil servants and teachers,
whereas among men committed by the police, the proportion was only 22 per
cent.46 The number of unskilled and skilled workers among voluntary male
patients was also lower: 8.8 per cent and 37.1 per cent respectively, compared
with 13.9 per cent and 45.3 per cent for ofcial admissions. Among women
voluntary patients, the pattern is even more pronounced. There were signi-
cantly fewer unskilled and skilled workers in this group47 and 52.6 per cent of
these women were recorded as having no occupation, compared with 31.1 per
cent of ofcial patients. While some of the voluntary women patients with

45 Of 2,430 voluntary patients admitted in the period 18761913, 39.6 per cent were admitted by
a spouse, 19.5 per cent by an immediate relative (a parent or child) and 23.6 per cent by another
family member. Although 17.3 per cent were admitted by a friend, often this was a common-law
spouse. Mothers committed 5.7 per cent of patients but assumed responsibility for the release
of 8.8 per cent of patients.
46 Male voluntary admission had a slightly higher proportion of bourgeois patients 6.8 per cent
compared with 5.6 per cent among men committed by the police.
47 Among female voluntary patients, 7.3 per cent were unskilled and 29.2 per cent were skilled
workers. Among ofcial women patients, 18.7 per cent were unskilled women workers and
39.3 per cent were skilled women workers.
88 Patricia E. Prestwich

no occupation were elderly, the admission registers indicate that most were the
wives of skilled workers or of petty bourgeois and did not work outside the
home.48
The higher social status of the families who used the procedures for vol-
untary admission suggests that either they were afuent enough to afford the
approximately 100 francs a month required of paying patients, or that they
were sufciently informed about the Parisian welfare system to arrange for free
voluntary care.49 Given the complexities of the French class system, where a
skilled worker might earn more than a shop owner or clerk, it was not always
the petty bourgeois who paid for treatment. Although the records for paying and
free voluntary admissions are not extensive, they do suggest the inadequacies
of occupational labels. In some cases, the differences between paying and non-
paying patients are clear: the head clerk at the tax ofce, whose son was an
employee at the Treasury, was a paying patient as were most patients identied
as proprietors, while the day labourer (homme de peine) whose wife was also
a day labourer ( journaliere) was a non-paying patient. Butchers, grocers and
bakers usually paid, as did almost all cafe owners, but patients identied as
investors (rentiers) could be found in both categories, as could teachers, tailors,
soldiers, seamstresses and clerks.
In some cases, non-paying voluntary patients had received information
about the regulations from doctors, as is probably the case with the teaching
assistant (maitre-repetiteur) at the prestigious Lycee Louis-le-Grand, who was
committed by his friend, a doctor. Others may have been advised by relatives
who worked in the public service, as is likely in the case of two female pa-
tients whose husbands were municipal policemen. The head shoemaker at the
Vaucluse asylum, who was admitted by his wife, a nurse at Vaucluse, had the
advantage of already knowing the asylum system and he received free treatment.
But how can one explain the paying patient who was a domestic servant, com-
mitted by her sister, a laundrywoman? Perhaps her employer paid, but if so, s/he
was a generous one, for the patient was being admitted, at her own request, for
the fth time. At Sainte-Anne, at least, patients seemed to be fully aware of the
regulations for free voluntary treatment, perhaps because the asylum also op-
erated a free clinic where Parisians could come for consultations or for baths.50

48 A sampling of registers for the 1880s indicates that over 50 per cent of married women listed as
having no occupation were the wives of petty bourgeois and another 25 per cent were married
to skilled workers.
49 The Seine was the only department in France to provide free voluntary committal. It required
a police investigation into the nancial status of the family, a condition that was not welcomed
by families. Ofcials were allotted 160 non-paying voluntary places in Parisian asylums per
year.
50 The cases cited in the two preceding paragraphs are taken from the admissions records of 1885
and 1887, where paying and non-paying patients are clearly identied. The cases, in order of
citation are: Registre de la loi, 1887 (men) no. 45; 1885 (men) no. 153, no. 77; 1887 (women)
no. 80, no. 145; 1887 (men) no. 206; 1885 (women) no. 123.
 Voluntary committal in a Parisian asylum, 18761914 89

Table 3.2 Admission diagnoses

Male Female

Ofcial Voluntary Ofcial Voluntary

% % % %

Alcoholism 28.3 13.7 5.2 5.3

Depression 11.3 16.3 27.8 35.2
General paralysis 17.4 30.3 4.6 7.3
Mania 6.4 2.4 13.4 12.3
Persecution 10.6 9.2 18.1 13.3
Senile dementia 3.3 3.1 5.2 5.6
Other 23.0 24.9 25.5 20.8

Number of cases: men 4,456, women 2,505.

At the heart of asylum doctors enthusiasm for voluntary admissions lay

the assumption that such patients suffered from acute rather than chronic con-
ditions. Yet the records of Sainte-Anne indicate that families made the decision
to commit not in the early stages of illness but when the situation had become
desperate. An analysis of admission diagnoses, for example, indicates a higher
rate of chronic or incurable illnesses among voluntary patients (Table 3.2).51
The rate of general paralysis among male voluntary patients was 30.3 per cent,
compared with 17.4 per cent for their ofcial counterparts. These men, usually
in their 40s or 50s, often exhibited such violent or bizarre behaviour that nurs-
ing homes and hospitals refused to keep them. One such patient, who had been
under a doctors care for a year and was not considered dangerous, was com-
mitted when he suddenly attacked his wife with a knife.52 Patients with general
paralysis also tended to have delusions of grandeur, spending hard-earned fam-
ily resources or incurring large debts. Typically, they would hire a cab for a
day-long tour of Paris and then refuse to pay the fare. In one case, the family
of a cafe owner committed him when he began giving free drinks to all his
customers.53 Although general paralysis was not a major reason for the com-
mittal of women, the rate among female voluntary patients was also higher.54
The incidence of depression was also signicantly higher for all voluntary
patients. Depression was not always considered a chronic condition, but patients
with this diagnosis stayed longer before release, thereby contributing to the con-
tinual overcrowding of Parisian asylums. They were also more likely to suffer

51 The admission diagnoses are taken from the rst two certicates in asylum registers, the cer-
ticate issued immediately and the certicate issued after twenty-four hours. Both certicates
were required by law.
52 Registre de la loi 1879 (men) no. 175. 53 Registre de la loi 1903 (men) no. 26.
54 Voluntary women patients had a 7.3 per cent rate of admission for general paralysis, compared
with 4.6 per cent for other women patients.
90 Patricia E. Prestwich

Table 3.3 Death rates

Male Female

Ofcial Voluntary Ofcial Voluntary

% % % %

Overall 32.1 42.4 18.8 28.0

Alcoholism 13.9 16.5 14.5 17.8
Depression 22.0 19.0 13.9 14.5
General paralysis 72.8 75.5 48.7 84.0
Mania 18.8 36.8 9.4 14.7
Persecution 15.0 30.6 10.0 19.0
Senile dementia 85.0 79.6 58.0 75.0

Number of cases: men 3,425, women 1,977.

a relapse and to be readmitted. Among female voluntary patients, 35.2 per

cent were diagnosed as suffering from depression, whereas for other women
patients the rate was 27.8 per cent. Although depression was not a major source
of admissions for men, it accounted for 16.3 per cent of all diagnoses among
voluntary patients, compared to 11.3 per cent for men admitted by the police.
Alcoholism, which was responsible for the short stay and high release rate of
many male ofcial patients, was conspicuously underrepresented among male
voluntary patients. It comprised only 13.7 per cent of these admissions, a
lower proportion than diagnoses of depression.55
There was also a higher death rate among all voluntary patients, another
indication that they were admitted at a later, more chronic, stage of their ill-
nesses (Table 3.3). Male voluntary patients, with a greater incidence of gen-
eral paralysis, had the highest death rate of all: 42.4 per cent, compared to
32.1 per cent for other men in the asylum. The death rate for women patients
was always lower, but 28 per cent of voluntary women patients died, in com-
parison with 18.8 per cent of other women patients. In some cases, death was
the result of old age, as there was a slightly larger proportion of elderly patients,
particularly women, among voluntary admissions.56 Even when patients were
diagnosed as suffering from conditions not usually considered fatal, such as

55 Sainte-Anne may have been atypical of the regions asylums in that few of its patients were
mentally handicapped. Such patients may have been placed directly in more distant and cheaper
asylums because relatives anticipated long-term care, or they may have been sent to the Bicetre
hospital where D. M. Bourneville had organized special facilities for mentally handicapped
children.
56 Among voluntary women patients, 17.3 per cent were over the age of sixty, compared with
14.9 per cent among ofcial women patients. Among male patients, the proportion of those over
sixty was the same (9 per cent), whether ofcial or voluntary, but there were slightly more
men in the fty to fty-nine age group among voluntary patients: 17.6 per cent compared with
15.2 per cent for ofcial male patients.
 Voluntary committal in a Parisian asylum, 18761914 91

mania or persecution, the mortality rates for voluntary patients were noticeably
higher.
The circumstances surrounding many voluntary admissions reinforce the
impression that families turned to the asylum only in periods of crisis or when
alternatives had failed. Violence, or the threat of violence, is a recurring theme
in the medical certicates and patient les. Of course, families may have ex-
aggerated the violence, either from fear or from an emotional need to justify
their actions, but they did not need to do so in order to have the patient com-
mitted. Voluntary admission, unlike ofcial procedures, did not require that
the patient be dangerous, only in need of treatment. Asylum records suggest
that in many cases the fear of violence was valid. One patient, for example,
had threatened to kill his mother and sister and had begun digging a grave in
the backyard. His mother brought him to Sainte-Anne after he tried to burn his
sisters eyes out with a red-hot iron.57 Wives appear to have used voluntary
admission as a temporary means of defence from domestic violence, partic-
ularly in the case of alcoholic husbands. In one typical case of alcoholism,
the husband had broken the furniture, threatened to strangle his wife, and had
provoked numerous complaints from neighbours.58 But abused wives were not
alone in seeking temporary relief from violence through committal. An eighty-
year-old man committed his son, suffering from general paralysis, when the son
became rude and violent, while the family of a female alcoholic, her doctors
noted, lived under a reign of terror.59 A suicide attempt, or even the threat
of suicide, was also sufcient reason for admission and was noted as such in
12.5 per cent of cases.
Complaints from neighbours could also provoke a familys decision to com-
mit a relative and, judging from the certicates, asylum doctors found this a
reasonable motive. A deaf-mute, who had stayed in her room for fteen months,
was brought to Sainte-Anne by her seventy-two-year-old father because she had
become violent and her screams disturb the neighbours.60 In another case, a
family reported that it was impossible to keep the patient in her room and that
she seeks ghts with all the neighbours.61 One elderly man threatened the
neighbours constantly and was in a lamentable state of lthiness while an
elderly woman was committed because she hit the concierge without any rea-
son and without any previous disputes.62 Doctors may have maintained that
families found mental illness so shameful that they kept it a secret, but privacy
was a rare luxury in working-class dwellings and the interests of one relative
might well be sacriced to the larger interests of the family. In some cases,

57 Patient le, no. 100796.

58 Registre de la loi 1895 (men) no. 21.
59 Registre de la loi 1915 (voluntary) nos. 84 and 86.
60 Registre de la loi 1891 (women) no. 258. 61 Registre de la loi 1877 (women) no. 32.
62 Registre de la loi 1887 (men) no. 200 and 1887 (women) no. 199.
92 Patricia E. Prestwich

the inuence of neighbours could be more positive: one man claimed that he
did not realize that his wife, who was diagnosed as suffering from depression,
had been selling their household goods and mistreating their children until his
neighbours told him.63
Usually, families had already tried other means of treatment before they
turned to the asylum. In some instances, patients had been in a hospital, a maison
de sante, or under the care of a local doctor who nally advised committal. In
other cases, families had relied on their own resources, either locking up patients
at home or sending them to stay with relatives in the countryside. One patient, a
woman who lived alone with her young son, was taken rst to a pharmacist and
then to a doctor when she began to behave strangely. Neighbours were looking
after her until she tried to commit suicide by jumping out of a window. Then
she was brought to Sainte-Anne. When she was released, her mother took her
to the countryside to recuperate.64
Families who turned to the asylum only when the situation had become
chronic or unmanageable were equally reluctant to abandon their relatives to the
exclusive care of the reputed medical experts. Patients in Parisian asylums were,
as doctors remarked, much visited65 and, given the overcrowded conditions,
families could be as well informed about the medical and living conditions
of their relatives as was the asylum doctor.66 Asylum records of voluntary
admissions indicate that families were not willing to defer to medical opinion;
rather they were able to use their knowledge and legal powers to intervene on
behalf of relatives in the two areas of most importance to patients, namely,
release and transfer.
Patients committed by their families had a signicantly higher rate of release,
whether looked at in terms of overall statistics or in terms of specic diagnoses
(Table 3.4). Women voluntary patients had the highest general release rate of
all patients in the asylum, even though, as a group, they were somewhat older.
Their release rate was 48.3 per cent, compared with 40.5 per cent for ofcial
women patients. The release rate for voluntary male patients (46 per cent) was
slightly higher than the rate for ofcial male patients (45.1 per cent), despite
a greater number of terminally ill patients and a markedly lower proportion
of alcoholics among male voluntary patients. Voluntary patients, whether
men or women, who were diagnosed as suffering from depression had a 64 per
cent rate of release, compared with 48 per cent for depressed ofcial patients.
There were similar patterns of a higher release rate for voluntary patients
suffering from alcoholism and persecution. However, the pattern did not hold

63 Patient le, no. 88488. 64 Registre de la loi 1895 (women) no. 16.
65 Rapport sur le service des alienes (1894), 89.
66 Rapport sur le service des alienes (1894), 89. At Sainte-Anne, there was one doctor for ap-
proximately 400 patients and doctors regularly complained that they were not able to see most
patients, let alone treat them.
 Voluntary committal in a Parisian asylum, 18761914 93

Table 3.4 Release rate

Male Female

Ofcial Voluntary Ofcial Voluntary

% % % %

Overall 45.1 46.0 40.5 48.3

Alcoholism 69.9 80.1 59.0 68.9
Depression 48.0 64.0 47.6 63.9
General paralysis 14.3 18.2 13.2 4.3
Mania 53.8 55.3 53.8 60.3
Persecution 43.0 50.0 39.0 46.0
Senile dementia 9.5 16.3 9.3 7.5

Number of cases: men 3,425, women 1,977.

true in diagnoses of general paralysis and senile dementia. In these cases, only
male voluntary patients were more likely to be released than their ofcial
counterparts; female voluntary patients, perhaps because older, were not so
fortunate.
In part, these higher release rates among voluntary patients are an indication
that many families did not lose touch with their relatives in the asylum. Families
were thus available either to accept trial leaves or to assure doctors that they
could look after convalescing patients at home. On rare occasions, doctors
acknowledged the presence of families as a positive factor that could lead to
innovative treatment. At the Villejuif asylum, for example, Dr Marie arranged
with the families of paying voluntary patients to lodge them with local families
as a preparation for full release.67 But usually the relationship between families
and psychiatrists was less amicable. Families frequently used their powers under
the law of 1838 to force the release of a patient in the face of opposition from
the asylum doctor. Psychiatrists resented this challenge to their authority. They
grumbled about the ill-considered impatience of families who, with the text of
the law in hand, demand the release of their patient68 and blamed the premature
release of patients on families who mistook a remission for a recovery.69 Asylum
doctors were careful to note on certicates that they did not agree with the family
decision and they took a lugubrious pleasure in pointing out when such releases
resulted in readmission or misfortune.
Psychiatrists dismissed this reluctance to defer to their medical expertise as
simply the result of families inclination to yield to pressure from patients or, as
one doctor at Sainte-Anne explained, families . . . often share the emotions and

67 Rapport sur le service des alienes (1911), 300.

68 Annales medico-psychologiques 2 (1888), 393.
69 Rapport sur le service des alienes (1897), 67.
94 Patricia E. Prestwich

delirious ideas of their patients.70 In some cases, families were undoubtedly

motivated by optimism, affection, or by insistent pleading. In many cases, how-
ever, relatives had formed their own judgement about the feasibility of release
in the same manner as did the asylum doctors, that is, from visits, information
from asylum attendants, and trial leaves. One husband, for example, reported
that his wife had asked him to take her out of the asylum with a sweetness that
disarms me. He consented to a trial leave but brought her back as he judged
she was not fully recovered.71 The advice of the asylum physician could be
a part of family calculations, particularly when committal had been the result
of violence, but relatives were also willing to offer their own diagnoses and to
act accordingly. For example, a man who was seeking the release of his sister,
whom he and other relatives had visited regularly, wrote to her doctor: her
condition appears to be much improved and I think that with my supervision
she can try to re-establish her own home.72 In some cases, the decision was
more informal: relatives simply did not return patients who had been released
on a trial leave. Doctors usually accepted this as a de facto release and issued
the appropriate certicate. Of one such patient the asylum doctor wrote, he is
far from cured, but is not dangerous and since it is a voluntary admission, I am
concluding that he has been released on the responsibility of his family.73
The familys decision to have a patient released was also based on less strin-
gent denitions of what constituted a cure. Families often seemed content with
some improvement in their relatives condition and were willing to tolerate be-
haviour that doctors might label abnormal. One husband, asking for the release
of his wife because he feared that the asylum was driving her mad, admitted that
she still heard voices, but I do not think that is a reason for committing her.74
This attitude may suggest a tolerance and affection on the part of immediate
relatives, or even a different denition of mental illness. But in many cases,
it was the result of economic necessity. Women who relied on a husbands or
sons income often used economic need as a reason to request the release of a
patient. One mother, who offered the opinion that her son appeared to be cured,
argued that an immediate release would enable him to nd work. If not, the
season would be over and I will suffer. He helps me out when he works and
I am elderly.75 Husbands of voluntary patients were less dependent on the
income of their wives, who often did not work outside the home, but they did
need their domestic work. The prolonged absence of a wife could result in the
children being sent to relatives and the husband being left to fend for himself.
One woman patient, in asking her doctor for a release that she herself seemed
to consider premature, argued that my husband is at the end of his patience
trying to cope . . . with the details of housekeeping, which he is not used to.76
70 Rapport sur le service des alienes (1889), 151. 71 Patient le, no. 126429.
72 Patient le, no. 135329, 1908. 73 Registre de la loi 1891 (men) no. 123.
74 Patient le, no. 129978, 1906. 75 Clinic, patient le, no. 140432.
76 Patient le, no. 118305, 1903.
 Voluntary committal in a Parisian asylum, 18761914 95

Table 3.5 Transfer rates

Male Female

Ofcial Voluntary Ofcial Voluntary

% % % %

Overall 20.8 9.1 38.6 20.0

Alcoholism 14.4 2.9 26.5 11.1
Depression 28.0 13.7 35.7 19.3
General paralysis 11.0 4.0 36.8 10.1
Mania 24.7 7.9 35.0 22.4
Persecution 39.0 16.0 48.0 27.8
Senile dementia 4.2 2.0 31.4 17.0

Number of cases: men 3,425, women 1,977.

The other important area of family intervention was in the decision to transfer
patients to more distant asylums. In the latter half of the nineteenth century,
asylums in the department of the Seine were so overcrowded that nearly half
their patients usually chronic and often female were transferred to provincial
asylums, where it was almost impossible for families to visit and where the
standards of care were suspect. Patients and families alike dreaded a transfer.
Families were so upset that asylum ofcials kept the departure date of convoys a
secret from them in order to avoid painful scenes at the railway station.77 Under
the terms of voluntary admission, the transfer of paying patients required
consent from the family, and the statistics clearly demonstrate that families
were unwilling to give this consent, even for patients who were chronically or
terminally ill.
The overall transfer rate for both male and female voluntary patients was
nearly half that of ofcial patients (Table 3.5). The difference is most noticeable
in the case of those female patients diagnosed as suffering from depression or
senile dementia. These patients ran a high risk of being transferred, yet for
those admitted by their families, the risk was cut almost in half. Even when
voluntary patients were eventually transferred, families were very effective
in delaying this decision as long as possible. The contrast in the length of stay
before transfer for ofcial and voluntary patients is striking. On average, male
ofcial patients stayed 176 days and female ofcial patients 233 days before
being transferred; their voluntary counterparts were transferred after 883 days
(for men) and 648 days (for women).78

77 Commission de surveillance, 12 June 1900, 199.

78 This is the median length of stay. If the interquartile ratio, i.e. the middle 50 per cent of the data,
is calculated, the differences are even greater: ofcial male and female patients were transferred
after 618 and 619 days respectively; for voluntary patients the gures are 2,315 days for men
and 1,611 days for women.
96 Patricia E. Prestwich

Families clearly wanted their patients nearby, whether for visits or even
for eventual release. (There were cases where the family sought the release
of a relative after many years of connement.) In some instances, families
preferred to take their relative home rather than consent to a transfer. Certain
families proved particularly adept at manipulating the system. In 1903, one
family removed a male relative from Sainte-Anne because the asylum doctor
wanted to transfer him to an agricultural colony for non-violent chronic patients.
After several months, they returned the patient to Sainte-Anne, claiming that
he was very dangerous and potentially violent, particularly when under the
inuence of alcohol. The patient stayed at Sainte-Anne until his death in 1919.79
If the family consented to a transfer, this did not necessarily mean that they
were abandoning their relative. Middle-class patients, particularly if chronically
ill, were frequently transferred to the pensionnat at Ville-Evrard, where the fees
were higher but the care more comparable to that of a private clinic. Some pa-
tients were transferred to asylums in their native provinces where, presumably,
nearby family could visit. (The system also worked in reverse: Sainte-Anne
was the preferred destination for patients in provincial asylums whose families
wanted them returned to Paris.) Families of paying patients might reconsider
their choice of asylum if treatment at Sainte-Anne, the most expensive of the
Parisian asylums, proved lengthy. One father, whose daughter had been under
treatment at Sainte-Anne for a year, wrote to her doctor: I was prepared to
make the sacrice for such lengthy treatment in the hope that, under your good
care, she would completely regain her reason. But, despite some improvement,
it will still be a long time before I can take her back without danger so I am
transferring her to Vaucluse, where it is cheaper.80
In their correspondence and statements, families and patients often referred to
Sainte-Anne as a maison de sante rather than as an asylum. Given the widespread
prejudice against the insane, this may have been simply a form of denial, but in
many instances it was also an accurate description of how many families viewed
the asylum, namely as a place that was also for the chronic, the elderly, and those
who were not, strictly speaking, mentally ill. In this sense families were not,
as some historians have suggested,81 merely enlarging the denition of mental
illness; rather they were changing the denition of the asylum from a place
for the treatment of the mentally ill to a source of care, whether temporary
or long-term, for a wide variety of conditions. Contrary to supply theories
about the development of asylums, which postulate that once the asylums were
constructed along medical lines the working-class family and neighborhood
obediently present[ed] its crazy cases,82 Parisian families were not simply
79 Registre de la loi 1903 (men) no. 227.
80 Patient le, no. 118305. 81 Tomes, The Anglo-American Asylum, 13.
82 M. Ignatieff, Total Institutions and Working Classes: A Review Essay, History Workshop 15
(1983), 172.
 Voluntary committal in a Parisian asylum, 18761914 97

passive users of asylum services. In reality, their demand for certain types of
care shaped the structure of institutions that were still developing.
In all likelihood, this varied use of the asylum was not restricted to those
more privileged groups who took advantage of the provisions for voluntary
committal. By the 1890s, psychiatrists were complaining that asylums were
so overcrowded with other patients that true madness has become rarer and
rarer in the asylums of the Seine.83 In order to return the asylum to its original
purpose, as they dened it, asylum doctors began to urge separate care facili-
ties for the elderly, the mentally handicapped, and the incurable. Several such
facilities, particularly agricultural colonies, were established in the department
of the Seine before 1914. The results of these reforms are evident in the records
of Sainte-Anne where, in the last decade before the war, the length of stay and
mortality rates for all patients declined, indicating the presence of fewer chronic
or incurable patients. Despite a psychiatric ideal of isolation from the commu-
nity, the development of the asylum must be understood within the context of
a complex system of services and institutions for the working classes.84
Although families increasingly turned to the asylum for assistance with rel-
atives whose behaviour had become intolerable, they did so despite the con-
dent rhetoric of psychiatrists as a last resort and with a clear unwillingness to
accept the psychiatric dogma that treatment could only be achieved through iso-
lation. Instead of abandoning their relatives to asylum doctors, they demanded a
voice in the release, transfer, or longterm care of their patients.85 This ambiva-
lent behaviour is not unique, nor is it surprising. As Michael Ignatieff has argued
in a discussion of prisons, workhouses, and asylums in Britain and France, the
poor were suspicious of institutions, but nevertheless supported them.86
Even middle-class families who placed relatives in well-appointed private
asylums expressed great anxiety about their decision and a need to be consulted
about treatment.87 Placing a relative in one of the public asylums of the Seine
could not have been an easy decision, even when families were armed with
legal powers under the terms of voluntary admissions. French psychiatrists,

83 Rapport sur le service des alienes (1892), 211.

84 An excellent example of such interconnections is found in Richard Foxs study of the California
committal process where he argues that the high percentage of aged women in asylums was
in part because almshouses became specialized institutions for the care of aged and destitute
men. R. W. Fox, So Far Disordered in Mind: Insanity in California, 18701930 (London and
Berkeley, 1978), 131.
85 Families often referred to patients in a possessive fashion as ma malade, mon malade or
notre malade.
86 Ignatieff, Total Institutions, 172. Ignatieff credits this insight to M. A. Crowther, The Workhouse
System, 18341929: The History of an English Social Institution (London, 1981).
87 See, for example, N. Tomes, A Generous Condence: Thomas Story Kirkbride and the Art
of Asylum-Keeping, 18401883 (Cambridge, 1984), 113, 12223; C. MacKenzie, A Family
Asylum: A History of the Private Madhouse at Ticehurst in Sussex, 17921917, PhD thesis,
University College, London (1986), 2789, 319.
98 Patricia E. Prestwich

unlike some of their North American counterparts,88 did not welcome family
intervention. Moreover, families did not need the press to conjure up images
of Bastilles: they needed only to look at the high walls and locked gates of
Sainte-Anne. This reluctant and selective, but increasing, use of voluntary
admissions should not be interpreted simply as a form of resistance to medical
or state power. Rather, it suggests that families had integrated the asylum into
their own well-established systems of treatment for the mentally disturbed or
chronically ill, systems that made skilful use of various formal and informal
resources available in the family, neighbourhood, and the larger community.
When these resources failed, they turned to the asylum, but not necessarily as
a permanent or long-term alternative.
French asylum doctors, recognizing the competition, denounced familial
treatment as a source of abuse and chronicity. Families, they maintained, could
not treat the unbalanced, they could only enchain them.89 Yet in daily prac-
tice, psychiatrists not only had to cope with the needs and views of the family,
they were also forced to use the familys resources. Faced with overcrowded
conditions, asylum doctors relied on the willingness of families to care for
convalescent patients, whether by trial leaves or permanent release. Families
often left with specic instructions for the treatment of recovering patients
and on occasion they consulted asylum doctors about continued home care. In
late-nineteenth-century Paris, the exclusion of families from the treatment of
the mentally ill was not, therefore, a realistic model, no matter how much it
remained an article of faith for the psychiatric profession. Today, when a de-
carceration movement has rejected the asylum and aspires to treat the mentally
disturbed within the community, it is necessary to understand how community
demand helped to shape the nineteenth-century asylum and, consequently, to
recognize that new methods of treatment or care must be based on a realistic
assessment of family resources and needs.
Finally, as a post-Foucaultian generation of historians focuses on the di-
alectical relationship between families and the asylum,90 it is important not
to lose sight of the individual patient, that ever-shadowy gure of asylum
records. Under law, the patient remained the object of family, administrative, or
medical decisions. A truly voluntary admission procedure (placement libre in

88 While psychiatrists in private asylums had an obvious motive for keeping the families of pa-
tients informed and pleased, there is some evidence from research on North American asylums
for the poor that doctors encouraged a more cooperative relationship with families. See, for
example, Constance McGoverns study of the Pennsylvania State Lunatic Asylum where, she
argues, working-class families interacted with it quite comfortably. C. M. McGovern, The
Community, the Hospital, and the Working-Class Patient: The Multiple Uses of Asylum in
Nineteenth-Century America, Pennsylvania History 54 (1987), 27.
89 When accused of unlawful connement, psychiatrists frequently retorted that the only such
proven cases were to be found within families. Rapport sur le service des alienes (1905), 187.
90 The term post-Foucaultian is from Tomes, The Anatomy of Madness, 358.
 Voluntary committal in a Parisian asylum, 18761914 99

France), with its challenges to medical and family power, was slow to emerge.
To what degree did family intervention ameliorate or complicate the patients
situation? Were patients able to use these conicting systems of treatment to
their own advantage? Although current research suggests that patients were not
simply dumped in asylums,91 this says little about the feelings of imprison-
ment, isolation, and abandonment that patients experienced. Families may have
viewed asylums as regrettable but indispensable necessities.92 It is unlikely
that patients agreed.

91 For example, Tomes, A Generous Condence, 123 and MacKenzie, A Family Asylum, 317;
E. Dwyer, Homes for the Mad: Life Inside Two Nineteenth-Century Asylums (New Brunswick,
1987), 3. Much, but not all, of the evidence for a family involvement in medical decisions comes
from studies of private asylums. In contrast, a recent study of a public asylum in Alabama
suggests that doctors in that asylum had much more control. J. Starrett Hughes, The Madness
of Separate Spheres: Insanity and Masculinity in Victorian Alabama, in M. C. Carnes and
C. Griffen (eds.), Meanings for Manhood: Constructions of Masculinity in Victorian America
(Chicago, 1990), 5366.
92 Fox, So Far Disordered in Mind, 10.
4 The connement of the insane in Victorian
Canada: the Hamilton and Toronto asylums,
c. 18611891

David Wright, James Moran and Sean Gouglas

Introduction
The changing approaches to the history of madness and the lunatic asylum in
Canada have broadly reected the ebb and ow of Anglo-American psychiatric
historiography. The rst generation of Canadian medical historians privileged
the role of individual politicians, the evolution of the medical profession, and the
difculties of state formation in the gradual establishment of state-run mental
hospitals. T. J. W. Burgess, for example, thought that Canada had shown a
gradual process of evolution in the care of the insane, from an era of neglect;
then, one of simple custodial care with more or less mechanical restraint; and
nally, the present epoch of progress.1 Burgesss account was followed by
more sobering interpretations of success of the lunatic asylum, such as that
written by Harvey Stalwick.2 In his formulation, social conditions and political
priorities beyond the control of pioneering alienists (psychiatrists) undermined
the potentially benecial aspects of institutional psychiatry. His sympathetic
assessment of psychiatry, and its shortcomings, was thematically consistent
with works produced contemporaneously in Britain and the United States, by
Kathleen Jones and Gerald Grob respectively.3 Their work continues to attract
considerable sympathy from researchers in Canada. Endorsing their meliorist
interpretation, Peter Keating has argued that the moral treatment of insanity
that inspired the rst generation of asylums is best understood as a hopeful

The authors would like to acknowledge the following agencies for their funding support: Canadian
Institutes for Health Research; Arts Research Board of McMaster University; Associated Medical
Services (Hannah Institute), Toronto; the Wellcome Trust, London, UK. An earlier version of
this paper was presented to the 2001 Annual Meeting of the Canadian Psychiatric Association,
Montreal, Canada.
1 T. J. W. Burgess, A Historical Sketch of Our Canadian Institutions for the Insane, Transactions
of the Royal Society of Canada 18 (1898), 4.
2 H. Stalwick, A History of Asylum Administration in Pre-Confederation Canada, unpublished
PhD thesis, University of London (1969).
3 K. Jones, A History of the Mental Health Services (London, 1972) and G. N. Grob, Mental
Institutions in America: Social Policy to 1875 (New York, 1973). For revisions of these inuential
monographs, see K. Jones, Asylums and After: A Revised History of the Mental Health Services
(London, 1993) and G. N. Grob, The Mad Among Us: A History of the Care of Americas Mentally
Ill (Cambridge, 1994).

100
 Hamilton and Toronto asylums, Canada, 18611891 101

new breakthrough in medical practice. Keating explains the failure of asylum

treatment and the rise of late nineteenth-century degeneration theory in Quebec
as the result of social and political factors outside the power and purview of the
early asylum promoters.4
As historians of madness know too well, the 1970s witnessed an unprece-
dented scholarly revision of the meliorist view of the rise of mental hospitals
and the consolidation of Anglo-American psychiatry. Historians such as David
Rothman and Andrew Scull offered a more cynical view of the rise of the asy-
lum, situating the mental hospital within a new range of institutional solutions
designed to incarcerate the deviant. Following closely on the work of Michel
Foucault, whose Histoire de la Folie was translated into English in 1972, these
scholars rejected the views of Grob and Jones that placed the establishment
of the asylums within the perspective of enlightened humanitarianism. Rather,
revisionist scholars suggested that the asylum, and the psychiatric profession
produced by it, represented a thinly veiled attempt to control the marginal, anti-
social and violent. They differed, however, on their explanations for this sudden
need for social control. Rothman emphasized the power and inuence of new
urban elites eager to nd a replacement for the diminishing moral authority
of the church; Scull, by contrast, highlighted the major disruptions that the
expanding capitalist market brought to older paternalist social relations. Scull
also directed his scathing critique at the entrepreneurial ambitions of asylum
doctors who, he suggests, had no real claim to expertise over the treatment of
the insane.5
Rather than moving to broad thematic national histories of the asylum and
the psychiatric profession, the colonial conguration of British North America
in the nineteenth century, and the decentralized nature of the Canadian confed-
eration in which health care became a provincial jurisdiction, has led historians
in this country to examine mental health services at the provincial or insti-
tutional level.6 Thus, although some regional studies incorporated aspects of
Rothmans and Sculls critique of the emergence of modern psychiatry and
the social control uses of the asylum, there was no overarching revisionist
monograph to appear in Canada during this important period in psychiatric
historiography. Arguably, the revisionist perspective was received most sympa-
thetically in Quebec where Andre Cellard, in his Histoire de la folie au Quebec,
placed asylum development into the wider volatile social, cultural and political
4 P. Keating, La science du mal: Linstitution de la psychiatrie au Quebec, 18001914 (Quebec,
1993).
5 D. Rothman, The Discovery of the Asylum: Social Order and Disorder in the New Republic
(Boston, Mass., 1971); A. Scull, Museums of Madness: The Social Organization of Insanity in
Nineteenth-Century England (London, 1979).
6 See, for example, T. Brown, Living with Gods Aficted: A History of the Provincial Lunatic
Asylum at Toronto, 18301911, unpublished PhD thesis, Queens University, Kingston (1980),
4351.
102 David Wright, James E. Moran and Sean Gouglas

contexts of early- and mid-nineteenth-century French Canadian society. Cellard

identies a broadening of the denition of, and a narrowing of tolerance for,
insanity among eighteenth- and early-nineteenth-century francophones leading
up to the creation of the Montreal and Beauport asylums. In the tradition of
Foucault, Rothman and Scull, Cellard problematizes the social constitution and
professional classication of behaviours labelled insane.7
During the last two decades, Canadian medical historiography has been
hugely inuenced by the emergence of a new approach to the history of
medicine, one that favours doing medical history from below.8 An explo-
sion of publications reected new methodologies and primary sources being
explored in the eld more generally, particularly an interest in the social his-
tory of patient populations. On the whole, these works shared with their British
and American counterparts a scepticism of the earlier Whig approaches, and
a critical engagement with (if not whole-hearted endorsement of) revisionist
accounts. The seminal Canadian publications of the last two decades remain
S. E. D. Shortts book on the London Asylum and Cheryl Warshs monograph
on the private Homewood Retreat. Shortt situated alienist Maurice Bucke in
the social and intellectual milieu of nineteenth-century psychiatry, while at the
same time employing statistical analyses to evaluate the human ecology of
the London Asylum patient population.9 It is not coincidental that his impor-
tant book was published almost simultaneously with the two other outstanding
English-language institutional studies of the period Anne Digbys book on
the Tukes and the Quaker York Retreat, and Nancy Tomess study of Thomas
Kirkbride and the Pennsylvania state asylum.10 The tradition of excellent, de-
tailed studies of institutions continued with Cheryl Warshs monograph of the
private Homewood Retreat. Warsh examined how the changing nature of the
middle-class Victorian family affected the denition of insanity, asylum com-
mittal practices, and the diagnostic and treatment strategies of Homewoods
medical directors. The trend in institutional histories towards those that in-
corporate the patients world has been taken to a provocative new level with
Geoffrey Reaumes history of the Toronto Asylum, a book directed entirely to
patients perspectives.11

7 A. Cellard, Histoire de la folie au Quebec, de 1600 a 1850: le desordre (Quebec, 1991).

8 R. Porter, The Patients View: Doing Medical History from Below, Theory and Society 14
(1985), 17598.
9 S. E. D. Shortt, Victorian Lunacy: Richard M. Bucke and the Practice of Late Nineteenth-Century
Psychiatry (Cambridge, 1986).
10 A. Digby, Madness, Morality and Medicine: A Study of the York Retreat, 17921914 (Cambridge,
1985); N. Tomes, A Generous Condence: Thomas Story Kirkbride and the Art of Asylum
Keeping, 18401883 (Cambridge, 1985).
11 C. Warsh, Moments of Unreason: The Practice of Canadian Psychiatry and the Homewood
Retreat (Montreal-Kingston, 1989); G. Reaume, Remembrance of Patients Past: Patient Life at
the Toronto Hospital for the Insane, 18701940 (Toronto, 2000).
 Hamilton and Toronto asylums, Canada, 18611891 103

Other themes in the Anglo-American historiography of madness in the last

two decades can clearly be seen in the scholarship emanating from Canadian
medical historians. Wendy Mitchinsons feminist analysis of admissions to the
Toronto and London asylums echoes the famous work of Elaine Showalter12
by emphasizing the way the medical profession treated women as patients
when they suffered from problems that were or could be related to their being
female. According to Mitchinson, at issue was the use of the male body as the
norm against which womens health including mental health was gauged.13
Rainer Baehre has contributed to the growing interest in the interconnection
between legal history and the history of madness by putting forth a complex
meta-analysis of penal and lunacy reform in early nineteenth-century Canada.
Baehre argues that lunacy reform in early Victorian Upper Canada preceded
the political unrest of the late 1830s, reecting more a consensus of political
culture between Tory and Reform politicians than the outcome of any clas-
sic form of class conict.14 More recently Peter Bartlett has analysed mental
health legislation in England and Canada in comparative perspective, warning
historians against making facile parallels between the two systems.15 Finally,
Alison Kirk-Montgomery and Robert Menzies have examined the relationship
between criminality and lunacy through their studies, respectively, of the in-
sanity plea in Victorian Ontario, and asylums for the criminally insane in early
twentieth-century British Columbia.16
The intense concentration on the asylum, and on patient populations, has
led inevitably to a questioning of the centrality of the asylum itself within so-
cial responses to mad behaviour. Reecting the growing interest in the history
of care and control of the insane outside of the asylum on both sides of the
Atlantic, James Moran has highlighted the importance in understanding tradi-
tional responses to madness as practised by local familial, legal, medical and
social authorities in New Jersey, Quebec and Ontario.17 His work reects a new

12 E. Showalter, The Female Malady: Women, Madness and English Culture, 18301980 (New
York, 1985).
13 W. Mitchinson, The Nature of their Bodies: Women and their Doctors in Victorian Canada
(Toronto, 1991).
14 R. Baehre, Imperial Authority and Colonial Ofcialdom of Upper Canada in the 1830s: the
State, Crime, Lunacy and Everyday Social Order, in L. Knaa and S. Binnie (eds.), Law, Society
and the State: Essays in Modern Legal History (Toronto, 1995).
15 P. Bartlett, Structures of Connement in Nineteenth-Century Asylums: A Comparative Study
Using England and Ontario, International Journal of Law and Psychiatry 23 (2000), 113.
16 A. Kirk-Montgomery, Courting Madness: Insanity and Testimony in the Criminal Justice Sys-
tem in Victorian Ontario, unpublished PhD thesis, University of Toronto (2001); R. Menzies,
I Do Not Care for a Lunatics Role: Modes of Regulation and Resistance Inside the Colquitz
Mental Home, British Columbia, 191933, Canadian Bulletin of Medical History 16 (1999),
181214.
17 J. E. Moran, Committed to the State Asylum: Insanity and Society in Nineteenth-Century Quebec
and Ontario (Montreal-Kingston, 2000); Moran, Asylum in the Community: Managing the
Insane in Antebellum America, History of Psychiatry 9 (1998), 124.
104 David Wright, James E. Moran and Sean Gouglas

interest in care outside the walls of the asylum and a slow decentring of the
asylum as the locus of historical enquiry. Along with scholars such as Mark
Jackson, he challenges the broader and overused notion of medicalization of
madness as a top-down process. Recent and forthcoming research by Thierry
Nootens and Andre Cellard investigates similar patterns of care and control in
the community in the context of nineteenth-century Quebec.18
The work on the care and control of insane individuals outside of lunatic
asylums has refocused an older debate over the reasons for asylum committal.
Clearly just as not every person conned in an asylum was insane, historians
also now appreciate the many thousands of individuals who, although they
were recognized as insane by family members and local community members,
were never institutionalized. So what combination of medical, behavioural and
socio-economic factors combined to create a situation whereby a family would
seek an institutional situation? And did these factors change over time?
The historical interest in the context of asylum committal, and in the strate-
gic use of mental hospitals by families and communities, dates back to the
late 1970s. At that time, Richard Fox, John Walton and Mark Finnane exam-
ined the background of patients admitted to the California state (United States),
Lancaster county (England), and Omagh county (Ireland) asylums, respectively,
in order to determine the social and economic factors inuencing the arrival
of patients to the mental hospital. All three agreed that the process of con-
nement was more complex than a situation of the state (or middle classes)
using the asylum as a means of social control. Each pointed to migration as an
important factor, though in very different ways. Fox identied isolated unmar-
ried and newly arrived immigrants in California as particularly vulnerable to
connement.19 John Walton, by contrast, argued that the dislocating process of
urbanization placed strains on family and kin resources of those who had left
the countryside for work in the developing industrial city of Lancaster.20 For his
part, Finnane suggested that the emigration of t young men and women from
Ireland (following the Famine) robbed households of caring resources, thus
making affected families vulnerable to seeking institutional solutions.21 Build-
ing on this work, Cheryl Warsh identied the isolation of young immigrants
as she directed her attention at the characteristics of patients admitted to the
London Asylum.22 These studies of sample populations looked for factors that
18 T. Nootens, Famille, communaute et folie au tournant du siecle, Revue dhistoire de lamerique
francais 53 (1999); A. Cellard, Folie, internment et erosion des solidarites familiales au Quebec:
un analyse quantitative, unpublished conference paper, Folie et societe au Quebec: 19e20e
siecles, Centre dhistoire des regulations sociales, luniversite de Quebec a Montreal, 10 March
1999.
19 R. Fox, So Far Disordered in Mind: Insanity in California, 18701930 (Berkeley, 1978).
20 J. Walton, Lunacy in the Industrial Revolution: A Study of Asylum Admissions in Lancashire,
18481850, Journal of Social History 13 (1979), 122.
21 M. Finnane, Insanity and the Insane in Post-Famine Ireland (London, 1981), chapter four.
22 C. Warsh, In Charge of the Loons: A Portrait of the London, Ontario Asylum for the Insane
in the Nineteenth Century, Ontario History 74 (1982), 13884.
 Hamilton and Toronto asylums, Canada, 18611891 105

may have made certain individuals vulnerable to being conned. In addition to

migration (both emigration, immigration and in-migration), they also analysed
the behaviour of patients, gender, marital status and the availability of beds.
Many of these factors will be discussed below.
A central theme to emerge from these studies was the active and determining
role of the family in the connement of their insane kin. In her analysis of
admissions to the Toronto Asylum, Wendy Mitchinson argued that the Toronto
Asylum was used by families to deal with those social excesses of insanity that
they thought warranted institutionalization.23 Similarly, Cheryl Warsh high-
lighted the social determinants of committal, and the experience of asylum life.
Warsh analysed the changing gender dynamics of the Victorian family and their
inuence on the committal process.24 Mary-Ellen Kelms work on the British
Columbia Provincial Hospital for the Insane pushed the historiography further
by detailing the inuence of families after the patient had been admitted.25
Other researchers have focused on particular patient groups. Edward-Andre
Montigny, for instance, has explored the connement of the elderly to the
Kingston Asylum in the latter part of the nineteenth century. He argues that
asylum superintendents exaggerated the numbers of aged in their institutions
as a means of exculpating themselves for low cure rates. Far from being ooded
with elderly admissions, the Kingston Asylum, according to this author, saw
a moderate, if slightly increasing, representation of admissions over the age
of sixty. Montigny, like many of the other historians just cited, was struck
by the distance families went to try and accommodate insane family mem-
bers within the community, before turning to the asylum as a measure of last
resort.26
The connement of the insane in purpose-built asylums, and the social his-
tory of madness more generally, have constituted rich elds in the history of
Canadian health and medicine, featuring prominently in monographs and in
articles in Canadian history journals. This chapter seeks to contribute to this
growing body of scholarship by analysing admissions to the Hamilton and
Toronto asylums, and placing them in the context of the literature cited above.
Before turning to admissions to these two Ontario institutions, it is necessary
to survey the establishment of legislation regarding the insane in the province
before and after the establishment of Canada through the British North America

23 W. Mitchinson, Reasons for Committal to a Mid-Nineteenth-Century Ontario Insane Asylum:

The Case of Toronto, in W. Mitchinson and J. Dickin McGinnis (eds.), Essays in the History
of Canadian Medicine (Toronto, 1988).
24 C. Warsh, Moments of Unreason: The Practice of Canadian Psychiatry and the Homewood
Retreat (Montreal-Kingston, 1989).
25 M Kelm, Women, Families and the Provincial Hospital for the Insane, British Columbia,
19051915, Journal of Family History 19 (1994), 17793.
26 E. Montigny, Foisted Upon the Government: Institutions and the Impact of Public Policy
upon the Aged. The Elderly Patients of Rockwood Asylum, 18661906, Journal of Social
History 28 (1995), 81936.
106 David Wright, James E. Moran and Sean Gouglas

(Confederation) Act of 1867. For the connement of the insane in any juris-
diction was not only a social and familial phenomenon, it was also a legal and
public action, requiring sanction by the state, certication by members of the
state-regulated medical profession, and nally admission to state-run public
institutions. An understanding of the growth of the state in Victorian Canada
is thus critical for understanding the constraints within which families and au-
thorities made choices over institutional connement.

The construction of psychiatric institutions in

nineteenth-century Ontario
Provision for the insane in early Upper Canada (Ontario) among European pop-
ulations followed the traditions of settler families and communities and included
boarding out,27 warning out,28 family care and management, and treatment by
local medical practitioners.29 Because Upper Canada did not incorporate the
English poor-law system when it was founded in 1791, there was neither orga-
nized outdoor relief nor workhouses for the maintenance of the poor insane.30
This partially explains why, in 1810, legislation was passed making the local
jail to be for certain purposes a house of correction . . . and that all and every
idle and disorderly persons, or rogues and vagabonds, and incorrigible rogues,
or any other person who also may by law be subject to be committed to a house
of correction, shall be committed to the said common gaols.31 The insane were
easily subsumed under this list, and the practice of conning them to the York
(Toronto) local gaol was eventually made legally explicit in an 1830 Act sup-
porting the maintenance of insane destitute persons either in the jail or some
other place. Three years later this Act was extended to include Upper Canadas
other district gaols.32
Dissatisfaction with this state of affairs emanated from many quarters. Local
magistrates and gaol wardens who complained about the costs and chaos re-
sulting from the incarceration of the insane issued Quarter Session petitions for
more appropriate asylum provision. Debtors and criminals in Torontos Home

27 Boarding out was the practice of placing insane individuals with non-co-residing kin or with
strangers for a fee. For an example of its use in Scotland at this time, see R. Houston, Not
simple boarding: Care of the Mentally Incapacitated in Scotland During the Long Eighteenth
Century, in P. Bartlett and D. Wright (eds.), Outside the Walls of the Asylum: The History of
Care in the Community, 17501900 (London, 1999), 1944.
28 Warning out referred to the banishment of the unwanted outside municipal or county boundaries.
For examples see Thomas Brown, The Origins of the Asylum in Upper Canada, 18301839:
Towards an Interpretation, Canadian Bulletin of Medical History, 1 (1984), 2758; Moran,
Committed to the State Asylum, 99112.
29 See Moran, Committed to the State Asylum, chapters three and four.
30 R. Splane, Social Welfare in Ontario, 17911893 (Toronto, 1965), 658.
31 Statutes of Upper Canada, 1810, C.5.
32 Splane, Social Welfare, 69; Brown, Origins of the Asylum, 2930.
 Hamilton and Toronto asylums, Canada, 18611891 107

District Gaol made their own protest over the smell and noise of their mad
co-habitants. Individual families also on occasion pleaded with the government
for more adequate facilities of safe keeping for their insane relatives. Finally,
reform-minded notables both inside and outside of Upper Canada pushed for
the establishment of a publicly funded lunatic asylum that would approximate
the emerging institutional ideal in other North American colonies, the United
States and Britain.33
These calls to institutional action stirred activity in the provincial House of
Assembly throughout the 1830s. But a combination of political inertia, political
ghting between Reform and Tory MPs, and political unrest in the province
at large, thwarted successful legislative action.34 A commission was formed in
1835 to investigate the best method of managing and establishing a Lunatic
Asylum in Upper Canada, but the fruits of these labours were not realized in
legal form until 1839 with the passing of An Act to Authorize the Erection of an
Asylum within this Province for the Reception of Insane and Lunatic Persons.35
Although this law allowed for the issue of debentures towards the construction
of an institution for the insane, a permanent asylum was not ready for patients
until 1850. In the interim, a temporary asylum was fashioned out of the Toronto
Gaol, which was vacated in 1841.
The temporary asylum was run in accordance with accepted organizational
wisdom with a superintendent, Board of Commissioners, and a set of rules
and regulations for the management of the new institution.36 Disputes over au-
thority between the board and superintendent, combined with ongoing political
struggles around asylum appointments, and the awkwardness of the converted
prison structure, seriously hampered treatment strategies at the temporary asy-
lum. Nevertheless, a form of moral treatment was introduced by Dr William
Rees, the rst superintendent, and modied by Drs Telfer, Park and Primrose.37
Admissions during this period were made by petition to the asylum commis-
sioners and to the superintendent himself.

33 National Archives of Canada (NA), RG4 B65, loose documents, Toronto Sheriff to Provincial
Secretary, 16 September 1840; P. Oliver, Terror to Evil-Doers: Prisons and Punishments in
Nineteenth-Century Ontario (Toronto, 1998), 445; Brown, Origins of the Asylum, 356;
Splane, Social Welfare, 203. Outside reform pressure was brought to bear by internationally
renowned asylum advocates Dorothea Dix and Daniel Hack Tuke. See, NA, RG4 C.1, le 2204,
Memorial of Dorothea Dix to the Provincial Parliament of Canada East and West; Dix to Charles
Metcalfe, Governor in Chief of the United Provinces, 12 October 1843; Tukes indictment of
the temporary asylum at Toronto and call for better provision is found in D. H. Tuke, The Insane
in the United States and Canada (London, 1885), 215.
34 Brown, Living with Gods Aficted, passim.
35 Journals of the Legislative Assembly of Upper Canada, 2nd Session, 12th Parliament, 1836,
196; Statutes of Upper Canada, 2 Vic., C.11,1839.
36 NA, RG5 C1, File 2883, Report of the Commissioner and Proposed Regulations, 17 February
1841.
37 Moran, Committed to the State Asylum, 5062.
108 David Wright, James E. Moran and Sean Gouglas

The opening of the permanent Toronto Provincial Asylum in 1850 soon al-
tered the social organization of treatment and care of the insane in Ontario. This
was partly achieved by the passing of the 1853 Act for the Better Management of
the Provincial Lunatic Asylum, legislation that signicantly increased the power
of the superintendent largely at the expense of the Board of Commissioners.38
Superintendent Joseph Workman vigorously incorporated the principles of this
new law, and took advantage of the larger purpose built space of the new
asylum during his twenty-two year career, in his efforts to implement moral
treatment in Ontario.
The Toronto Provincial Asylum was overcrowded with patients soon after
its doors were opened. This led to the establishment of branch asylums at
the University of Toronto in 1856, at Fort Malden (near Amhertsberg) in 1859,
and at Orillia in 1861. The branch asylums were populated with patients whom
Workman considered to be chronically or incurably ill in order that the Toronto
Asylum might be maintained as a curative institution, and were closed in 1870
with the construction of the London Asylum.39 The asylum infrastructure was
further expanded in Ontario when a criminal lunatic asylum was opened in
Kingston in 1855,40 when the London Asylum was opened in 1870, and when a
new regional institution was built in Hamilton in 1875. The Orillia Asylum re-
opened as a specialist institution for idiot and imbecile children in 1876.41 To
regulate this expanding public42 asylum system (and other government institu-
tional infrastructures) a Board of Inspectors of Prisons and Asylums was created
in 1857.43 Thus, for the period under study (c. 186191) there were four princi-
pal lunatic44 asylums for the Province of Ontario: Toronto, Kingston, London
and Hamilton. After Confederation these institutions were considered the hubs
of four health regions of the province. Patients were supposed to be admitted
to the asylum in the region in which they resided (though, due to overcrowding,
and various other social factors, this procedure was not always followed).45
Laws governing individual insanity and asylum committal were not well
developed in Ontario until the mid nineteenth century. Two early Acts relating
38 Statutes of Canada, 16 Vic., C. 188.
39 Warsh, In Charge of the Loons, 141. This practice of building chronic facilities in the hopes
of keeping others as curative institutions was also implemented south of the border. See for
example the use of the Willard and Utica asylums in Ellen Dwyers, Homes for the Mad: Life
Inside Two Nineteenth-Century Asylums (New Brunswick, 1987).
40 The Kingston Asylum, also known as the Rockwood Asylum, began to accept general patients,
in addition to criminal lunatics, in 1862. See Montigny, Foisted Upon the Government, 821.
41 The nineteenth century ended with the establishment of four more psychiatric institutions in
Ontario, respectively at Mimico (1894), Brockville (1894), Cobourg (1902) and Penetangueshine
(1904).
42 There was one large private institution the Homewood Retreat in Guelph which was estab-
lished in 1884.
43 Statutes of Canada, 20 Vic. C. 58.
44 This chapter will not discuss the asylum for idiots in Orillia.
45 Warsh, In Charge of the Loons, 140.
 Hamilton and Toronto asylums, Canada, 18611891 109

to the estates of specic individuals sanctioned commissions of lunacy whose

authority was ultimately vested in the Court of Chancery. The powers of the
Court of Chancery were solidied in an 1846 Act. Commitment law was not
legally dened until An Act to Authorize the Connement of Lunatics in Cases
where their Being at Large may be Dangerous to the Public was passed in 1851.
This act stipulated that the insane could be placed into custody if convicted of
a crime, or if considered dangerous either to themselves or to the public.46 Two
certicates of insanity were required to admit such lunatics to an asylum (this
was later changed to three in 1853) and the assent of the local mayor or reeve.47
The lunatic could then be placed in an asylum and remain there until certied
sane again by two medical practitioners along with the sanction of the Governor
of the Province. This law also allowed for the connement of suspected lunatics
to local gaols, a practice that, in the absence of sufcient asylum provision at
mid century, was frequently exercised.48 Indeed the cumbersome nature of the
(regular) civil connement, where a bed was often not available, and the cost of
securing three separate medical certicates, have led some historians to suggest
that desperate families resorted to declaring non-violent family members as
dangerous lunatics, and thus subject to the 1851 statute. Under a dangerous
lunatic warrant, local authorities were forced to gaol the individual immediately
and then nd them an asylum bed.49 Although precise gures are difcult to
tabulate, approximately one-third of admissions to the Toronto and London
asylums in the 1860s occurred through the gaol system.50
The connement of the insane in Victorian Ontario thus occurred within the
context of an expanding provincial asylum system subject to provincial laws and
an implicit desire to locate institutional care close to the family. The tables that
follow constitute the rst results of a major research project analysing the socio-
demographic and medical characteristics of the psychiatric patient population in
nineteenth-century Ontario. By the time of completion, the project will examine
the admissions of all patients to the four principal lunatic asylums in the province
of Ontario, involving the examination of approximately 8,000 patients.51 For

46 R. Baehre, From Pauper Lunatics to Bucke: Studies in the Management of Lunacy in 19th
Century Ontario, unpublished PhD Thesis, University of Waterloo (1976), 11824.
47 Bartlett, Structures of Connement in Nineteenth-Century Asylums, 10.
48 See J. E. Moran, Dangerous to be at Large? Folie et criminalite au Quebec et en Ontario au
19th siecle, Bulletin dhistoire politique (in press).
49 Montigny, Foisted upon the Government, 827. There seems to be some disagreement about
the requirement to nd a dangerous lunatic a place in the asylum. For a dissenting view to
Montigny, see Bartlett, Structures of Connement, 1011.
50 Bartlett, Structures of Connement, 10.
51 The data include all patients admitted to the Provincial Lunatic Asylum in Toronto in the
decennial census years of 1861, 1871, 1881, 1891 and all patients admitted to Hamilton Asylum
from its construction in 1875 until the end of the year 1885. The authors would like to thank
Nanci Delayen of McMaster University for assistance in the input of patient records admitted
to the Hamilton Asylum.
110 David Wright, James E. Moran and Sean Gouglas

the purposes of this chapter, a sample of 1,682 individuals from the Toronto
and Hamilton asylums will be analysed for socio-demographic characteristics.
These results will be compared with the research conducted by historians on
the demographic, social and economic composition of Victorian Ontario.

Characteristics of patients
52
Ontario was the largest English-speaking province in Canada by population,
bordered to the south by the Great Lakes, and stretching from the predominantly
French-speaking province of Quebec on the east to the Prairie Provinces on the
west. In terms of landmass, the size of the province at Confederation (1867)
approximated that of France, though only a small strip of population along
the American border and the Great Lakes has ever received sustained non-
Aboriginal settlement. Thus, with a population distribution not unlike colonial
Australia, the European settlements in Victorian Ontario consisted of a small
clutch of cities growing quickly in size and stature, and surrounding agricul-
tural settlements to the southwest and east of the province. To the north lay a
vast, largely unpopulated northern interior. The principal cities were, and re-
main, Toronto (the provincial capital, formerly known as York), Ottawa (which
became the nations capital in 1867), Kingston to the east of the province,
London in the heart of the agricultural southwest, and Hamilton (fty miles
around Lake Ontario to the south of Toronto) which became the industrial and
steel-producing centre of the province. The major cities were connected by the
construction of a rail network in the 1850s running along the northern shores
of the St Lawrence and Great Lakes, from Montreal to the border with Detroit,
Michigan. As the asylum system expanded, the lunatic asylums were placed in
the principal cities, in Toronto, Kingston, London and then Hamilton. Ottawa
never received an asylum, but hosted instead Canadas parliament.
The results of the analysis of a sample of 1,682 patients53 admitted to the
Toronto and Hamilton asylums reveal the remarkably diverse backgrounds of
asylum patients that have been illustrated in other chapters in this book. To begin
with, it has now become common for medical historians to uncover a sex ratio of

52 During the period under study, what was called the Province of Ontario (after 1867) was variously
known as Upper Canada (17911841) and Canada West (184167). Since 1867, following the
Confederation of the provinces of Canada, the province has been known as Ontario. We shall
use Ontario in this chapter for matters of consistency and to avoid confusion.
53 Patients who had been admitted to Toronto and then transferred to Hamilton after its construc-
tion in 1875, were included as Toronto rst admissions. In order not to bias the results, only
rst admissions for both institutions were included in the data, thus preventing the duplicated
recording of socio-demographic characteristics of the identical individual. Of the patients sam-
pled (1864) 1,684 or 90.3 per cent were rst admissions. Excluding second and subsequent
admissions tended to increase slightly the average length of stay in the tables presented and to
increase slightly the age (by excluding multiple readmissions of a few young patients).
 Hamilton and Toronto asylums, Canada, 18611891 111

patients reective of the proportion of men and women in the adult population
from whence the patients came. In countries with a (relatively) balanced sex
ratio, such as western Europe and Britain, the number of men and women at the
time of asylum admission was evenly matched.54 In jurisdictions where there
was a surplus of men such as certain colonial or frontier societies of California,
South Africa, Argentina and New Zealand men were more numerous in the
asylums, reective of their larger numbers in those populations.55 Moreover,
in his examination of the connement of the insane in colonial New South
Wales, Stephen Garton has argued that the preponderance of male admissions
in frontier society asylums may also reect the centrality of the police in
the committal process and the desire to reinforce a sense of social stability
and conformity in communities that had no tradition of welfare institutions.56
Certainly his study of New South Wales, and Bronwyn Labrums examination
of New Zealand, suggest that men may have been incarcerated at a rate in excess
of their already-disproportionate representation in colonial Australia and New
Zealand.
In the rst two decades of the provisional and permanent Provincial Asylum
in Toronto, Ontario conformed to the colonial pattern of a signicantly high
male : female ratio of admissions as much as 3:1. By the 1860s, however, there
seems to have been a rebalancing of admissions by gender, a trend seen in
other industrializing countries. By the 1870s and 1880s, the gender ratio began
to conform, more or less, to the representation of men and women in the adult
population of the time.57 For the sample under study (186191), men consti-
tuted 53 per cent of the sample population admitted to the Toronto Asylum,
and 52 per cent of the sample population admitted to Hamilton (see Table 4.1).
Although considerations of gender must have played some role in the percep-
tion of insanity and the familial decision to seek (or not to seek) connement,
these preliminary results suggest that gender considerations worked towards
the connement of certain groups of women and men, not women instead of
men.58 Indeed, when one brings in quantitative work previously published on the

54 See Gasser, Malcolm and Dorries in this volume.

55 See Fox, So Far Disordered in Mind; B. Labrum, Looking Beyond the Asylum: Gender and
the Process of Committal to Auckland, 18701910, New Zealand Journal of History 26 (1992),
55374.
56 S. Garton, Medicine and Madness: A Social History of Insanity in New South Wales, 18801940
(Kensington, Australia, 1988).
57 W. Mitchinson, Reasons for Committal to a Mid-Nineteenth-Century Ontario Insane Asylum:
The Case of Toronto, in Mitchinson and Dickin McGinnis (eds.), Essays in the History of
Canadian Medicine.
58 For a similar discussion of the role of gender, and the lack of a disproportionate connement of
women in Victorian England and Wales, see J. Buseld, The Female Malady?: Men, Women
and Madness in Nineteenth-Century Britain, Sociology 28 (1994), 25977; K. Davies, Sexing
the Mind?: Women, Gender and Madness in Nineteenth Century Welsh Asylums, Llafur
Journal of Welsh Labour History/Cylchgrawn Hanes Llafur Cymru 7 (1996), 2940.
112 David Wright, James E. Moran and Sean Gouglas

Table 4.1 First or subsequent admissions to the institution, admissions to

the Toronto and Hamilton asylums, selected years, 18511891
(n = 1862)

Toronto Hamilton

Men Women Men Women

no. % no. % no. % no. %

First 272 83 238 83 612 94 560 94

Second 40 12 37 13 38 6 31 5
Third or more 15 5 13 5 1 0 4 1

Sub-total 327 288 651 595

n/a 0 0 0 1

Total 327 288 651 596

London Asylum,59 the Toronto Asylum (from 1841 to 1874),60 and the British
Columbia asylums61 work that also conrms that women were admitted in
numbers either in proportion to their representation in the adult population (or
less than their proportion) the evidence supporting Showalters famous claim
for the disproportionately high rate of incarceration of women in Victorian
asylums becomes very thin, if non-existent.62 The reasons behind the gradual
process of balancing female and male admissions remain difcult to determine
from an aggregate study of admission records. It may well be, as Nancy Tomes
has argued for nineteenth-century Pennsylvania,63 that families became less
reluctant to send female patients to state institutions, as the asylum slowly dis-
tanced itself from its institutional cousin the poorhouse. Much more research
is needed, however, to elucidate the motivations of families in their decision to
seek institutional connement.
The age-distribution of patients at the time of admission also conforms to the
general demographic distribution of Ontario adult society at the time (Table 4.2).
In terms of age and life cycle, these two Ontario asylums under study accepted
patients from across the adult age-spectrum. The inter-quartile age range (the
middle 50 per cent of all patients) was between the ages of twenty-seven and
forty-nine for men and women in both institutions. The median fell between
59 Warsh, In Charge of the Loons, 155.
60 Mitchinson, Reasons for Committal to a Mid-Nineteenth-Century Ontario Insane Asylum, 92.
61 M. Kelm, Women, Families and the Provincial Hospital for the Insane, British Columbia,
19051915, Journal of Family History 19 (1994), 17793.
62 For a more substantial exploration of the relationship between gender, class and madness, see
chapters in J. Andrews and A. Digby (eds.), Sex and Seclusion, Class and Custody: Gender,
Class and the History of Psychiatry in Britain and Ireland (Amsterdam, forthcoming).
63 Tomes, A Generous Condence, chapters three and ve.
 Hamilton and Toronto asylums, Canada, 18611891 113

Table 4.2 Age of patients at time of admission, rst admissions to the

Toronto and Hamilton asylums, selected years, 18511891
(n = 1682)

Toronto Hamilton

Men Women Men Women

Age no. % no. % no. % no. %

<20 11 4 5 2 18 3 14 3
209 67 25 78 34 167 28 150 28
309 76 29 57 25 152 26 134 25
409 52 20 42 18 112 19 107 20
509 31 12 21 9 80 14 81 15
609 19 7 25 11 42 7 37 7
>69 9 3 4 2 15 3 12 2

Sub-total 265 232 586 535

n/a 7 6 26 25

Total 272 238 612 560

Median 35 35 36 36
IQ Range 2848 2647 2748 2849

the ages of thirty-ve and thirty-six. There were no signicant inter-sex or

inter-institutional differences in the ages of patients at time of admission. Rather
than representing the aged and demographically marginal, as has been found
in case studies of Houses of Industry that were gradually being created in the
province in the late Victorian period,64 the majority of admissions to both institu-
tions were in their so-called prime of life in their twenties, thirties and forties.
The distribution of ages illustrates that it was extremely rare for children
and adolescents to be admitted to a general lunatic asylum in Ontario before
the twentieth century. Only one patient out of the sample was under the age of
sixteen at the time of admission. Children suffering from idiocy were sent to
a specialist institution in Orillia, 100 miles northwest of the city of Toronto.65 It
is unclear, however, where adolescents, not identied as idiots, but exhibiting
strange behaviour, would have been sent. It is quite possible that many may
well have found their way into the juvenile reformatories also being built at
this time.66 But without a comparison of the behavioural characteristics of
64 See R. Baehre, Paupers and Poor Relief in Upper Canada, Canadian Historical Associa-
tion: Historical Papers (1981), 5780; S. A. Cook, A Quiet Place . . . To Die: Ottawas First
Protestant Old Age Homes for Women and Men, Ontario History 1 (1989), 2540.
65 For a history of the Orillia Asylum and mental retardation in the province of Ontario, see H.
Simmons, From Asylum to Welfare (Downsview, Ont., 1982).
66 R. Nielsen notes that, at the Penetanquishene Reformatory Prison for boys, opened in 1859, the
most common charge was larceny; others had been sent to Reformatory for obstructing a railway,
114 David Wright, James E. Moran and Sean Gouglas

adolescents being admitted to reformatories and adults sent to lunatic asylums,

this remains a question demanding further comparative research.
Medical superintendents of Ontario asylums complained that their institu-
tions were lling up with the elderly who were senile, but did not constitute
the curable insane. The aged, however, did not constitute a ood of admis-
sions during this time, though they may have been slightly overrepresented.
From a low of 3.1 per cent of admissions, the proportion of elderly67 admis-
sions rose to 14 per cent by 1903, a period in which the elderly increased as
a percentage of the general population68 from 3.1 per cent to 8.4 per cent. In
total, the aged constituted only 7.4 per cent of the over 4,000 admissions to the
Kingston (Rockwood) Asylum between 1866 and 1906.69 Comparable gures
for Hamilton between 1875 and 1885 show 10 per cent of admissions were sixty
years or older. Toronto admissions reect a similar proportion (10 per cent
13 per cent). The elderly constituted between 8.4 per cent and 10.5 per cent of
the adult population of Ontario society at the time, depending upon whether
one uses everyone over the age of fteen or twenty as a comparable group for
asylum admissions.70 Thus the proportion of elderly, at the time of admission,
was hardly remarkable.
The balance of elderly women and elderly men merits further comment.
Demographic reconstructions of nineteenth-century Ontario society have sug-
gested that elderly women were commonly kept in extended households, es-
pecially if they could contribute to the household economies by childminding.
Indeed, they were three times more likely than men to appear in household enu-
merators schedules of families living in their early or mid-life cycle.71 Elderly
men, by contrast were more likely to be boarders and to nd themselves in
Houses of Refuge or Houses of Industry as they were built from the 1860s

keeping found money, breaking windows, and even lunacy. Nielsen, Total Encounters: The Life
and Times of the Mental Health Centre, Penetanguishene (Hamilton, 2000), 89 (our italics);
Paul Bennett, Taming Bad Boys of the Dangerous Class: Child Rescue and Restraint at
the Victoria School 18871935, Histoire Sociale/Social History 21 (1988), 7196; S. Houston,
The Waifs and Strays of a Late Victorian City: Juvenile Delinquents in Toronto, in J. Parr
(ed.), Childhood and Family in Canadian History (Toronto, 1982), 12942.
67 For consistency, we have dened the elderly as all those sixty years of age or older.
68 Montigny, Foisted on the Government, 821. It is unclear, from Montignys research, whether
his gures of comparison are for the general population of the time (including children), or the
adult population of the time. This is of particular interest inasmuch as children were not, as noted
above, admitted to the general lunatic asylums. If he chose the former (the population including
those under the age of sixteen years) as a point of comparison, then it is entirely possible
that, even at the level of 14 per cent of adult admissions, the elderly were not overrepresented
compared to the adult population of the general population.
69 Montigny, Foisted on the Government, 821.
70 Calculated from Table VII Ages of the People. Census of Canada, 187071, vol. 2 (Ottawa,
1873), 5861.
71 M. Katz, The People of Hamilton, Canada West: Family and Class in a Mid-Nineteenth-Century
City (Cambridge, 1975), 231.
 Hamilton and Toronto asylums, Canada, 18611891 115

and 1870s. According to one study, elderly men outnumbered elderly women
in these welfare institutions by a ratio of 4 to 1,72 a number more pronounced
when one considers the lower life expectancy of men during this period. Clearly
over this period, as with the Kingston Asylum, even if the admissions of the
elderly to the Toronto and Hamilton asylums were slightly higher than their rep-
resentation in the population would merit, the Victorian Asylum was hardly a
refuge for the elderly or the senile.73
The regions surrounding the cities of Toronto and Hamilton were undergo-
ing rapid economic, social and demographic change during the period under
study (186191).74 The background of the patients admitted to the Toronto and
Hamilton asylums reects this diverse and changing society. Judging from their
occupational backgrounds, they represented what can best be described as the
lower two-thirds of Ontario society. However, with fewer than 10 per cent of
patients recording no occupation or having no entry in the occupation column
of the admission registers, these male admissions clearly reected the working
(rather than marginal) poor of Ontario society. Male admissions to the asylums
may have been marginalized by their disorder, but the vast majority seem, by
all evidence, to have been gainfully employed in the period before the onset of
their attack. Indeed, an analysis of the occupations of Toronto and Hamilton
asylum patients reects a staggering variety of employments performed by
Ontarians who were eventually committed to one of these two asylums under
study (see Table 4.3a). As in Ontario society at the time, by far the largest male
occupational group were listed as farmers in the asylum admission registers
(30 per cent of Toronto Asylum male admissions; 33 per cent of Hamilton
Asylum male admissions). These gures can be compared with Ian Drum-
monds statistical table of occupations of Ontarios gainfully employed. We can
calculate from Drummonds gures that approximately 49.2 per cent of males
were employed in agriculture (excluding labourers) from 1871 to 1901.75 This
suggests that the percentage of the farmers committed to Ontarios asylums
(Toronto in particular) was noticeably lower than that of the Ontario population
as a whole. This difference might be explained by the relatively stable family
structure in place among settled (even recently settled76 ) farmsteads. At the

72 See S. Stewart, The Elderly Poor in Rural Ontario: Inmates of the Wellington County House
of Industry, 18771907, Journal of the Canadian Historical Association (1992), 21733.
73 C. Warsh, In Charge of the Loons, 154.
74 Katz, The People of Hamilton; G. S. Kealey, Toronto Workers Respond to Industrial Capitalism,
18671892 (Toronto, 1980); D. McCalla, Planting the Province: The Economic History of Upper
Canada, 17841870 (Toronto, 1993).
75 See I. Drummond, Progress Without Planning: The Economic History of Ontario from Confed-
eration to the Second World War (Toronto, 1987), table 2.2.
76 D. Akenson argues that in some Ontario counties, newcomers could form well-established
communities rather quickly. See Akenson, The Irish in Ontario: A Study in Rural History
(Kingston, 1984).
116 David Wright, James E. Moran and Sean Gouglas

Table 4.3a Previous occupation of male patients at time of

admission, rst admissions to the Toronto and Hamilton
asylums, selected years, 18511891 (n = 884)

Toronto Hamilton

Occupational group no. % no. %

No occupation 11 4 22 4
Labourers 51 20 175 31
Servants/porters 5 2 10 2
Soldiers/sailors 6 2 6 1
Skilled artisans 49 19 98 17
Clerks 14 5 18 3
Small shopkeepers 21 8 20 4
Merchants 6 2 11 2
Professionals 9 4 5 1
Farmers 76 30 188 33
Other 8 3 17 3

Sub-total 256 570

n/a 16 42

Total 272 612

very least, farms would have the physical space and some kin resources for
the care and management of the insane. In more settled agricultural communi-
ties, there would also have been traditions of treatment and care which might
have forestalled somewhat asylum committal. The distance of some agricultural
communities from the main asylums may also have had an impact, as discussed
below.
Farmers could include a wide range of individuals, from impoverished
tenant farmers to large-scale landowners to farm-labourers.77 Without further
specication as to the size of their land holdings, the precise socio-economic
situations of these farming families remain uncertain. One clue to the familys
socio-economic circumstances, however, may be gleaned from the negotiation
over their contribution (or not) to the cost of asylum treatment. The Toronto
and Hamilton asylums accepted patients who entered free of charge (known as
Provincial patients), and paying patients who were assessed on a graduated

77 For a discussion on who could rightly be considered a farmer, please see G. Darroch, Scanty
Fortunes and Rural Middle-Class Formation in Nineteenth-Century Rural Ontario, Canadian
Historical Review 79 (1998), 62159; and R. M. McInnis, Perspectives on Ontario Agriculture,
18151930 (Gananoque, Ont., 1992).
 Hamilton and Toronto asylums, Canada, 18611891 117

scale of Can$1/week to Can$5/week according to their ability to pay.78 In just

over one-half of the cases of farmer-admissions to the Toronto asylum, the
individual or his family paid nothing towards the cost of connement. This pro-
portion was much higher close to 80 per cent in the case of farmers admitted
to Hamilton asylum. In the other one-half of admissions to Toronto (and 20 per
cent in Hamilton), the person himself, the family or friends were recorded as
paying between Can$1 and Can$5 per week. It is difcult to assess accurately
the average income of Ontario farmers. Alongside the much-noted poverty and
transience of rural existence in Victorian Ontario79 stood the constancy of many
middling80 and well-established families, suggesting that many could afford
the required fees to commit a family member.
If advantages in the domestic care and management of the insane led to the
underrepresentation of Ontarios farming population in the provinces public
lunatic asylums, the reverse argument seems to have held true for the second
largest group of male admissions labourers. Listed as 20 per cent of the patient
population in the Toronto asylum and 31 per cent at the Hamilton institution,
labourers (including farm labourers) constituted roughly 10.6 per cent of
the male workers in Ontario between 1871 and 1901. Male labourers often
emigrated to Canada alone, working long and physically taxing hours on road,
railroad, building and canal construction, hoping to earn enough to support
the immigration of other family members or to send needed funds back to the
home country. This lack of family as a social resource may in part account for
labourers overrepresentation in the asylums of Hamilton and Toronto. Their
poverty and social isolation is reected in the fact that only one out of fty-three
labourers paid anything towards his upkeep in the asylum (and in this case, it
was paid by friends).
The third most prevalent recorded group of occupations were those male ad-
missions whose work can be grouped under the general category of skilled, or
semi-skilled, artisans. These patients included men who had worked in one of
over forty distinct occupational listings, including employment as carpenters,
shoemakers, painters, blacksmiths, cabinetmakers and machinists, to the rela-
tively rare marble-cutters, broom makers, turners and saddlers. In comparison
to farmers, fewer skilled artisans paid anything at all towards their maintenance
(no more than approximately 10 per cent in both institutions). In contrast to
78 The precise manner in which a family was assessed is not clear from the historical record. Clearly
there was some haggling, and no few disputes, over the familys proportion of the upkeep of
the patient. Naturally, those who paid the higher amounts received better accommodation and a
lower patient : staff ratio. They were also absented from certain chores within the institution. For
those who did not pay, either the province, or the municipality in which the lunatic previously
resided, paid for the cost of maintenance. See Bartlett, Structures of Connement, 11.
79 See, for example, Katz, The People of Hamilton.
80 The term comes from Darroch, Scanty Fortunes, 623.
118 David Wright, James E. Moran and Sean Gouglas

farmers and labourers, the percentage of male skilled workers in the Hamilton
and Toronto asylums appear consistent with that of the provincial population
as a whole.81
Although Ontario was predominantly an agricultural province during the
second half of the nineteenth century, it was, as mentioned above, experiencing
the classic symptoms of industrialization, including accelerated urbanization,
the rise of large-scale factory production and the emergence of a larger profes-
sional and entrepreneurial middle class. To what extent were these middle-class
occupations reected in the prole of patients admitted to the mental hospitals?
The answer: not a great deal. Only 13 per cent of male admissions to Toronto,
and 7 per cent of male admissions to Hamilton, were designated as coming
from the lower middle class, including clerks and schoolteachers, and small
shopkeepers, such as grocers, butchers and bakers. Members of the merchant
or professional middle class were even rarer: only a handful of physicians and
barristers ever made their way into the public institutions, no doubt preferring
the privacy of the private Homewood Asylum in Guelph, approximately forty
miles west of Toronto, or possibly a private institution for the insane across the
border in New York state and Pennsylvania.
Womens occupations, as historians of women and womens work know too
well, were poorly and inconsistently recorded in the nineteenth century. Congru-
ent with prevailing property laws that placed legal rights and responsibilities in
the hands of the single womans father or the married womans spouse, womens
occupations in nineteenth-century English and Canadian censuses often listed
a womans position in terms of her relationship to the male head of household.
Thus, women, who may well have been receiving wages for casual work, were
often lumped under the title wife of . . . or daughter of . . .. This practice was
less common, however, in instances where womens work was located outside
of the domicile, and less usually applied to working daughters than working
wives. Keeping in mind, then, the extreme difculty of using listed occupation
as an indicator of womens paid employment, Table 4.3b lists the occupations
of women patients admitted to the asylum.
The most frequently cited occupation for female asylum patients was do-
mestic service, which accounted for almost 200 of the 700 female admissions,
or 27 per cent of the entire female patient population (the comparable gure
for the London Asylum was 32.5 per cent82 ). Of those who listed an actual
occupation, domestics represented 70 per cent of all listed waged occupations
for women. Borrowing from Carolyn Stranges tabulations of Torontos female
domestics in her book on urban women at the turn of the century, and from
Drummonds statistics on the percentage of women in service in his economic

81 Drummond, Progress without Planning, table 2.2.

82 Warsh, In Charge of the Loons, 153.
 Hamilton and Toronto asylums, Canada, 18611891 119

Table 4.3b Previous occupation of female patients at time of

admission, rst admissions to the Toronto and Hamilton asylums,
selected years, 18511891 (n = 798)

Toronto Hamilton

Listed occupational no. % no. %

Wife/housewife, n.o.s. 41 19 16 3
Housekeeper/domestic dutiesa 12 5 71 14
Spinster (n.o.s) 3 1 4 1
Domestic servants/maids/nursesb 53 24 144 29
Seamstress/dressmaker/tailoress 6 3 18 4
Teacher 5 2 15 3
Milliner 0 0 5 1
Labourers w/d/w 9 4 36 7
Artisans w/d/w 4 2 25 5
Farmers w/d/w 31 14 89 18
Shopkeepers or clerks w/d/w 0 0 6 1
Merchants w/d/w 2 1 4 1
Professionals w/d/w 1 0 3 1
Lady 7 3 1 0
None/no occupation 32 14 55 11
Other 15 7 13 3

Sub-total 221 505

n/a 17 55

Total 238 560

n.o.s. = not otherwise specied

w/d/w = wife, daughter or widow
a including housework
b including governesses

history of Ontario, domestic service can be estimated at approximately 45 per

cent of the listed female waged labour force in 1881 and 53.5 per cent in 1891.83
A comparison of the percentages of listed female waged labour in the asylum
and in the province at large indicates that, as an occupational group, female
domestics were well overrepresented in the asylum. This adds evidence to the
argument that female domestic servants, many of whom came to Canada as
single emigrants, were more vulnerable to institutionalization.
It has been argued elsewhere that being an unmarried domestic servant was
an occupational risk factor that made women more vulnerable, ceteris paribus,
to being conned during times of emotional or mental crisis. Furthermore,
83 C. Strange, Torontos Girl Problem: The Perils and Pleasures of the City, 18801930 (Toronto,
1995), tables A4 and A6; Drummond, Progress Without Planning, table 2.2.
120 David Wright, James E. Moran and Sean Gouglas

unmarried single female workers may have been disproportionately new im-
migrants, thus suffering in many cases from a distancing of kin that might
otherwise have acted as a protective barrier to institutional committal. When
compared to the percentage of women listed as female domestic servants in the
two asylums (70 per cent of those with an occupation listed), these results seem
to reinforce contemporary observations of the extraordinarily high number of
female domestics incarcerated during the Victorian era. Two-thirds of them
were unmarried, swelling the disproportionate number of unmarried patients
mentioned below. Almost 90 per cent were paid by the province, a further proxy
to their impoverished state, or their lack of kin support, at the time of admission.
One is also struck by the one third of these predominantly unmarried domestic
servants who were born in Ireland and Scotland (a proportion higher than the
already-elevated higher rate of non Canadian-born patients). The chapter will
now turn to this question of the role of migration and the distancing of kin
resources that may have had an impact on an individuals vulnerability to being
conned in an asylum.

Migration, kin and connement

The question of migration and kin resources must be considered when assessing
the vulnerability of different groups to being conned in the lunatic asylum.
Researchers working on the connement of the insane in the industrializing
countries of western Europe have tended to downplay the role of migration
(either of patients or their families) as a factor in the likelihood of an individual
being conned.84 By contrast, researchers working on countries experiencing
high rates of immigration have tried to account for higher-than-expected num-
bers of patients who were not born in the country. They have offered two pos-
sible explanations for this phenomenon. First, new migrants were more likely,
they argue, to be suspected or labelled mentally ill because of their strange
appearance, lack of language skills and different cultural habits. An incipient
racial approach to incarcerating individuals has often been alluded to in the case
of the high incarceration rate of the Irish.85 Thus, authorities, using conne-
ment in part as a form of social control, may have identied and incarcerated
undesirable individuals, and have viewed newly arrived single men as part of
this potentially troublesome group. Second, other historians have placed greater

84 See J. Walton, Lunacy in the Industrial Revolution: A Study of Asylum Admissions in Lan-
cashire, 18481850, Journal of Social History 13 (1979), 122; R. Adair, J. Melling and B.
Forsythe, Migration, Family Structure and Pauper Lunacy in Victorian England: Admissions
to the Devon County Pauper Lunatic Asylum, 18451900, Continuity and Change, 12 (1997),
373401. For an opposing view, see D. Wright, Family Strategies and the Institutional Com-
mittal of Idiot Children in Victorian England, Journal of Family History 23 (1998), 190208.
85 Mitchinson, Reasons for Commital, 93.
 Hamilton and Toronto asylums, Canada, 18611891 121

Table 4.4 Place of birth of patients, rst admissions to the Toronto and
Hamilton asylums, selected years, 18511891 (n = 1682)

Toronto Hamilton

Men Women Men Women

no. % no. % no. % no. %

Canadaa 117 44 114 49 292 50 287 53

United States 2 1 7 3 17 3 13 2
England and Wales 57 21 33 14 108 18 66 12
Scotland 22 8 19 8 56 10 40 7
Ireland 61 23 54 23 96 16 116 21
Germany 3 5 3 1 11 2 14 3
Other 5 2 2 1 9 2 9 2

Sub-total 267 232 589 545

n/a 5 6 23 15

Total 272 238 612 560

a Including Upper and Lower Canada, New Brunswick, PEI, Western Canada. Not including

Newfoundland.

emphasis on the lack of kin resources that may have acted as a protective barrier
to institutional committal.86
Studying the admissions of Irish immigrants may unpack some of these argu-
ments. Research has detailed the extraordinarily high number of Irish-born ad-
missions to the Toronto asylum in the 1840s, 1850s and 1860s, and to the London
Asylum in the 1860s. Over a third of all admissions to these institutions were
Irish natives. The Great Famine resulting from massive potato crop failure
during the 1840s substantially increased the numbers of Irish immigrants that
already existed in Upper Canada. Many of these newcomers worked as labour-
ers either in their geo-social transition to more rural environments, or as more
permanent urban dwellers.87 From 1870s, however, the Irish then diminish
steadily in their representation in asylum admissions, to 23 per cent in Toronto
(1871, 1881) and 19 per cent in Hamilton Asylum (187585) (see Table 4.4).

86 Yet this argument needs to confront the tradition of chain-migration whereby migrants often
located in foreign countries where they had some, albeit limited, kin connections. It is possible
that in the case of female domestics, chain migration might have helped to establish some of the
familial infrastructure necessary to buffer the fallout from mental trouble. Marylin Barber notes
that there are examples recorded by government ofcials [that] illustrate the chain migration
process among female domestics and their families. See M. Barber, Immigrant Domestic
Servants in Canada, Canadian Historical Association 16 (1991), 5. Mitchinson, Reasons for
Committal, 94, table 2.
87 Akenson, The Irish in Ontario.
122 David Wright, James E. Moran and Sean Gouglas

Table 4.5 Marital status of patients at time of admission, rst

admissions to the Toronto and Hamilton asylums, selected years,
18511891 (n = 1682)

Toronto Hamilton

Men Women Men Women

no. % no. % no. % no. %

Unmarried 143 53 88 37 333 55 239 43

Married 108 40 120 51 266 44 299 54
Widowed 17 6 27 11 10 2 20 4

Sub-total 268 235 609 558

n/a 4 3 3 2

Total 272 238 612 560

Even at these lower levels, the Irish more than double the representation of the
Scottish-born admissions and equal that of the much more numerous (demo-
graphically speaking) English-born admissions. Teasing out poverty, prejudice
and familial isolation in the social process of connement is extraordinarily dif-
cult. Just at the time when the Irish were claiming the dubious title of having
the highest incarceration rate in their own country, their emigrants were also
ooding into colonial mental hospitals.
In the last ten years, analyses of household structure and intra-familial dy-
namics have also become more of a focus for historians of the asylum. The
household is seen both as a place of connement, control and care before
and after institutionalization, but also as a locus for lunacy identication and
certication.88 Certainly, as far as the gross characteristics of patients go, there
were several important variables related to marriage and household formation
found amongst patients (Table 4.5). First, there was an overrepresentation of
the unmarried and widowed (as compared to the population from whence the
patients came). Over one-half of all men admitted to both institutions were
unmarried, a proportion much higher than the general adult population at the
time. The percentage of unmarried women patients was lower than men in both
institutions, but still elevated compared to the general population. Historians
who have found similar results in patient populations have posited several ex-
planations for the elevated level of the unmarried. First, it may be likely that

88 P. Prestwich, Family Strategies and Medical Power: Voluntary Committal in a Parisian Asy-
lum, 18761914, Journal of Social History 27 (1994), 799818; M. Kelm, Women, Families
and the Provincial Hospital for the Insane, 17793.
 Hamilton and Toronto asylums, Canada, 18611891 123

Table 4.6 Length of stay of patients: rst admissions to the

Toronto and Hamilton asylums, selected years, 18511891
(n = 1682)

Toronto Hamilton

Men Women Men Women

In months no. % no. % no. % no. %

0 to 6 90 37 86 38 130 22 126 23
6 to 12 32 13 53 23 92 15 85 16
12 to 24 33 14 18 8 69 12 46 8
24 to 60 42 17 31 14 86 14 83 15
60 to 120 19 8 16 7 66 11 66 12
>120 27 11 22 10 155 26 137 25

sub-total 243 226 598 543

n/a 29 12 14 17

Total 272 238 612 560

Median 11.8 8.0 26.5 29.0
IQR 3.2 to 48.6 3.9 to 32.0 7.2 to 127.7 6.4 to 120.5

those individuals suffering from recognizable levels of mental disturbance may

well have been less likely to have been married in Victorian society (as today).
In terms of the social context of committal, those who were married may also
have been more integrated into a particular primary household (and thus needed
for wages or primary-care giving). Thus, there may have been disincentives to
seeking formal institutional committal. Clearly, more work on household struc-
ture as a factor in asylum committal needs to be done.89

Length of stay and transcarceration

So far these two institutions have revealed remarkably similar socio-
demographic characteristics, save for the slightly lower socio-economic back-
ground that the Hamilton Asylum patients reected, inter alia, in the statistically
signicant higher admissions of labourers to the latter institution. Where these
two asylums diverge, however, is in the length of stay of patients (see Table 4.6).
Toronto, it will be remembered, was the only institution in the province, until

89 See J. Moran and D. Wright, The Lunatic Fringe: Households and the Management of Mad
Behaviour in Victorian Ontario, in N. Christie and M. Gavreau (eds.), On the Margins of the
Family: Essays on the History of the Family in Canada (Montreal-Kingston, in preparation).
124 David Wright, James E. Moran and Sean Gouglas

Table 4.7 Outcome of patients: rst admissions to the Toronto and

Hamilton asylums, selected years, 18511891 (n = 1682)

Toronto Hamilton

Men Women Men Women

no. % no. % no. % no. %

Discharged 113 45 132 57 225 37 250 46

Died 82 33 49 21 274 45 206 38
Eloped/escaped 8 3 0 0 31 5 1 0
Transferred 46 18 49 21 75 12 83 15

Sub-total 249 230 605 540

n/a 23 8 7 20

Total 272 238 612 560

the construction of the Kingston Asylum in 1855,90 the London Asylum in 1870
and the Hamilton Asylum in 1875. With these other outlets, Toronto could be
more selective in the admission and continued stay of patients. Its medical su-
perintendent, Joseph Workman, by all accounts the most powerful alienist in
English-speaking Canada at the time, prioritized Toronto as a curative insti-
tution, and seems to have redirected or transferred several score of incurable
patients to the Hamilton Asylum. Thus, 50 per cent of men and 60 per cent
of women admitted to the Toronto Asylum stayed for twelve months or fewer.
Torontos middle 50 per cent of patients stayed between three months and four
years. These gures are directly comparable to major studies of length of stay
of general lunatic asylums in Britain and Europe. Hamilton, by contrast, had
their middle 50 per cent of patients staying between twelve months and ten
years. Furthermore, a full one-quarter of all patients stayed for more than ten
years. What appears to have happened, then, was a prioritization of Toronto as
the primary curative institution of central Ontario.91
Differences between sexes emerge in the outcome of patients, their length
of stay and their likelihood to be discharged (see Table 4.7). Ten per cent more
women than men were eventually discharged from their respective institutions;
conversely, 10 per cent more men died in the institution. Here it is very difcult

90 The Kingston Asylum was built primarily for criminal lunatics, but was transformed into a
mixed criminal asylum and a general mental hospital serving the eastern part of the province.
91 Other North American jurisdictions formalized the idea of asylums for the curable and asylums
for the incurable. For an example, see Ellen Dwyers study of two institutions for the insane
in upper New York State namely the Utica and Willard Asylums. E. Dwyer, Homes for the
Mad.
 Hamilton and Toronto asylums, Canada, 18611891 125

to separate cause and effect. It is well known that men had considerably higher
mortality rates in the Victorian era, which may have led them to die more
quickly in the institution. They may also have had higher rates of fatal diseases
(with psychiatric manifestations) at time of admission, such as tertiary syphilis
or chronic alcoholism.92 Further detailed work on medical casebooks will be
required in order to answer questions concerning the physical (non-psychiatric)
ailments of individuals admitted to the asylums.
The records of discharge from the Hamilton Asylum allow for some general
comments about transfer to other institutions. Ofcial transfers to other asylums
represented approximately 13 per cent of the eventual outcomes of male ad-
missions and 15 per cent of female admissions to Hamilton Asylum. Transfers
reected not a continuous process, but rather a movement of groups of patients
over a relatively discrete period of time. For instance, the Hamilton Asylum
transferred forty-ve patients to the Kingston Asylum, forty-three in the year
1885/6 alone. A further eighteen patients were removed from Hamilton Asylum
to the newly opened Mimico branch of the Toronto Asylum in the year 1892/3,
and twenty further patients shortly after the opening of the Penetanguishene
institution for the criminally insane in 1909. There were no readily observ-
able characteristics by sex or age for these transferred patients. This reshufing
of patients thus seems to have occurred most often initially after new institu-
tions were established. Indeed a signicant proportion of rst admissions to
the Hamilton Asylum in the rst year of its existence were transfers from the
Toronto Asylum.
Although transcarceration was an important component of the asylum
system in Victorian Ontario, a more signicant dimension one hitherto
unexplored is the movement of discharged asylum patients into the new
welfare institutions of the late nineteenth century, be they houses of indus-
try, houses of refuge or old-age homes. Until further research determines
the presence of ex-asylum patients in these institutions, the extent to which
short asylum stay actually represented the reintegration of thousands of dis-
charged former patients back into their community remains an unanswered
question.
The richness of asylum records has inevitably made them a popular re-
source for social historians of medicine. However, asylums were but one of
a range of inter-dependent carceral institutions that emerged in the latter part
of the nineteenth century. Future research must focus on tracking patients be-
tween different asylums, between asylums and other custodial institutions (such
as reformatories and inebriate asylums), and particularly between gaols and

92 For a discussion of these factors in the characteristics of patients more generally, see E. Shorter,
A History of Psychiatry; From the Era of the Asylum to the Age of Prozac (New York, 1997),
chapter two.
126 David Wright, James E. Moran and Sean Gouglas

asylums. Almost as many insane individuals were being conned in gaols

as were admitted to lunatic asylums in any given year in the province of
Ontario. Did these numbers represent the same individuals? What proportion
of insane individuals remained in the criminal system? More research also
should be conducted on the nancing of the asylum. How were decisions made
as to who was responsible for the cost of maintenance? And how did these
nancial responsibilities shape and inuence those who were (and were not)
conned?

Conclusions
The results of this study have added weight to a new historiography of medicine
that fundamentally reconsiders the patient populations of nineteenth-century
mental hospitals. As this and other chapters in this book have shown, the
Victorian asylum was not populated by the fringe elements of industrial society,
at least certainly not from a socio-demographic standpoint. An older body of
literature suggesting that women were disproportionately incarcerated in Victo-
rian mental hospitals nds little to no support in empirical research.93 Nor does
there seem to be any convincing research indicating that the aged in Ontarios
mental hospitals were overrepresented. Like Gasser and Hellers quantitative
study of two asylums in Switzerland in the early twentieth century, this research
found that the Toronto and Hamilton asylums received patients from all ages,
and equally from both sexes.94 Indeed, the lack of sex as an important socio-
demographic variable when cross-referenced with age, occupation, length of
stay, religion and geographical background, is nothing short of remarkable.
Moreover, the majority of patients in our sample appeared to be productively
employed, and thus functional in one sense prior to their committal. Keeping
in mind the mounting evidence of the broad similarity of patient populations in
the latter half of the nineteenth-century, it is at least worth posing the question

93 The major studies suggesting women were disproportionately conned in asylums are: P.
Chesler, Women and Madness (New York, 1973); E. Showalter, The Female Malady: Women,
Madness and English Culture, 18301980 (New York, 1985); Y. Ripa, Women and Madness:
The Incarceration of Women in Nineteenth-Century France (Minnesota, 1990). For excellent
summaries of feminist critiques of psychiatry and the history of psychiatry, see J. Buseld,
Sexism and Psychiatry, Sociology 23 (1989), 34364 and N. Tomes, Feminist Histories of
Psychiatry, in M. Micale and R. Porter (eds.), Discovering the History of Psychiatry (Oxford,
1994), 34883. For a more recent discussion of the role gender played in the history of psy-
chiatry, see the collected papers in J. Andrews and A. Digby (eds.), Sex and Seclusion, Class
and Custody: Perspectives on Gender and Class in the History of British and Irish Psychiatry
(Amsterdam, 2002).
94 The big exception in admissions was the connement of Native North Americans. This paper
could not identify any signicant cluster of aboriginal Canadians in the four institutions under
study. This absence requires further investigation.
 Hamilton and Toronto asylums, Canada, 18611891 127

as to whether social historians, in their desire to highlight the importance of

social and cultural factors in the construction of ideas about madness, have
inadvertently overemphasized the role of these same factors in the connement
of the insane a bias existing at the expense of a comprehensive analysis of
the behavioural and medical characteristics of the patients. For all the work that
has been conducted around the world on the socio-demographic characteristics
of patients, there has been little attention paid to the symptom proles of these
patients.95
This does not undermine the importance of social historical analysis of the
asylum. While contributing to a growing literature that challenges some of
the long-held assumptions of earlier feminist and social control accounts, this
paper has emphasized the many ways that class and gender relations, and the
social-familial dislocations resulting from large-scale emigration patterns, have
inuenced connement and the representation of individuals in the asylum.
But the paper also underscores the need to integrate the concept of madness
as mental illness into the social and demographic history of the asylum era.
This, as Charles Rosenberg has noted for the history of medicine in gen-
eral, is no easy task. For Rosenberg, disease is at once a biological event,
a generation-specic repertoire of verbal constructs reecting medicines intel-
lectual and institutional history, an occasion of and potential legitimation for
public policy, an aspect of social role and individual intrapsychic identity,
a sanction for cultural values, and a structuring element in doctor and patient
interactions.96
Social historians of the asylum era have been loath to integrate the con-
cept of mental illness as disease (however complicated and variegated a con-
cept that might be when considering a heterogeneous patient population)
with the myriad social constructions around mental illness that are the his-
torical inevitability of our response to it. By and large we have found it
safer to avoid the rst item in Rosenbergs list altogether, seeking academic
refuge in the new social history of the asylum. This latter body of liter-
ature has, since the late 1970s, vastly expanded our understanding of the
intricacies of insanity in the asylum era and it has done so from a range of
perspectives. This chapter suggests that the incorporation of analyses of symp-
tom proles, and, in some instances, of the physiological manifestations of
madness, into the new social history of the asylum will lead to further fruitful
reconsiderations of nineteenth-century asylum history.

95 A recent exception to this rule is D. Malleck, A State Bordering on Insanity? Identifying Drug
Addiction in Nineteenth-Century Canadian Asylums, Canadian Bulletin of Medical History 16
(1999), 24770.
96 C. Rosenberg, Framing Disease: Illness, Society and History, in C. Rosenberg and J. Golden
(eds.), Framing Disease: Studies in Cultural History (New Brunswick, 1992), xiii.
128 David Wright, James E. Moran and Sean Gouglas

Appendix
Religion of patients at time of admission, rst admissions to the Toronto and
Hamilton Asylums, selected years, 18511891 (n = 1682)

Toronto Hamilton

Men Women Men Women

no. % no. % no. % no. %

Baptist 9 3 14 6 25 4 39 7
Bible Christian 2 1 2 1 0 0 2 0
Church of England 74 28 65 28 89 15 52 10
Congregational/Independent 4 2 2 1 3 1 5 1
Disciple 1 0 2 1 3 1 2 0
Episcopalian 0 0 3 1 56 9 42 8
Lutheran 5 2 2 1 8 1 13 2
Mennonite 1 0 1 0 5 1 2 0
Methodist 51 19 49 21 120 20 114 21
Presbyterian 62 23 46 20 117 20 109 20
Protestant 0 0 1 0 10 2 8 1
Quaker 2 1 0 0 6 1 1 0
Roman Catholic 44 17 39 17 113 19 123 23
Salvation Army 2 1 0 0 0 0 1 0
Other 6 2 5 2 32 5 26 5
None 1 0 2 1 4 1 5 1
264 233 591 544
n/a 8 5 21 16
Total 272 238 612 560
5 Passage to the asylum: the role of the police in
committals of the insane in Victoria, Australia,
18481900

Catharine Coleborne

Australias European population arrived in 1788, transported from the British

Isles to establish New South Wales as a penal colony. In the rst few years of
settlement, David Collins, legal advocate on the First Fleet and chronicler of
the early history of the colonies, commented on the existence of insanity among
convicts.1 Policies, legislation and practices surrounding insanity in the different
Australian colonies developed over the next ten decades. Subsequent histories of
the insane in nineteenth-century Australia, following the trajectory of British
scholarship on asylumdom, have largely been explored through institutional
records.2 Historians have been interested in exploring the broad concept of
asylum committals, and have considered the relationships between agencies of
the law, including police and the courts, families and asylums.3 The custodial
character of the colonial asylum meant that public disturbances could result
in asylum committals, rather than imprisonment, for women and men. Colonial
policing practices of detection and surveillance, and the policing of sex and
race, were central to the apprehension of lunatics. Families negotiated with the
police in many instances, and the police played roles as intermediaries between
the asylum and the families of lunatics. This chapter examines the development
of policing practices around lunacy and the asylum in the colony of Victoria in
the nineteenth century.
The history of the asylum in colonial Victoria was not unique, and is use-
fully compared to the histories of other Australian colonies and also the colony
of New Zealand.4 By the mid-nineteenth century, asylums were part of the

1 See W. D. Neil, The Lunatic Asylum at Castle Hill: Australias First Psychiatric Hospital
18111826 (Castle Hill, Australia, 1992), 23; G. Davison, et al., The Oxford Companion to
Australian History (Melbourne and Oxford, 1998), 1378.
2 On British scholarship, see J. Melling, Accommodating Madness: New Research in the Social
History of Insanity and Institutions, in J. Melling and B. Forsythe (eds.), Insanity, Institutions
and Society, 18001914 (London and New York, 1999), 123.
3 See especially S. Garton, Medicine and Madness: A Social History of Insanity in New South Wales,
18801940 (Sydney, 1988); M. Finnane, Asylums, Families and the State, History Workshop
20 (1985), 13448.
4 For an account of the potential of historical comparisons between Victoria and New Zealand, see
C. Coleborne, Making Mad Populations in Settler Colonies: The Work of Law and Medicine

129
130 Catharine Coleborne

Australian colonial welfare landscape. These were large physical structures

modelled on the British Victorian asylum, and they housed increasing numbers
of the insane. The rst ofcial lunatic asylum in New South Wales, smaller and
more makeshift than later asylum buildings, was opened at Castle Hill in 1811.
By 1866, when the asylum building was demolished, it had already assumed
an identity as mad house and as a landmark of colonial history, as reported
in the Illustrated Sydney News.5 Before the temporary asylum at Castle Hill,
which operated for over fty years, lunatics, as they were known, were conned
in crowded gaol conditions west of the settlement at Parramatta. Rules regard-
ing lunatics estates had been formed in 1805, and ad hoc procedures for the
certication and discharge of gaoled lunatics were operating.6 Humanitarian
concepts of authority circulated in the new colony. In 1814 the Governor of
New South Wales, Lachlan Macquarie, instructed the asylum superintendent
that lunatics were to be treated with mildness, kindness, and humanity.7
The evolution of the asylum network was marked by legislative and insti-
tutional watersheds, and in the colonial period prior to 1900, was concerned
with the distinctions between insanity and criminality. Van Diemens Land
(Tasmania), also a penal colony, had separated the insane from the criminal
since 1829. Historians have characterized the lunatics, like the convicts, of Van
Diemens Land as desperate characters.8 The case of the criminal lunatic
raised many questions about the nature of the criminal impulse and the relation-
ship this impulse had to insanity. In 1857 the Australian Medical Journal (AMJ)
reported the case of John Quigley, charged with a violent crime in Tasmania in
1856. The medical testimony produced in this case seemed to be conicting.
Was Quigley a malingerer or a dangerous lunatic? The AMJ commented on
the phenomena of half-mad criminal convicts and in its editorial concluded
that in many instances it is difcult to distinguish insanity from crime.9
South Australia, never a penal colony, had an asylum from 1846, and Queens-
lands Woogaroo Asylum was built in 1864. The insane were conned in the
Moreton Bay Hospital before Woogaroo was established. Western Australia
was unusual and interesting in that it had a perceptibly more penal approach
to the connement of the insane; there was no asylum, not even a temporary
structure, until 1857 and the rst permanent building was erected in 1865. After

in the Creation of the Colonial Asylum, in D. Kirkby and C. Coleborne (eds.), Law, History,
Colonialism: The Reach of Empire (Manchester, 2001).
5 Illustrated Sydney News, 16 July 1866. See Neil, The Lunatic Asylum at Castle Hill, 75.
6 E. Cunningham-Dax, Australia and New Zealand, in J. G. Howells (ed.), World History of
Psychiatry (London, 1975), 7067; M. Lewis, Managing Madness: Psychiatry and Society in
Australia, 17881980 (Canberra, 1988), 45.
7 A. Atkinson, The Europeans in Australia: A History, Volume One (Melbourne and Oxford, 1997),
106; Cunningham-Dax, Australia and New Zealand, 706.
8 Cunningham-Dax, Australia and New Zealand, 707.
9 Australian Medical Journal 2 (1857), 768.
 Insane in Victoria, Australia, 18481900 131

the arrival of convicts in 1850, insanity posed more of a problem. The asylum
system in Western Australia developed slowly; legislation was not enacted until
1871 and the rst inquiry into the state of the asylum was not held until 1886.10
Historians have explored the ways in which Western Australias asylums, in-
cluding Fremantle Asylum, were custodial in nature. As in Victoria, gendered
and racial denitions of inmates as evidenced by readings of patient casebooks
at the Fremantle Asylum go some way towards explaining nineteenth-century
attitudes to the vagrant, the socially troubling or unsettled populations in
Australian colonies.11 In Victoria, known as Port Philip until 1851, lunatics
were sent on a long journey to New South Wales until the rst asylum at Yarra
Bend was built in 1848.
The Yarra Bend Lunatic Asylum housed all certied insane in the colony
until 1867. Two large rural asylums were established that year at Ararat and
Beechworth, and by 1871, a new metropolitan asylum at Kew was built to house
several hundred inmates. Yarra Bend was located, as its name suggests, on a
bend of Melbournes Yarra River north of the towns centre, and away from
centres of population. The Yarra Bend quickly became part of the local imagi-
nation. When it rst opened, lunatics could be seen by the public as they were
transported to the asylum on carts, which drew criticism at an ofcial inquiry
of 1852. Wood engravings of the asylum appeared on the front page of the
Illustrated Melbourne Post in 1862. A few years earlier a visitor from Hobart,
Tasmania, commented that the asylum was in a sombre, almost gloomy set-
ting near the river, peculiarly lonely.12 Inmates sometimes escaped from this
gloom, like Catherine Canning who made it over the fence and into the yard
outside in 1860.13 In the 1870s Melbournes residents reportedly hung about
the reserve near Kew Asylum for sport and had to be watched by police.14
Ofcial inquiries into the management of the asylums were held from the 1850s
to the 1880s, with the Yarra Bend receiving particular scrutiny in its early years
of operation. The custodial character of the Yarra Bend was noted; yet doctors
and superintendents brought from England to reform this institution defended
the practices at the asylum.

10 A. S. Ellis, Eloquent Testimony: The Story of the Mental Health Services in Western Australia
18301975 (Perth, 1984).
11 See B. Harman, Women and Insanity: The Fremantle Asylum in Western Australia, 18581908,
in P. Hetherington and P. Maddern (eds.), Sexuality and Gender in History: Selected Essays
(Perth, 1993), 16781; N. Megahey, More than a Minor Nuisance: Insanity in Colonial Western
Australia, in C. Fox (ed.), Historical Refractions: Studies in Western Australian History 14
(1993), 4259.
12 See Illustrated Melbourne Post, 25 June 1862. R.W. Willson, A Few Observations Relative to
the Yarra Bend Lunatic Asylum (Melbourne, 1859), 4.
13 Argus, 20 March 1860, 5.
14 Kew Lunatic Asylum Police Duty At, 12 November 1873, Victorian Public Record Series
(VPRS) 937, Unit 60, Inwards Registered Correspondence, Police Department, Bourke District,
Bundle 4.
132 Catharine Coleborne

The Yarra Bend, Kew Metropolitan Asylum, and Ararat Asylum, together
with other similar institutions in the colony in this period, continued to exist
in various forms in the twentieth century and their records, particularly patient
casebooks, are extant. These are mostly complete sets of records of patients in
nineteenth and early twentieth-century Victorian asylums. Other sources used
in this chapter include records of the Victoria police, including police manuals
and police regulations, the Victoria Police Gazette, and medical journals and
ofcial asylum inspectors reports. Historians in Australia have made useful
assessments of the role of police in the matter of lunacy using similar sources
for different regions.15 Yet these historians have not focused on the relationship
between police and medicine, nor have historians of lunacy incarceration elab-
orated on the police role in lunacy committals.16 Nineteenth-century legislation
changed the nature of legal and medical practices regarding lunacy, including
police practices, and with it, the nature of the lunatic identity.17
The rst piece of lunacy legislation enacted in Australia was the Dangerous
Lunatics Act of 1843.18 This Act reected the fear of dangerousness and
of lunacy in its language. It also introduced the medical practitioner to the
procedure of connement, which meant that wrongful connement was less
likely to occur.19 In the different colonies, specic legislation came to replace
this Act. In Victoria, the Lunacy Statute of 1867 implemented an increased
surveillance of the lunatic patient, particularly through the requirements for
the medical casebook.20 At the same time the Lunacy Statute made provisions
for the building of the two new asylums in rural Victoria at Beechworth and
Ararat. With this Statute, police began to play an important role in the process
of enforcing laws which attempted to control and describe disorderly behaviour
for medicine.
This intervention of police in the matter of lunacy has more signicance
than it has been given in historical accounts. Increasing scrutiny of settled
populations in towns and shifting populations in the mid-nineteenth century

15 S. Garton, Policing the Dangerous Lunatic: Lunacy Incarceration in New South Wales,
18431914, in M. Finnane (ed.), Policing in Australia: Historical Perspectives (Kensington,
Australia, 1987), 77.
16 See S. Garton in Bad or Mad? Developments in Incarceration in New South Wales 18801920,
in Sydney Labour History Group, What Rough Beast? The State and Social Order in Australian
History (Sydney, London and Boston, 1982), 89110; and Policing the Dangerous Lunatic,
7587; see also M. Finnanes Insanity and the Insane in Post-Famine Ireland (London and
Totowa, 1981). For a history of police in colonial Victoria, see J. McQuilton, Police in Rural
Victoria: A Regional Example, in Finnane (ed.), Policing in Australia, 3658.
17 Finnane, Insanity and the Insane in Post-Famine Ireland, 121.
18 Dangerous Lunatics Act, 7 Vic. No. 14, 1843.
19 C. Coleborne, Legislating Lunacy and the Female Lunatic Body in Nineteenth-Century
Victoria, in D. Kirkby (ed.), Sex, Power and Justice: Historical Perspectives on Law in Australia
(Oxford, 1995), 889.
20 Lunacy Statute, 31 Vic., No. 309 (Amended in 1869 and 1878).
 Insane in Victoria, Australia, 18481900 133

was becoming part of the bureaucratic mentality and practice in the colonies.21
A small number of women in Victorias asylums were described as prostitutes,
and these women were particularly vulnerable to police surveillance. Paula J.
Byrne has shown that in New South Wales in the nineteenth century, women
were watched differently from men by police.22 Other groups in Victorian
society were similarly watched differently and closely by police, and were
at times considered dangerous and disruptive: these included the Chinese, the
vagrant and destitute and the alcoholic. Lunacy was coming under far greater
notice than it had previously, and particularly by ofcial bodies.
The policing practices discussed here evolved over the course of the nine-
teenth century and were formalized at specic points. The ofcial Regulations
for the Guidance of the Constabulary of Victoria of 1877 marked one moment
of formality for the role of police in regard to lunacy. The increasing concern
about asylum management in Victoria suggests that advice to police from asy-
lum authorities which followed was informed by this investigation. This chapter
considers both regulatory texts, and policing practices. It was in formal police
regulations that evidence of the increasing emphasis on the medical role for
police shows that lunacy was itself becoming indisputably a medical matter.

Colonial policing and lunacy in Victoria

William aBecketts Magistrates Manual for the Colony of Victoria, published
in 1852, had not mentioned lunacy.23 Yet it is safe to assume that police were
involved in the apprehension of alleged lunatics prior to this. From 1867, police
were formally involved in the process of lunacy committals. This process was
shaped by ideas about sex, race and class as police made discretionary judge-
ments about vagrant, alcoholic, wandering and disorderly women and men. In
1877 the new Regulations for the Guidance of the Constabulary of Victoria out-
lined the particular medical procedure to be followed by police where lunatics
were concerned, and the lunatics passage to the asylum was one increasingly
marked by police-enforced medical regulations around her/his body. Police
were responsible for the large numbers of committals of lunatics to asylums
in New South Wales before 1900.24 During the same period in Victoria, police
21 For an indication of what the historian might nd within bureaucratic texts, see O. MacDonagh
in A Pattern of Government Growth 18001860: The Passenger Acts and their Enforcement
(London, 1961), 1719.
22 P. J. Byrne, Criminal Law and Colonial Subject: NSW 18101830 (Cambridge, 1993). See also
J. Allen, Sex and Secrets: Crimes involving Australian Women since 1880 (Melbourne, 1990).
23 W. aBeckett, The Magistrates Manual for the Colony of Victoria, containing practical direc-
tions to Justices of the Peace, in the performance of their Duties, as Required by the Adoption
of Jerviss Acts, Melbourne Morning Herald, 1852. See also T. Weber, History of the Mag-
istracy, in La Trobe Legal Studies Department, Guilty, Your Worship: A Study of Victorias
Magistrates Courts (Bundoora, 1980), 316, esp. 11.
24 Garton, Policing the Dangerous Lunatic, 76.
134 Catharine Coleborne

literally created boundaries between the asylum and the outside world, as their
presence was required for the smooth ordering of the division between the in-
sane and curious onlookers, and the 1877 Regulations signalled an increasingly
medical role for the police in the matter of lunacy.
Fear of disorder and violence in the community, and the increased capa-
bility of state intervention into the lives of citizens by this time, made police
intervention into everyday life possible and permissible. The so-called dan-
gerousness of the lunatic was less predictable than the violence of assault,
murder or robbery; laws regarding criminal offences helped shape lunacy laws,
although it was tacitly acknowledged that the lunatic was not criminal. Yet
police had the power to suspect the mad person as capable of committing
crime, and magistrates could choose gaol or the asylum for the person brought
before the court. Where lunacy was concerned, the preservation of social order
remained paramount in the intentions of the legislators in early Australia.25
Harriet Deacon notes that dangerousness was also a key to understanding as-
sessments of the insane in Cape Colony. Deacon comments on police as part of
the screening mechanism for asylum admissions in South Africa in the nine-
teenth century. In Victoria the police were encouraged to use their discretion
when apprehending suspected lunatics and other idle and disorderly persons.
They were given the power of interpretation of behaviour but asked to be at-
tentive to the processes of the law, and in the case of lunacy were reminded to
proceed under the provisions of the Lunacy Statute, and not under the provi-
sions of the Police Offences Statute.26 This was particularly relevant in arrests
of drunk women and men, and police were advised to keep these patients as
prisoners until their lunacy had worn off.27
In their daily work police had broad categories of disorder to identify,
usually based on behaviour and bodily deportment. As early as 1856 police were
encouraged to use their discretion when apprehending idle and disorderly
persons. Police could arrest without warrants all loose, idle and disorderly
persons whom [they] shall nd disturbing the public peace. This was extended
to include persons found in a state of intoxication or behaving riotously, every
common prostitute wandering in any street or public highway, persons begging
or displaying obscene material and using insulting and threatening words in
public.28 The role played by police was not one exclusively conned to issues
of arresting, charging and locking up those who had breached the law but was

25 Ibid., 767. Finnane, Insanity and the Insane in Post-Famine Ireland, 122. The situation in
England was different, largely because the Poor Law helped to dene the lunatic population.
Finnane also sees the question of social order in Ireland as central to lunacy legislation.
26 Regulations for the Guidance of the Constabulary of Victoria (Melbourne, 1877), 141.
27 See for instance the instructions for police in 1873 regarding lunacy brought on by excessive
drinking, Victoria Police Gazette, September 1873, 236.
28 Manual of Regulations for the Guidance of the Constabulary of Victoria 1856, paragraphs 7881.
 Insane in Victoria, Australia, 18481900 135

broad and far reaching, suggesting that the policing of social life and the creation
of order was important to colonial society.
Evaluating order and disorder in colonial society involves the use of con-
temporary denitions of crime. Criminal statistics for 1865 in Victoria indicate
that lunacy was recorded and considered as an offence. Other offences along-
side lunacy included categories such as Disorderly characters, Disorderly
prostitutes, and Drunk and disorderly characters, and misdemeanours in-
cluded Drunkenness, Nuisance, the use of obscene language and the
crime of vagrancy. While large numbers of women and men were taken
into custody by police under the charge of lunacy, only ninety-three women
were convicted of lunacy in this year, and 214 men were also convicted. To-
gether with lunacy, many of these offences involved vulnerable bodies in public
spaces.
People became more or less vulnerable in public spaces for different reasons.
As this chapter argues, gender and race were contributing factors. For instance,
women gured substantially among the statistics as disorderly, drunk, obscene
and homeless, indicating that women were not only disruptive in private but also
in public space.29 Not only did police make choices about what constituted mad-
ness, possibly based on popular conceptions of lunacy, but they were also given
permission to interpret behaviour.30 They were involved in the creation of the
lunatic asylum population, but also in the construction of the patient identity.
Interestingly, this patient identity was constructed in relation to ideas about
colonial laws and order. By 1874 ofcial statistics of police (Apprehensions,
Commitments, Convictions) still listed lunacy as an Offence against good
order together with vagrancy, libel, keeping a gambling house, gambling, of-
fences relating to lotteries, nuisances, cruelty to animals and breaches of the
Inebriate Act. In this year a total of 294 men and 170 women who were ap-
prehended by police on the charge of lunacy were summarily convicted by
magistrates.31 In 1877, similar police statistics reveal that a range of other of-
fences had been added to the list of Offences against good order: breaches of
by-laws, offences with horses and vehicles, habitual drunkenness, disorderly
conduct, using obscene, threatening or abusive language in public, indecently
exposing the person, being an idle or disorderly person or prostitute, and keep-
ing a brothel or disorderly house. The total number of convicted lunatics in
1877 was 434, comprising 285 males and 149 females. In this year the statistical
29 Returns of the Number of Persons taken into Custody by the Victorian Police Force during the
Year 1865, with Particulars as to their Disposal, etc., Criminal Statistics, Victoria Parliamentary
Papers (VPP), 1867, 3.
30 Garton, Policing the Dangerous Lunatic, 80.
31 Return Showing the Number of Males and Females taken into Custody by the Victorian Police
during the Year 1874 and the Offences with which they were charged . . ., Statistical Register
of the Colony of Victoria for the Year 1874, No. 27, Part IV, Law, Crime, etc., 7880. VPP,
18756.
136 Catharine Coleborne

Table 5.1 Number of lunatics received at Victorian

asylums through police, 18751890a

Date 1875 1885 1890

Lunatics received through police 407 332 414

Total admissions 659 615 912

a The three tables in this chapter were prepared using the

Annual Reports of Asylum Inspectors in the Colony of Victoria,

published in the Parliamentary Papers in the following year.
Researcher Fiona Kean assisted in the preparation of the tables.

register detailed the numbers of people taken into custody by police for each
offence in the previous eleven years. Numbers of people arrested under the
charge of lunacy remained fairly consistent but there was an actual if slight
decrease over the period between 1867 and 1877 of police intervention into the
matter of lunacy. It is likely that police were arresting large numbers of people
in public spaces, and perhaps charging them under the many and increasingly
varied categories of offences against good order rather than the charge of lu-
nacy. The fact that there was an increase in the number of people arrested for
habitual drunkenness with disorderly conduct and using obscene, threatening,
or abusive or insulting language or behaviour in public between 1867 and 1877
suggests that police used a variety of strategies to deal with disorderly people.32
Yet it was the very medical nature of the problem of lunacy which set it apart
from these other offences (as it was still identied) which required more clari-
cation and different practices as far as the police strategies were concerned.
Police scrutiny of a wandering population and of those considered disor-
derly did not go unnoticed by the wider community in Victoria in the 1870s.
In 1873 the Age reported that laws surrounding the connement of lunatics
needed some clarication, notwithstanding the efforts of the Victorian legisla-
ture in 1867 to rene the Lunacy Statute. The problem seemed to be that it was
difcult to get out of the asylum once inside.33 Furthermore, problems with
the policing of the lunatic raised questions about police powers with regard to
the denition of insanity. The report raised important questions: the Lunacy
Statute of 1867 had not been amended since its enactment; no bills which chal-
lenged its operation had been introduced to the Victorian Parliament; and many
other lunatics apprehended by police would have been admitted to the asylum

32 Statistical Register . . . 1877, Part VII, Law, Crime, etc., 1867, 194. Persons taken into
custody return for eleven years (Lunacy), VPP, 1878, 3. The return shows these numbers:
1867: 657, 1877: 567 (Habitual drunkenness with disorderly conduct); 1867: 9,351, 1877: 12,
368 (Obscene, threatening or abusive or insulting language or behaviour in public); 1867: 1,473,
1877: 3,487, 194.
33 Age, 3 May 1873, 4.
 Insane in Victoria, Australia, 18481900 137

under the terms of the Act without any controversy or criticism, as far as it is
possible to see, by newspapers and the community. The Police Gazette in 1873
reported that in September the police were given instructions regarding lunacy
brought on by excessive drinking, but this appears to be the only substantial
change to the policy of policing lunacy reported that year.34
The paragraph of the 1867 Lunacy Statute which was questioned by the Age
was Section 7.35 This section detailed the legal provision for police to appre-
hend people who were possibly at risk from family members or others being
neglected or cruelly treated and those who were wandering at large. These
categories of neglected and wandering raised questions about the legal def-
inition of insanity. The very broad nature of the legal understanding of lunacy
reects a certain willingness to control a large number of possibly disrup-
tive behaviours in public spaces. The very idea of dangerousness, the central
term used in the Dangerous Lunatics Act of 1843 which shaped the 1867 Act,
was also used to create social fears about different members of the community.
By 1874 the AMJ was also critical of the role played by police in the com-
mittal of lunatics. The Report of the Acting Inspector of Lunatic Asylums for
1873 raised serious questions for the medical press.36 At issue was the ability
of police and the ability of friends or relatives of patients to understand
the causes of insanity. The journal stipulated that if a policeman gives the
cause, drunkenness, religion, love, or some other very potent cause, is likely
to be pitched upon. Thus statistics which were tabled as representative of the
causes of insanity according to judgements made by those committing lunatics
to the asylum were considered by the AMJ to be worse than valueless.37 In this
way the judgement of the medical man in the asylum, and thus asylum (psychi-
atric) medicine, was presented as the only valid judgement. Yet the surveillance
and arrest of the lunatic by the police in public and private spaces continued,
suggesting that somehow the role of the police had to become increasingly
medical if the medical fraternity was to accept it as legitimate.

Regulatory texts
The admission of lunatics to the asylum was characterized by bureaucratic
processes. When Margaret Tweed was admitted to Yarra Bend Asylum by police
in 1873 there were three key documents which accompanied her there. The rst
was an Order for Conveyance to an Asylum, etc., of a lunatic not under Proper
Care and Control, etc. This was signed by two medical practitioners, Thomas
Hewlett and Edward Hunt, and two Justices of the Peace, John Falconer and
G. B. Heales. The second was a certicate that a person is a lunatic, and a
34 Victoria Police Gazette, September 1873, 236. 35 Lunacy Statute 1867, s. 7.
36 See Review, Report of the Acting Inspector of Lunatic Asylums, on the Hospital for the Insane,
for the Year 1873. AMJ 19 (July 1874), 21117.
37 Ibid., 214.
138 Catharine Coleborne

proper person to be detained under care and treatment, which was provided
for by the Lunacy Statutes seventh schedule under section 8. The third was the
Police Report of the lunatic Prisoner.38 The role of the police was central to
the process of making her lunacy both a legal and a medical issue.
In the restraining and treatment of persons apprehended by police as lunatics
the police were given medical directives from asylum authorities. By 1877
medical hints for the Management of lunatics en route to the asylum were
provided to the police.39 These were instructions which were about both how
to deal with lunacy and also the lunatics physical condition. Advice about
restraint, travel, weather, physical nourishment, posture and pregnancy was
offered. The bodies of female lunatics were an oddity here, given that police
were always male, so women were to be accompanied by a female attendant.
These examples indicate that the police were to manage the bodies of lunatics
as much as they were to describe and inscribe them for and in the law.
Police surveillance did not end here: lunatics on trial release from the asylum,
and placed with relatives and friends, were to be watched by police in case of
relapse. This had been the case since before the 1877 Regulations, and directives
for the police were issued in the Police Gazette in September of 1874.40 Perhaps
following the AMJs criticism of the police in their role regarding lunatics, in
November of 1874 Edward Paley at the Department of Hospitals for the Insane
was given the opportunity to amend police regulations regarding lunatics.41 He
wrote to the Chief Commissioner with his thanks, making only a small addition
marked in the margin of Police note.42 But by 1877 it seems that Paley was
more implicated in assisting the police with medical information about the
management of lunatics en route to the asylum; the police regulations of 1877
were quite detailed in their expectations of police, and further articulated their
medical role in relation to lunatics. The Regulations for the Guidance of the
Constabulary of Victoria of 1877 related to, and were revised and prepared
under, section 16 of the Police Regulation Statute of 1873. They were the rst
new regulations for police since the Manual of 1856.43 Lunacy was not the only
medical problem faced by police; the Regulations also outlined procedures for
the Medical Attendance to Prisoners and rescue procedures for the apparently
drowned, snakebite victims and the injured.44
38 Margaret Tweed, 14 June 1873, VPRS 7562/P1, Yarra Bend Asylum, Unit 7.
39 Regulations for the Guidance of the Constabulary, 144; see also Finnane, Insanity, 108.
40 Victoria Police Gazette, 1 September 1874, 182. 41 See Review, 214.
42 Letter to Captain Standish from Edward Paley, 18 November 1874, VPRS 937, Unit 128,
Correspondence to the Chief Commissioner, Department of Hospitals for the Insane, Melbourne,
Bundle 3.
43 As suggested by my research and the research of J. OSullivan, Mounted Police of Victoria and
Tasmania (Adelaide, 1980).
44 Regulations for the Guidance of the Constabulary. See also Police Regulation Statute, 1873,
no. 476. In the Police Regulations, lunatics, paragraphs 103762, 1415; Medical Attendance
for Prisoners, paragraphs 7728, 1023 with appendices.
 Insane in Victoria, Australia, 18481900 139

In November 1877 the Police Gazette announced that new Regulations for
the Guidance of the Constabulary of Victoria were available for police. A brief
article drew attention to the Chief Commissioners emphasis on regulation no.
391 which provides for the form in which police reports are to be prepared.
This signalled attention to the bureaucratic nature of policing, and police re-
sponsibilities towards the asylum fell within this ambit. The appendix attached
to the police regulations regarding lunacy, to be discussed in some detail below,
was entitled a Police Report of the lunatic Prisoner arrested, and yet it also
required police to identify this prisoner as a patient. The language here was
signicant: the police were beginning to make distinctions between criminality
and lunacy, as they were given more guidelines for this identication.
Regulations for the Guidance of the Constabulary in Victoria provided of-
cially for police practices which had been in effect for some time previously.
These regulations took the form of advice to police about lunatics relating
to the Lunacy Statute, and included directions regarding the Information to
be furnished respecting lunatics, the Removal of lunatics, particular infor-
mation regarding female lunatics and their children, and the Management of
lunatics, a section based on medical advice from the superintendent of Yarra
Bend Asylum. Writing about Ireland, Finnane asserts that such regulations can
tell us about the expectations surrounding policing in the eld and argues
that the very statement of rules for police embodies some highly symbolic
observations on the preferred modes of policing.45 The Information to be
furnished respecting lunatics is of central interest to me at this point, as this
detail was clearly linked to the medical casebook, a technique of surveillance
in the asylum. Rule 1043 stated that police must procure particulars of the
apprehended and alleged lunatic: her/his history, character and pursuits. This
information, for medical and legal purposes, was to be attached to the warrant
of committal.46 The police were being asked to identify patients in this situ-
ation. They were encouraged to provide extra information which may be of
assistance to the medical or other authorities in indicating the kind of treatment
required by the patient.
Similar in style to the casebook proforma was the schedule contained in
Appendix 11, the Tenth Schedule Statement, the Police Report of the lunatic
Prisoner arrested. The role of police surveillance in this instance was directly
informed by medical discourse. The Police Report of the lunatic Prisoner
arrested of 1877 was part of the process of identifying the lunatic, and also part
of the committal process. Its similarity to the patient casebook proforma which
collected details about the medical condition as well as the life situation of the
lunatic is important. It suggests that there were in each lunatics committal layers

45 Finnane, Police and Government, 153.

46 Regulations for the Guidance of the Constabulary, 141.
140 Catharine Coleborne

Table 5.2 Policing sex of lunatics and

passage to the asylum in Victoria,
1885 and 1890

Lunatics received
through police

Date Male Female

1885 208 124

1890 280 134

of meaning created about her/his condition. Some lunatics were committed on

the strength of family or friends testimony and medical certicates; but the
lunatic prisoner was committed with two or three detailed documents already
inscribed even before the asylum began its own process of bodily inscription.
The Police Report of the lunatic Prisoner is drawn from the tenth schedule
statement of the 1867 Lunacy Statute where the person(s) admitting the lunatic
were required to detail the lunatics illness. In this way other people admitting
lunatics were also performing a medical role. The police were given separate
instructions which lent them the added responsibility of having some kind of
medical expertise in the matter of lunacy. The police were required to ask or
ascertain the Supposed cause of the lunatics insanity, as well as collecting
detail about the duration of the attack, the possibility of epilepsy, and the form
of insanity. This surely is the most medical of requirements; it appears that
police were to have some understanding of the labels in use by the asylum, such
as mania or melancholia, and to apply these to the arrested lunatic.

Policing sex
The policing of sex in nineteenth-century Victoria involved police observation
of women and men which was shaped by ideas about appropriate sex-role
behaviour, and the construction of gendered mad identities. Police were aware
of local communities and kept a close eye on events. While Table 5.2 indicates
that more men than women were admitted to asylums by police in the latter
part of the century, signicant numbers of women were also apprehended and
admitted by police. Mary Ann Cook was taken by police to the asylum in
1870 suffering from melancholia. The casebook recorded that: this unfortunate
woman was the wife of the man Cook who shot Mrs Moss in Ballarat some time
ago, then shot himself. She is very desponding and has attempted to strangle
herself.47 Police brought Mary Jane Secombe from Geelong to Yarra Bend in
47 Mary Ann Cook, 9 July 1870, VPRS 7400/P1, Ararat Asylum, Unit 4, 9.
 Insane in Victoria, Australia, 18481900 141

1878. Suffering from melancholia and suicidal, Mary Jane had jumped from an
upstairs window in the hospital at Geelong to escape the chloroform.48 Police
were also called to restrain women who posed problems for others. In the 1867
cases of Eleanor Jenkin and Mary Jane Squires, the police were called upon by
family and husband to commit women identied as lunatics to Ararat Lunatic
Asylum. Eleanor Jenkin was suffering from puerperal mania and in decline. The
casebook noted that she and her family had been in great poverty. Mary Jane
Squires was suffering from acute mania and became violent.49 The unfortunate
Sarah Stynes, deaf, dumb and blind from birth, was transported by police to
Ararat from her previous residence, the Geelong Gaol.50 There are many other
cases similar to these of police playing a very central role in the committal
of needy women women who were neglected, ill, and also troublesome to
family.
Other women were clearly disturbing good order and arrested under the
charge of lunacy. Alice Rose Patterson, Bridget Callaghan, Louisa Gee, Mary
Hegarty, Martha Gorwood and Anne Ah Lou were identied as prostitutes.
Women who worked as prostitutes were certainly far more vulnerable before
the law and the police than many other women; like vagrant women or women
already understood to be criminal they were under surveillance by police for
most of the time. Upon her arrival to Ararat Asylum in police custody, Alice
Rose Patterson stated that she had been drinking and that she had experi-
enced delusions.51 Bridget Callaghan was perhaps known to police as she was
intemperate, described as dangerous and destructive and had been previ-
ously imprisoned for vagrancy and in and out of gaol for offences relating to
her drinking.52 Louisa Gee was transferred from Yarra Bend to the asylum at
Kew, and the label prostitute followed her there; her child, born at Pentridge
Gaol, was taken from her and sent to an Industrial School.53 Mary Hegarty and
Martha Gorwood went to Kew as prostitutes, both disordered through drink,
with delusions in the case of Mary and loss of memory and violence in the
case of Martha.54 Anne Ah Lou was arrested by police at Sandhurst some years
later, diagnosed as suffering from mania and described as a prostitute.55
In 1877 several Police Gazette reports of escaped male lunatics detailed the
clothing and appearance of the escapees for police detection and recapture.

48 Mary Jane Secombe, 10 April 1878, VPRS 7400/P1, Ararat Asylum, Unit 5, 269.
49 Eleanor Jenkin, 22 October 1867, VPRS 7401/P1, Ararat Asylum, Unit 1, 4; Mary Jane Squires,
29 October 1867, VPRS 7401/P1, Ararat Asylum, Unit 1, 5.
50 Sarah Stynes, 6 December 1867, VPRS 7401/P1, Ararat Asylum, Unit 1, 12.
51 Alice Rose Patterson, 18 December 1870, VPRS 7401/P1, Ararat Asylum, Unit 1, 250.
52 Bridget Callaghan, 12 April 1873, VPRS 7400/P1, Yarra Bend, Unit 5, 122.
53 Louisa Gee, 29 July 1872, VPRS 7397/P1, Kew Asylum, Unit 1, 102.
54 Mary Hegarty, 28 February 1874, VPRS 7397/P1, Kew Asylum, Unit 2, 94; Martha Gorwood,
18 January 1875, VPRS 7397/P1, Kew Asylum, Unit 2, 276.
55 Anne Ah Lou, 27 May 1887, VPRS 7397/P1, Kew Asylum, Unit 8, 113.
142 Catharine Coleborne

Around twelve reports of escaped lunatics (some of whom were recaptured)

resembled criminal proles and, in their descriptive style, were precursors to
later surveillance technologies used by police:
THOMAS MILNE escaped from the Yarra Bend lunatic Asylum about 7.20pm on
the 11th instant. Description: 55 years of age, 5 feet 2 or 3 inches high, small features,
grey eyes, long grey hair; wore the asylum clothing; was sent to the asylum from Camper-
down. 0.5082. 14th August 1877.56

The escaped lunatics listed throughout 1877 were all men.57 Wife deserters
and male criminals were described in similar ways, as were absconders and
vagrants. However, lunatics were mostly identiable by their asylum clothing
which literally branded their bodies as they ed the place (unless they had the
wherewithal to dispose of it).58
Men who were arrested by police on charges of lunacy and taken to Yarra
Bend Asylum in the 1870s included thirty-three-year-old Matthew Larkin of
Melbourne, a single tailor who came from Ireland and was Roman Catholic.
Larkin suffered from delusions: Fancies that he hears everything, and every-
body talking, that the Bible is being read all night.59 Achilles King was a pub-
lican who used to keep the cafe de Paris and managed the Athenaeum Club
who suffered a loss in business. He was taken to the asylum by police perhaps
with the co-operation of his wife, Lavinia Anne King.60 Police found George
Peters and Thomas Williams, who had been in the bush for ten days without
food and found wandering about the streets half naked.61 Being arrested in
the bush or the streets was not uncommon for men who were understood to be
insane as a result of loneliness, isolation, sunstroke: the casualties of colonial
conditions.62
The female lunatics passage to the asylum was a particularly complex rite
as, caught within a medico-legal framework, the potential disorder of her sexual
difference created some police anxiety. Prior to the 1877 Regulations, police had

56 Victoria Police Gazette 15 August 1877, 221.

57 See references to James Morrison and Patrick William Daglish (14 February, 39), Patrick
Byrne (21 February, 53), Christian Burke (28 February, 53), George Henry Heather (7 March,
59), James Baker (28 March, 81), R. G. Bayldon (23 May, 136), Joseph Guella (30 May,
142), Vincent Mitchell (8 August, 215), Thomas Milne (15 August, 221), Edward Gangaillot
(26 September, 257) and William Johnstone Cooke (28 November, 312) in the Victoria Police
Gazette for 1877.
58 For a detailed description of asylum clothing printed in the police gazette for the police, see
Victoria Police Gazette, 22 May 1878, 142.
59 Matthew Larkin, 30 January 1872, VPRS 7399/P1, Yarra Bend Asylum, Unit 1, 12.
60 Achilles King, 31 January 1872, VPRS 7399/P1, Yarra Bend Asylum, Unit 1, 13.
61 George Peters, 6 Feburary 1872, fancies that people are running after him, VPRS 7399/P1,
Yarra Bend Asylum, Unit 1, 19; Thomas Williams, 8 February 1872, VPRS 7399/P1, Yarra
Bend Asylum, Unit 1, 20.
62 As Garton also suggests in Policing the Dangerous Lunatic, 812. This phrase is suggested by
Kathryn Cronins Colonial Casualties: Chinese in Early Victoria (Melbourne, 1982).
 Insane in Victoria, Australia, 18481900 143

to make decisions about how to transport and police the lunatic female. In 1866
Sergeant King of the Belfast Police Barracks in rural Victoria reported to his
superintendent that when Mrs Chastele was arrested she was quite incapable of
looking after herself. He arranged for a woman to attend the patient cheaper
than any person he could nd.63 In 1869 another police constable offered his
wife this role when a female lunatic was transported to Yarra Bend Asylum,
but he had to wait for some time before her payment was made.64 There was
still confusion about payments to police in 1873.65 One historical account of
mounted police in colonial Victoria comments that the task of transporting
lunatics was one of the most unpleasant tasks faced by police, as unpleasant
as transporting corpses from outlying and remote areas.66

Policing race
Sex was one characteristic police used in their observations of the population;
race was another. There are virtually no records of Aborigines in Victorian
asylums, suggesting that asylum was not automatically a destination for the
indigenous peoples in the colony. There were however new arrivals, including
Chinese, in the colonial population.67 Anne Ah Lou and Margaret Ah Lee
were both arrested by police in 1887. There were not many Chinese women in
Victoria, and Margaret Ah Lee was identied by the Kew Asylum as A Chinese
half-caste girl. As women with Chinese heritage they were both obvious to
police. In fact Margaret was apprehended twice by police, rst in March 1887
when she was seventeen, and later in August of 1888 when she was nineteen.
Her age, her status she was a single servant and her appearance made her
particularly vulnerable to arrest.68 Of the Chinese men found at Kew Asylum
in the 1870s, all were taken there by police. They were also subject to more
scrutiny inside the asylum. A number of these men were miners, and others
were labourers. Ah Lop was said to have murdered a man on the diggings
63 Belfast The Hire of attendant on female lunatic prisoner, VPRS 937 Victoria Police Force,
Unit 35, Belfast District.
64 Re Mrs McCraith, attendance on lunatic Eliza Wernmouth en route to asylum, VPRS 937
Victoria Police Force, Unit 105, Castlemaine District, no. 5.
65 See another letter from Kew Station on 21 December 1873 regarding the lunatic prisoner
John Kenny and payment to police, VPRS 937 Unit 60, bundle 4. This issue of payment to
police involved in the transporting of lunatics seems to have been one common to English
and Australian lunacy practices. James Adam, Superintendent of Caterham Asylum in Surrey,
recorded in his diary in 1876 that Sergeant Biddlecomb asked is there anything allowed for the
capture of the female lunatic who was found wandering at Lingeld . . .? 9 December, 1876, J.
Adam, Diaries 187282, MS 551019, London.
66 Victoria Police Management Services Bureau, Police in Victoria 18361980 (Melbourne, 1980),
301.
67 See Coleborne, Making Mad Populations in Settler Colonies.
68 Margaret Ah Lee, 19 March 1887, VPRS 7397/P1, Kew Asylum, Unit 8, 88; 20 August 1888,
VPRS 7397/P1, Kew Asylum, Unit 8, 272.
144 Catharine Coleborne

which even the asylum notes recorded as a possible ight of fancy: this is
only hearsay. Nevertheless, Ah Lop was very insane, and other Chinese
men admitted by police to Kew were similarly constructed as dangerous and
excessive in their madness.69
Ah Lang was rather dangerous; Ah Gee dangerous and destructive; Ah
Shung not to be trusted; Ah Sin potentially dangerous and an opium user;
and Ah Him was both dangerous and of immoral habits.70 Like most of
the Irish women who were identied as intemperate, vagrant or prostitutes,
these Chinese men were vulnerable to police and had no one to speak on their
behalf. They usually remained in the asylum until their deaths. The Chinese
were feared to be sufferers of mania in large numbers, as an early article in
the AMJ asserted, connecting the problem with the use of opium among the
Chinese. In the article the police were identied as the proper agents of restraint
and conveyance to the asylum for one case of a mongolian with the disease
of insanity who had run away into the bush attacking people who crossed his
path, and was captured by a European. The police were obliged to bind him
hand and foot in a sack as he was kicking, hitting out, spitting, and biting
with terric strength and energy and hideous cries.71
The writings of Chinese miner Jong Ah Sing provide another glimpse at the
process of negotiation by a patient with authorities like police, magistrates and
doctors in the event of committal.72 The painful memoir by Ah Sing reveals
much about his sense of frustration with these authorities, perhaps due to his
poor skills in English. The memoir is a record of a possibly wrongful conne-
ment and one that may also have been motivated by a skirmish on the goldeld
which led to the arrest of the Chinese man.
Jong Ah Sing was an inmate of Yarra Bend Lunatic Asylum sometime around
1869. His diary or memoir, or possibly his plea, is an extraordinary account
of his experiences under arrest, at trial and in the asylum. Ah Sing was appre-
hended by police around rural Dunolly or Maryborough, possibly because of a
disturbance on the diggings. He appears to have been quite ill, and found himself
in hospital in Dunolly. It is difcult to understand the story completely, but by
piecing it together a number of revealing themes emerge. Ah Sing wrote about
his feelings during his encounters with colonial law enforcers. My freedom

69 Ah Lop, 16 January 1874, VPRS 7397/P1, Kew Asylum, Unit 2, 53.

70 Ah Lang, 22 April 1874, VPRS 7397/P1, Kew Asylum, Unit 2, 130; Ah Gee, 10 November
1874, VPRS 7397/P1, Kew Asylum, Unit 2, 287; Ah Shung, 6 March 1875, VPRS 7397/P1,
Kew Asylum, Unit 3, 89; Ah Sin, 26 March 1875, VPRS 7397/P1, Kew Asylum, Unit 3, 104,
Ah Him, 28 June 1878, VPRS 7397/P1, Kew Asylum, Unit 6, 149.
71 Chinese lunatics, Australian Medical Journal 10 (1865), 202.
72 Jong Ah Sing, MS 12994, Box 1718/10, La Trobe Australian Manuscripts Collection, State
Library of Victoria, 91pp. Jong Ah Sing was a Chinese inmate of Yarra Bend Lunatic Asylum,
December 1872. No record of his admission to Yarra Bend Asylum can be found, due to the lack
of extant male casebook records from the Yarra Bend in the period of Ah Sings connement.
 Insane in Victoria, Australia, 18481900 145

my body, he wrote, and my no likey englishman tucker.73 His observations

about the different goldseekers are also very interesting; the conicts between
British, Scottish, Irish and Chinese are clearly as much about race as they are
about gold. But his encounters with police were starkly portrayed:
Police . . . tear my body clothes take my money go, police take my money go . . . police
tear my clothes 1 China good coat 1 china cotton thick coat 2 wool warm shirt 1 moleskin
breeches undress my pair top boots
Police keep batton stick step my shoulder 2 time police go out police go back my yard
keep batton ght my body 3 time.74
Jong Ah Sing was evidently taken to Yarra Bend Asylum by the police. He
mentions a gaoler, Thomas Peacock, who came with a cart to take him to
B Ward of the Yarra Bend. One line announces his arrival: Dr Paley lunatic
Asylum.75 That Ah Sing met the asylum through its doctor, Paley, indicates that
for him the institution and its medical keeper were closely associated; Paleys
presence marked his rst encounter with the asylum. The police had transported
him from a punitive space to one dened by medicine.

Families
Police made observations of sexual and racial differences within the population
which aided them in their work to identify trouble and danger. At times members
of the community asked for their assistance as they too identied difcult
behaviour, and thus the police were sometimes required by friends and families
of alleged lunatics to monitor private space. In 1873 it was with difculty and
some reluctance that William Robertson wrote to the Chief Commissioner of
Police in Victoria regarding his unfortunate friend Mr Pettet, requesting police
assistance in his connement. Acting on behalf of Pettets wife, Robertson
asked that a member of the Police Force (preferably a Detective) arrange the
committal of Pettet to a private asylum. Pettets condition, wrote Robertson,
border[ed] on insanity and medical advisers recommended restraint.76 The
request was approved by Chief Commissioner of Police, Frederick Standish.
The letter, and others like it, suggest that there was an awareness that police
could perform such a role in relation to lunatics and troubled families.
Asylum authorities also made contact with the Chief Commissioner of Police
when they needed assistance in a lunacy matter. In February of 1878 the Master-
in-Lunacy, who watched over all insane asylums in the colony, wrote to the Chief
Commissioner about lunatic patient Margaret Houston at Cremorne Asylum,
a private establishment. In this instance police were being asked to co-operate

73 Jong Ah Sing, 29, 31. 74 Ibid., 32, 50. 75 Ibid., 50.

76 Letter from William Robertson to Chief Commissioner, 13 September 1873, VPRS 937
Unit 128, Chief Commissioner, Correspondence, Bundle 5.
146 Catharine Coleborne

in the continuing surveillance of the patients family of four children, left to

survive under the care of the eldest girl who earned money as a dressmaker.
She earned 12s. a week, but the other children, aged nine, four and two, needed
care. The Master-in-Lunacy asked for the address of the visitors of the Ladies
Benevolent Society in Collingwood, and also suggested that Margaret Houston
might be moved to Yarra Bend or Kew Asylums as funds were not available to
keep her at Cremorne.77 Some days later the local Collingwood police wrote to
the Chief Commissioner to report that the older sister was caring for the family
and wanted to continue this by herself. She had also asked that their mother be
transferred to Kew Asylum as it would be a saving for them. The police letter
reported that the girl had admitted her mother acting on the advice of a Lay
Minister of the Gipps Street Wesleyan Church.78 This case reveals that family
members negotiated with police not only about the problem of lunacy but also
about the care of dependent children and welfare.79 It also reveals that religious
gures played a part in the committal of some of those deemed to be lunatics.
Police were sometimes also required by asylum authorities to help trace
lunatic patients and their families. A number of police stations were involved
in tracing the whereabouts of the wife and daughter of lunatic patient Thomas
Birch at the Kew Asylum in 1878. On 25 February 1878 the Chief Commissioner
was able to inform the Master-in-Lunacy that Thomas Birch had lived with a
prostitute at Black Creek where he was employed butchering sheep, and had
been locked up for drunkeness on a number of occasions; his wife and daughter
were living in New Zealand.80 In 1880 police were asked to trace the brother
of Georgina Watson, a patient at Yarra Bend, regarding the payment of asylum
costs in her maintenance there as a patient. When traced, Hugh Watson refused
to make any payments.81
Readings of the patient casebooks and asylum inspectors reports indicate
that police were in some instances perhaps performing work which families
could not. Table 5.3 indicates that the majority of asylum inmates were brought
to asylums by police over the years of this study. Families perhaps counted
among the friends who also admitted lunatics, but police also assisted. Young
women living at home were sometimes placed in the asylum by police, pos-
sibly because family members were unable to undertake this task themselves.

77 Cremorne Asylum (a private institution) 14 February 1878. VPRS 937, Unit 299, Melbourne
Police Inward Correspondence, Complaints against, Melbourne District Police Magistrates
(hereafter abbreviated as MPIC MDPM).
78 18 Feburary 1878. VPRS 937, Unit 299, MPIC MDPM.
79 On welfare policing see C. Twomey, Deserted and Destitute: Motherhood, Wife Desertion and
Colonial Welfare (Melbourne, 2002).
80 Correspondence to Chief Commissioner: 15 January 1878, 14 February 1878, 20 February 1878,
25 February 1878. VPRS 937, Unit 299.
81 Hugh Watson, Master-in-Lunacy, letter of 20 February 1880. VPRS 937, Unit 302, Inwards
Registered Correspondence, Police Department, Melbourne District, bundle 5.
 Insane in Victoria, Australia, 18481900 147

Table 5.3 Passage of lunatics to Victorian

asylums, 18751890

Date 1875 1885 1890

Brought by friends 123 150 268

Received through police 407 332 414
Sent from benevolent asylum 26 4 4
Sent from hospital 0 6 9
Sent from gaols 21 23 37
Sent from other institutions 71 83 154
Recaptured 11 17 26
Total 659 615 912

Whether some of these women were so uncontrollable that police were required
is not known in all cases, suggesting that at least in some instances families
needed more than physical assistance to deal with the problem at hand they
needed the support and validation that the police could provide in the committal
of their family member.

Conclusion
In identifying lunatics and lunacy in the colony of Victoria the police operated
in both public and private spaces. Their role in the identication and detection of
lunacy existed in relation to the asylum. By the early twentieth century criminal
investigation was theorized by writers who emphasized the role of scientic
investigation in police work, especially in the detection of crime. By 1906 one
published work on criminal investigation declared that insanity was one of
the many practices adopted by criminals and it was important for police to
know the difference between feigned and actual insanity.82 Thus lunatics were
not only branded by their asylum clothing when inside the asylum or trying
to escape from it. They were increasingly branded by the ofcial language of
bureaucracy which grew up around them during the nineteenth century. By 1893
the Police Gazette reminded its constables that:
Members of the Force are instructed that, when drawing requisitions for the conveyance
per rail of lunatics and their escorts, they must write the word lunatic at the top of the
requisition conspicuously or in red ink. They are not to include in the same requisition
lunatics with other prisoners.83

82 Criminal Investigation: A Practical Textbook for Magistrates, Police Ofcers and Lawyers,
adapted by J. Adam and J. Collyer Adam from the System Der Kriminalistic of Dr Hans Gross
(London [1906], 1962), 195.
83 26 July 1893, Victoria Police Gazette, 202; for the increasing complexity of police procedures
regarding lunacy see also 10 August 1887, 231.
148 Catharine Coleborne

This marking of the lunatic and marking out of the lunatic from the prisoner
was by 1893 a sign of two things: that the police still struggled in their dealings
with lunacy, and that the way to deal with lunacy was to separate it and categorize
it as different from criminality, a process underway in the 1870s. Despite the
decrease in the role of police where lunacy admissions was concerned by the
early 1900s, in part because police discouraged the public from involving them,
in the nal decades of the nineteenth century the bureaucratic and quasi-medical
management of the insane by police was evident.84 The police were being asked
to perform both bureaucratic and medical roles, roles which were created by
the asylum and medical bureaucracy as much as they were by the increasing
bureaucratization of police practices.
Police work happened in conjunction with the asylum and its inmates and
their families. Police liaised with the asylum, they transported lunatics to the
asylum, and they watched families left alone when parents spent time away
in the institution. Whether this might be understood as welfare policing or
surveillance is a tension in the social history of the nineteenth-century city in
Victoria. During the nineteenth century police work was becoming profession-
alized and the expansion of duties and techniques of police, including policing
the passage of lunatics to the asylum, may be understood as part of this process.
As agents of colonial medicine, law and order they further dened the colonial
lunatic for Victorias asylums.

84 Dean Wilson, On the Beat: Police Work in Melbourne 18531923, Unpublished PhD thesis,
Monash University, 2000, 197.
6 The Wittenauer Heilstatten in Berlin: a case
record study of psychiatric patients
in Germany, 19191960

Andrea Dorries and Thomas Beddies

Introduction
In 1933, Gustav Blume, a psychiatrist at the Wittenauer Heilstatten Asylum in
Berlin, wrote:
It is no secret to say that reading psychiatric case reports is not an unspoiled pleasure.
Often it is a hopeless torture! I am not talking about the content of the reports, but about
the technical process of reading them. For example, you have to work out a case history
of an old schizophrenic, which covers some 20 to 30 years and more than a dozen stays
in different hospitals. You sit worried in front of a chaotic package of more or less
faded, damaged, and mostly loose sheets of paper from which stacks of illegible and
crumpled letters and papers emerge. You try unsuccessfully to nd out where the case
history begins, where the most recent entries can be found; you reorganise, sort, and take
notes. You dig deep into the scientists last reserves of courage and dive into the stormy
sea of faded or fresh hand-written psychiatrists notes, and you nally collapse. You
then despair (or become enraged, depending on your temperament) of decoding your
colleagues notes and you are driven over the precipice to complete frustration. To
document a case history by handwriting required a slower pace of life compared with
today. To then read these old-fashioned entries, however, is impossible for the modern
rational man in a time of portable typewriters. He refuses to do this as an enormous
waste of time and power.1

Despite these remarks, during the last two decades the use and decoding of
patient records as a historical source has become increasingly important.2 The
development of computer programs graphical user interface offers an ex-
panded range of quantitative and qualitative approaches. Major advantages are
an improvement in precision, a dynamic view3 and new insights not easily

1 G. Blume, Uber die Einrichtung Psychiatrischer Krankheitsgeschichten, Allgemeine Zeitschrift

fur Psychiatrie 99 (1933), 8497.
2 A. Digby, Quantitative and Qualitative Perspectives on the Asylum, in R. Porter and A. Wear
(eds.), Problems and Methods in the History of Medicine (London, 1987), 15374; O. Larsen,
Case Histories in Nineteenth-Century Hospitals What do They Tell the Historians? Medi-
zin, Gesellschaft und Geschichte, 10 (1991), 12748; V. Rodel, Moglichkeiten und Grenzen
der Archivierung medizinischer Unterlagen, Der Archivar 3 (1991), 42735; G. E. Berrios,
Historiography of Mental Systems and Diseases, History of Psychiatry 5 (1994), 17590.
3 Digby, Quantitative and Qualitative Perspectives, 15374.

149
150 Andrea Dorries and Thomas Beddies

acquired by more traditional methods of analysis,4 as well as a change of per-

spective regarding the persons involved in hospital life.5 Though case records
seem to be informative as historical sources, their limits can be overcome by
supplementing case-record information with other historical sources such as
statistical data, administrative reports, and proceedings of meetings.6
The aim of our study was to focus within the constraints of the German data
protection law7 on patients lives in a psychiatric hospital, to dene patient
proles and to reconstruct the activities on the wards and in the hospitals
treatment facilities.8 The intention was to do this on the background of the
changing social life of three different political systems.

Psychiatric institutions and the Wittenauer Heilstatten in Berlin

The opening of the City of Berlins rst public lunatic asylum in 1880 coincided
with a phase of numerous constructions for new institutions considered neces-
sary due to a strong increase in patients needing the care of an institution.9 In
the German Empire, the number of public institutions for psychiatric patients
almost doubled between 1877 and 1904 (from ninety-three to 180); the number
of in-patients nearly tripled (from 33,023 to 111,951).10 Various approaches
exist to explain the causes of this increase, ranging from the scientic advance-
ments of psychiatry and its establishment as an academic medical discipline, the
consequences of industrialization, urbanization and rural drain, to the impacts
of jurisdiction resulting last but not least from the bourgeois-bureaucratic
desire for security and order.11 In the case of Prussia, this applies to the Poverty
Law (Landarmengesetz) of 11 July 1891,12 which facilitated an increase in ad-
missions by redistributing expenditure. All in all, a whole bundle of reasons
4 Ibid.,15374.
5 M. MacDonald, Madness, Suicide and the Computer, in Porter and Wear (eds.), Problems and
Methods, 20729; G. B. Risse, Hospital History: New Sources and Methods, in Porter and
Wear (eds.), Problems and Methods, 175203.
6 Digby, Quantitative and Qualitative Perspectives, 15374; Risse, Hospital History, 175203;
G. B. Risse and J. H. Warner, Reconstructing Clinical Activities: Patient Records in Medical
History, Social History of Medicine 5 (1992), 183205.
7 W. Rossler, Uberlegungen zur Archivierung Psychiatrischer Krankenunterlagen, Der Archivar
3 (1991), 43542.
8 T. Beddies and A. Dorries (eds.), Die Patienten der Wittenauer Heilstatten in Berlin, 19191960
(Husum, 1999); A. Dorries and T. Beddies, Coping with Quantity and Quality: Computer-based
Research on Case Records from the Wittenauer Heilstatten in Berlin (19191960), History of
Psychiatry 10 (1999) 5985; Risse and Warner, Reconstructing Clinical Activities, 183205.
9 D. Blasius, Einfache Seelenstorung. Geschichte der deutschen Psychiatrie 18001945 (Frank-
furt, 1994), 61.
10 Ibid., 64. 11 Ibid.
12 Gesetz-Sammlung fur die Koniglichen Preuischen Staaten 1891, Nr. 9471. Where the effects
of this law in comparison to Bavaria are concerned, see G. Kolb, Die Familienpege unter
besonderer Berucksichtigung der bayrischen Verhaltnisse, Zs. fur die ges. Neurologie und
Psychiatrie 6 (1911), 273304.
 Wittenauer Heilstatten in Berlin: 19191960 151

determined the increase in asylum patients which was enormous even when
considering a strong population increase. The decision in 1868 to allocate the
mentally diseased to major integrated hospital and care units outside their com-
munities came at a time when a fundamental argument broke out about the
foundations and forms of institutions within psychiatry. The protagonists of this
discussion were Walter Griesinger, Professor of Psychiatry at Berlin University,
and the asylum psychiatrist Heinrich Laehr. At a vote among the psychiatric
section at the Gesellschaft deutscher Naturforscher und Arzte in Dresden in
September 1898, Laehrs position prevailed. The most essential consequences
of this argument were the lasting distance of institutional psychiatry to the up-
coming academic psychiatry and the creation of large remote hospital and care
units.
In the empires particularly thriving capital, Berlin, the rapid increase in the
number of mostly poor people needing institutional care posed a special chal-
lenge. This is where the fundamental argument between Laehr and Griesinger
became particularly explosive, as both competed for an inuence on planning
and setting up the rst public lunatic asylum.13 As early as 1853 and corre-
sponding to the lunatic doctors beliefs at that time, Laehr had pleaded for the
erection of a relatively integrated hospital and care institution for Berlin in
a rural and friendly setting; however, respective fundamental decisions stipu-
lated by the community council were not followed by actual steps.14 The project
was taken up again and submitted to a group of experts for evaluation as late as
the early 1860s, under the City Mayor Karl Theodor Seydel. In the spirit of the
ten-year-old plea by Laehr, the overwhelming majority of experts favoured the
construction of a lunatic asylum in conjunction with a sick unit for lunatics. In
1866 (meanwhile, Griesinger had joined the evaluation group), the experts were
heard once again, and once more the majority of them voted for a centralized,
closed unit, thus rejecting Griesingers suggestion for decentralized accommo-
dation in small colonies or in family care. Griesinger nevertheless regained
inuence on the planning phase due to a power struggle between the magistrate
and the citys delegates by pleading for the site of the Dalldorf domain in North
Berlin and the establishment of a rural asylum there, but the defeat he suffered
in his absence in Dresden as well as his death shortly afterwards, led to the
fact that his concept was no longer followed up and that a hospital and care unit
was established in the traditional style.
However, the Dalldorf institution, opened in 1880 after three years of con-
struction, could not cope with the demand for accommodation of mentally ill

13 As to the following details on the argument between Griesinger and Laehr, please see
K. Sammet, Uber Irrenanstalten und Weiterentwicklung in Deutschland. Wilhelm Griesinger im
Streit mit der konservativen Anstaltspsychiatrie 18651868 (Hamburger Studien zur Geschichte
der Medizin, 2000), 1, 4172.
14 Ibid., 45.
152 Andrea Dorries and Thomas Beddies

patients from the very rst day,15 so that the allocation of patients to private
institutions was to some extent inevitable. Facing an average annual increase of
130 to 160 patients, a requirement for 2,800 to 3,000 beds was envisaged until
two projected institutions were established. Whereas these gures alone proved
the necessity for new buildings, it was also considered urgently necessary that
epileptics were separated form the actual mentally ill and admitted to a special
institution. In 1893, the rst transfers from Dalldorf to the newly established
second city lunatic asylum Herzberge became possible.16 Also in 1893, the
third institution, Wuhlgarten, for epileptic patients was opened.17 In 1906, a
further unit nally went into operation in Buch, northeast of Berlin. But even
this fourth institution for mentally ill Berliners (three lunatic asylums and the
institution for epileptics) would not meet the expected requirements. Towards
the end of 1911, barely two-thirds of the registered 8,431 mentally diseased
patients in Berlin (5,270 = 62.5 per cent) were allocated to the public units, a
considerable proportion of the rest found accommodation in private institutions
and in family care. In 1919 (the beginning of the actual period of investigation
for this study), far fewer admissions were recorded for the hospital and care
units than, for instance, in 1914 due to the enormously increased mortality rate
among patients during the First World War.18 This allowed for an allocation of
the remaining 4,255 patients (as per 1 April 1919) to the existing city institu-
tions without any problems; the communal wards in private Berlin institutions,
which had accommodated some 2,350 patients just before the war, disappeared
completely.19
Hardly any generally applicable statements can be made for the reported
period regarding the legal grounds of admission and hospitalization in German
hospital and care units in general, as these differed considerably from one region
to the next according to the federal structure regarding care for the mentally ill.
Although a supposedly progressive lunatic law had been passed in the Grand
Duchy of Baden as early as 1910,20 developing respective regulations for Prussia
or the German Empire proved unsuccessful despite intensive negotiations in
the twenties.21 Only after the foundation of the Federal Republic of Germany
and the passing of the German constitution (Grundgesetz), relevant state laws

15 Statistisches Jahrbuch der Stadt Berlin 10 (1884), 229.

16 C. Moeli, Die Irrenanstalt der Stadt Berlin in Lichtenberg mit Bemerkungen uber Bau und
Einrichtung von Anstalten fur Geisteskranke (Berlin, 1896).
17 J. Bresler (ed.), Deutsche Heil- und Pegeanstalten fur psychisch Kranke in Wort und Bild
(Halle, 1912), 2, 315.
18 H. Faulstich, Hungersterben in der Psychiatrie 19141949. Mit einer Topographie der NS-
Psychiatrie (Freiburg Breisgauim, 1998), 58.
19 G. A. Waetzold, Die Berliner Heil- und Pegeanstalten in den ersten 10 Jahren des Gesetzes
Gro-Berlin, Zs fur das gesamte Krankenhauswesen 19 (1931), 533.
20 L. Holdermann, Das badische Irrenfursorgegesetz mit Vollzugsordnung (Karlsruhe, 1927).
21 A. Beyer, Irrengesetzgebung, Psychiatr. Neurol. Wschr 26 (1924), 37.
 Wittenauer Heilstatten in Berlin: 19191960 153

were passed based on Article 104 of the constitution (restriction of personal

freedom).22
Probably owing to the federal structure of the empire, too, hardly any reliable
records on either the number of existing beds in the public hospitals and care
units or their utilization to capacity are available. In a fundamental study about
starvation in German psychiatry from 1914 to 1949, Heinz Faulstich gathered
the recorded gures for the years 1928 to 1937 and arrived at an overall gure of
101,470 (1928) or 119,591 (1937) for these years.23 This is signicant inasmuch
as the increase in the number of beds did not correspond with the building
of new institutions; instead the existing institutions were utilized to a higher
concentration of beds in order to save costs.
The psychiatric institution of our investigation was a typical representative
of the centralized, closed unit type of psychiatric hospitals mainly for the lower
classes. It was founded in 1880 under the name of Irrenanstalten der Stadt
Berlin in Dalldorf. As late as 1920, when Greater Berlin was established, it was
situated within the city limits of Berlin in the new district of Reinickendorf. In
the mid-twenties, its name was changed to Wittenauer Heilstatten of the City
of Berlin due to programmatic reasons. As Dalldorf before, to the Berliners
the term Wittenau became a common synonym for the psychiatric institution
existing there. It was renamed Karl-Bonhoeffer-Heilstatten at the end of the
fties, and was nally given the name Karl-Bonhoeffer-Nervenklinik (KBoN).
As the name Wittenauer Heilstatten was most commonly used during most of
the investigated period, it shall be the term used throughout the following.

The patients
The patients of the Wittenauer Heilstatten (between 1919 and 1960) lie at the
centre of the study. With the aid of supplementary source material, the analysis of
4,000 case histories from a total of forty-two admission years, aimed at making
the acquaintance with human beings who were admitted to the institution and
who remained there for a relatively long time compared to modern conceptions,
very often dying there.
It becomes apparent that the respective concerns and needs of the sick and
healthy very often differed considerably. The public interest outside the insti-
tution walls was hardly ever the interest of the individuals inside the institution
who were sick or considered diseased, especially as the latter had for a long time
been considered a risk to public safety and order, their status as patients in need
of healing and care taking only second place. By placing the individuals who

22 F. Berlin, Gesetz uber die Unterbringung von Geisteskranken und Suchtigen, GvBl. (1952), 636
and GvBl. (1958), 521.
23 H. Faulstich, Hungersterben in der Psychiatrie 19141949, 129.
154 Andrea Dorries and Thomas Beddies

160
male (n = 1,866)
female (n = 2,134)
140

120
Number of admissions

100

80

60

40

20

0
1919

1922

1925

1928

1931

1934

1937

1940

1943

1946

1949

1952

1955

1958
Year
Figure 6.1 Number of male and female admissions per year (19191960)

were either sick or declared sick rst in our survey, the (psychiatry-relevant)
scientic-historic approach was reduced in favour of an approach relating more
to social history. It is not only the disease and its therapy which mattered, but
also a strong emphasis lay particularly on the patients social environment,
the way they and their families were treated, and the question as to how their
elementary rights were upheld or withdrawn.
Furthermore, the relationship between the patients and the medical staff of
the institution physicians and nurses was examined. The results of the study
remain unaffected as we draw attention to the fact that, on one hand, the physi-
cians at the institution particularly acted as the committed expert administrators
on behalf of the sick individuals they looked after, especially as they literally
found themselves on the same side of the clinic walls as the patients in their
charge. On the other hand, however, it is also true that some physicians
and some of the most dedicated at that were involved in the unprecedented
crimes that patients during the Nazi regime fell victims to in their thousands.
The Wittenauer Heilstatten doctors, too, were representatives of their faculty
who were not born as monsters but rather acquired expert knowledge and
 Wittenauer Heilstatten in Berlin: 19191960 155

sought-after positions in our society in a more or less inconspicuous way and

with average talent before they took to anaesthetising the acquired skills of
humanity,24 in order to participate actively or by tolerating the atrocities with
the gift of self-appeasement bordering onto the artistic.25

Period of investigation
When we decided on the period to be investigated, the years between 1930 and
1960 became our rst preference for reasons, among others, of the structure of
the hospital archives. In 1930, the case-history administration within the clinic
was reformed at the suggestion of a physician. This included a change from the
traditional stitch les to letter les. Due to the increased need for more space,
it became necessary to revise the ling system itself, so that a comprehensive
system comprising roughly 40,000 units of case histories (between 1930 and
1960) in alphabetical order arose over the years in the KBoN archives. It be-
came apparent that a representative random selection of this number should be
examined.
Thematically, it was recommendable to extend the period investigated, ac-
cepting a certain workload when extracting the respective case histories from
the old system. It was repeatedly noted that the roots of the excesses and crimes
committed in the name of psychiatry during National Socialism could be traced
to the Weimar Republic. The end of the World Economic Crisis, beginning in
the late twenties and bringing about a general deterioration of living conditions,
especially elevated the rise of racial hygiene (or eugenics) to a doctrine of na-
tional salvation. National Socialists supplied conditions for this type of science
that led to the well-known results such as forced sterilization and the killing
of psychiatric patients. However, it is also recorded that towards the end of the
Weimar Republic, when the economic factors seemed to be compelling, the liv-
ing conditions of patients in mental institutions deteriorated drastically. It was
believed that the inferior should have fewer liberties than the people outside
who were healthy and t for work. Stretching the period of investigation to the
entire post-war years of the First World War enabled us to take a look at the
development within the institutions from its lowest level in 1919 over the years
of revolution and ination, the economic boom in the mid-twenties right up to
the years of crisis towards the end of the Republic, thus abandoning the focus
on the last years of the Weimar Republic as the years of preparing the ground
for National Socialism. Widening the scope of time offered an opportunity for
looking at the poor treatment of psychiatric care units in the end phase of the

24 A. Mitscherlich and F. Mielke (eds.), Medizin ohne Menschlichkeit. Dokumente des Nurnberger
Arzteprozesses (Frankfurt, 1962), 7.
25 Ibid., 8.
156 Andrea Dorries and Thomas Beddies

Weimar Republic as a continued resumption of the type of behaviour already

familiar from the First World War.
The selection of the 1960s as the end of the investigated period was partly due
to the ling system of the hospital archives. The year 1960 saw a new assessment
of les corresponding with the creation of a so-called new archive, which
was in operation right up to the era of electronic data-processing some years
ago. In the 1960s the division of Berlin was consolidated with the building
of the Wall. The transfer of patients between east and west was no longer
possible. At the same time, a second psychiatric hospital in Berlin was opened
in the western part of the city, in Spandau, ending the role of the Wittenauer-
Heilstatten as the only major unit to provide for the mentally ill in the western
part of Berlin. Another contribution was the gradual change within German
psychiatry, which began to shape in the early sixties and lead to the so-called
psychiatric reform. This development could not be included as an issue in our
study.
Looking at the relatively long period of forty years called for the need for pe-
riodization; thus, changes in the political systems from the Weimar Republic
to National Socialism and from National Socialism to the West German Democ-
racy suggested themselves. Within these three large political eras: from 1919
to 1933, from 1933 to 1945, and from 1945 to 1960, sub-periods could in turn
be made: for the Weimar Republic, these are primarily the restless years until
the end of ination in 1923, followed by the phase of relative stability until the
beginning of the World Economic Crisis of 1929/30, and nally, the years up to
1933 which were marked by material hardship and political radicalization. The
era of National Socialism can be subdivided into the years prior to 1939 (i.e.
the era of consolidation and the beginning of internal economic prosperity while
the war as well as the nal solution and the killing of patients was prepared
by the National Socialists), and the Second World War itself, when a still-
unknown number of psychiatric patients was murdered. The years from 1945
to 1960 should be subdivided into the immediate post-war era which lasted as
long as the end of the blockade of Berlin in 1949, and, nally, the period of
beginning normality since 1950, where increasingly easier restructuring, facili-
tated by the improvement of material preconditions, replaced the administration
of shortage.
Linking the periodization of the outside world with the history of the psychi-
atric unit was of double importance. Firstly, the exterior conditions represented
the economic, scientic, ethical, healthcare-relevant and socio-political frame-
work for the institution and the people working within. Secondly, these outward
events of course also exerted an inuence especially on a psychiatric hospital
and its patients, whose scope of experience in turn was determined by the
respective events.
 Wittenauer Heilstatten in Berlin: 19191960 157

Patient records
The patient records, which were analysed, consisted of a representative selec-
tion from the total records dating back to the period concerned which were
still in existence (8 per cent of approximately 50,000, i.e. 4,000). This does,
however, not imply a representative selection of all patients who were admit-
ted. Regarding data protection, we have sought approval in respect of archive
legislation as well as the Berlin Hospital Law.
In this context it is worth mentioning a fundamental decision concerning the
treatment of evaluated case histories. Case histories, and psychiatric case histo-
ries in particular, pose some considerable methodical problems as to their use
as historical sources, however, they open up special opportunities. The hardly
transparent entanglement of fact and ction in these records is no doubt prob-
lematic. To illustrate this, one may imagine a reality scale: the accurately
completed and well legible laboratory note recording the result of a blood ex-
amination would be at one end of the scale, whereas a patients detailed social
success story which turns out to be the megalomaniac imagination of a para-
lytic would probably belong to the other end. The most diverse data in terms
of formality, contents, origin and time range somewhere between these two
extremes. The often multiple refraction of information is signicant in this
context: the physician remarks about the patients brother telling him that their
father had also been a heavy drinker; furthermore, the mother is said to have
been of a nervous disposition. In the end, there was only one way of accom-
modating the difculties in recording the patients non-veriable social data
and life stories: we decided generally to believe the statements made by the
patients and their family members. Whenever there were contradictions in the
details we made a note of it. Wherever the contradictions were unresolvable,
the information was not used.
A special chance resulted from recording the patients delusions (paranoia,
excessive jealousy, megalomania, etc.). Beyond the medically interesting state-
ment that the patient was under the inuence of delusions, the opportunity
opened up to link the contents of this statement with reality. Corresponding
with Reinhart Koselleck who demonstrated the importance of dreams for his-
toric science,26 it became possible to introduce a source based on the delusions
of the Wittenau patients. This becomes especially apparent in the years of the

26 R. Koselleck, Terror und Traum. Methodologische Anmerkungen zu Zeiterfahrungen im Dritten

Reich, in R. Koselleck (ed.), Vergangene Zukunft. Zur Semantik geschichtlicher Zeiten (Frank-
furt, 1979), 27899. The reference to this comprehensive article was found in D. Blasius,
Der verwaltete Wahnsinn. Eine Sozialgeschichte des Irrenhauses (Frankfurt, 1980), 108 and
283.
158 Andrea Dorries and Thomas Beddies

Third Reich where patients in their delusions directly referred to political events
taking place around them.
The analysis of the patients life circumstances, their actions and their treat-
ment in the social environment added up to a picture of many individual des-
tinies, which could, however, be summarized under a diversity of aspects. We
have undertaken to do this especially concerning the patients gender, age and
their diagnoses, while taking care to elucidate individual lengths of time in
order to take into consideration external and time factors and their inuence on
the patients.

Diagnostic classication
In 1930, a classication of psychological disorders, later to be called the
Wurzburger Schlussel, was elaborated for statistical purposes and tested for
a period of two years.27 It replaced the so-called Reichsirrenstatistik of 1901
and listed new groups of disorders. The pragmatic categorization was mainly
descriptive and age-orientated with etiological components. The Wurzburger
Schlussel focused largely on addiction (especially alcohol), psychopathies (dif-
ferentiating between adults and adolescents), and syphilis-related disorders.
Hereditary aspects were taken into consideration. Several disorders affecting
elderly patients were not listed in individual descriptive categories, but catego-
rized as age-related. Using the discussion about the Wurzburger Schlussel and
its application in psychiatric clinics not only facilitates the illustration of scien-
tic opinion of that era, but due to the pragmatic background the evaluation
of specic syndromes towards the end of the Weimar Republic. A basic, socially
compatible agreement on normality and disease is immanent in this classica-
tion of psychological diseases as well as in those classications still valid
today. The psychiatrist George Agich demonstrated this in his analysis of an-
tisocial personality disorder belonging to a contemporary classication system
(Diagnostic and Statistical Manual for the American Psychiatric Association,
DSM-III-R).28 The psychiatrist Fulford even demanded that classication sys-
tems be used not only for statistical purposes, but to examine, publicize and
deliberately utilize the value-orientation of such classication systems today.29
27 See appendix. A. Dorries and J. Vollmann, Medizinische und ethische Probleme der Klassika-
tion psychischer Storungen, dargestellt am Beispiel des Wurzburger Schlussels von 1933,
Fortschr Neurol 65 (1997), 5504; A. Dorries, Der Wurzburger Schlussel von 1933 Diskus-
sionen um die Entwicklung einer Klassikation psychischer Storungen, in Beddies and Dorries
(eds.), Die Patienten der Wittenauer Heilstatten in Berlin, 19191960, 188205.
28 G. J. Agich, Evaluative Judgement and Personality Disorder, in J. Z. Sadler, O. P. Wiggins,
M. A. Schwartz (eds.), Philosophical Perspectives on Psychiatric Diagnostic Classication
(Baltimore, Md., 1994), 23345.
29 K. W. M. Fulford, Closet Logics: Hidden Conceptual Elements in the DSM and ICD Classica-
tions of Mental Disorders, in J. Z. Sadler, O. P. Wiggins, M. A. Schwartz (eds.), Philosophical
Perspectives on Psychiatric Diagnostic Classication, 21132.
 Wittenauer Heilstatten in Berlin: 19191960 159

1400
1227
1200

1000
Number

800
616
600
398
400 303 299
193 208
200 150 131
57 95 88
28 13 11 34 31 9 32 9 16 39
0
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
others
Diagnosis number according to the Wrzburger Schlssel
Figure 6.2 Distribution of diagnoses (N = 3983)

In the present study of a description of patients in the Wittenauer Heilstatten

in Berlin, a representative selection of 4,000 case les for the period 191960
was analysed. The methodical approach facilitated a vertical section to be inves-
tigated and a search for annual distributions.30 The case les at the Wittenauer
Heilstatten proved to be a rather informative source, containing entries and
complementary medical documentation about various individuals and occupa-
tional groups (psychiatrists, nursing staff, administration), thus enabling us to
extract patterns.31
According to our experience with this study, the quantitative analysis should
always be supplemented by a qualitative focus analysis and an analysis of
certain groups of les. It makes sense to have research carried out by an inter-
disciplinary group (e.g., medical history, medicine, or history) with experience
in handling large amounts of data as well as a basic knowledge of statisti-
cal methods in order to conduct a quantitative investigation of case les. The
quantitative analysis required the clear categorization of the various elds. The
preliminary diagnosis at the time of admission, however, was taken over word
by word, so that moral implications of medical practice could be analysed for
certain periods of time. The diagnosis at the time of discharge was based on
the Wurzburger Schlussel. For the evaluation, the necessary categories cor-
responded to the time-relevant categories, not to the present classication of
psychological disorders, International classication of Diseases (ICD 10). The
qualitative analysis was elaborated by means of key words and supplemented
30 Risse and Warner, Reconstructing Clinical Activities, 183205. 31 Ibid.
160 Andrea Dorries and Thomas Beddies

by additional research into source material the traditional way. It proved to be

essential for the overall picture when evaluating individual life data and helpful
in respect of the patients view, as it facilitated a subjective interpretation of
the reasons stated for the admission, of the social context, and of the political
behaviour.
Although a large amount of detailed information was theoretically possible,
the entire scope could only be exploited in just a few cases due to the varying
contents of the individual les.32 In general, however, it can be said that the
social data of psychiatric patients were documented in much more detail than
the case les in other areas of medicine. Newer les showed more complete
and detailed entries than those dating back to the twenties and thirties. They
contained more details on diagnostics and courses of treatment; the precise
descriptions of patients of the past which were often signied by personal
terminology, however, were missing. In the fties, the choice of words for
describing the patients changed. The kind of documentation (e.g., the summaries
in the discharge papers) altered the le prole and subsequently led to a new
number of les from 1960.
The greatest challenge in the investigation was the elaboration of constancy
and change during the four decades. The renamings of the clinic indicated how
internal conditions and self-image changed. By means of the representative
data, for instance, it became possible to illustrate and interpret the change in the
range of diseases, the conditions for admission and an accurate determination
of the conditions inside the hospital. For a more comprehensive evaluation,
however, the conditions outside the clinic and the interactions with the political
system had to be determined by studying additional sources. Comparisons with
other hospitals provide a useful tool with which to judge the importance of local
inuences.
However, some problems and limitations occur when working with case les
of the twentieth century. As an analogy to Daniel Greensteins conditions that
he laid out regarding computer-assisted work with historic patient les, the
procedure can be extrapolated to our study. For the computer-assisted analy-
sis of patient les, Greensteins theoretical concept identied, in particular, an
awareness of the limits of information, the inclusion of the context and the nec-
essary self-criticism when analysing the case les; at the same time, however,
he dispelled any frequently made reservations as to the respective historical im-
portance of patient les, the risk of taking a purely scientic view, the necessary
acquisition of comprehensive computer skills, and the time factor involved.33
His notes and reservations proved to be justied.

32 M. W. Dupree, Computerising Case Histories: Some Examples from Nineteenth Century

Scotland, Medizin, Gesellschaft und Geschichte 11 (1992), 14568.
33 D. I. Greenstein, A Historians Guide to Computing (Oxford, 1994), 10813.
 Wittenauer Heilstatten in Berlin: 19191960 161

Evaluation of medical data

The greatest number of patients by far was admitted for age-related psychologi-
cal disorders, followed by schizophrenia, alcoholism, progressive paralysis and
reactive disorders. Mentally diseased juveniles and children as well as purely
neurological disorders were documented in only a few individual cases, as the
former were kept in separate les and the latter were not treated primarily at
Wittenauer Heilstatten. In addition to the psychiatric diagnoses, further organic
diseases were frequently diagnosed, especially in elderly patients, paralytics
and patients with somatic psychoses. The sexes were unevenly distributed
among the individual diagnostic categories. Whereas alcoholism was almost
exclusively diagnosed in men, and while men prevailed among the diagnoses
for psychopathy, progressive paralysis, injuries, addictive diseases, and brain
disease, women formed the larger part of cases with schizophrenia, reactive dis-
orders, suicide attempts, age-related psychological disorders, epilepsy, the few
cases of encephalitis epidemica and chorea huntington (Huntingtons disease),
as well as some uncertain diseases.
Based on 630 case les of schizophrenia patients at Wittenauer Heilstatten,
some statements as to genesis, development and therapy of this disease could
be made for the period under investigation.34 Some of the results conrmed
the existing impression of this group of patients. Part of this picture is the
good somatic condition of the patients, the low percentage of married persons,
or the relatively high intensity of the new shock and convulsive treatments.
However, those observations deviating from the expected which elucidate a
gender-specic differentiation are naturally far more interesting. Not only do the
les at least show a considerable female majority among the patients. The female
schizophrenia patients also received medical treatment later while subsequently
staying in the clinic twice as long as their male fellow sufferers, undergoing
the various shock and convulsive therapies noticeably more intensely. In this
context, the rst elucidation of the recorded le material has at least yielded a
research desiderate specic to the clinic.
In a timely respect, the increase in admissions of old-age-related mental dis-
orders since the Second World War was especially signicant. However, prior
to that elderly people had increasingly been admitted as in-patients. At the
same time, mentally disabled patients whose institutions had been either de-
stroyed during the war or dissolved were increasingly admitted to the Wittenauer
Heilstatten. In the forties, the change of the annual average age for the men-
tally disabled allowed for some respective conclusions as to the admission of
a larger group of patients from outside. High gures could be established for

34 R. Giel, Schizophreniepatienten in den Wittenauer Heilstatten (19201960), in Beddies and

Dorries (eds.), Die Patienten der Wittenauer Heilstatten in Berlin, 399434.
Figure 6.3 Distribution of diagnoses according to gender (N = 3983)
 Wittenauer Heilstatten in Berlin: 19191960 163

alcoholics towards the end of the twenties and the early thirties. It was not until
the end of the forties that the admission gures rose again. The former was due
to the establishment of a new special ward for alcoholics (192832), the latter
may be regarded as a renewed admission of alcoholics after the interruption of
the Second World War. In the fties, the proportion of women admitted with
alcoholism increased markedly. The number of patients with reactive disorders
was also constantly on the increase during the period of investigation. It is
possible, however, that this was due to the increased use of a new diagnosis
category in conjunction with the Wurzburger Schlussel; on the other hand, the
reason could be a modern therapeutic concept with an in-patient component.
Patients with progressive paralysis were admitted mainly from the early twenties
up to the forties, which was partly associated with the malaria therapy carried
out at Wittenauer Heilstatten. This high-risk therapy was applied in only a few
specialized clinics; the Wittenauer Heilstatten took up this therapeutic concept
at an early period.
During the entire period of investigation, the average admission age remained
remarkably constant for certain diagnostic categories, e.g., for age-related psy-
chological disorders and schizophrenia. Whereas schizophrenia was mainly
diagnosed in younger women, the average age for the predominantly male al-
coholics was signicantly higher, but still under the average age for the group of
patients with age-related psychological disorders. A high proportion of suicide
attempts could be established, which prevailed for the diagnoses psychopa-
thy (including adolescents), manic-depressive psychosis and reactive disor-
ders. Elderly patients with psychological disorders and schizophrenics made
signicantly fewer suicide attempts.
On the therapeutic side, any state-of-the-art methods were applied in their re-
spective time: medication, occupational therapy, various forms of shock therapy.
Electro-convulsive therapy was employed from the mid-thirties, requiring the
purchase of new technical equipment. It was mainly applied for schizophrenics
and reactive disorders and partly replaced the expensive and high-risk insulin
shock therapy. By far the most common forms of medication were sedatives,
followed by analeptics, antibiotics, major tranquillizers and a great number
of other drugs. The percentage of patients treated with at least one type of
drug rose continually during the period investigated especially at the end of the
fties. Although some uncertainties are assumed in the documentation, this re-
sult proved the rapid increase in the number of newly discovered and approved
drugs. Some drugs, such as major tranquillizers and antibiotics, were prescribed
in increasing quantities soon after their approval. Sedatives were applied to a
large part in cases of reactive disorders, schizophrenia and for elderly patients.
Analeptics were used for the elderly (e.g., camphor) and for schizophrenics
(e.g., cardiazol). The application of major tranquillisers was above-average in
schizophrenics and patients with reactive disorders. The malaria blood therapy
Figure 6.4 Therapies (including occupational therapy and electric shocks) concerning certain diagnoses (numbers
according to Wurzburger Schlussel)
 Wittenauer Heilstatten in Berlin: 19191960 165

90
80
70
60
Percentage

50
40
30
20
10
0
1919

1922

1925

1928

1931

1934

1937

1940

1943

1946

1949

1952

1955

1958
Year
Figure 6.5 Annual percentage of patients treated with at least one drug
(N = 4000)

was exclusively prescribed for progressive paralysis and included careful doc-
umentation.
Occupational therapy formed an important supplement to drug therapy, espe-
cially for alcoholics. It was utilized throughout the entire period of investigation
and was specially supported. In this context, the proportions of male and female
patients were almost even. Only in the thirties, more men than women were
asked to join occupational therapy. According to the case les, an economic
advantage could only be supposed in a few individual cases. The patients were
mainly occupied in the eld crew, with gardening or housework; in addition
to housework, female patients were also employed in the sewing room. Pluck-
ing, which was considered the lowliest activity, was mainly carried out by the
elderly, epileptics, paralytics and mentally disabled persons.
Approximately 37 per cent of the admitted patients died in the institution.
Discharge as a recovered patient was effected in about half the cases, while
the term recovered is only justiable when compared to the states of agitation,
attacks and depressive phases that preceded the time of discharge. Due to the
reasons described above, transfers to care units were documented comparatively
rarely. The majority of patients was moved to general hospitals (sometimes for
sterilization), moved or returned to prison, or during the Second World War
to one of the euthanasia units. Handing over to the medically supervised
family care did not class as a discharge from the institutional care.
166 Andrea Dorries and Thomas Beddies

300

250
Discharges (n = 3,911)
Deaths (n = 1,423)
200
Number

150

100

50

0
1919
1921
1923
1925
1927
1929
1931
1933
1935
1937
1939
1941
1943
1945
1947
1949
1951
1953
1955
1957
1959
Year
Figure 6.6 Number of discharges and deaths per year (19191960)

Roughly a third of the 4,000 patients examined died in the clinic; by far
the highest mortality rate occurring in the period immediately after the Second
World War. The major cause of death was diagnosed as cardiac arrest, followed
by lung infections, other organic diseases and other infections. Suicides as
opposed to suicide attempts only occurred in a few individual cases. Cardiac
arrest as the recorded cause of death increased since the forties, whereas the
proportion of missing details after a case of death decreased. In the autopsies,
mainly organic diseases previously not recognized were diagnosed. The greater
part of the pathological examinations took place between the twenties and early
forties. In 1923 and 1924, signicantly fewer autopsies were carried out a
result of the economizing measures in the institution. The rate of dissected
patients markedly decreased since 1942 for about a decade, only to increase
marginally afterwards. The strongly uctuating annual dissection rates in the
early fties may be explained in the context of problems in co-operation and a
pronounced absenteeism of the prosecutor employed.

Social history
During the entire period of our investigation, the Wittenauer Heilstatten was an
institution for the initial psychiatric care of patients in Berlin who had shown
 Wittenauer Heilstatten in Berlin: 19191960 167

peculiar behaviour. If it became apparent after a certain phase of observation and

possible therapeutic measures that an improvement in the patients condition
was not to be expected, a transfer to another institution mostly a psychiatric
unit in the province of Brandenburg was aimed at for nancial reasons and,
above all, to reduce overcrowding.
Probably a large part of the case histories of these transferred long-term
patients could not be used for the random check, as the les often remained in
possession of the institution the patients had been moved to. Quantitative data
from the analysed random check should be seen in the light of this background.
In particular, it needs to be pointed out that the average hospitalization period
for all patients recorded would probably have been considerably longer than
the period of 300 days obtained in the random check. On the other hand, the
mortality rate in comparison to the total number of admissions i.e., including
the patients who had been moved may have been lower than the mortality rate
obtained in the random check (slightly higher than a third).
The function of the Wittenauer Heilstatten as a psychiatric hospital for acute
cases explains the low rate of patients who were moved to it from other psy-
chiatric units. At the time of their admission, the overwhelming majority of
patients came straight from home or from a general hospital where they had
been considered intolerable due to the additional care they required or because
of their behaviour.
The patients of the Wittenauer Heilstatten were not a homogenous group of
mentally ill behind asylum walls. Rather than that, the analysis of the patients
circumstances, their actions and their treatment within their social environment,
add up to a picture of a great number of individual fates, which can however
be summarized under various aspects. This has primarily been done in respect
of gender, age, and the diagnoses for the patients while examining preferably
short periods of time in order to be able to consider external and time-relevant
factors and their inuence on the patients.
Under the aspect of gender, the increasing number of elderly women among
the admitted patients was especially striking. Since the forties, it rose steadily
and under the aspect of the patients gender, the increase in elderly women
among the admissions was especially signicant. Since the forties, it rose con-
tinuously and, in the fties, outnumbered the admission rate for men by far.
The care unit and hospital nature of the institution that had surfaced since
the forties is possibly one of the reasons for the increase in the proportion
of female patients with psychological disorders in conjunction with old age.
The analysis of the female patients life circumstances showed that they lived
alone much more often than was the case for men. It became apparent that the
loss of a spouse also had a negative inuence on the material living conditions
of these women, so that, according to the negotiations during the admission
procedure, the female patients often showed symptoms of malnutrition and
168 Andrea Dorries and Thomas Beddies

neglect in addition to their alleged mental disorders, especially during the war
and post-war years. In conjunction with supposedly endangering themselves
and others, this diagnosis sufced for an admission to Wittenauer Heilstatten.
Since at least 1943, the admission to the hospital had been synonymous with
the real danger of being transferred to the euthanasia unit in Obrawalde, about
200 km east of Berlin, for numerous female patients with the diagnosis mental
disorder of older age who needed care or were regarded as troublesome and
incurable.35 In this context, the social component of the Nazis euthanasia
activities supposedly based on research on hereditary diseases became evident.
In the collapse situation of 1945, the number of admissions especially of old,
helpless and feeble people increased to such an extent that the institution could
no longer work appropriately. In 1945/6 the mortality rate for admitted patients
was almost 80 per cent.
Under the aspect of gender, the extreme differences in the average period of
stay for various diagnoses is striking. On average, schizophrenic women spent
more than twice as much time in the institution than schizophrenic men (335 :
748 days). A possible explanation for this phenomenon could be the signif-
icantly greater number of therapeutic measures for female schizophrenics.36
Another aspect which can, however, hardly be quantied is the deliberate
connement to the institutions of female patients up to their enforced steril-
ization. It is well known that in the mid thirties there had been longer waiting
lists for the more elaborate sterilization methods for women. For the growing
number of female patients with mental disorders associated with older age, the
care unit and hospital nature of the institution, which became more and more
predominant from the forties, may have been the cause for longer periods of
stay.
The educational standard and the details of the patients occupations initially
showed the clear discrepancy between the sexes again; this can, however, not be
regarded as a specic feature of patients in psychiatric institutions. Women in
general had a poorer school education, often received no occupational training,
did less paid work and worked in socially low-grade jobs. This supposition
is relative when one looks at the patients spouses. Here, social categorizing
leads to signicantly different results from the corresponding categorization
of the female patient itself. The proportion of unskilled labourers was much
lower, the proportion of skilled workers and craftsmen signicantly higher.
The female patients therefore must be seen in a context of a social position
dependent on their husbands, a social position which could deteriorate rapidly
if the husband died especially as, compared to the women and considering
35 T. Beddies, Die pommersche Heil- und Pegeanstalt im brandenburgischen Obrawalde bei
Meseritz, Baltische Studien 84 (1998), 85114.
36 Robert Giel, Schizophreniepatienten, in Beddies and Dorries (eds.), Die Patienten der
Wittenauer Heilstatten in Berlin, 399434.
 Wittenauer Heilstatten in Berlin: 19191960 169

all due differentiation in respect of age and diagnosis, the markedly higher
proportion of married men indicates that the chances for men to marry or
remarry despite their conspicuous psychological features or relatively old age
was greater than for women.
It could be clearly seen that the social position of the patient strongly de-
pended on the age at the rst incidence of the disease. Diseases which had ex-
isted since birth (congenital feeble-mindedness) or which had rst appeared
in younger years (schizophrenia) would naturally have a negative effect on a
patients life in view of marriage and occupation. Thus it is not surprising that
a large part of the patients with mental disorders of older age were judged in
a more favourable way in the social anamnesis than most of the younger pa-
tients. Similarly, this applies to alcoholics and drug addicts. Addictions allowed
for a relatively long occupational period of paid work as well as a family life
functioning at least on the outside. However, the comparatively high proportion
of upper-class drug addicts among the patients must not be overestimated. All
persons with an academic background were considered to belong to this group.
Nevertheless, the economic situations of numerous patients thus classied had
deteriorated in such a way at the time of their disease or other unfavourable
conditions that they could hardly be considered as belonging to the social upper
class. This applied especially to the strongest group of drug-addicted physicians,
who in many cases had already been deprived of their qualication.
Under critical source-relevant aspects, it is worth noting that as a rule
interest, opportunities and the relevance of anamnesis in respect of family back-
ground and education would have been greater in the case of younger patients
than for the elderly. Considering this, the question arises as to the direction of
causality if it can be determined that there would be a higher proportion among
younger patients of illegitimately born children or children who did not grow
up with their parents than in the case of older patients.
By contrast, the alcoholics and drug addicts as well as the paralytics and
patients with mental disorders of older age had more favourable prospects when
it came to education, occupation as well as marriage and family bonds; this was,
however, due to the large proportion of relatively young male alcoholics. The
considerable fraction of war participants, especially among the alcoholics and
paralytics, was signicant for the social functioning of this group up to the time
of their admission. On the other hand, many men particularly blamed the war
for their syphilis infection, their tendency to drink alcohol, or their morphine
addiction.

Conclusions
The purpose of the analysis of 4,000 case histories from forty-two recording
years was to become acquainted with the details of patients who were admitted
170 Andrea Dorries and Thomas Beddies

as a result of their psychological disorders and behaviour and, compared to

modern experiences, spent some considerable time and often died there. De-
tailed information on diagnosis, diagnostic procedures, therapies and causes of
death could be obtained. In the eyes of healthy contemporaries and the author-
ities, the patients had become estranged from their familiar environment, they
appeared to be troublesome, in need of care and were regarded as potentially
and immediately dangerous. When one looks at the phenomenon of emotional
or mental deviation from the perspective of the individuals concerned, however,
one discovers human beings who had become estranged from themselves, felt
disturbed or threatened, isolated and in need of help. Furthermore, the greater
part of the clients in the citys mental care institution originated from the so-
cially disadvantaged population groups of Berlin. In the majority of the cases,
the costs of their institutionalization had to be borne by the respective welfare
or social security authority. Thus the deviation caused by poverty and its related
problems often contributed to the psychological disorder.
A rather favourable evaluation of social status for a large part of the patients
must not distract from the fact that this was only derived in a comparison with
the signicantly more disadvantaged patients with mental disorders acquired in
early life. In addition, the social classication only recorded their status before
the time of admission. One of the problems for psychiatry in institutions and
thus for the institutionalized patients for the whole duration of the investigated
period, however, was the stigma the admission or transfer entailed. Misgivings
regarding job loss, the partners intention to end the relationship and general
social isolation prevailed particularly in patients who were formally settled
when they demanded their immediate discharge. These symptoms were neither
changed by frequent name changes for the institution which was founded as
a lunatic asylum nor by the psychiatrists noted repeated efforts to suppress
the mental home nature of the unit in favour of an outward appearance as a
hospital.

Appendix Wurzburger Schlussel classication system

(1933)
(1) Congenital and childhood mental deciencies (idiocy and imbecility):
[Angeborene und fruherworbene Schwachsinnszustande]
(a) with unknown cause
(b) due to known brain damage
(c) cretinism
(2) Mental disorders due to brain damage (concussion or contusion of the
brain):
[Psychische Storungen nach Gehirnverletzungen, Gehirnerschutterung
und Gehirnquetschung]
 Wittenauer Heilstatten in Berlin: 19191960 171

(a) acute traumatic psychosis (psychosis due to concussion)

(b) traumatic sequelae (epileptic change of character, etc.)
(3) Progressive paralysis
[Progressive Paralyse]
(4) Mental disorders due to lues cerebri, tabes and lues latens
[Psychische Storungen bei Lues cerebri, Tabes und Lues latens]
(5) Encephalitis epidemica
[Encephalitis epidemica]
(6) Mental disorders of old age:
[Psychische Storungen des hoheren Lebensalters]
(a) arteriosclerotic forms (including general hypertonia)
(b) presenile forms (depressive and paranoid forms)
(c) senile forms
(d) other forms (Alzheimer, Pick)
(7) Huntingtons disease
[Huntingtonsche Chorea]
(8) Mental disorders associated with other brain diseases (tumours, multiple
sclerosis)
[Psychische Storungen bei anderen Hirnkrankheiten]
(9) Mental disorders associated with infections, diseases of internal organs,
general diseases and cachexia (symptomatic psychoses in the narrower
sense):
[Psychische Storungen bei akuten Infektionen, bei Erkrankungen in-
nerer organe, bei Allgemeinerkrankungen und Kachexien: sympto-
matische Psychosen im engeren Sinne]
(a) due to infectious diseases (including chorea minor)
(b) due to diseases of internal organs, general diseases and cachexia
(diseases of circulation, the intestine, diabetes, uraemia and eclamp-
sia, anaemia, carcinosis, pellagra)
(c) due to Morbus Basedow, myxedema, tetany and other endocrino-
logical diseases
(d) symptomatic psychosis in puerperium and during lactation
(10) Alcoholism:
[Alkoholismus]
(a) intoxication
[Rauschzustande]
(b) chronic alcoholism (excessive jealousy)
[Chronischer Alkoholismus: Eifersuchtswahn usw.]
(c) delirium tremens and hallucinations
[Delirium tremens und Halluzinose]
(d) Korsakows psychosis (polioencephalitis hemorrhagica)
[Korsakowsche Psychose: Polioencephalitis haemorrhagica]
172 Andrea Dorries and Thomas Beddies

(11) Addiction (morphinism, cocainism)

[Suchten]
(12) Mental disorders due to other intoxications:
[Psychische Storungen bei anderen Vergiftungen]
(sedatives, lead, mercury, arsenic, carbon disulphite, carbon monoxide)
(13) Epilepsy:
[Epilepsie]
(a) with unknown cause
(b) symptomatic epilepsy (if not mentioned in another group)
(14) Schizophrenic forms
[Schizophrener Formenkreis]
(15) Manic depressive forms:
[Manisch-depressiver Formenkreis]
(a) manic and depressive phases
(b) hyperthymic, dysthymic and cyclothymic constitution
(16) Psychopathic personality
[Psychopathische Personlichkeiten]
(17) Abnormal reactions:
[Abnorme Reaktionen]
(a) paranoid reactions and paranoid development (paranoia querulans)
[Paranoide Reaktionen und paranoische Entwicklungen: Queru-
lantenwahn]
(b) depressive reactions not included in 15a
[Depressive Reaktionen, welche nicht unter 15a fallen]
(c) psychotic reactions to imprisonment
[Haftreaktionen]
(d) compensation neurosis
[Rentenneurose]
(e) other psychogenic reactions
[Andere psychogene Reaktionen]
(f) induced mental illness
[Induziertes Irresein]
(18) Psychopathic children and adolescents
(up to eighteen years of age)
[Psychopathische Kinder und Jugendliche]
(19) Unresolved cases
[Ungeklarte Falle]
(20) Nervous diseases without mental disorders
[Nervenkrankheiten ohne psychische Storungen]
(21) No nervous disease and free of mental deviations
[Nicht nervenkrank und frei von psychischen Abweichungen]
7 Curative asylum, custodial hospital: the South
Carolina Lunatic Asylum and State Hospital,
18281920

Peter McCandless

The South Carolina State Hospital, formerly the South Carolina Lunatic
Asylum, is one of the oldest public mental institutions in the United States.
The oldest, in Williamsburg, Virginia, dates from 1773. For several decades
after its opening, Virginias asylum remained an anomaly, the only institution
in the country founded specically to care for the insane. The South Carolina
Lunatic Asylum, however, was founded at the beginning of a sustained wave of
asylum construction. During the early nineteenth century, increased population
density, growth of towns, and expansion of a market economy brought dissatis-
faction with existing modes of caring for the insane in private homes and public
poorhouses. Enlightenment empiricism encouraged a faith in human ability to
solve human problems. European psychiatric innovations, particularly moral
treatment, inspired therapeutic optimism, the belief that lunatic asylums could
cure large numbers of the insane and restore them to productive labour.
Between 1817 and 1824, philanthropists in several northeastern states, often
aided by public subsidies, opened private charitable asylums intended to serve
patients of all social ranks. These institutions were inuential, but they ended
up catering to a small, mainly afuent clientele and did not provide the organi-
zational pattern for American asylums. Neither did private proprietary asylums,
which rst appeared in the 1820s, and had become common in some parts of
the country by the 1870s. The dominant type of mental institution in the United
States has been public. But the American model differed from that of most
European countries in that the federal (central) government did not pass legis-
lation mandating the construction of public asylums. The initiative in building
and maintaining asylums remained with individual states. The public model
was adopted by three southern states in the 1820s: South Carolina, Kentucky,
which opened an asylum at Lexington in 1824, and Virginia, which opened its
second state asylum at Staunton in 1828. In 1833, Massachusetts became the
rst northern state to open a state asylum, at Worcester. By the late nineteenth
century, nearly every state had one or more asylums and most mental patients
resided in them. These state asylums were promoted by small groups of re-
formers and were often designed, like the private charitable asylums, to serve a

173
174 Peter McCandless

socially mixed clientele. Funding varied but initially included some combina-
tion of revenue from the state, local government, and families of patients.1
Although the earliest state asylums were in the south, few historians have fo-
cused on southern psychiatric developments.2 Moreover, historians of insanity
in the United States have tended to portray the south as psychiatrically back-
ward. According to this scenario, founders of early southern asylums were igno-
rant of moral therapy and therapeutic optimism, and created custodial welfare
institutions.3 The evidence for South Carolina does not support this argument.
But some of these historians have rightly stressed a more important psychi-
atric distinction between north and south. The souths large black and (until
1865) slave population made race a much more signicant issue for southern
than northern asylums, at least before the twentieth century. In South Carolina,
blacks constituted more than 50 per cent of the population between 1820 and
1920, and reached a high point of 60 per cent in 1880.4
The question of southern distinctiveness that such a comparison arouses
has been debated in American historiography since the1920s. Recently, his-
torians have begun to explore how differing regional experiences of disease
and its treatment may have contributed to southern distinctiveness.5 The de-
bate over southern distinctiveness raises a number of important questions for
historians of American insanity. How psychiatrically distinct was the south?
How did southern responses to insanity and southern mental institutions dif-
fer from those in other regions of the country? How did issues of slavery and
race inuence the care and treatment of the insane? To what extent and in
1 G. Grob, The Mad Among Us: A History of the Care of Americas Mentally Ill (Cambridge,
Mass., 1994), chapters one and two, G. Grob, Mental Institutions in America: Social Policy to
1875 (New York, 1973), chapters one to three, ve; D. Rothman, The Discovery of the Asylum:
Social Order and Disorder in the New Republic (Boston, 1971), chapters ve and six. On South
Carolina, see P. McCandless, Moonlight, Magnolias, and Madness: Insanity in South Carolina
from the Colonial Period to the Progressive Era (Chapel Hill and London, 1996); P. McCandless,
A Female Malady? Women at the South Carolina Lunatic Asylum, 18281915, Journal of the
History of Medicine 54 (1999), 54371.
2 See S. B. Thielmann, Southern Madness: The Shape of Mental Health Care in the Old South,
in R. L. Numbers and T. L. Savitt, Science and Medicine in the Old South (Baton Rouge, 1989),
25675; N. Dain, Disordered Minds: The First Century of Eastern State Hospital in Williamsburg,
Virginia, 17661866 (Charlottesville, 1971); J. S. Hughes, Labeling and Treating Black Mental
Illness in Alabama, Journal of Southern History 58 (1993), 43560; R. F. White, Custodial
Care for the Insane at Eastern State Hospital in Lexington, Kentucky, 182444, Filson Club
Quarterly 62 (1988), 30335.
3 A. Deutsch, The Mentally Ill in America: A History of their Care and Treatment from Colonial
Times (Garden City, NY, 1937), 106; Grob, Mental Institutions in America, 9596, 190, 195,
3424, 35968; G. Grob, Mental Illness and American Society, 18751940 (Princeton, NJ, 1983),
256, 104, 15960, 21820, N. Dain, Concepts of Insanity in the United States (New Brunswick,
NJ, 1964), 128, 177, 225n.2, 242n.17.
4 Grob, Mental Institutions in America, 24355; Grob, Mental Illness and American Society,
18751940, 223, 26, 22021; Dain, Concepts of Insanity, 901, 1048.
5 T. L. Savitt and J. H. Young (eds.), Disease and Distinctiveness in the American South (Knoxville,
Tenn., 1988).
 South Carolina Lunatic Asylum, 18281920 175

what ways did the regions economic problems after the Civil War affect the
insane?
South Carolina presents an excellent venue for the examination of these
questions. In South Carolina, as in the south as a whole, race has always been
a powerful historical theme. From the early eighteenth century until the 1920s,
the majority of South Carolinas population was African-American. The state
produced some of the staunchest defenders of slavery and precipitated secession
and Civil War. For more than a century after the war, it, like the south generally,
was marked by poverty, racial segregation, and nostalgia for a mythical Old
South of cavalier planters, plantation mistresses and happy slaves.
In many ways, the history of the South Carolina Lunatic Asylum resem-
bled that of contemporary public asylums in the northern states and Europe. Its
founders were inspired by moral treatment and therapeutic optimism to create
a curative institution for patients of all social classes. In 1821, they convinced
the legislature to establish an asylum at Columbia, the state capital. The com-
missioners who superintended its construction incorporated features of recent
European and American asylums into its design. The architect was inuenced
by British innovations in asylum architecture, particularly those advocated by
one of the most important advocates of moral treatment, Samuel Tuke of the
York Retreat.6 Although the asylum never fully achieved the founders ther-
apeutic hopes, its ofcers came closest to replicating the ideal community of
moral treatment during the antebellum decades. This may have been partly
because the antebellum asylum cared for a relatively small and homogeneous
clientele. Although the patients included both rich and poor, the number of
paying patients nearly balanced the number of paupers. The number of patients
never exceeded 200 before the Civil War, and most of them were white and
native born. The asylum did not formally accept blacks until 1849 and housed
only a few black patients when the Civil War began in 1861.
For both South Carolina and its asylum the war was a watershed. Econom-
ically and politically, the state changed radically in the post-war decades. In
1800, it had been one of the richest states. By the late nineteenth century, it
had become one of the poorest. Economic decline began in the antebellum
period. The 1860s and 1870s brought defeat in war, the emancipation of the

6 Special Committee on Lunatics, 1818, General Assembly Papers (hereafter cited as GAP); South
Carolina Department of Archives and History (hereafter cited as SCDAH); W. Crafts, Oration
on the Occasion of Laying the Corner Stone of the Lunatic Asylum at Columbia, July, 1822
(Charleston, SC, 1822), 1216; Joint Committee of the Senate, Report on the Lunatic Asylum
and the School for the Deaf and Dumb, 1822, GAP; Reports and Resolutions of the General
Assembly of South Carolina (hereafter cited as RR), 1822, 1034; The Statutes at Large of South
Carolina (Columbia, SC, 1836), vol. 6, 168; J. M. Bryan and J. M. Johnson, Robert Mills
Sources for the South Carolina Lunatic Asylum, 1822, Journal of the South Carolina Medical
Association 75 (1979), 2648; J. Bryan (ed.), Robert Mills, Architect (Washington, DC, 1989),
858.
176 Peter McCandless

slaves, federal reconstruction, severe economic dislocation, and enormous loss

of wealth. Despite the emergence of a textile industry after 1880, the states in-
habitants became more dependent than ever upon the cultivation of cotton and
rice in a time of falling agricultural prices. For much of the late nineteenth and
early twentieth centuries, South Carolina suffered severely from depression.7
The South Carolina Lunatic Asylum also changed radically after the war.
The patient census grew enormously, from 192 in 1860 to over 2,200 by 1920,
and altered both socially and racially. The number of paying patients declined
to insignicance and the institution was ooded with publicly supported pa-
tients, many of them black. Emancipation fully opened the asylum to the black
majority and the number of black patients rose to nearly 1,000 by 1920. As the
asylum population grew larger and more heterogeneous, its therapeutic function
declined. The proportion of patients discharged as recovered dropped substan-
tially, and it effectively became a custodial welfare institution. These changes
coincided with a marked deterioration in patient care and internal conditions,
due to grossly inadequate funding. To a large extent this development resulted
from the states steep economic decline and a profound legislative antipathy to
debt and taxes. But it also reected the signicant changes in the institutions
clientele. Legislators committed to scal conservatism and white supremacy
showed little sympathy for a patient population that was increasingly poor,
black and chronic. Many patients endured horric conditions as a result, but
black patients suffered more than whites.
To be sure, the asylum faced severe obstacles from the beginning. Its pro-
moters failed to achieve a broad consensus of public support for their goals.
Building it cost much more and took much longer than they had predicted. Cost
overruns and delays angered legislators, and conicts arose over the nature,
functions and even necessity of an asylum. Many legislators were sceptical
about the feasibility of a curative institution for all ranks of citizens. Like most
early nineteenth-century Americans, they viewed hospitals as disreputable in-
stitutions for people too poor to get care at home. In the 1820s, such institutions
were few, and they served a predominately lower-class clientele. The only hos-
pital in South Carolina prior to the establishment of the state lunatic asylum was
connected with the poorhouse in Charleston. Although the poorhouse hospital
admitted some paying patients, many people viewed a public lunatic asylum as
a pauper institution no respectable family would wish to patronize.8 Legislators

7 The best history of South Carolina is W. Edgar, South Carolina: A History (Columbia, SC,
1998).
8 Journal of the South Carolina House of Representatives, South Carolina Department of Archives
and History, 1827, 1947, GAP; Joint Committee of the Senate on the Lunatic Asylum, 1822,
GAP; Governors Messages, Thomas Bennett, 1822, no. 1318, GAP; Reports from Commission-
ers of the Poor in Obedience to the Act of 1821, GAP; Charles Rosenberg, The Care of Strangers:
The Rise of Americas Hospital System (New York, 1987), 1822.
 South Carolina Lunatic Asylum, 18281920 177

who held these views charged that the asylum commissioners were building a
palace for paupers and were able to cut funds for outtting the building when it
was nally completed in 1827. As a result, the asylums ofcers were initially
unable to purchase items considered essential to effective moral therapy, such as
gardens, pleasure grounds, indoor plumbing, cattle, horses and carriages. The
absence of these things initially increased the asylums difculties in attract-
ing wealthy patients and implementing its therapeutic ideals. These problems
were exacerbated by the legislatures refusal to provide annual appropriations
for operating expenses. For this outcome, the asylums advocates were largely
to blame. They had repeatedly assured legislators that the institution would
support itself from patient fees.9
For several years after the asylum opened in 1828, few patients arrived. In
1831, when it nearly closed down for lack of funds, only thirty-ve patients
were in residence in an institution designed for a hundred.10 The number of pa-
tients did not reach a hundred until 1849, and its nancial condition remained
precarious until the late 1830s. Critics who had doubted the demand for such
an institution found conrmation in its inability to attract enough patients to
sustain itself nancially.11 The ofcers blamed the difculty in attracting pa-
tients largely on unenlightened public attitudes and inadequate laws. Too many
families had outmoded, negative stereotypes of asylums; too many local of-
cials valued keeping taxes low over curing the insane poor; and the law gave
these ofcials too much discretion in deciding whether or not to commit pauper
lunatics (insane persons local poor-law ofcials declared unable to afford to
pay for treatment). After the asylums Board of Regents threatened to close the
asylum due to a lack of patients and revenue in 1831, the legislature passed an
Act which required counties to transfer pauper lunatics to the asylum.12 The Act

9 Journal of the House of Representatives, 1826, 2401, 1827, 1956; Report of the Trustees to
Effect the Operation of the Lunatic Asylum, 1827, GAP; Columbia Telescope, 30 January 1829;
Pendleton Messenger, 6 February 1828; McCandless, Moonlight, Magnolias, and Madness,
chapter two.
10 South Carolina State Hospital (hereafter cited as SCSH), Admission Book, 182874, Department
of Mental Health (hereafter cited as DMH), SCDAH, 1; Charleston Mercury, 28 November 1828;
Pendleton Messenger, 10 December 1828; SCSH, Minutes of the Board of Regents (hereafter
cited as MBR), 5 July, 12 December 1828, DMH, SCDAH; SCSH, AR, 1831.
11 SCSH, Admission Book, 18281874, AR, 18291850; W. G. Simms, The Morals of Slavery,
in The Proslavery Argument (Charleston, 1852), 22627.
12 Statutes, vol. 6, 437; MBR, 29 November, 22 December 1828, 4 February 1832; AR, 1828, 1830.
In South Carolina, paupers were technically persons unable to support themselves without public
assistance. South Carolina had adopted the English Poor Law in 1712, and established a system
of relief funded by a tax collected and distributed by overseers of the poor in each parish (after
the Revolution, by commissioners of the poor in the districts or counties). Pauperism did not
carry the legal disqualications it did in England, and for many whites the stigma of it was
reduced somewhat by the need to maintain a united white community in the face of the black
majority. The stigma attached to pauperism was also less when it was the result of disease.
For example, a pauper lunatic was often simply a person deemed to lack sufcient personal or
178 Peter McCandless

brought a modest stream of admissions. But it did not provide any penalty for
non-compliance, and local poor-law commissioners continued to keep many of
the insane paupers in poorhouses or board them out.13
A ood of pauper patients would not have solved the asylums nancial prob-
lems. It needed to attract enough high-paying private patients to subsidize the
care of the poor. During the asylums rst decade, few wealthy families sent
insane relatives to the asylum, either out of prejudice against public hospitals
or fear of exposing the family shame.14 Their reluctance led the asylums re-
gents to seek patients in neighbouring states. The commitment law allowed the
regents to admit patients from other states and the asylum was well positioned
geographically to serve insane southerners of means. Until the 1840s, it was the
only asylum south of Virginia. Georgia, North Carolina, Alabama and Florida
did not open theirs until 1844, 1856, 1860 and 1877, respectively. In 1829 the
rst of many Georgia patients was admitted to the asylum. Others soon came
from North Carolina, Alabama and Florida. Throughout the antebellum period,
the asylum received wealthy patients from these and other southern states.15
By the mid-1830s, wealthy South Carolina families were also becoming more
willing to patronize the asylum. Positive comments about the asylum from its
promoters, physicians and a few prominent families who had sent relatives to
the asylum helped make it a respectable alternative to home care, boarding out,
or an asylum in the north.16 As one can see from Table 7.1, paying admissions
outnumbered pauper admissions during the years for which such information
is available.
To be sure, the asylum never attracted as many private patients as its sup-
porters had hoped; and paupers normally constituted a slight majority of the
resident patients, because they tended to remain longer than paying patients.
But, as Table 7.2 shows, the number of pauper patients never greatly exceeded
that of paying patients before the Civil War.
An obvious way to increase the number of patients would have been to admit
blacks. The asylums regents began to receive applications to admit insane
family income to afford medical treatment. Paupers were necessarily treated generously. As in
England and other American states, their treatment varied considerably according to time, place
and local attitudes towards poverty. Statutes, vol. 2, 593598; Barbara L. Bellows, Benevolence
Among Slaveholders: Assisting the Poor in Antebellum Charleston, 16701860 (Baton Rouge
and London, 1993).
13 AR, 1842, 23, 1847, 89; Statutes, vol. 6, 437. For more information on boarding out and other
forms of community care, see McCandless, Moonlight, Magnolias, and Madness, 149151, and
chapter eight.
14 Pendleton Messenger, 11 February, 20 May 1829; Columbia Telescope, 30 January 1829; see
also, W. G. Simms, Lunatic Asylum, Magnolia; or Southern Apalachian 1, n.s. (1842), 394.
15 MBR, 7 March, 2 May 1829, 3 April 1830; SCSH, Admission Book, 182874.
16 Townes Family Papers, correspondence, MayAugust 1835, South Carolina Library, Columbia
(hereafter cited as SCL); J. C. Calhoun to A. Burt, 18, 27 May 1838, Ms. Dept., Perkins Library,
Duke University; R. L. Meriwether (ed.), The Papers of John C. Calhoun (Columbia, 1981),
vol. 14, 2923, 305, 31112, 354, 394, 499, 593.
 South Carolina Lunatic Asylum, 18281920 179

Table 7.1 Paying and pauper admissions

to South Carolina Lunatic Asylum, for
selected periods, 18281852

Period Paying Pauper

182838 117 110

183741 68 59
184852a 118 65

a Statistics for 184247, 1851 are unavailable.

Sources: South Carolina State Hospital, Admission

Book, 182838; Annual Report, 1842, 184852.

Table 7.2 Average number of paying and

pauper patients resident in South
Carolina Lunatic Asylum, for selected
periods, 18301864

Period Paying Pauper

18304a 15 18
18404 26 39
18459 34 49
18504 68 78
18559 88 97
18604 82 94

Note: Averages are rounded to the nearest number.

a Statistics for 1832, 183539 are unavailable.

Sources: South Carolina State Hospital, Annual

Report, 1831, 1833, 184264; Minutes of the Board
of Regents, 1 May 1830; Journal of the South
Carolina House of Representatives, South Carolina
Department of Archives and History, 1834, 1645;
Charleston Courier, 20 December 1864.

blacks soon after it opened, but at rst decided not to admit them because
the law did not expressly permit blacks admission and because their presence
would increase expenses and complicate the running of the institution. They
could not be mixed with the whites, and they would need a separate keeper and
exercise yard. Ironically, one of the rst patients to be admitted was a fourteen-
year-old slave named Jefferson. He was admitted as a favour to his owner, who
had committed his brother at the same time. Jefferson was not housed in the
main building with the white patients, and his name was not recorded in the
asylums admission book. His owner removed him after a few months. Only
180 Peter McCandless

one other non-white patient appears in the asylums record before 1850, a free
mulatto who spent several months there in 1839. Several years after the asylum
opened, its regents declared themselves willing to admit blacks if the legislature
approved it. They periodically advocated the reception of black patients during
the 1830s and 1840s.17
The legislature voted to legalize the admission of blacks in 1848, largely
in an effort to counter abolitionist propaganda. To be sure, the Acts advo-
cates stressed the standard humanitarian, medical and social control arguments
for asylum care. They argued that the state had a moral responsibility to care
for faithful servants, and to protect slave owners families from the dangers
of living in proximity to lunatic slaves. But they also stressed the political
dangers of refusing to admit blacks to the asylum. Charleston writer William
Gilmore Simms warned that discrimination between the sufferings of [insane]
blacks and whites could help give anti-slavery propaganda credibility. A leg-
islative committee noted that opening the asylum to blacks would enhance
South Carolinas reputation for humanity and serve as a rebuke to the idle and
vicious fanaticism of the abolitionists.18
That the Act admitting blacks to the state asylum was largely a political ex-
ercise is supported by the minimal impact it had on their situation. During the
1850s, only around thirty blacks were admitted to the asylum, compared to more
than 600 whites. At the end of 1858, seven of 180 patients in the asylum were
black.19 The accommodation the asylum provided for blacks was much inferior
to that for the white patients, consisting of a couple of small brick outbuildings
placed near the main asylum structure. Soon after the rst black patients arrived,
the physicians protested that provision for them was unacceptable medically,
racially and administratively. The black patients could not get proper exer-
cise because their building was located in the white patients exercise court.
The presence of the blacks distressed the whites and inhibited their recovery.
The asylum had to hire a special attendant for the few black patients, since the
regular attendants refused to care for them. Because of these problems, the
regents decided in 1858 to release the black men patients and admit no
more until the state agreed to fund a proper building and grounds for them.
The asylum continued to admit a few black women, but turned down numerous
applications for the admission of male slaves.20 South Carolinas reluctance to
provide accommodation for insane blacks was not unusual, although the states
17 AR, 1829, 1832, 1844; H. Martineau, Society in America, 2 vols. (New York, 1837), 2912;
MBR, 7, 27 June, 28, 29 November, 1828, 4 April, 6 June, 3 October, 1829, 5 January, 2
February, 2 March, 1839, 2 November, 1844; SCSH, Patients Treatment Record, I, Jefferson,
II, David I. Duncan, DMH, SCDAH.
18 Simms, Lunatic Asylum, 395; RR, 1848, 77.
19 AR, 1858, 1213; SCSH, Admission Book, 182874.
20 AR, 1850, 1851, 8, 1853, 24, 1858, 1213, 1860, 13; MBR, 6 November 1858, 5 November
1859, 4 August, 17 September 1860.
 South Carolina Lunatic Asylum, 18281920 181

black majority made its consequences signicant. Prior to the Civil War, most
asylums in the United States either did not accept black patients or provided
them with separate and inferior facilities to those for whites. Southern asylums
admitted more blacks than northern ones, but the north had a tiny black popu-
lation. Only the Eastern Virginia Lunatic Asylum accepted signicant numbers
of black patients before the 1860s.21
The founders of the South Carolina Lunatic Asylum not only aimed to attract
large numbers of patients of all classes, but they also expected to cure most of
them. James Davis, who became the institutions rst physician, argued that an
asylum should not be merely a place of comfort but also a house of cure.
Davis and the other antebellum physicians claimed that 80 to 90 per cent of the
insane could be cured if sent to an asylum in the early stages of the disease. This
therapeutic optimism, as in the north and Europe, was largely based on faith
in moral treatment. Soon after the asylum opened, its regents advertised that it
was conducted on the principles of moral treatment. The physicians repeatedly
claimed that they governed their patients by moral methods. They employed
mechanical restraints and other forms of coercion only when necessary for
medical or safety reasons and applied them as leniently and gently as possible.
The asylums reports frequently compared the patients to a happy family, in
which the physician played the role of the wise and benevolent father, and
the patients were like children. Nineteenth-century asylum ofcials often used
such a rhetoric of domestic patriarchy, both to dene their mission and to allay
suspicions of madhouses.22
Such descriptions represented an ideal. In reality, lack of money hampered
the asylums efforts to supply the facilities and personal attention moral treat-
ment demanded, especially during the rst decade. Coercion in the form of
mechanical restraint, seclusion and cold showers was common during the early
years. The physicians also relied heavily at rst on drastic medical therapies
such as purging, bleeding and blistering. Yet, the evidence indicates that they
conscientiously tried to employ moral methods within the limits of their re-
sources. During the 1840s and 1850s, they greatly decreased their use of drastic
medications and mechanical restraints. Over time, the asylum was able to sup-
ply occupation and amusement for many of the patients. The regents gradually
purchased or were donated land for farms and gardens, horses and carriages for
riding, a library, a bowling alley, billiard tables and other games.23
But the South Carolina Lunatic Asylum, like other contemporary asylums,
never achieved the high cure ratios its promoters had anticipated. During the

21 Proceedings of the Association, American Journal of Insanity 12 (1855), 43; Grob, Mental
Institutions in America, 24355; Savitt, Medicine and Slavery, 25879; Dain, Disordered Minds,
19, 105, 10913; Dain, Concepts of Insanity, 1078.
22 AR, 1829, 1830, 1842, 1844; Pendleton Messenger, 20 May 1829.
23 McCandless, Moonlight, Magnolias, and Madness, 84118.
182 Peter McCandless

rst four years, 19 per cent of the patients were discharged as cured. Between
1835 and 1855, the proportion of recoveries claimed rose to about 45 per cent,
still far from the predicted 90 per cent.24 The ofcers explained their failure to
cure a larger percentage of patients much like asylum authorities did elsewhere:
the admission of too many chronic cases, inadequate facilities, and an inability
to get and keep a sufcient number of qualied attendants. They also blamed
unenlightened social attitudes which led families and local ofcials to delay
sending patients to the asylum and to squander the best chances of obtaining
a speedy and lasting cure. The commitment law did not help: it required the
asylum to admit idiots and epileptics as well as lunatics.25
From the 1840s, the ofcers often cited inadequate means of classifying pa-
tients as a major hindrance to the asylums therapeutic and nancial success.
Implementing moral therapy required separating the quiet from the noisy, the
peaceful from the violent, the clean from the dirty, the respectable from the
indecent, rich from poor, women from men. To separate these classes from one
another in one building in which the patients also had to be separated by sex, and
after 1850 by race, was no simple matter.26 On the other hand, the asylums of-
cers never complained about a classication problem that beset many American
asylums in the 1840s and 1850s, the admission of large numbers of immigrants,
especially Irish. At some northern asylums immigrants constituted a majority
of the patients by mid-century. But South Carolinas immigrant population was
small. In 1850 and 1860, less than 1 per cent of the states inhabitants were
foreign born, and most of them lived in Charleston. The foreign born never
made up more than a small minority of the total patient population at the South
Carolina institution. During the 1850s, when the percentage of foreign-born
patients was highest, they never exceeded 15 per cent of the total in residence.
As in the north, most of them were Irish.27
Yet the ofcers often complained about inadequate means of classication,
not only because it hampered moral treatment, but because it had important
nancial consequences. The asylums inability to segregate pauper and paying
patients made it harder to attract wealthy patients, whose fees subsidized the
paupers. Unless the asylum provided suitable accommodation for paying pa-
tients, paupers would predominate and it would have to be supported entirely by
public funds. In 1842 and 1848, the ofcers used these arguments successfully
to convince the legislature to fund extensions to the original building. By the

24 AR, 182933, RR, 1855, 1558.

25 AR, 1829, 1842, 1113, 20, 1852, 4, 1857, 6; Statutes, vol. 6, 323, 382, 437.
26 AR, 1842, 7, 16, 22, 1844, 12 , 1852, 4.
27 AR, 1853, 2731, 1859, 1621, 23; US Bureau of the Census, A Century of Population Growth
(Baltimore, 1967), 128. US Bureau of the Census, Statistics of the United States in 1860 (New
York, 1976), vol. 20; Grob, Mental Institutions in America, 2306; Dain, Concepts of Insanity,
99104.
 South Carolina Lunatic Asylum, 18281920 183

early 1850s, they decided that proper classication was impossible within the
existing asylum structure, and began a campaign to replace it with a new one.
A second building was begun in 1858, but construction was interrupted by the
outbreak of the Civil War in 1861 and it was not completed until 1885.28
Despite problems in attracting and curing patients, the asylum came closer
to achieving its founders therapeutic and social goals before the Civil War than
after it. The war proved a radical disjunction in the history of the asylum as
well as the state. Soon after the outbreak of war in 1861, the nancial situation
of the asylum became desperate. War created an emergency situation only the
state government had the resources to deal with, but it also diverted most of the
states revenue to military purposes and greatly weakened its economic position.
By preventing the export of cotton and rice, the federal blockade deprived the
state of hard currency. Many citizens were caught between eroding incomes
and rampant ination. The end of the war brought no relief. South Carolina had
suffered staggering economic losses. Many people were impoverished by the
accumulation of debt, loss of land and slaves, and the breakdown of traditional
patterns of trade and agriculture.29
The asylum shared the misfortunes of the general populace. The ofcers had
to pay highly inated prices for food, medicine, clothing and other essentials.
They found it increasingly difcult to collect payment for patients and debts
mounted quickly. The legislature raised the fee for paupers several times during
the war, and began making annual appropriations for the asylum. But ination
rendered such assistance inadequate before it was granted. To meet the emer-
gency, the asylums ofcers economized, borrowed, begged and pledged their
own resources and credit. They also discharged many patients and prohibited
admissions from other states. The patient census dropped from 192 in Novem-
ber 1860 to 128 at the end of 1865. Conditions deteriorated badly during the
wars later stages. The ofcers could not get enough money to feed and clothe
the patients properly or pay the attendants regularly. Mortality, which had aver-
aged 8 per cent of the patients under treatment in the decade 185362, increased
to 13 per cent between 1863 and 1865. The ofcers kept the asylum running
only by putting off badly needed repairs and improvements. By the late 1860s
various observers declared the asylums condition a disgrace to the state.30
Following the Civil War, the asylum came under closer state supervision and
control. Between 1868 and 1877, the victorious federal government imposed

28 AR, 1842, 1517, 1848, 2, 49, 1851, 34, 1852, 4, 89, 1853, 5; Journal of the South Carolina
House of Representatives, 1842, 17; RR, 1842, 99, 1848, 77; MBR, 7 October 1848; McCandless,
Moonlight, Magnolias, and Madness, chapter six.
29 W. Roark, Masters Without Slaves (New York, 1978), 4052, 778, 889, 13253, 17080; E.
M. Lander, A History of South Carolina, 18651960 (Chapel Hill, NC, 1960), 35.
30 AR, 185369; MBR, 186169, 2 February, 2 March 1867; RR, 1868, 11416; Anderson Intel-
ligencer, 8 December 1870.
184 Peter McCandless

Table 7.3 Number of patients and number of black patients in South Carolina
Lunatic Asylum/State Hospital, 18401920

Percentage of blacks in
Year All patients Black patients SC population SC population

1840 51 0 594,398 56.4

1860 192 7(1858)a 703,708 58.6
1880 490 187 995,577 60.7
1900 1027 393 1,340,316 58.4
1920 2205 988 1,683,724 51.4

a The number of black patients was not reported in 1860 but was in 1858.

Sources: Annual Report, 1840, 1858, 1860, 1880, 1900, 1920; South Carolina Statistical Abstract,
1998 (Columbia, South Carolina: Budget and Control Board, Division of Research and Statistical
Services, 1998), 325, 335.

reconstruction on South Carolina and other former Confederate states. Its goal
was to ensure that the civil rights of the newly emancipated blacks would be
respected. Protected by federal troops, northern Republicans took control of
the state government, supported by newly enfranchised blacks and a minority
of white residents. The asylum was soon affected by this political revolution.
A new state constitution of 1868 gave the governor the power to appoint the
superintendent and all other ofcers, including the regents.31 Previously, the
regents had essentially controlled all appointments, including lling vacancies
in their own ranks. The new Republican governor replaced the existing regents
and superintendent with Republicans. Six of the new board of regents were
black and three white. Reconstruction ultimately failed to protect the rights of
the black population, but it did politicize the care of the states insane to a greater
extent than ever before. In the postwar era, the asylum became the source of
political patronage and was charged with corruption and extravagance.32
The nature and function of the asylum also changed radically. As one can
see from Table 7.3, the number of patients exploded after the Civil War, and
black patients came to constitute a large proportion of the clientele. Without
explicitly abandoning its therapeutic goal, the asylum became a receptacle
for large numbers of defectives of both races, whose common denominator
was poverty. Emancipation of the slaves transferred responsibility for insane
blacks from their owners to the public authorities. Black patients became a
signicant presence in the institution for the rst time. By 1920, they made
up nearly half of its clientele, a number close to their proportion of the states

31 Statutes, vol. 14, 24.

32 Charleston Daily News, 13 January 1869; Journal of the South Carolina House of Representa-
tives, 1869, 278; Columbia Daily Phoenix, 25 November 1869; J. S. Reynolds, Reconstruction
in South Carolina (Columbia, SC, 1905), 1235.
 South Carolina Lunatic Asylum, 18281920 185

population (51.4 per cent). Over the same period, the number of private patients
dropped precipitately. In 1865, the number of paying patients (sixty) was still
nearly in balance with the number of paupers (sixty-eight). By 1881, paupers
outnumbered paying patients almost twenty to one (464 to twenty-six). The
trend continued and became a major political issue. As the number of publicly
supported patients increased, politicians justied low appropriations for the
asylum by arguing that the states charity was being abused by families who had
enough property to defray the costs of their relatives care. Governor Benjamin
R. Tillman, who had harshly criticized the asylum administration as extravagant
during his campaign for ofce, remarked sarcastically to legislators in 1890 that
the proportion of pauper patients was so high that we are forced to ask whether
only the poor people go crazy.33
Of course, the poor were not the only ones who went mad. The increase
in the proportion of pauper patients had a variety of economic and political
causes. First, the states white citizens were poorer than before. Many families
who had once been able to pay for the care of their insane relatives at home,
in boarding houses, or in public or private asylums could no longer afford to
do so. Second, nearly all of the new black patients were unable to pay for their
care. Third, a lack of poorhouses and general hospitals meant the state hospital
received patients who might have been sent to such institutions. Many counties
did not have poorhouses, or their poorhouses had no secure accommodation.
Until the end of the nineteenth century, the state hospital was virtually the only
hospital in the state outside of Charleston. Finally, a major change in scal
policy contributed to the sharp increase in pauper patients. In 1871, the state
assumed nancial responsibility for the care of pauper patients. This freed the
institution from the problem of trying to collect fees for pauper patients from
the counties. But it also encouraged local ofcials to commit people, because
the state and not the county was paying the cost. Many families, too, were less
reluctant to accept assistance from the state than from poor-law authorities.
The term pauper lunatic was abandoned in favour of beneciary during the
1870s, both a sign of changing attitudes towards accepting public care and an
additional inducement to such acceptance. By 1900, less than 3 per cent of the
patients were paying anything towards the cost of their maintenance at the state
hospital.34

33 Quotation from Journal of the South Carolina House of Representatives, 1890, 140; AR, 1881,
14, 19; Journal of the South Carolina House of Representatives, 1882, 2627.
34 AR, 1871, 30, 18834, 21, 18912, 6, 16, 1894, 13, 1900, 8, 21, 1904, 72. The increase in pro-
portion of black to white patients does not seem to have been affected much by whites recourse
to alternative institutions. The rst private asylum in South Carolina, Waverley Sanitarium in
Columbia, was not opened until 1915. Some wealthy white families continued to send their in-
sane to institutions in the north after the Civil War as before. But the numbers of South Carolina
families that availed themselves of such options seems to have declined. For example, the records
186 Peter McCandless

The number of patients grew much faster than the funds appropriated for
their maintenance. Between 1875 and 1905, the patient census quadrupled, but
the legislative appropriation only doubled, from $70,000 to $140,000. Annual
expenditure per patient fell from around $200 to around $100, while prices of
food and supplies increased by about 25 per cent. Per capita expenditure for
maintenance around the turn of the century was regularly the lowest, or close
to the lowest, of American public mental institutions.35
The rapid inux of beneciary patients, combined with low funding, over-
whelmed the asylums facilities. Severe overcrowding, an occasional problem
before the Civil War, became chronic. Overcrowding was common to most
public asylums in the United States and Europe in the late nineteenth century,
and the explanation was much the same everywhere: over time, chronic pa-
tients accumulated. The ofcers constantly complained that the asylum was
clogged with chronic and aged patients whose presence excluded the acute in-
sane. More than 18 per cent of the admissions to the state hospital from 1891
to 1911 were diagnosed as imbeciles, idiots, epileptics and inebriates. Between
1875 and 1895 the percentage of resident patients over fty increased from 11.7
to 27.6.36
Faced with a constantly expanding crowd of unpromising patients, the ofcers
repeatedly appealed for additional accommodation. But they were never able
to secure enough money from the legislature to keep pace with the demand
for space. An example is the completion of the new asylum building begun in
the late 1850s. One wing had been erected before construction was suspended
by the Civil War. Work resumed in 1870, but was stopped several times by
inadequate appropriations or funding delays. The building was not completed
until 1885, and then only by nancing much of its cost out of appropriations
for the patients maintenance and by using convict and patient labour.37
Even after the completion of the new building, many patients, especially the
blacks, remained in dangerous and unhealthy structures. During the 1880s, the
black women were gradually moved to the original asylum building, which
the asylums ofcers had for decades condemned as obsolete and unhygienic.
The black men remained housed in temporary wooden buildings they had oc-
cupied since the late 1860s. The medical superintendents routinely condemned
these buildings as retraps and pleaded with the legislature to replace them with

of the Pennsylvania Hospital in Philadelphia between 1841 and 1865 include those of twenty-
seven patients from South Carolina. Between 1866 and 1905, the number of South Carolina
patients at that hospital shrank to ve. McCandless, Moonlight, Magnolias, and Madness, 145,
313 n. 6, 360.
35 AR, 18823, 225, 18878, 15, 579, 1900, 1516; Journal of the South Carolina House of
Representatives, 1904, 24; Grob, Mental Illness in America, 256.
36 AR, 18751911; Grob, Mental Institutions in America, 3078; Grob, Mental Illness and
American Society, 24, 17988, 1956.
37 AR, 187085.
 South Carolina Lunatic Asylum, 18281920 187

permanent brick structures, but to little effect. The markedly inferior accom-
modation allotted to the blacks did not arouse much concern among the white
politicians who dominated state government after Reconstruction. Between the
late 1870s and 1890s, they stripped blacks of their civil rights and established
racial segregation and white supremacy.38
The problem of getting permanent facilities for the black insane was compli-
cated by divisions among white politicians over long-term policy towards their
care. One group, upset by the proximity of the races as well as the difculties
of managing a multi-racial institution, wanted to establish a separate institution
for blacks, a solution adopted by several other southern states shortly after the
Civil War. Another group favoured retaining a single institution for both races
on grounds of economy and ease of administration. The legislature did not
begin to resolve the issue until 1910, when it authorized the purchase of a tract
of land several miles from Columbia for the purpose of erecting a second state
hospital. Development of this site, known as State Park, was slowed and at times
suspended by insufcient appropriations, disagreement over its purposes, and
the opposition of Governor Coleman Blease (191014). He objected to spend-
ing white taxpayers money on providing a new hospital for blacks. Instead,
he proposed to convert the state penitentiary into an asylum for blacks.39 His
opposition was eventually overcome and a transfer of black patients to State
Park began in 1914. But development was slow, and the last black patients were
not removed from the old state hospital until the 1930s.40 The failure to develop
a second institution for the black insane before the First World War forced the
asylum authorities to provide permanent accommodation at the Columbia loca-
tion. In 1893, the legislature approved construction of a brick building for black
men but allocated no money until 1897, when it appropriated a paltry $7,500.
Black patients excavated the foundation, convicts made some of the brick, and
the demolition of an old brick wall provided the rest. The total cost to the state
of the building, designed for 200 patients, was only $21,000.41
While the new building for black men was under construction, in 1895, the
South Carolina Lunatic Asylum changed its name to the South Carolina State
Hospital for the Insane. Superintendent James Woods Babcock proposed the
38 AR, 187798; Report of the Legislative Committee on the State Hospital (Columbia, SC, 1910),
7; I. A. Newby, Black Carolinians (Columbia, SC, 1973), chapter two; Lander, History of South
Carolina, 1067.
39 AR, 18801, 18, 18878, 1213, 18889, 78, 18923, 6, 1115; 1902, 12, 1904, 68, 1908,
24, 1910, 58; Journal of the South Carolina House of Representatives, 1887, 25; Report and
Proceedings of the Special Legislative Committee to Investigate the State Hospital for the Insane
and State Park (Columbia, SC, 1914), 5960, 6970; Hughes, Black Mental Illness in Alabama,
441.
40 AR, 191435. The state hospitals were integrated in 1964.
41 AR, 18938; Notes on Page Ellington, James Woods Babcock Papers, SCL; MBR, 8 February
1912; Testimony, Taken Before the Legislative Committee to Investigate the State Hospital for
the Insane at Columbia (Columbia, SC, 1909), 3935.
188 Peter McCandless

change to emphasize that the institution was a hospital, not a prison or an

almshouse.42 Although Babcock intended no irony, by the time the asylum
became a hospital it was functioning largely as a custodial welfare institution.
The percentage of patients discharged as recovered fell from about 30 per cent
of those admitted in the 1870s to less than 17 per cent between 1902 and 1911.
The hospitals recovery rate was also worse than that in many other institutions.
In 1904, a special report of the United States Census Ofce revealed that the
South Carolina State Hospitals recovery rate was about 5 per cent below the
national and South Atlantic averages.43
The emergence of a custodial regime coincided with the decline of moral
treatment. During the late nineteenth century, asylum physicians everywhere
were losing faith in the therapeutic effectiveness of moral treatment, as they
confronted the accumulation of chronic cases in their institutions. Increasingly,
experts on insanity stressed that it was primarily somatic in origin, and that
psychological therapies were ineffective.44 In South Carolina, too, the retreat
from moral therapy was an adjustment to the changing nature of the hospital
population. But the change in South Carolina was perhaps more sudden than in
many other state hospitals because the patient population changed its nature so
rapidly and grew so much faster than the facilities or staff. With the violent, sui-
cidal, epileptics, idiots, criminally insane, feeble-minded and senile of all ages
mixed through overcrowded wards and segregated by race, a systematic pro-
gramme of moral therapy became virtually impossible. Traditional amusements
such as bowling, billiards, and carriage rides were sacriced to the demands of
retrenchment. In 1909, a legislative investigation claimed that the proportion of
the hospitals patients who participated in occupation and amusement was far
below the average for American hospitals. Most of the hospitals patients spent
their lives sitting in their rooms or wandering about the wards and grounds.45
The nature and purpose of employment also changed during the later nine-
teenth century. It became more economic than therapeutic in nature and also
became differentiated by race. After the Civil War, the asylums ofcers in-
creasingly tried to cut costs by having patients do much of the institutions
cleaning, repair and general maintenance. Patients produced and mended their
own clothing, grew their own food, made bricks, dug foundations, and helped
erect buildings. As the number of black patients grew, black women patients
gradually took over most of the cleaning, laundry and kitchen work, and black
42 AR, 18923, 910, 18956, 8.
43 AR, 18707, 190213, patient statistics; Report of Legislative Committee on State Hospital,
478.
44 Dain, Concepts of Insanity, 12939, 2056; Grob, Mental Institutions in America, 2024;
Rothman, Discovery of the Asylum, 26587.
45 MBR, 3 January 1878; AR, 189293, 17; Report of Legislative Committee on State Hospital, 23,
315; Report and Proceedings of the Special Legislative Committee, 363; Testimony, Legislative
Committee, 889, 160, 3035.
 South Carolina Lunatic Asylum, 18281920 189

Table 7.4 Percentage of deaths of patients under

treatment, at the South Carolina State Hospital, at ve
year intervals, 18901915

Year All patients All black patients All white patients

1890 14 21 9
1895 13 17 9
1900 16 23 10
1905 13 17 9
1910 14 21 8
1915 18 27 11

Note. Averages are rounded to the nearest number.

Source. Annual Report, 188990, 18945, 1900, 1905, 1910, 1915.

men were assigned most of the menial work outdoors. The investigation of 1909
estimated that 40 per cent of the black patients were employed, but only 24 per
cent of the white women and 16 per cent of the white men. When it came to
amusement, however, the positions of the races was reversed. The hospital gave
white patients cards, a weekly dance, the use of a gramophone, and occasional
other entertainments. For black patients, the hospital provided no amusement.46
The use of mechanical restraint and seclusion also increased around the turn
of the century. The case histories of the period indicate routine use of restraint.47
Between 1891 and 1914, the hospital probably used mechanical restraint more
than at any time since the 1830s, and more than many contemporary American
mental institutions. According to the investigating committee of 1909, the av-
erage proportion of patients under restraint at any time in American hospitals
for the insane was 1 per cent. The committee estimated the proportion at the
South Carolina State Hospital at 7 per cent overall, and 10 per cent in the white
mens department.48
The worst consequence of the deteriorating conditions at the hospital was high
mortality rates, especially for black patients. Between 1890 and 1915 mortality
averaged about 14 per cent of the patients under treatment. As one can see from
Table 7.4, black mortality was more than double that of white patients. These
mortality rates were much worse than those of similar institutions in the nation
and region. In 1904, a special census report revealed that the mortality rate at
46 AR, 187794; MBR, 2 May 1878, 6 February, 3 April 1879, 14 July 1887, 1 August 1908;
Report of Legislative Committee on State Hospital, 315; Testimony, Legislative Committee,
613, 723, 80, 8890, 132, 1589, 1667, 25961, 27982, 3025, 408, 414, 430; Report and
Proceedings of the Special Legislative Committee, 509; Grob, Mental Illness and American
Society, 234.
47 SCSH, Case Histories, 1430; DMH, SCDAH.
48 Report of Legislative Committee on State Hospital, 402, 645; Testimony, Legislative
Committee, 4067; Grob, Mental Illness in America, 1719.
190 Peter McCandless

the South Carolina State Hospital was more than double the national average,
and almost double the average for the South Atlantic states. The black death
rate was double the regional average and more than double the national average
for blacks in mental hospitals.49
The above-average mortality was not entirely the result of substandard hos-
pital conditions. The extreme poverty of the states population contributed to it.
Many patients came to the hospital with severe physical illnesses, some on the
verge of death. Nor can the higher black mortality be blamed solely on the hos-
pital environment. Blacks in the general population had much higher mortality
and morbidity rates than whites.50 Yet the hospitals deciencies undoubtedly
increased its mortality rates. A diet heavy in corn meal, molasses and fatback
probably contributed to deaths from pellagra, a niacin-deciency disease whose
symptoms include skin lesions, diarrhoea and mental derangement, including
psychosis. Pellagra was rst diagnosed at the hospital in 1907 and its prevalence
may help account for the rapid increase in poor and black patients admitted to
the hospital around the turn of the century. The physicians attributed more than
1,100 deaths to pellagra between 1908 and 1914. Overcrowding helped spread
contagious diseases such as tuberculosis, the leading cause of death in the hos-
pital around the turn of the century. By 1909, the hospital housed 1,500 patients
in buildings designed for 1,000. Many patients slept in corridors or in dark,
poorly ventilated basement rooms which the chairman of the State Board of
Health compared to dungeons. The original asylum building, congested with
black women patients, had a mortality rate of over 34 per cent of the average
number of inmates in 1908 and over 28 per cent during the previous ve years.
In the recently constructed and badly overcrowded building for black men the
death rate averaged 27 per cent for the same period.51
A high ratio of patients to staff intensied the effects of the hospitals other
deciencies. The number of patients increased much faster than the number of
physicians and attendants. The ratio of patients to physicians rose from 105:1 in
1878 to 376:1 in 1909. Over the same period, the ratio of patients to attendants
rose from 10:1 to 18:1 in the departments for white women, white men and black
women, and to 36:1 in the black mens department. On one of the black mens
wards it was 55:1. These ratios were higher than in most other state hospitals
in the nation and region. In 1894, the nine state hospitals of New York had an

49 AR, 18901915; Report of Legislative Committee on State Hospital, 4750; US Bureau of the
Census, Insane and Feeble-Minded in Hospitals and Institutions, 1904 (Washington, DC, 1906),
table 37, 1968.
50 E. H. Beardsley, A History of Neglect: Health Care for Blacks and Mill Workers in the Twentieth-
Century South (Knoxville, Tenn., 1987), 1141; Newby, Black Carolinians, 11421, 21117.
51 AR, 1907, 11, 190814, statistical tables; Report of Legislative Committee on State Hospital,
506; Testimony, Legislative Committee, 4224, 432. John Hughes found conditions for blacks in
the Alabama State Hospital similar to those in the South Carolina institution, although mortality
rates were lower in the former. See Hughes, Black Mental Illness in Alabama, 4505.
 South Carolina Lunatic Asylum, 18281920 191

average patient-physician ratio of 171:1. In 1923, American mental hospitals

averaged 234:1. Around the turn of the century, the ratio of patients to attendants
in American mental institutions averaged about 12:1; in the south, it averaged
15:1.52
The patients at the South Carolina State Hospital were among the worst cared
for in the nation in the early twentieth century. For most of them, especially
the blacks, the hospital was unable to full even the minimal expectations of
the custodial role. The majority report of the investigating committee of 1909
charged that the hospitals custodianship is a menace to the health and life of
these aficted citizens.53 Yet it took another damning legislative investigation
in 1914 to bring about improvement. The election that year of the Progressive
Richard Manning as governor reected a growing perception that the state had
fallen embarrassingly behind the rest of the nation. Capitalizing on this view,
Manning secured a series of reforms designed to modernize and improve the
administration of public institutions. At the state hospital, mechanical restraint
was eliminated, the use of drugs to sedate patients decreased, and opportunities
for occupation and recreation increased. By 1920, the mortality rate had fallen
to 10 per cent.54
Within a few years, practices at the state hospital came closer to those pre-
vailing at similar institutions in other states. Yet the patients care remained
substandard in many respects. Overcrowding continued to be a serious prob-
lem. Although mortality rates for patients of both races continued to fall, blacks
continued to die at signicantly higher rates than whites.55 Mannings reforms
may have brought the hospital closer to the mainstream of American psychi-
atry, but the founders goals a curative asylum for all of South Carolinas
insane remained elusive. Since the Civil War, the institution had experienced
a marked deterioration that was difcult to overcome. To a large extent, this
development resulted from the states steep economic decline and destructive
political struggles. But it also reected the scal, social, and racial outlook
of the white establishment, combined with radical changes in the institutions
clientele and function. The result was that an institution established as a house

52 AR, 18767, 21, 18778, 1891, 1909, 1911, statistical tables; MBR, 5 July 1877, 11 June 1891,
15 June 1893, 18 May 1909; Report of Legislative Committee on State Hospital, 24; Testimony,
Legislative Committee, 423; US Bureau of the Census, Patients in Hospitals for Mental Diseases
in 1923 (Washington, DC, 1926), 240; Grob, Mental Illness in American Society, 19.
53 Report of Legislative Committee on State Hospital, 50.
54 R. M. Burts, Richard Irvine Manning (Columbia, SC, 1974), esp. 8791, 11415; Correspon-
dence Relating to State Hospital, 191518, Governor Richard I. Manning III Papers, SCDAH;
AR, 1915, 47, 1527, 1920, 8; Journal of the South Carolina House of Representatives, 1916,
804.
55 A. P. Herring, Report to the Hon. Richard I. Manning Governor of South Carolina, on the State
Hospital for the Insane (Columbia, SC, 1915), 9; AR, 1917, 6, 1921, 11, 19, 1922, 8, 16, 1925,
4, 17, 1926, 6, 1819, 1930, 89; Annual Report of the State Board of Public Welfare, 1920, 61,
1921, 53, 1922, 12, 1923, 7186.
192 Peter McCandless

of cure was unable to provide even basic custodial care to patients increasingly
marginalized by chronic disease, poverty and race. The history of the South
Carolina Lunatic Asylum and State Hospital illustrates how the broader politi-
cal, economic, social and racial context could profoundly inuence the internal
workings of mental institutions, and effectively undermine the aims of their
founders.
8 The state, family, and the insane in Japan,
19001945

Akihito Suzuki

A brief look at the history of psychiatric connement in Japan from the

Meiji Restoration (1868) to the Japanese experience of the Second World War
(19415) must give a sense of deja-vu to those familiar with its European coun-
terparts in the nineteenth century. A cause celebre of wrongful connement
led modern Japan to the Mental Patients Custody Act (1900), its rst national
legislation for regulating the connement of lunatics. In 1919, the effort of
a few eminent psychiatrists, as well as the initiative of health ofcials at the
central government, led to the Mental Hospitals Act (1919), which promoted
hospital-based provision for the insane. Under these two acts, psychiatric provi-
sion in pre-war Japan expanded rapidly in the rst four decades of the twentieth
century, just like its empire in the Far East. Especially when compared with
the situation in England in the late eighteenth and early nineteenth century,
one is struck by the similarities. When the two countries started to conne the
insane on a large scale, with an interval of about one century, they were both
in the turmoil of industrialization, which perhaps acted as a kind of predispos-
ing condition to the rise of asylum. Moreover, England and Japan shared three
important factors in their creation of asylum-based psychiatric provision: the
impetus given by expose of the abuse of psychiatric connement, the initia-
tive taken by the central government, and the establishment of a psychiatric
profession.1 The rise of journalism and public opinion, the re-denition of
the relationship between the central and local governments, and the arrival of
a professional society, all left their stamp on the making of asylumdom both in

I would like to thank Dr Kazushige Komine, who has kindly allowed me to consult the archive of
Oji Brain Hospital, and Ms Kaoriko Yokozawa, whose efcient assistance has been vital to the
conduct of this research. I should also like to thank Professor Kenichi Tomobe and Dr Takeshi
Nagashima at Keio University, whose encouragement and comments have been invaluable. Parts
of this chapter were read at a Seminar for the Research Group of History of Psychiatry and
the International Workshop for the History of Psychiatric Hospitals, held at Keio University in
December 2000. I should like to extend my thanks to those who attended the seminar and the
workshop, particularly to Dr Yasuo Okada. The research for this chapter has been generously
funded by the School of Economics of Keio University.
1 For the situation of psychiatric provision in England in the nineteenth century, A. Scull, The Most
Solitary of Afictions: Madness and Society in Britain, 17001900 (New Haven, Conn., 1993)
remains the most comprehensive work.

193
194 Akihito Suzuki

Japan and England. Such similarities, obvious at a most cursory glance at two
randomly selected countries, entice historians to seriously engage in in-depth
and comparative socio-cultural studies in the history of psychiatry, one of the
principal aims of this volume.
One can as easily spot major disparities between psychiatric provision in pre-
war Japan and other European and North American countries. One of the most
important differences is the sheer size of institutionalized population. Pre-war
Japan conned only a fraction of the mentally disordered within the walls of
asylums. In 1919, on the eve of the Mental Hospitals Act, there were only about
3,000 patients conned in mental hospitals, which is a remarkably small number
for a nation of the population of about 55 million. England and Wales in the same
year had about 35 million population and more than 100,000 asylum inmates.2
The 1919 Act rapidly increased the number of those conned, but in 1940 the
gure reached just around 22,000, still lagging far behind countries in the
West. The Second World War and post-war upheavals subsequently paralysed
Japanese mental health care. The National Institute of Mental Hygiene reported
in 1953 that at that time there were in Japan 18,527 psychiatric beds or 22.6
per 100,000; the corresponding gures for England was 313 beds per 100,000,
278 for USA, and 497 for New Zealand. Even Italy, another defeated power,
had 134 psychiatric beds per 100,000.3 Pre-war Japan thus did not witness the
full-bloom great connement, which was a common feature in many western
countries discussed in this volume.
The restricted growth of asylum accommodation has been mainly explained
by Japan being a latecomer. From the early twentieth century through to the
present, there have been abundant discourses that criticize the inadequacy of
Japanese psychiatric provision and relate it to the hidden backwardness of
a state with impressive military or economic prowess. There is considerable
historical truth and moral wisdom in this line of interpretation. This view,
however, masks some crucial issues, which have been the subject of intense
debate in the recent historiography of psychiatry. Most importantly, criticizing
psychiatric provision in pre-war Japan for backwardness tacitly assumes that
hospitalization of the insane was an inevitable or natural step at a certain stage of
the evolution of psychiatric social policy. One of the major achievements in the
history of psychiatry in the last twenty or thirty years is to have demonstrated that
the great connement was a product of intense conict, political manoeuvres,
and specic historical forces, being far from a pre-destined social phenomenon.4
2 Scull, The Most Solitary of Afictions, 33474.
3 National Institute of Mental Hygiene, Seishin Eisei Shiryo [Sources for Research in Mental
Hygiene], 1 (1953), 21.
4 Literature on this subject is now too vast to be listed here. For a useful and insightful overview
of the latest scholarship, see J. Melling, Introduction, in B. Forsythe and J. Melling (eds.),
Insanity, Institutions and Society: A Social History of Madness in Comparative Perspective
(London, 1999).
 State, family and the insane in Japan, 19001945 195

Without either reducing pre-war Japanese psychiatric provision to a botched

attempt at mimicking western practice nor romanticizing it as an alternative
to western-style modernity, this chapter will try to analyse its pattern, content
and shortcomings within its own context and parameters.
Particular emphasis will be laid on the role of the family. As has been em-
phasized by Patricia Prestwich in the French context and David Wright in the
English one, the major actor in decision-making in psychiatric committals was
normally the family.5 In many cases, the family decided what should be done to
control the troublesome and troubled family member; whether he or she should
remain at home and under family management, or whether he or she should be
sent to an institution to become its inmate, and if so, which type of institution
should be utilized. The history of the family and its internal dynamics, its soli-
darity, and its codes of behaviour for its members, are thus a crucial part of the
history of psychiatric institution in many countries in Europe. Moreover, many
recent studies in the social history of psychiatry have revealed that the role of
the family in psychiatric committal and institutionalization is best understood
in the context of the familys interaction with its neighbours, its relationship
with the local and the central governments, and its negotiation with the asylum
doctors it consulted.6 This chapter attempts to bring this family-centred con-
texualist model into the relatively uncharted landscape of Japanese psychiatric
provision in the earlier half of the twentieth century.
The major sources this chapter uses are twofold. The rst is a series of Annual
Reports of the Department of Hygiene (ARH) which was issued annually by
the Central Sanitary Bureau (CSB) in the Ministry of Home Affairs and, after
1938, by the newly created Ministry of Health and Welfare. Although the data
published in ARH constitute the most basic material for any historian interested
in medicine, disease and hygiene in modern Japan, this indispensable set of
sources has not been used extensively by historians of Japanese psychiatry.7
From 1905, ARH included detailed statistical tables of mental patients, and
from 1928, a list of all mental hospitals and the numbers of patients kept in
each hospital, with annual admissions, discharges and deaths. My statistical
account below is drawn mainly from compiling the tables published in ARH.

5 D. Wright, Getting Out of the Asylum: Understanding the Connement of the Insane in the Nine-
teenth Century, Social History of Medicine 10 (1997), 13755; P. Prestwich, Family Strategies
and Medical Power: Voluntary Committal in a Parisian Asylum, 18761914, Journal of Social
History 27 (1994), 799818. See also chapters by Wright, Moran and Gouglas, and Prestwich,
in this volume.
6 Two recent collections of essays that emphasize this direction are: Forsythe and Melling (eds.),
Insanity, Institutions and Society; P. Bartlett and D. Wright (eds.), Outside the Walls of the Asylum:
The History of Care in Community 17502000 (London, 1999).
7 Annual Reports of the Department of Hygiene for the period 18771926 have been reprinted as
Meiji-ki Eisei-kyoku Nenpou [Annual Report of the Department of Hygiene in Meiji Era] (Tokyo,
1992) and Taisho-ki Eisei-kyoku Nenpou [Annual Report of the Department of Hygiene in Taisho
Era] (Tokyo, 1993).
196 Akihito Suzuki

These aggregate data are supplemented by statistical analysis of admission

registers and individual patients case records at Oji Brain Hospital (OBH).
Established in 1901 in Takinogawa in the northeast suburb of Tokyo, OBH was
one of the rst private psychiatric hospitals in Tokyo. Its extremely detailed,
voluminous and uncatalogued case records from around 1920 to 1945 have
survived intact, with other archival materials, which are now held by Komine
Research Institute for History of Psychiatry run by Dr Kazushige Komine, a
practising psychiatrist and historian of psychiatry based in Tokyo. From this
formidable archive, I have been able to examine systematically admission reg-
isters between 1925 and 1945 and about ninety case records of the patients
discharged in 1935.
As well as these hitherto unexamined materials, this chapter relies heavily on
works of two outstanding Japanese scholars. The rst is Yasuo Okada, whose
voluminous works based on painstaking research into the history of psychia-
try in Japan from the late nineteenth century onwards, deserve to be known
beyond the small circle of Japanese historians of psychiatry. His history of
Matsuzawa Hospital is a 650-page magnum opus, that (literally) chronicles the
most important psychiatric institution in Japan. It will perhaps remain unsur-
passed in its exemplary care about historical details and rm grasp of day-to-day
activities within the hospital, where Okada himself worked in his youth as a
medical doctor.8 Okada has also excavated numerous important medical arti-
cles, newspaper reports and archival materials and has made them available
through reprints with invaluable comments.9 Less voluminous but historio-
graphically more sophisticated are works by Genshiro Hiruta (who is also a
practising psychiatrist) whose Hayari-yamai To Kitsune-tsuki [Epidemics and
Fox-Possession] is an in-depth study of medical and psychiatric history in small
villages in northern Japan in the longue-duree from 1703 to 1867.10 Although
Hirutas work examined a very different area and a much earlier age than my
own, his insightful arguments turned out to be a constant source of inspiration
for this chapter.
The account below is divided into three parts. The rst section will briey
examine the two laws which structured psychiatric provision in Japan before
the Second World War, namely the Mental Patients Custody Act (1900) and
Mental Hospitals Act (1919). Emphasis will be laid on both the continuity

8 Y. Okada, Shisetsu Matsuzawa Byoin-shi: 18791980 [Matsuzawa Hospital: A Private History,

18791980] (Tokyo, 1981). Other major works of Okada include two biographies of pioneering
psychiatrists in Japan: Kure Shuzo: Sono Shougai To Gyouseki [The Life and Works of Kure
Shuzo] (Kyoto, 1982); Saito Mokichi No Shougai [The Life of Saito Mokichi as a Psychiatrist]
(Kyoto, 2000).
9 The most important collection of materials is Y. Okada and S. Sakai (eds.), Kindai Shomin
Seikatsu-shi, vol. XX, Byoki / Eisei [Social History of the Lives of Populace in the Modern Age,
vol. XX, Disease and Hygiene] (Tokyo, 1995). Hereafter this work is referred to as SHDH.
10 G. Hiruta, Hayari-yamai To Kitsune-tsuki [Epidemics and Fox-Possession] (Tokyo, 1985).
 State, family and the insane in Japan, 19001945 197

from earlier times and the innovative nature of this legislation. The second part
will investigate the statistical proles of mental patients and hospitals during
1905 to 1941, and examine the rise and fall of various styles of care of the
insane. Particular attention will be paid to care and connement at home, both
because ofcial sanctioning of connement at the patients own home is a
highly idiosyncratic practice if seen from the viewpoint of modern European
practice, and because this home custody provided an important prototype for
management of the insane practised in other loci of care. The third section will
cast a brief look at the early history of OBH and its patients, in order to examine
some issues discussed in the previous two sections in the context of one specic
institution. The limit of the space only allows me to address a few points from
this rich archive, and I will be very selective in my choice of the insights drawn
from the intimate life stories of madness at mental hospitals in Japan in the
early twentieth century.

Home or hospital?: Mental Patients Custody Act (1900)

and Mental Hospitals Act (1919)
Like early modern European countries, the apparently sole concern of public
authorities over lunatics in Japan in earlier times was to prevent the harm done by
the insane in the administrative context and to regulate penalties for crimes done
under reduced mental capacity in the forensic context.11 Particularly prominent
was the fear of lunatics at large, wandering on the city street and the country
eld, committing or threatening violence on the person and property of others,
setting re to buildings, and so on. Hirutas study has revealed that lunatics (who
were sometimes, but not very often, regarded as possessed by a fox or other
animal) in small northern villages in the Edo period (16031867) were put in
sashiko, or a makeshift cage set up next to their own house. Especially furious
ones were further handcuffed or chained in their cages.12 In Edo, recourse was
taken to the prisons and poorhouses for keeping vagrants and the sick poor, as
well as putting the patient in the cage at his or her own house.13 Lunatics were
seen and treated in the framework of their threat of violence against themselves
and others, and connement and bodily restraint were the order of the day. In
short, they posed a problem to the police, which is a familiar background to
understanding insanity in many societies.
11 For an overview of the concept of medical and legal insanity in earlier Japan, see G. Hiruta,
Nihon No Seishin-iryo-shi [History of Japanese Psychiatry], in M. Matsushita and G. Hiruta
(eds.), Seishin-iryo No Rekishi [History of Psychiatric Practice] (Tokyo, 1999), 3564.
12 Hiruta, Hayari-yamai To Kitsune-tsuki, 56126.
13 H. Kuwahara and K. Itahara, Edo-jidai Kouki Ni Okeru Seishin Shougaisha No Shogu,
[Management of the Mentally Handicapped in Late Edo Period], parts IV, Shakai Mondai
Kenkyu [Studies in Social Problems], 48 (19989), 4159; 49 (19992000), 93111 and
183200; 50 (20001), 7994 and no. 2, 145.
198 Akihito Suzuki

The Meiji Restoration in 1868 put an end to the semi-feudal rule of the
Tokugawa Shogunate (16031867) and restored the emperor as the head of
the centralized state modelled after western countries (particularly Germany).
The restoration did not immediately change policies towards the insane. The
emphasis on the necessity of controlling the violence of lunatics persisted, with
strong associations of insanity with ferocity of animals on the loose. Early
police rules of the city of Tokyo soon after the Meiji Restoration put the rules
for the regulation of lunatics next to those about unrestrained and dangerous
animals on the street, such as oxen, horses and mad dogs.14 Through successive
legislation between 1878 and 1884, the basic pattern for administrative control
over dangerous lunatics was completed in Tokyo. When necessary, lunatics
were ordered to be kept in custody either in their own house or a hospital, and
the local police visited the place of their abode once a month. Although details
remain to be investigated, evidence suggests that similar rules were established
by local governments in other areas.15
Perhaps the most important element in this concern of the policing of the
lunatics at large was that of the responsibility of the family for the management
of its disorderly member. Although the evidence is patchy, Hirutas examples
from small villages in the Edo period and Okadas evidence from the already
highly modernized and then rapidly westernized metropolis concurred on this
point of the familys duty to be vigilant over their dangerous insane member.
In one of the villages studied by Hiruta, when a lunatic son escaped from
his fathers house and killed two villagers and himself, the father was punished
severely for the neglect of his duty. Half of the fathers property was conscated
and he was expelled from the village.16 The 1882 Old Criminal Code ned
between 50 sen and 1 yen 50 sen those who failed to perform the duty of
the custody of the mad and let them wander on the street. As Okada has
rightly pointed out, the lunacy problem in late nineteenth-century Japan was
thus characterized by the convergence of two elements the police and the
family.17 Perhaps the most striking element is the ease with which a prison-like
facility was created in a private house with the sanction, and at the instigation,
of public authority.
Predictably enough, the tradition of incarceration at home made the situation
open to a type of abuse familiar in the history of psychiatry, namely wrongful
connement, or shutting up a person on the false pretence that he or she was

14 Y. Okada, Seishin Eisei Hou [Mental Hygiene Act] in Gendai Seishin Igaku Taikei [An Outline
of Modern Psychiatry], vol. v-c (Tokyo, 1977), 35197, 3534.
15 See the speech of Toshio Saito in the House of Commons in the Imperial Diet, Teikoku Gikai
Shugi-in Giji Sokkiroku [Parliamentary Debates in the House of Commons] (Tokyo, 197985),
19 February 1900.
16 Hiruta, Hayari-yamai To Kitsune-tsuki, 11213. 17 Okada, Seishin Eisei Hou, 3535.
 State, family and the insane in Japan, 19001945 199

insane.18 In 1885, the nation was shocked by the Soma case, in which a former
feudal lord (Daimyo) was conned under dubious pretence. The Soma case
revealed the glaring defect of the system and exemplied how easily one could
be conned illegally. A call for new legislation quickly gained momentum.
In 1898 a governmental committee was appointed to study psychiatric laws in
western countries, particularly those of England, and one high government of-
cial with a medical background agitated for a major reframing of the regulations
of the insane in the light of trends in western medicine.19 Another motive for the
new legislation was to demonstrate legal maturity of Japan towards the western
countries, which had still maintained a colonialist tariff policy and allowed only
semi-independent status to Japan on the justication that the Japanese legal sys-
tem was not modern enough for it to be granted an autonomous status in the
international community. These concerns culminated in the Mental Patients
Custody Act in 1900.
This rst piece of national legislation regulating the connement of the in-
sane aimed both at the prevention of wrongful connement and the secure
custody of lunatics. For the former purpose, the Act took a straightforward but
fresh approach, by newly criminalizing unjust or improper connement, and
set heavy nes and penalties on those who detained a sane person or improp-
erly conned an insane person, and on those doctors who issued an improper
certicate of lunacy.20 In contrast, in order to achieve the second aim, the Act
not so much created something new as codied the old practice. In essence,
the Act demanded that if one wanted to have a lunatic conned, one should
do so by appointing a custodian, who was responsible for the provision, care
and connement of the patient. Only the custodian was allowed to conne the
lunatic, and he or she could do so only with the permission of the authority
of the local government of city, town or village. When a competent custodian
could not be found, the administrative head of the city, town or village in which
the patient lived, would assume the status of the custodian. The place of con-
nement should be licensed by the administrative head and should meet special
requirements for the safe custody of the patients: normally, the place was ei-
ther the custodians house or a mental hospital or mental ward of a general

18 From the numerous studies of wrongful connement in England, see particularly R. Porter, The
Social History of Madness (London, 1987); M. Clark, Law, Liberty and Psychiatry in Victorian
Britain; an Historical Survey and Commentary, c. 1840 c. 1890, in L. de Goei and J. Vijselaar
(eds.), Proceedings of the First European Congress on the History of Psychiatry and Mental
Health Care (Rotterdam, 1993), 18793; P. McCandless, Liberty and Lunacy: The Victorians
and Wrongful Connement, in A. Scull (ed.), Madhouses, Mad-Doctors, and Madmen: the
Social History of Psychiatry in the Victorian Era (London, 1981), 33962.
19 Okada, Seishin Eisei Hou, 3545.
20 Teikoku Gikai Kizoku-in Giji Sokkiroku [Parliamentary Debates in the House of Lords] (Tokyo,
19791985), no.12, 20 January 1900 and no. 21, 10 February 1900.
200 Akihito Suzuki

hospital. If the custodian wanted to conne the patient at his or her own house,
he should do so rst by seeking permission from the local administrative head
and making a petition which included a detailed plan of the place and cage. Local
police and/or doctors were ordered to inspect the place of connement as often
as necessity arises (how often varied from place to place). To ensure that the
patient should not escape and do harm to others, he or she kept under custody at
the custodians house was put in a cage set up there. Perhaps both to allow light
and air to the place and to facilitate vigilance over the conned, a latticework,
with a window to serve food for the patient, seems to have been a norm. This
meant extremely high visibility of the patient in connement, and those now
in their sixties or seventies still retain vivid memories of chilling horror
and dark fascination when they saw a furious patient through a lattice cage.
Despite the rhetoric of modernization and protection of human rights sur-
rounding this piece of legislation, a core part of the Mental Patients Custody Act
was a national and legal conrmation of a long-standing local semi-customary
practice. First, the custody was done in a small social and administrative unit,
exclusively the business of the family and/or the local authority (city, town and
village). It determined who should pay the cost for conning the patient, and
whether in a hospital or at a private house. In contrast, the involvement of the
central or intermediate local government (fuken or prefecture) in the imple-
mentation of the Act was nil. Secondly, the pattern of the family asking the local
authority for permission to conne the patient in their own house had a long
tradition. As Hirutas work has demonstrated, since the Edo period, putting
a lunatic in a sashiko was by no means a purely private business, and there
existed a fairly strict procedure: those who wanted to set up a sashiko had to
rst ask the permission of the village authority who, at the petition, examined
the patient and the place of connement and referred the case to the legal court
of the han (a semi-independent feudal state) for the nal approval.21 Mutatis
mutandis, this procedure was exactly what the Mental Patients Custody Act
decreed. Particularly important here is the question over who should be a cus-
todian of the patient. Although the legal guardian was named at the top of
the list of possible custodians, Earl Ogimachis explanation to the House of
Lords in 1900 reveals that this was made merely for legal cosmetic purposes,
in order to make this law consistent with other civil codes. The government
conceived of the business of custody primarily as the private discretion of the
head of the household over matters within the household, rather than that of
a guardian, who could hail from outside the household and whose power was

21 Hiruta, Hayari-yamai To Kitsune-tsuki, 10711. Cases of procedure in a similar spirit are to be

found also in Edo. See Yasuo Okada, Edo-ki No Seishin-ka-iryo [Psychiatry in the Edo Period],
in Masa-aki Matsushita and Genshoiro Hiruta (eds.) Rinsho Seishin Igaku Kouza [Encyclopedia
of Clinical Psychiatry] Supplement 1 (Tokyo, 1999), 2323; Kuwahara and Itahara, Edo-jidai
Kouki Ni Okeru Seishin Shougaisha No Shogu.
 State, family and the insane in Japan, 19001945 201

based upon contract.22 The Custody Act thus ofcially sanctioned the natural
power and responsibility of the head of household over his family members, as
well as nationally codifying the long-standing local and customary rules of the
domestic connement of lunatics under public control. An important aspect of
the Mental Patients Custody Act is that it did not aim for the encouragement or
enforcement of psychiatric connement. Actually, the Act made connement
more difcult, both by penalizing improper detention and by setting a standard
for home custody, the cost for which (alteration to the building to meet the stan-
dard, latticework, lock and so on) was to be met by the custodian. The goal of
the Act was the regulation of connement, and to make it both legal and strict.
The promotion or numerical increase of connement was neither the stated aim
nor the likely effect of the Act, as I shall discuss in detail below.
The expansion of connement in hospital was exactly what the Mental Hos-
pitals Act attempted. Again, several factors seem to have converged to effect
its creation. The most prominent was the glaring fact that psychiatric provision
was badly in short supply. In the House of Commons, Takejirou Tokonami,
then Minister of Home Affairs, repeatedly cited the gure that only 4,000 out
of 60,000 mental patients were conned in hospitals, and emphasized that this
rate of connement was far below the western standard and a national shame.
Another reason frequently raised at the parliament was the wretched situation
of some of the patients under home custody, revealed by a massive four-part re-
port written by the team of Shuzo Kure and Goro Kashida, the former being the
leading gure in psychiatry in Japan: Professor of Psychiatry at Tokyo Impe-
rial University and the head of the Tokyo Metropolitan Hospital at Matsuzawa
(hereafter Matsuzawa Hospital), then the only public asylum in Japan. The
report was far from a work of sensationalistic journalism, but was published
in a leading medical journal at that time, based on a painstaking, detailed and
rigorous survey of about 400 cases of home custody, conducted intermittently
from 1910 to 1914.23 I shall come back to this enormous piece of work below,
but sufce it to say that Kures condemnation of cases of home custody was
no doubt a part of the almost universal strategy of psychiatrists to medicalize
the realm of the care of the insane and exclude non-medical, lay or unquali-
ed practitioners. The fact that the report included a critical and condemnatory
survey of the practice of religious and folk healing of insanity betrays the ulti-
mate motive of the authors of the report. Although their condemnation of the
22 Teikoku Gikai Kizoku-in Giji Sokkiroku, 10 February 1900.
23 S. Kure and G. Kashida, Seishin Byosha Sitaku Kanchi: Jikkyo Oyobi Sono Toukei-Teki
Kansatsu [Home Custody of Mental Patients: Its Situations and Its Statistical Observations],
Tokyo Igaku-kai Zasshi [Journal of the Medical Society of Tokyo], 32 (1918), cases 52156,
60949, 693720, 762806. A work in a similar vein is S. Ishikawa, Seishin-byousha No
Kanchi Ni Tsuite [On the Custody of Mental Patients], Kokka Igaku-kai Zasshi [Journal of
State Medicine] 236 (1906), 77990. Kure and Kashidas work has been reprinted and published
by Seishin-igaku Shinkeigaku Koten Kankou-kai in 1973 and re-issued in 2000.
202 Akihito Suzuki

practice of conning the patient in a private house was sincere, and almost cer-
tainly motivated by genuine concern over the plight of the patients conned in
a cage and exposed to the gaze of neighbours, emphasizing the horror of home
custody was, at the same time, a convenient lever towards creating hospitals,
which meant stable and prestigious jobs for psychiatrists and the enhancement
of their role in the medical machinery of the state.24
Another push towards hospitalization came from a renewed and revitalized
fear of the danger posed by unconned patients. This time, however, the image
of the dangerous lunatic was not the traditional one of the wild animal, but
rather that of criminal monomaniacs. The fear became more intense, because
these monomaniacs were apparently normal except for one single issue and thus
difcult to spot, unlike the all-too-obvious savageries of classic maniacs. At the
House of Commons in 1918, Kiichi Saito, an MP and the founder of Aoyama
Brain Hospital, delivered a long speech accusing the government of leaving
numerous dangerous lunatics at large.25 Amid the jeering of Shorter! Shorter!
and Cant see what you mean!, Saito conjured up the dark threat posed by
homicidal monomaniacs, arson-monomaniacs, theft-monomaniacs and rape-
monomaniacs, the number of which were all allegedly increasing. Although
the governments explanation of the purpose of the new Bill was less hysterical
than Saitos panic-mongering, it nevertheless frequently referred to a handful
of criminal lunatics (estimated at about 150) and talked about a plan of erecting
a national hospital for conning dangerous monomaniacs.26 The scare raised
by the supposedly rapid increase of dangerous monomaniacs who lurked on the
street played perhaps an important role in passing the Bill in 1919.
With these concerns as the major driving forces, the Mental Hospitals Act
(1919) was conceived in a very different spirit from the Custody Act. While the
earlier Custody Act was centred around the prevention of wrongful connement
and the regulation of psychiatric custody, the major aim of the new Act was the
expansion of hospital-based public provision for mental patients. To achieve this
goal, the Act empowered the Minister of Home Affairs to order the prefectures
to build public asylums in which poor patients were to be kept, and that half of
the cost for building the hospital and one-sixth of the cost for maintaining the
patients would be covered by the central government. From the viewpoint of
both central and prefectural governments, however, it must have been deemed
unrealistic to expect speedy completion of a nationwide system of hospital-
based provision based only on purely public resources, for there existed only

24 The classic studies of the history of psychiatry from this perspective in nineteenth-century Britain
and France are, respectively, Scull, The Most Solitary of Afictions and J. Goldstein, Console
and Classify: The French Psychiatric Profession in the Nineteenth Century (Cambridge, 1987).
25 Teikoku Gikai Shugi-in Giji Sokkiroku, 6 March 1918, a question entitled Why Does the
Government Leave Numerous Mental Patients at Large When They Disturb the Public Order?
26 Ibid., 23 February 1919.
 State, family and the insane in Japan, 19001945 203

one public asylum, which was in Tokyo and housed about 450 patients in 1918.
In contrast, in the same year there already existed fty-seven private psychiatric
hospitals, with total capacity for about 4,000 patients.27 Most crucially, many
of the private mental hospitals admitted patients whose cost for staying at the
hospital was paid by their local authority, either through the Mental Patients
Custody Act or otherwise. From the viewpoint of private psychiatric hospitals,
keeping public patients brought the benet of stable income from long-term
stay, while from that of public authority, they provided a place to conne dan-
gerously insane patients whose family could not take sufcient care of them.28
In short, there already existed a large mixed sector in psychiatric provision. The
Mental Hospitals Act codied this practice of conning patients in privately run
asylums at public cost. Some private asylums were allotted a certain number
of substitute (daiyo) beds, and were arranged to accept public patients up
to that number. Private mental hospitals thus appointed were called substitute
hospitals, which were to become the major provider of the care for the insane
in the next couple of decades. The manifest goal of all these procedures was
to expand hospitalization, an aim which was virtually absent in the Mental
Patients Custody Act.
Another important departure from the previous Act was the role of the state,
prefectures and the asylum doctor. As noted above, the Custody Act conceptu-
alized the control of lunatics on a small social scale. The business was done by
the family, relatives, neighbours and city, town or village. The Mental Hospitals
Act put the care in a larger social frame, namely that of the central state and the
prefecture. The cost of the provision for lunatics now would be met from the
budget of the prefecture, with help from the central government as noted above.
The head of prefecture now possessed enhanced powers to admit or discharge
a patient to public and substitute mental hospitals.29
Yet another beneciary of the new Act was the asylum doctor. Before, doc-
tors had little power over committal and discharge, which were at the discretion
of the custodian of the patient. Under the new Act, medical power increased
considerably. The doctor was now able to admit or discharge the patient only
with the sanction of the head of the prefecture. Having fended off the sugges-
tion of a system of external inspection by members of the city council, the
Act granted the asylum doctor tremendously increased power.30 Likewise, the
Japanese Association of Psychiatrists, a group established by Kure, acted as a

27 Kure and Kashida, Seishin Byosha Sitaku Kanchi, case 524.

28 The mutual dependence and benet of the public and private asylums in Tokyo is satirically
described in the serialized articles in Yomiuri Shinbun [Yomiuri News]. See SHDH, 183223.
29 For an account of the erce debate at the Diet over this enormous discretion given to the head of
prefecture, see M. Yuasa, Lectures on the Mental Hospitals Act, Shinkei-gaku Zasshi [Journal
of Neurology] 19 (1920), 48894 and 54350.
30 Ibid.
204 Akihito Suzuki

kind of professional consultant group for the law makers at the Central Sani-
tary Bureau and executor of the policy at the Metropolitan Police, and had a
certain say both in legislation and administration of the Act.31 Although the
archive of the association reveals more humiliation and bitter compromise of
the doctors vis-a-vis the high-ranked civil servants at CSB and the Metropolitan
Police, the chance to negotiate with those who virtually ran Japan and Tokyo
was obviously greeted by its members aspiring for a secure place in the ma-
chinery of the state.32 The role and the power of psychiatrists in the new Act
thus grew to a considerable extent, when compared with those dened in the
Custody Act, which referred to doctors mainly in the context of punishing their
misconduct. The new Act thus signalled the rise of the state, the prefecture, and
the psychiatrist vis-a-vis the family and the local government.

Progress of connement or persistence of domestic care?

Statistical analysis of psychiatric patients
In order both to assess the impact of the two Acts and to detect the trends
which prompted the legislation, as well as to describe the general picture of
psychiatric patients in early twentieth-century Japan, I should like to turn to the
presentation of statistical data and their analysis, compiled from tables in the
ARH.
Any discussion of psychiatric provision should start with a basic question,
namely, the number of patients. Figure 8.1 represents the numbers and rate (per
10,000) of the known mental patients from 1905 to 1941, published in ARH.
The gures were calculated by health ofcials by adding up the numbers of
three categories of patients, namely: (1) those who were found by a visiting
police ofcer as insane but regarded as unnecessary to be conned; (2) those
who were conned (either at home or in institution) under the Mental Patients
Custody Act; and (3) from 1919, those who were put into mental hospitals
under the Mental Hospitals Act.33 During the period under consideration, both
the actual number of the patients and the rate per population sharply increased,
the former having more than trebled and the latter having doubled. This growth
is rather difcult to interpret, like so many data in psychiatric epidemiology.
Did the increase in gures or rates represent real increase in disease occur-
rence, lowered tolerance towards the behaviour of the insane, or more effective
detection? Although many early twentieth-century Japanese commentators on
31 K. Komine (ed.), Nihon Seishin Byou-i Kyoukai Kiji [Archives of the Japanese Association of
Psychiatrists], (Tokyo, 1974).
32 Ibid., 145.
33 In addition, a small number of patients (about 100200) who were temporarily conned were
added to the gure. Also note that the gures in the tables published in ARH did not include
those who were put in a place of connement through a procedure based neither on the Mental
Patients Custody Act nor the Mental Hospitals Act. For a further discussion on this omission,
see note 51 below.
 State, family and the insane in Japan, 19001945 205

psychiatric issues maintained that the occurrence of mental disease was grow-
ing in accordance with the modernization of Japan, the Central Sanitary Bureau
was well aware that this type of argument did not hold true, even with a most
cursory look at the evidence. In its rst report on mental patients in 1905,
the CSB pointed out that although major urban areas such as Tokyo or Kyoto
showed relatively higher rates, the correlation between mental disease rate and
the extent of modernization ended just there. Osaka, with the second largest city
in Japan, had the second lowest rate, while rural areas such as Iwate, Saga and
Okinawa had higher rates.34 The pattern of regional variations in mental disease
rate continued to bafe the simple scenario of the link between civilization and
madness until the end of my period.
More promising is the line of argument that sees the growth in rate as a result
of increased awareness of those troubled in mind. Without adhering to the
simple scenario of linking civilization with intolerance toward madness, there
exist several reasons to suppose that some part of the increase of mental disease
during this period resulted from more effective detection of lunatics. Among
the factors which might have contributed to making the insane more visible,
the most powerful one is the public cult of emperor. The colossal ceremonies
for the burial of the old emperor and the accession of a new one involved a
massive policing of the entire population all over the nation and colonies. 35 In
order to prevent any disruption of the sacrosanct sobriety of the ceremonies,
an enormous number of local and special policemen were deployed to remove
the slightest possibility of disorder. At the accession of Emperor Hirohito,
according to a study by Yutaka Fujino, the particular target of scrutiny was
the Other in the Japanese society at that time Koreans, socialists, the urban
poor, those suffering from communicable diseases and the insane. To take an
example of Hyogo, a round-up survey of all households for mental patients and
other undesirable members of society was completed in ten days. Wandering
madmen were sought during three days from 7.00 a.m. to 4.00 p.m., which led
to the discovery of 229 new patients.36 Also imperial rituals of a more modest
size were accompanied by intensive search for mental patients. Indeed, in 1939
a doctor in Hiroshima tried to interpret the high patients rate of the prefecture
(twice as much as the national average) to frequent visits of the royal family
to important shrines in the area.37 The erection of the mausoleum of Emperor

34 ARH (1905), 5960.

35 Central Sanitary Bureau, Showa Tairei Eisei Kiroku [The Hygienic Report at the Showa Grand
Ceremony of Accession], (1929), reprinted in Showa Tairei Kiroku Shiryo [The Records of
the Showa Grand Ceremony of Accession], introduction by H. Nishi, F. Ogino, and Y. Fujino
(Tokyo, 1990).
36 Y. Fujino, Showa Tairei To Minshu No Seikatsu To Kenko [The Showa Grand Accession
Ceremony and Peoples Health], in Showa Tairei Kiroku Shiryo, 6586.
37 A Round Table for Mental Patients Protection Day, Wako [Harmonious Light] 6 (1939),
91108, 97. One police ofcer at the round table, however, refuted this argument by citing the
low rate of Mie, another prefecture visited frequently by the royal family.
 100000 20

90000 18

80000 16

70000 14

60000 12

50000 10
s
40000 8

No. of patients
Patients per 10,000

30000 6

20000 4

10000 2

0 0
1905 1910 1915 1920 1925 1930 1935 1940
Year

No. of patients Patients per 10,000

Figure 8.1 Number of patients

 State, family and the insane in Japan, 19001945 207

Yoshihito in 1926 in Tama Hill in the west of Tokyo and the increased concern of
the police to guard the sacred place, led to tighter regulation of patients staying
for hydrotherapy at waterfalls in Takao, a mountainous region close to Tama.38
An increasingly intense cult of the emperor in the early twentieth century, and
the resultant intense scrutiny of the population must have contributed to the
steady rise of the number and rate of the patients.
On closer examination, however, it turns out that the extent of the contribution
of the search for the undesirable elements of the population was not very great.
Figure 8.1 shows two periods of rapid increase in the reported rate of mental
disease, namely in 191118 and 192435. Although the beginning of the rst
sharp rise coincided with the coronation of Emperor Yoshihito, the start of
the second rise was prior to the accession to the throne of Emperor Hirohito.
Moreover, it should be noted that those two intense phases of massive surveys
did not necessarily result in the increase in institutionalization. Figure 8.2 shows:
the number of patients hospitalized; the number of the patients conned in other
places; the rate of those hospitalized against the entire patients population;
and the rate of those in other places against the entire patients population,
again from 1905 to 1941.39 Although the number grew almost steadily, the rate
of connement both in the hospital or at other places remained almost stable
during the two phases of rapid growth of the number of the patients. In fact,
the rate of those put under home custody sharply declined during the rst rapid
rise of the number of registered patients. This almost certainly suggests that the
intense search of the population in preparation for the sacred ceremonies did
not lead to connement of the insane, either at home or in hospital. At least
at the national level, pace Fujino, the direct impact of imperial rituals on the
connement of the insane does not seem to have been great.
The patients under home-custody will be our next subject of attention. Al-
though the number of the cases of home custody slowly grew, their proportion
to the entire patient population was in constant decline during the entire period
(Figure 8.2). If examined vis-a-vis hospitalization, the growth in home custody
was clearly outstripped by hospital provision. During the period 1905 to 1940,
home-custody cases only doubled, while the hospitalized population grew 9.2
times. Certainly the Japanese psychiatric provision in the early twentieth century

38 W. Omata, Seishin-byoin No Kigen [Origins of Psychiatric Hospitals], 2 vols. (Tokyo,

19982000), I, 678. Omatas work is based on staggeringly ambitious research, collecting
numerous pieces of patchy evidence from more than a millennium of Japanese history.
39 The exact details of the category of those conned at other places remain elusive. Perhaps
they included those kept at municipal poorhouses, as well as the home-custody cases. Numer-
ically speaking, no doubt the most important contribution was made by home-custody cases.
Fragmentary evidence suggests that municipal poorhouses were far from a major player in the
provision for the insane. In 1918 Kure estimated that about 200 patients were conned in such
places all over Japan, while in the same year 4,750 patients were conned at other places. Kure
and Kashida, Seishin Byosha Sitaku Kanchi, case 524.
 16000 16.00

14000 14.00

12000 12.00

10000 10.00

8000 8.00

6000 6.00

No. of patients
4000 4.00
Proportion of confined patients (%)

2000 2.00

0 0.00
1905 1910 1915 1920 1925 1930 1935 1940

No. of hospitalized patients No. of home-custodied patients

Hospitalization rate (%) Home custody rate (%)

Figure 8.2 Patients conned in hospitals and at home

 State, family and the insane in Japan, 19001945 209

witnessed a marked shift in the locus of the connement of the insane, from their
own private home to the hospital governed by a doctor. Especially important was
the period of the most sharp decline in the custody rate, which took place from
about 1911 to 1920. This suggests that, proportionally speaking, home custody
was a means of connement which was becoming increasingly unpopular, even
before the passing of the Mental Hospitals Act. Perhaps this decline in home
custody had something to do with the urbanization of early twentieth-century
Japan. Although there is no conclusive evidence at the national level, home
custody seems to have been a rural phenomenon, while hospitalization was an
urban solution to the problem posed by insanity.40 Exactly why urbanization
prompted connement in a hospital instead of at ones own house is unclear.
Availability of mental hospitals in cities, sheer lack of space to set up a cage
in terraced-houses in major cities, urban sensibility and sense of privacy, and
the internalization into urban mentality of the cultural hegemony of medical
discourse all these factors might have contributed to the relative decline of
home custody.
Nevertheless, one should not mistake the early signs and dawn of asylum-
dom with its full arrival: the number of home-custody cases continued to grow
until the late 1930s, and it remained a crucial part of the psychiatric provision
during the entire period under consideration. Hospitalized patients outnum-
bered those conned in other places only in the early 1930s, and one-third
of conned patients were still placed at home in 1940. Although the private-
house-custody is still a historical terra incognita, there existed a colossal and
invaluable survey conducted by Shuzo Kure as noted above.41 Kure sent fteen
students and assistants of his to fteen prefectures to personally visit about
360 patients under home custody, interviewing the patients and their families,
sketching the plan of the place of the custody, and photographing the cages
as well as the patients. The surveyors spent several days or a few weeks in
each area during the summer. Apart from a few cases, the majority of cases
were clearly in rural areas. As noted above, the apparent ultimate motive of
this survey was to demonstrate the shortcoming of home custody and promote
hospital or asylum care, a nding which is more than predictable from the
professor of medicine who had studied in Germany and who was at the time
involved in the installment of a non-restraint system at Tokyo Metropolitan
Asylum at Matsuzawa. The general impression one gets from the survey is,
however, not propaganda for asylum care and against home custody, but an

40 Although no correlation can be statistically established at the national level between urbaniza-
tion and the ratio of hospitalization or home custody, two prefectures with remarkable high
hospitalization rate remained Tokyo and Osaka.
41 Kure and Kashida, Seishin Byosha Sitaku Kanchi. For a detailed account about the making of
this paper, see Y. Okada, K. Komine, S. Yoshioka, The Making of Home Custody of Mental
Patients , Rinsho Seishin Igaku [Journal of Clinical Psychiatry] 13 (1984), 145769.
210 Akihito Suzuki

Table 8.1 Types of places of custody

Detached cottage 8
A room in another house 19
Warehouse 12
Shed 43
In the main house 43
Extension to the main house 18
Extension to the warehouse 4
Unoored part of the main house 7
Kitchen 3
Others 5
Not in the private abode 13
Total 175

even-minded and rigorous social survey, which requires some closer attention
here.
Reecting that home custody was practised widely across the social classes,
the situation and quality of home custody varied greatly. The place of custody
varied from purpose-built detached house within the same premises, refurbished
warehouse close to the main house (dozo, a common feature for wealthy
agricultural households), a part of the main living space (zashiki), to a part
of a shed (mono-oki, a place to store tools and straws), a shabby extension to
the main house, a cage set up in an unoored part (doma) of the house (see
Table 8.1). Although the space of the cage also varied according to the wealth,
space availability, and perhaps the extent of compassion towards the patient,
mostly each cage was about 3.3 m2 . Personal care of the patient by the family
also varied. Some families treated the patient with exemplary kindness and
attention, others did not hide their hope to be able to get rid of the patient. One
thing in common in those hugely varying places of connement was the wooden
bars or lattice, which seems to have been almost compulsory in order to be
approved by the local police. Although seeing a combination of a cage and
private home is surreally shocking to our modern sensibility, the lattice allowed
the light and the air to the space. Also it secured high visibility of the patient,
which must have facilitated vigilance and supervision, as well as exposed the
antics of lunatics through the latticework to neighbours and visitors to the house.
An important insight is gained through the analysis of the reasons given
for the custody (see Table 8.2). The reasons given by the families reveal an
important aspect which has not been fully addressed by historians who have
studied the Custody Act. It is true that some of the patients were obviously put
under home custody through the concern of the police to conne disorderly and
dangerous elements and to secure public order. The reasons attributed to public
order in the list above are, however, a decided minority. Offence against public
 State, family and the insane in Japan, 19001945 211

Table 8.2 Reasons given for home custody

Domestic violence against person and property 145

Violence to persons and property of others 90
Wandering and vagrancy 72
Arson and threat of arson 31
Offence against public morals 9
Attempted suicide 9
Intrusion into eld and woods 7
Intrusion into public places 6
Violence at religious places 2
Public disobedience 1
Others 43
Total 415

morals, intrusion into public places, violence against religious places and
public disobedience comprise only 4 per cent of the total. By far the largest
category is that of domestic violence, which suggests that the major motive for
putting the patient in custody at home was for the family to protect themselves
from the violence and disturbance of an insane person who lived with them, and
to facilitate the management of the unruly and dangerous member. The second
largest category was that of violence against the person and property of others.
In the context of a rural community, this others must have meant neighbours.
A culture of domestic responsibility as well as law made the family members
responsible for the safe-keeping of their insane family member. If the lunatic at
large committed some misdemeanour, the family would be morally blamed by
their neighbours, as well as facing the possibility of criminal persecution. The
predominance of these two categories clearly demonstrates that home-custody
cases were prompted by concrete concerns generated in a small social world
of the family and the local community. The initiative for home custody mainly
came more from the interaction, negotiation and shared beliefs between the
family and the local neighbourhood than from the dictates of public authorities.
The role of the public authority, with its concern over public security, was
perhaps that of encouragement and sanctioning of the familys recourse to
home custody, not its enforcement.
Another important insight gained from this report concerns the attitude of
the surveying medical students to the practice of home custody. Despite the
sonorous condemnatory tone assumed by their mentor Kure in the end-product
of the survey, some students did not universally nd signs of glaring cruelty,
abuse, or neglect in the places they visited. Actually, their reports suggest their
ambivalent attitude towards asylum care and hospitalization. One of the visiting
students, Tamao Saito wrote about the area he had visited:
212 Akihito Suzuki

This prefecture is a place of small industries, with the gap between the rich and the poor
still small. Each household has modest property, and the peoples behaviour is not very
competitive. Accordingly, chronic mental patients are taken care of by their neighbours,
and a few wander on the street. This state, however, will not continue for long. The
population will grow year by year, highways will be opened, and major industries will
arise. Then, if the poor and the weak become insane, their only help will come from the
public and the state.42

Here, one can sense a kind of nostalgia for a traditional society which modern
Japan was quickly losing. Saito appears to have believed that, in this mythical
world of the traditional society, people had been kind to each other, and the
able helped the unable within their community. He was, however, sure that this
idyllic society would before long be washed away by the merciless advent of
capitalism. The public psychiatric hospital was, Saito seems to have believed,
only necessary in the harsh society whose ominous arrival was impending. He
was a half-hearted modernizer, so to speak.
We should now direct our attention to the mental hospital, Saitos antidote
against an evil capitalist society. Figure 8.2 clearly shows the rapid growth of
psychiatric institutions during our period. The absolute number of institution-
alized patients grew more than nine times, and the rate of those hospitalized per
population grew nearly three times. It also establishes the impact of the Mental
Hospitals Act, which took effect in 1923. The rate of institutionalization had
stagnated until 1922, after which the rate increased rapidly until the late 1930s.
After the Mental Hospitals Act, there existed three categories of mental
hospitals. First, there were public hospitals, which were maintained at the cost
of prefectures with help from the state, and which accepted (mainly) public
patients. Second, there were substitute hospitals, which were maintained as
private businesses and accepted private patients, substitute patients supported
by the prefecture and the state, and public patients whose fee was paid by the
city, town or village. Third, there were private hospitals, some of which accepted
only private patients, but many of them keeping both private and public patients,
but no substitute patients.
The rst public psychiatric hospital in Japan opened in Kyoto in 1875. It was
situated on the premises of Nanzenji Temple. This venture lasted only for seven
years and in 1882 was sold to a doctor who renamed it Kyoto Private Mental
Hospital (later Kawagoe Hospital). Before 1920, the only public psychiatric
hospital in operation was Tokyo Metropolitan Mental Hospital formerly in Ueno
and Sugamo and then at Matsuzawa, in the western outskirts of the suburb. This
housed about 350450 patients between 1905 and 1920, about 700 patients in the
1920s and, after 1930, about 1,000 patients. In 1926 a second public asylum with
a capacity for 300 patients opened in Osaka, which soon expanded its capacity

42 Cited in Ibid., 1464.

 State, family and the insane in Japan, 19001945 213

to 450. These were followed by one in Kanagawa (1929), Fukuoka (1931),

Kagoshima (1931), Aichi (1932) and Hyogo (1937), all created through the
Mental Hospitals Act.43 By 1940, there were seven public hospitals operating.
These public asylums, however, housed a distinctively small share of patients.
In terms of their size many remained modest: Tokyo excepted, each housed only
120400 patients, whereas in England the average number of inmates per public
asylum exceeded 1,000 in the early twentieth century. The limited provision at
public asylums means that the burden of the mass-hospitalization was born by
privately run mental hospitals, either substitute or private ones. In 1928 there
existed about seventy privately run mental hospitals, and in 1941 the number
grew to 160. The ratio of patients at public hospitals to all institutionalized ones
remained below 20 per cent between 1921 and 1941. Public mental hospitals
in Japan played a decidedly small role in actually carrying the burden of the
growth of institutionalization in the early twentieth century. The task was done
by privately run hospitals.
The conceptual prototype of these numerous private institutions for the in-
sane was inns built around religious places of healing, such as Shintoist shrines,
Buddhist temples, and waterfalls.44 During the Edo era, a highly developed
market economy and the completion of major highways both by the Tokugawa
Shogunate and local feudal lords facilitated a travel and tourist industry. Nu-
merous hot-spring baths boasted inns built around it for those who sought the
pleasure of bathing as well as cure from various chronic diseases. Prot-making
institutions built around places of religious-medical healing were a common
business in Edo Japan. In the late eighteenth and early nineteenth century, the
Daiunji Temple in Iwakura in northern Kyoto had several inns for those seeking
a cure from diseases of the head and the eye. These inns merged with each other
and developed into a private mental hospital established there in 1884.45 Similar
patterns abounded elsewhere, in which a guesthouse catering for the patients
staying at the place of religious healing of insanity evolved into a centre of care
or private asylum.46 The ways in which early private psychiatric hospitals in
Tokyo attempted to attract patients betrayed their inn-like character, although
many of them did not have their origins in the hotel business. Tokyo Mental
Hospital, the largest private asylum in 1903, sent touts to the gates of the Tokyo
Metropolitan Asylum, in order to catch and steer the patients to their own in-
stitution, and Tokyo Brain Hospital set up a large billboard next to the public
asylum, stating in-patients information office.47
43 Except in Kagoshima, these prefectures were all urbanized and industrialized areas.
44 Omata, Seishin-byoin No Kigen, I, 47192.
45 N. Kato, Iwakura Wo Shu-To-Shita Minkan Ni Okeru Seishin Iryou-Shi [History of Folk
Psychiatric Therapy, with Particular Emphasis on Iwakura], in Matsushita and Hiruta (eds.),
Seishin-iryo No Rekin, 23750.
46 Omata, Seishin-byoin No Kigen, I, passim.
47 SHDH, 2078, 21415.
 25000

20000

15000

10000

No. of patients
5000

0
1928 29 30 31 32 33 34 35 36 37 38 39 40

Public patients in pub. asylums Private patients in pub. asylums

Public patients in sub. asylums Private patients in sub. asylums
Public patients in priv. asylums Private patients in priv. asylums

Figure 8.3 Public and private patients in public, substitute, and private asylums
 State, family and the insane in Japan, 19001945 215

These touting and advertising activities suggest not only the commercial
nature of the early private psychiatric hospitals in Tokyo but also the close
liaison between the public sector and the private one in psychiatric provision.
The public asylum in Tokyo played the role of the magnet attracting the patients,
some of whom were directed to the prot-making sector, in a way very similar to
the situation in eighteenth-century London, where two public hospitals for the
insane (Bethlem and St Lukes) stimulated the growth of private madhouses.48
For private institutions in Tokyo, personal connection with public ofcers was
crucial to secure the patients. An ofcer of the Hygiene Department of the
Metropolitan Police contributed money for the foundation of Toyama Hospital
for Lunatics, and Tokyo Mental Hospital forged close ties with the hygiene
ofcers at the boroughs of the metropolis.49 In 1906, about one-third of 601
patients hospitalized by the cities, towns and villages in Tokyo were sent to
the private hospitals. In 1918, on the eve of the Mental Hospitals Act, the
rate increased to about one-half.50 The substitution clause of the 1919 Act
conrmed this close interdependence between the private and public hospitals,
and under this Act both sectors grew hand in hand, creating a large mixed sector
in psychiatric provision. The public sector needed the private facilities in order
to supplement its severely limited provision, and the private sector wanted the
supply of patients and income from the public sector.
The mutual stimulation between the public and private sector seems to have
been the main engine behind the increased institutionalization of the insane.
Figure 8.3 itemizes the patients in mental hospitals into six categories: patients
supported in public asylum at public cost and paying patients in public asylums;
patients in substitute asylums at public cost (including substitute patients and
other public patients) and paying patients in substitute asylums; patients sup-
ported in private asylums at public cost and paying patients in private asylums.
Both paying and public patients at public asylums grew steadily but slowly,
whereas private asylums kept increasingly larger number of patients until the
late 1930s, when they changed status to substitute hospitals and their num-
bers dwindled. The largest increase in terms of numbers came from respectively
public and paying patients kept at substitute asylums. If we lump together the
substitute and non-substitute private asylums into commercial and examine
the proportions of paying and public patients kept there as well as those for
public asylums, we get the results shown in Figure 8.4. Purely public patients
(patients kept at public asylums at public cost) remained stable or declined
very slightly in terms of proportion. The contribution of the mixed sector, i.e.,
public patients kept at commercial (both substitute and non-substitute) asylums
48 For the close link between charity and voluntary hospitals for the insane and the prot-making
institutions in England in the eighteenth century, see R. Porter, Mind-Forgd Manacles: A History
of Madness in England from the Restoration to the Regency (London, 1987).
49 SHDH, 196 and 208. 50 ARH (1906) and ARH (1918).
 60.0

50.0

40.0

30.0

patients (%)
20.0

Proportion to total hospitalized

10.0

0.0
1928 29 30 31 32 33 34 35 36 37 38 39 40
Year

Public patients in public asylums Private patients in public asylums

Public patients in commercial asylums Private patients in commercial asylums

Figure 8.4 Proportions of public and private patients in public and commercial asylums
 State, family and the insane in Japan, 19001945 217

declined gradually but more markedly. The sector that had the largest share in
1939 was the private sector, private patients staying at commercial asylums.
The numerical and proportional growth of the private sector tells a hitherto
little noticed factor in the rise of mental hospitals in pre-war Japan, namely the
emergence of a large number of people who were ready to pay signicant sums
of money to be treated there. In other words, the growth of the clients with
demand for psychiatric service made the greatest contribution to the making of
a society that segregated a large number of the insane.
It should be emphasized, however, that one should not call this a great
connement. Figures 8.5 and 8.6 show the numbers of entire known patients,
and those patients regarded as not needing connement or custody, with the
latters ratios to the former from the years 1905 to 1927 and from the years
1928 to 1941.51 These two gures conclusively show the persistence of informal
domestic care without recourse to either hospital or home custody, long after
the Mental Patients Custody Act and Mental Hospitals Act. Although the ratio
declined steadily from 79.5 per cent to 70.8 per cent from 1928 to 1941, at the
end of the period, we are still talking about a society that put only about 30 per
cent of publicly recognized psychiatric patients in connement.
The everyday lives of those who were left to the family or at large are hard to
know, and here again the survey by Kure throws invaluable light on the lives of
the largest category of patients. Kures students were able to nd and interview
eight patients publicly recognized as insane but not in home custody.52 One of
them, a lower civil servant, was forced to live on rotten tatamis and his son
does not treat the father with kindness, although the patient was not under

51 Figure 8.5 and Figure 8.6 represent slightly different categories of patients. Figure 8.5 represents
only those conned under the two Acts. Figure 8.6 represents those actually conned in mental
hospitals. The general table of mental patients of the ARH had included only the number of
patients hospitalized, conned, or put in custody either through the Mental Patients Custody
Act or through the Mental Hospitals Act, until 1939. In that year, however, the table started to
list patients who were hospitalized or conned not through the two laws. This is not a minor
group of patients: 9,979 patients coming under this category in 1939. Looked at in detail, this
group could be broken into: (1) private patients in private and substitute mental hospitals, (2)
public patients supported in private and substitute mental hospitals outside the two laws, (3)
patients in the psychiatric wards of hospitals for medical schools, (4) patients in the psychiatric
wards of general hospitals, (5) patients maintained in non-medical places of connement, and
(6) patients maintained in nursing homes at temples, shrines and waterfalls. From 1929 on, the
exact gures for the sum of categories (1) and (2) were available in table of mental hospitals
annually published in ARH. The numbers of categories (3) (6) were, however, unavailable in
any of ARH. Fortunately, we have exact gures for the numbers of the four types of institutions
and their capacity for the years 1929 and 1935, and of the actual number of patients for 1929.
Figures for 1929 are taken from the Department of Hygienes Survey of the Places for Conning
Mental Patients (1929). Those for 1935 are taken from Osama Kan, Hon-Pou Ni Okeru Seishin-
byosha Narabini Kore Ni Kinetsu Seru Seishin-Ijousha Ni Kansuru Chousa [Statistical Survey
of Mental Patients and Similar Mentally Abnormals in Japan], Shinkei-gaku Zasshi 41 (1937),
793884. See table 8.5.
52 Kure and Kashida, Seishin Byosha Sitaku Kanchi, cases 10614.
 100000 100 00

90000 90 00

80000 80 00

70000 70 00

60000 60 00

50000 50 00
(%)

40000 40 00

No. of patients
30000 30 00

20000 20 00
Propor tion of PaL to total patients

10000 10 00

0 0 00
1905 1910 1915 1920 1925
Year

No. of PaL Total no. of patients Proportion of PaL

Figure 8.5 Patients at large (PaL), 19051927

 100000 100 0

90000 90 0

80000 80 0

70000 70 0

60000 60 0

50000 50 0

40000 40 0
patients (%)

No. of patients
30000 30 0
Proportion of PaL to total

20000 20 0

10000 10 0

0 00
1928 1930 1932 1934 1936 1938 1940
Year

Number of PaL Total number of patients Proportion of PaL

Figure 8.6 Patients at large 19281941

220 Akihito Suzuki

threatening or instrumental coercion. Another patient was reported that he does

not receive any particularly kind treatment from the family due to his disease,
and quarrels with his younger brothers and sisters. Despite these somewhat crit-
ical comments, the surveyors did not nd widespread glaring abuse or cruelty.
Also it should be emphasized that the demonstration of particularly praisewor-
thy care was rare. In one case, the brother of a female patient made her open and
run a haberdashers shop without any hope of making prot, which must have
been conceived both as a kind of work therapy and as a way to keep the outlook
of normality. Such generosity was, however, an isolated expression of special
concern in the eight samples of Kure, and is highly unlikely to be prevalent in
the vast number of the mental patients at large. The common picture emerging
from Kures sample is a life of dependent, sub-normal, troubled, but essentially
the same life as the rest of the family. Many patients were left to themselves
and the families dont meddle with the patients. They were made to do what
work they could. One of them volunteered for outside work without telling her
family, for she wanted to be useful.53 One was explicitly stated to be taking
meals with the family.54 They were not treated either with particular kindness
or with particular cruelty. As an disabled person living with able family mem-
bers, they may have been a source of irritation and no doubt received at least
occasional scolding or even punishment. But conicts or minor punishments
were a part of normality in life, without the status of sick role, and they do not
necessarily mean active cruelty on the side of the family. Rather, they suggest
the normal life that the patients were both allowed and forced to live.

Oji Brain Hospital and its patients

Against the background of psychiatric provision sketched above, we can now
examine the Oji Brain Hospital and its patients. OBH was one of several psychi-
atric ventures which were started by doctors and entrepreneurs in Tokyo around
1900, counting on the increase in the demand for hospital-based psychiatric ser-
vice created by the Mental Patients Custody Act in the metropolis.55 The only
material we now have about its beginning in 1901 is the expose of abuses, cor-
ruption and negligence which occurred at seven psychiatric hospitals in Tokyo,
serialized in the Yomiuri News, a popular daily paper.56 Naturally, a historian
should treat such an account with caution, but there is a ring of truth in the
reports. The beginning of OBH told by Yomiuri epitomized one of the origins
of Japanese private psychiatric provisions: the intersection of medicine and ho-
tel, a business of providing accommodation associated with a medical facility.
53 Accordingly, she boasted about being very useful, although in reality her contribution was very
small. This led to frequent quarrels with her sister-in-law, who was sometimes hit by the patient.
Kure and Kashida, Seishin Byosha Sitaku Kanchi, case 110.
54 Ibid., case 107. 55 SHDH, 183223. 56 SHDH, 2023.
 State, family and the insane in Japan, 19001945 221

Zenjiro Komine had owned an inn mainly catering for those who travelled to and
stayed in Tokyo to be treated at University of Tokyo Hospital. This innkeeper
and a few doctors working at another asylum in Tokyo joined forces to start a
brand-new and purpose-built psychiatric hospital in Oji, a remote agricultural
suburb of Tokyo. Yomiuris comical account suggests that there were personal
disagreements between the governor of the hospital (Komine) and its medical
staff, mainly due to the shortage of patients and the very small prot that the
hospital was able to make in its early years. The report also satirized Komine
as a parvenu rising from an innkeeper to a hospital governor in its depiction of
his daily inspection of the hospital kitchen:
[Komine] threw off his stylish waistcoat to inspect the kitchen of the hospital, and
immediately the governors eyes are xed on pickles portions to be served to the patients.
He could not tolerate such a generous serving of the pickles. Such was his penny-pinching
interests in this kind of matters that he not only scolded the cook but also cut the pickles
himself as thin as possible.57

Allowing for a certain amount of comic licence, this sketch effectively captures
the characteristics of early OBH and many other early psychiatric ventures in
Tokyo, that is the mentality of a small family trade, for whose survival the ap-
portioning of pickles made a great difference. Despite such lowly behaviour and
personality of its owner (or, perhaps because of his disarmingly unpretentious
down-to-earth character), the Yomiuri reporter was somewhat sympathetic, hop-
ing that the hospitals perseverance under chronic nancial crisis would some
day be rewarded.58
Yomiuris ironic and satirical well-wishing materialized. From such an inaus-
picious beginning, OBH made a meteoric rise in the social ladder. Shigeyuki
Komine, Zenjiros adopted son, studied medicine at Saisei Gakusha, a private
medical school in Tokyo, and worked briey at Tokyo Metropolitan Asylum
until 1908, when he assumed the post of OBHs medical superintendent around
the age of twenty-ve.59 Shigeyuki was an able superintendent, a well-read
medical scientist, and he became a leading member of the profession. Perhaps
with Shigeyukis arrival, OBH had nally solved its chronic problem of the
absence of a medical ofcer and started to ourish. When the Mental Hos-
pitals Act was passed in 1919, OBH was one of the rst that was appointed
as a substitute hospital, an honour that only eight other private mental hospi-
tals in Japan were able to enjoy at that time. In the mid-1920s, a brand-new
three-storied western building, complete with recessed arches, was erected at
the old premise, which housed the Komine Research Institute and newly added
wards for private patients. Patients from all over Japan ocked to the hospital,
whose success allowed the Komine Institute to conduct serious research into

57 SHDH, 2056. 58 SHDH, 207. 59 Nihon Seishin Byou-i Kyoukai Kiji, 74.
222 Akihito Suzuki

Table 8.3 Admissions of private and substitute

patients at Oji Brain Hospital (1935)

Male Female Total

Private 272 119 391

Substitute 43 34 77
Total 315 153 468

Table 8.4 Lengths of stay of the discharged Oji Brain Hospital patients

Private Male Private Female Substitute Male Substitute Female

Time
Length No. % No. % No. % No. %

010 days 22 16 7 9 0 0 0 0
1130 days 29 21 14 19 0 0 0 0
13 months 46 33 29 39 2 12 1 11
39 months 21 15 11 15 1 6 3 33
69 months 6 4 3 4 1 6 0 0
912 months 4 3 2 3 2 12 0 0
12 years 6 4 3 4 3 18 1 11
14 years 3 2 3 4 5 29 3 33
over 4 years 2 1 2 3 3 18 1 11
Total 139 100 74 100 17 100 9 100

most up-to-date therapeutics, such as malarial therapy and insulin-coma therapy.

Recognition by professional brethrens soon followed. Shigeyuki played impor-
tant roles in psychiatric associations, and in 1932 was elected a Representative
Governor of the Japanese Association of Public and Substitute Mental Hospi-
tals. Komine and his hospital thus represented the ourishing private practice
and the upward mobility of Japanese psychiatry in the early twentieth century.
As a Substitute Hospital, OBH accepted both private and public patients. In
terms of the number of patients staying at the end of the year 1935, OBH housed
fty-ve private patients and 108 public patients, and the ratio between the pri-
vate and public patients remained about 1:2 during the period of 192741. In
terms of the number of admissions, however, private patients vastly outnum-
bered public patients, with their ratio being 5:1 (see Table 8.3 and Table 8.4).60
This higher number of private admissions was certainly because the private
patients at OBH stayed for much shorter periods than the public patients. The

60 The male : female ratio of the patients admitted in 1927 was about 32 per cent, not very different
from the national average of institutionalized patients.
 State, family and the insane in Japan, 19001945 223

Table 8.5 Capacities of places other than mental hospitals, 1929 and 1935

Medical General Connement Nursing Total Total

schools hospitals houses homes capacity patients

1929 856 192 439 708 2195 1365

1935 1237 127 423 1074 2861 1802a

a an estimated gure

distribution of the length of stay among the patients discharged (including

cured, relieved, uncured, and dead patients) in 1935 is given in Table 8.4. This
shows that a long-term stay (more than half a year) was rare among the private
patients, while public patients tended to stay much longer. The median length
of stay for private patients discharged in 1935 was forty-four days (average
being 134) for male patients, and sixty-three days (average = 183) for females,
while the corresponding gures for public patients was 717 (average = 869) for
male and 404 (average = 575) for female patients. For the majority of private
patients, their experience of OBH was a trial for a relatively shorter period than
an extended stay. Figures published in the ARH mask a large number of private
patients who had been admitted but discharged before they were counted into
the statistical tables. Experimenting with a spell at a psychiatric hospital was a
more widespread practice among relatively well-off sectors of the society than
tables in ARH suggest.
The general pattern of the patients experience of OBH briey discussed
above suggests that OBHs major role for the private patients was that of sup-
plementing care given at another site, which was often the patients own home.
Numerous cases indicate that hospitalization to OBH was a trial to see whether
the patient would recover at the beginning of the disease, an emergency measure
to cope with a particularly difcult manifestation of the disease, or a change of
scene inserted in long-term domestic care. M.N. rst stayed at OBH in about
1921, secondly in 1930 for three months, and thirdly in 1935 for another three
months. For the most time during his disease, he stayed at home and often
troubled his family and neighbours by his violence.61 G.T. had been insane for
about twenty-ve years when he was admitted to OBH, during which time he
worked as a farmer at his own house. C.M. had been mentally ill and had stayed
at her own house for about eight years before her admission: she quarrelled and
occasionally wounded another insane sister of hers during the period. M.G.s
three years of mental disease before admission to OBH had been spent mainly
at her own house, interrupted by two brief terms of hospitalization and one
longer stay at her relatives in the country for change of air. N.A. had been a

61 Case Record (hereafter CR) of Oji Brain Hospital for M.N., discharged on 10 September 1935.
224 Akihito Suzuki

highly troublesome patient for about one-and-a-half years, during which she
went out naked and used abusive language to her family and neighbours. She
had experienced a brief spell at another private asylum, from which she had
been discharged for nancial reasons and had stayed at her own home until
admitted to OBH.62 Although increasing numbers of private patients were hos-
pitalized, for many of them, staying at an asylum seems to have been shorter
episodes inserted in the major framework of care at home.

Conclusion
My account above has done little more than scratch the surface of the vast
and rich area of psychiatry in Japan in the early twentieth century. Much of
my argument remains tentative, to be further examined through research into
psychiatric archives. Having said that, however, in the light of what I have
argued above I should like to offer one historiographical point which might be
pertinent to the theme of this volume.
The point is about the origin of the major driving forces of psychiatric mod-
ernization. The two major laws, the Mental Patients Custody Act and the Mental
Hospitals Act, provided the basic framework for psychiatric provision until the
post-war Mental Hygiene Act (1950). Although they were conceptualized in
very different spirits and aims, it should be emphasized that these two Acts had
one thing in common. Note well that home custody and the mixed sector of psy-
chiatric hospitalization, respectively the core part of each piece of legislation,
had already been a well-established practice before the Acts codied them. In
their crucial aspects, these pieces of legislation followed what people then were
practising, not the other way round. The historiographical implication of this
pattern of the law heeding the practice is that one should look for factors other
than legal or legislative for the real driving force of historical change in Japanese
psychiatric provision. Social and cultural forces from below created trends,
patterns and models of the care of the insane, some of which were selected to
be conrmed and encouraged by the law from above. Another implication is
that one should not overestimate the inuence from the West, which has been
one of the major frameworks within which the history of Japanese psychiatry
during the period under review has been described. Instead of the select few
who were enlightened and westernized and who drafted Bills and rules or wrote
textbooks of psychiatry, a mass of patients, families and neighbours set the basic
trends of psychiatric provision, some of which in turn were selectively codied
by the elite with the ambition to Westernize Japanese psychiatry. Needless to

62 CR for G.T., discharged (dead) on 10 November 1935; CR for C.M., discharged (dead) on 28
February 1935; CR for G.M., discharged on 31 December 1939; CR for N.A., discharged on 7
May 1935.
 State, family and the insane in Japan, 19001945 225

say, the inuence from the West was tremendous in almost every aspect of life
in Japan at that time and the care for the insane was no exception. This does not
mean, however, the programme of Westernization was the major driving force
in the making of basic paradigms of Japanese psychiatric provision.
Instead of seeing the progress of psychiatric connement in early twentieth-
century Japan as an attempt to import western systems of care of the insane, this
chapter set out to understand it within the complex interaction and negotiation
between various basic social units, such as the family, community, local and
central governments, and psychiatrists. This chapter has also tried, whenever
possible, to throw light on the larger contexts in which those interactions took
place, such as the market economy, urbanization, totalitarian policing of the
population, and medicalization. I can only hope that my attempt will encourage
future researchers in the comparative social history of psychiatry to tackle big
issues at which this chapter is only able to hint.
9 The limits of psychiatric reform in Argentina,
18901946

Jonathan D. Ablard

In 1934, La Nacion, Argentinas oldest daily newspaper, reported that every

public institution for the insane and mentally retarded in the republic was
severely overcrowded. The National Hospital for the Female Insane (Hospital
Nacional de Alienadas, hereafter the HNA), with a capacity for 1,600 patients,
cared for over 3,000. The mens Hospice of the Virgin of Mercy (Hospicio de
las Mercedes, hereafter the Hospicio), was 890 patients over its 1,100 bed limit.
Overcrowding was even more dire in the countrys rural facilities, several of
which had been designed to relieve urban hospitals.1
While the crisis had in fact been long in the making, the 1930s marked
a new low point in the public image of the hospitals. In 1910 Argentinas
centennial year these same hospitals enjoyed reputations as being advanced
medical institutions. The 1908 visit of Georges Clemenceau, future president
of France, to the Hospicios rural satellite facility, and his report of the trip
in 1910, is emblematic of Argentinas prospects. The future French president
reported that the ten-year-old National Colony for the Insane was a model for
the older peoples of Europe to emulate. Forcible restraints and isolation cells
were absent, and patients lived in modern, spacious and comfortable cottage-
style dormitories. The daily schedule revolved around work therapy that kept
all able bodied busy, productive and mentally focused.2 Similar reports, many
coming from other European observers, echoed Clemenceaus optimism.3 Sev-
eral years earlier, the Argentine government had established a commission to
supervise the development of a national network of regional asylums (as well
as other medical institutions) to meet the needs of the republics fast growing,
but geographically scattered, population.

1 La hospitalizacion de alienados en el pas constituye un serio problema de solucion inmediata,

La Nacion, 26 January 1934.
2 G. Clemenceau, South America Today: A Study of Conditions, Social, Political and Commercial
in Argentina, Uruguay and Brazil (New York, 1911), 12332.
3 C. Lupati Guel, Vida Argentina (version espanola) (Barcelona, 1910), 14668; J. Huret, En
Argentine: De Buenos Aires au Gran Chaco (Paris, 1911), 1007; A. Meyer Arana, La Caridad
en Buenos Aires (Buenos Aires, 1911); Hommage au professeur Cabred, LHygiene Mentale
7: 22 (JulyAugust 1927).

226
 Psychiatric reform in Argentina, 18901946 227

Optimism about Argentinas psychiatric facilities mirrored a more general

positive outlook about the republics prospects in the realm of international
business. Fuelled by an export economy that rivalled that of Canada or Australia,
Argentina received massive immigration from Europe. From the mid-nineteenth
century until the eve of the Second World War it transformed a largely mestizo
and mulatto population into one that was primarily of European stock.4 In the
process, Argentina became Latin Americas most likely contender to become a
developed nation.5 Prosperity, and the elites afnity for French culture, led
Buenos Aires to earn in the late nineteenth century the nickname Paris of Latin
America.6 During this same period, Argentine professionals, intellectuals and
scholars looked to Europe, and particularly France, Britain and Germany, for
models to build a modern, efcient and prosperous society and state.
The neglect suffered by patients, and the inability of doctors to modernize
the hospitals, represented the failure of Argentine psychiatrists to live up to
their aspirations to reach modern levels of care. This chapter seeks to explore
the causes and consequences of the collapse of Argentinas public psychiatric
hospitals. Careful attention to the existing archival evidence from the hospitals
as well as close readings of published sources underscores the extent to which
psychiatrists fell far short of their expressed desire to modernize and expand
Argentinas public psychiatry. The root of their failure lies as much in the states
unwillingness to properly fund existing hospitals, as in the lack of a national
network of institutions.

Origins
Argentina became independent of Spain in 1810 but quickly plunged into a
series of civil and international wars that did not end until the 1850s. As a
result, national consolidation and the creation of a viable national state were
delayed. Not surprisingly, this period dominated by the rule of local strongmen

4 The impact of immigration on Argentine politics, culture and society was profound, in part
because per capita, Argentina received far more newcomers than any other nation. See J. Moya,
Cousins and Strangers: Spanish Immigrants in Buenos Aires, 18501930 (Los Angeles, 1998).
Most immigrants were from Italy, followed by Spain, France, Northern Europe, Eastern Europe,
and the Middle East.
5 The question of Argentinas economic rise, and then steady decline after 1930 is an area of much
scholarly debate. See J. Carlos Korol and H. Sabato, Incomplete Industrialization: An Argentine
Obsession, Latin American Research Review 25 (1999), 730.
6 On the inuence of French architecture and urban planning between 1850 and 1914, see J. R.
Scobie, Buenos Aires: Plaza to Suburb, 18701910 (New York: 1974). The Argentine elite was
also interested in convincing Europe that Argentina was worthy of joining the ranks of civilized
nations. See I. E. Fey, Peddling the Pampas: Argentina at the Paris Universal Exposition of
1889, in W. H. Beezley and L. A. Curcio-Nagy (eds.), Latin American Popular Culture: An
Introduction (Wilmington, Del., 2000), 6185.
228 Jonathan D. Ablard

(caudillos) witnessed few lasting developments in the realm of medicine,

education or social welfare.
In 1852, the most powerful of the strongmen, Juan Manuel de Rosas, fell to
forces who supported the national unication of Argentina and its reorientation
towards European and North American models of economic and social de-
velopment. Although Argentinas constitution was established in 1853, effec-
tive national integration was delayed until 1880 when Buenos Aires became
a federal district and the national capital. It seems evident that the delay in
effective national integration had a profound impact on the later course of the
hospitals.
The ascendant liberal elite of Buenos Aires, not yet in full control of the
entire country, chose to portray Rosas as the embodiment of Argentinas bestial
and barbaric underside.7 Generations of porteno (residents of Buenos Aires)
elite viewed the Rosas period as one in which civil disorder, political violence,
and provincial rivalry had essentially unhinged the native populace. To his
well-placed critics, eager to win European approval, Rosas had upset the
Argentine social order by aligning himself with the Indian, mestizo, and Afro-
Argentine majority. Similarly, Rosas had demonstrated a disdain for European
culture through his public preference for creole (that is, native) cultural mores.
The reformers were further motivated by the fact that Rosas had repressed
embryonic reforms of the countrys medical and charitable organizations.8
While national political consolidation continued to elude Argentina, urban
political elites (primarily in Buenos Aires) nevertheless began to create in-
stitutions of social welfare. To that end, the new government established
the elite womens Society of Benecence (SB) and its male counterpart, the
Philanthropic Commission, to oversee the development of health and wel-
fare institutions.9 The government also reopened the countrys only school
of medicine.10 These measures, as well as the reform of education policy and
the articulation in the national constitution of a policy to encourage European
immigration, were part of a larger elite project to reorient Argentina towards
Europe.
In this endeavour, health care, and particularly care for the mentally ill, was
of critical importance to the national rejuvenation project. Argentine scholar

7 J. Lynch, Argentine Dictator: Juan Manuel de Rosas, 18291852 (Oxford, 1981); R. Salvatore,
Death and Democracy: Capital Punishment after the Fall of Rosas, Work Papers/Documents
de Trabajo, no. 43 (Buenos Aires, 1997), 129.
8 E. A. Balbo, translator, Classic Text no. 6 Dissertation on Acute Mania, Diego Alcorta,
History of Psychiatry 2 (1991), 207.
9 The society operated all of Buenos Airess health and welfare institutions devoted to children
and women until 1947. The Philanhropic Commission, by contrast, dropped out of sight.
10 E. A. Balbo, El Manicomio en el Alienismo Argentino, A sclepio 40 (1988), 153. All three of
these institutions had been created in the late 1820s, during a brief period of liberal reform, but
had been quickly thereafter closed by Rosas.
 Psychiatric reform in Argentina, 18901946 229

Hugo Vezzetti has argued that the new government viewed the early decades
of independence as a period of barbarism, in which racial, class and gender
distinctions had eroded along with traditional hierarchies.11 According to some
contemporary observers, the years of civil unrest caused increased mental im-
balance, particularly among women and non-Europeans of both sexes. Worse
still, it was commonly believed that Rosas had consciously recruited lunatics
(usually non-white) to serve as his henchmen.12
Argentinas asylums developed coterminously with the establishment of a co-
herent national state and grew out of a larger effort by the elite of Buenos Aires
to restore their political and moral capital after decades of civil and interna-
tional war, and dictatorship. Reformers thus understood that creating hospitals
was part of a larger project that would help Argentina to earn the reputation
of a civilized nation. With direction from the newly created charitable orga-
nizations, the city of Buenos Aires constructed separate asylums for women
and men.
The womens asylum, which started in an old convent on the edge of town,
opened in 1854. Over the next four decades the asylum grew with little planning,
as the city around it grew in size and population. By 1890, the hospital was
a series of buildings connected by covered passageways, and was considered
unsanitary and dangerous to patients and staff alike.13 In 1880, Buenos Aires was
federalized, the Society of Benecence, which ran the asylum, was placed under
the Ministry of the Interior and the asylum was renamed Hospital Nacional de
Alienadas. Finally, in 1898 the national government placed the society and
its institutions under the auspices of the Ministry of Foreign Relations and
Religion.14 There it remained until 1947, when the recently elected government
of Juan Peron placed all health facilities under the newly created Ministry of
Health and Welfare.15

11 H. Vezzetti, La Locura en la Argentina [Madness in Argentina] (Buenos Aires, 1985). Recent

scholarship has softened the differences between the two periods, and noted that the post-1853
regime exaggerated the change for its political purposes. See Salvatore, Death and Democracy.
12 E. A. Balbo, Argentinian Alienism from 1852 to 1918, History of Psychiatry 2 (1991), 18192;
Vezzetti, La Locura en la Argentina; and the earlier work of the same title by J. Ingenieros, La
Locura en la Argentina (Buenos Aires, 1920), 136; J. Salessi, Medicos, Maleantes y Maricas:
Higiene, Criminologa y Homosexualidad en la Construccion de la Nacion Argentina 18711914
[Doctors, Crooks and Gays: Hygiene, Criminology and Homosexuality in the Construction of
the Argentine Nation] (Buenos Aires, 2000).
13 For a celebratory history of the hospitals early years, see Arana, La Caridad en Buenos Aires.
Recent scholarship includes C. Jeffress Little, The Society of Benecence in Buenos Aires,
18231900, PhD thesis, Temple University, Philadelphia (1980).
14 Despite nationalization, the hospital continued to be administered by the private Society of
Benecence who named medical directors and kept the books. Furthermore, until the late 1960s,
the principle nurses of the hospital came from a female Catholic order. See Archivo Hermanas
de Caridad-Hijas de Maria Senora del Huerto-Casa Provincial (Buenos Aires).
15 K. Mead, Oligarchs, Doctors and Nuns: Public Health and Benecence in Buenos Aires,
18801914, PhD thesis, University of California, Santa Barbara (1994), 239. On the history of
230 Jonathan D. Ablard

The mens asylum followed a similar trajectory, although it was always more
directly connected to the national state. In 1863 the city of Buenos Aires,
under consultation with the Philanthropic Commission, constructed the Casa de
Dementes (House for the Insane) across the street from the womens asylum.16
By the 1880s, the hospital had deteriorated so severely that the city ordered a
total renovation that was completed in 1887. The hospital was renamed Hospicio
de las Mercedes in honour of the Virgin of Mercy, patroness of convicts and the
mentally ill. Facing the same pressures as the womens hospital, the Hospicio
quickly returned to its earlier state of decay and, by 1904, the city relinquished
authority of the institution to the federal governments ministry of Foreign
Relations where it remained until 1947.17

Ideological foundations
Despite the best efforts of many public health doctors, health policy proved self-
limiting by the very course of Argentinas political and economic development.
Resistance to the creation of a comprehensive health system was largely a
reection of the liberal doctrine adopted by the Argentine elite that called for
scal restraint in public expenditure. As Argentinas export-based economy
expanded, traditional elites maintained an ambivalent view of social-welfare
projects. To become modern, Argentina needed to have a public-health network.
Yet, as Ernest Crider has pointed out By implication . . . such assistance was
limited to that necessary to preserve the social structure and the prominent role
of the oligarchy; therefore it could not lead to fundamental changes in the living
standards and quality of health care extended to the poor.18
One way to maintain this precarious balance between largely contradictory
goals was to delegate as much of the public welfare responsibility to private,
religious and charitable organizations. A case in point was the placement of
the hospitals under the Ministry of Foreign Relations, as well as the large in-
uence of the Society of Benecence which ran most of the hospitals devoted
to the care of women and children in Buenos Aires. The arrangement was a
source of constant frustration to many public-health doctors who wished to
create a unied, national and modern health-care system. Likewise, wherever
possible, the state used either inexpensive labour, such as female, religious or

psychiatric care in Argentina after 1946, see J. Ablard, Madness in Buenos Aires: Psychiatry,
Society, and the State in Argentina, 18901983, PhD thesis, University of New Mexico (2000).
16 Ingenieros, La Locura en la Argentina, 198; M. Sbarbi, Resena historica del Hospicio de las
Mercedes, Acta Neuropsiquiatrica 6 (1960), 420; L. Meyer, Los Comienzos del Hospicio de
las Mercedes, Acta Psiquiatrica Psicologico de America Latina 33 (1987), 3389.
17 Memoria del Intendecia Municipal (Ano 1903, Administracion del Sr Alberto Casares) (Buenos
Aires, 1904), 81; E. Allen Crider, Modernization and Human Welfare: The Asistencia Publica
and Buenos Aires, 18831910, PhD thesis, Ohio State University (1976), 61.
18 Ibid., 227.
 Psychiatric reform in Argentina, 18901946 231

even prisoners. These cost cutting practices ultimately prevented the develop-
ment and maintenance of modern hospitals.19
The Argentine elites parsimony in social projects was reinforced by massive
European immigration that exercised a profound inuence on both psychiatric
theory and practice in Argentina. Since the 1850s, a cornerstone of Argentinas
modernization project was to attract European immigrants to ll in the vast
empty spaces of the interior. But the plan backred and Argentina received far
fewer northern Europeans prepared to settle in the countryside and many more
southern and later eastern Europeans who tended to gravitate to the cities.20
As immigration steadily increased between the 1880s and 1920s the porteno
public-health system was unable to keep up with the pace of urban growth.21
Yet, Argentina, ravaged by serious but preventable epidemics as late as 1900,
needed to provide a basic level of sanitation and health care to make immigration
appealing.22 Although public-health bureaucracies had made crucial strides in
the eradication of infectious disease (a key to attracting immigrants) many elites
feared that an overly generous welfare system would provide an unwanted pull
factor for Europeans in search of an easy life in the New World.23
As early as the 1870s medical and lay writers began to identify the problem
of mental disturbance among recent arrivals. The directors of the capitals two
asylums were the rst to call attention to the problem of the loco inmigrante,
the insane immigrant.24 In large part, this was because both hospitals, well
into the 1930s, housed a greater number of foreign-born than native patients.25
Most were from Italy and Spain, but there were sizeable numbers from the
Middle East, Russia, France and Central Europe.26 In 1906, for example, future
director of the Hospicio, Jose T. Borda, complained that recent arrivals from

19 R. Gonzalez Leandri, Medicos, Damas y Funcionarios: Acuerdos y Tensiones en la Creacion

de la Asistencia Publica de la Ciudad de Buenos Aires, in J. Lus Peset (ed.), Ciencia, Vida
y Espacio en Iberoamerica (Madrid, 1989), 85; Crider, Modernization and Human Welfare,
3839; Mead, Oligarchs, Doctors, and Nuns, 4252.
20 C. E. Solberg, Immigration and Nationalism: Argentina and Chile, 18901914 (Austin, Tex.,
1970), 93116; Moya, Cousins and Strangers, 556. By 1914, a little over half of Buenos Airess
population was foreign born.
21 Crider, Modernization and Human Welfare, 46.
22 C. Andres Escude, Health in Buenos Aires in the Second Half of the Nineteenth Century, in
D. C. M. Platt (ed.), Social Welfare, 18501950: Australia, Argentina and Canada Compared
(London, 1989), 69. Crider, Modernization and Human Welfare, 22830. Crider also argues
that public health was intended to help acclimatize new arrivals.
23 Vezzetti, La Locura en la Argentina, 26; Crider, Modernization and Human Welfare, 18095.
24 Vezzetti, La Locura en la Argentina, 18591.
25 Sociedad de Benecencia (SB), Memoria (1900, 1905, 1910, 1915, 1920, 1925, 1935, 1940)
and Hospicio (1893, 1913, 1916, 1917, 1918, 1919, 1925, 1926, 1927, 1931, 1932, 1935, 1936,
1937, 1939).
26 Ministerio de Relaciones Exteriores y Culto, Comision Asesora de Asilos y Hospitales Re-
gionales, Hospicio de las Mercedes: Memoria Medico-Administrativo Correspondiente al Ano
1939 (Buenos Aires, 1940), 515; Sociedad de Benecencia de la Capital, Memorias (190043).
232 Jonathan D. Ablard

Europe tended to ll mental asylums rather than the countryside.27 Several

years later, writer Lucas Arrayagaray alerted readers that both asylums and
gaols were full of immigrants who, shortly after arriving to Argentina, either
committed a crime or went insane.28
Doctors offered a host of explanations for immigrants predisposition to
insanity. A common theme was their excessive desire for wealth, combined
with love of drink, social dislocation, and the disappointment when immigrants
dreams of a new and better life went unfullled.29 For many writers, immigration
was tightly woven into the wider problem of modernity which, they argued,
destabilized peoples mental health. Paradoxically, mental illness was a price
that nations paid for modernization, urbanization and immigration.30 Perhaps
the most common connection between social condition and medical diagnosis,
however, was found in the image of the alcoholic male immigrant. Of the 7,339
alcoholics admitted to the Hospicio between 1899 and 1913, for example, 76
per cent were foreign born.31
Behind medical concern over unchecked immigration lay a more general-
ized fear for the future of the Argentina race. Degenerationist models had
been popularized in Argentina since the 1870s, and remained current well into
the 1940s.32 Fear of the biological and psychiatric danger posed by immigrant
groups was aggravated by the fact that, unlike the United States or Canada,
Argentina exercised little control over who was allowed to enter the country. Of
the over 600,000 immigrants who came to Argentina between 1907 and 1910,
for example, only sixty-ve were excluded for mental or physical defects.33
Unregulated immigration, and overcrowded hospitals also led to growing con-
cerns during the 1920s and 1930s over the large number of mentally ill persons
who presumably had evaded connement to psychiatric hospitals.34
Ambivalence about immigrants, and fear of creating a welfare state, inu-
enced the material and therapeutic life of the hospitals. Since their creation, both
hospitals engaged in a moral therapeutic regimen that was heavily weighted
towards productive and lucrative work. Argentine alienists began to implement
27 J. T. Borda, Inmigrantes enfermos, El Diario, 12 January 1906.
28 R. Huertas Garca-Alejo, La Aportacion de la Escuela Argentina al Concepto de Criminal
Nato, in Peset (ed.), Ciencia, Vida y Espacio en Iberoamerica, 111.
29 Vezzetti, La Locura en la Argentina, 18591; Little, The Society of Benecence in Buenos
Aires, 18231900, 2423.
30 See Archivo General de la Nacion-Sociedad de Beneciencia-Hospital Nacional de Alienadas,
Legajo 203, Expediente 5057 (19246) (hereafter AGN-SB-HNA). Dr Lus Esteves Balado to
Senor Director del Hospital Nacional de Alienadas, Dr Julio G. Nogues.
31 Memoria del Hospicio de las Mercedes Correspondiente al Ano 1913, Memoria del Ministerio
de Relaciones Exteriores y Culto Correspondiente al Anos 191314 (Buenos Aires, 1914), 564.
32 M. Ben Plotkin, Freud, Politics, and the Portenos: The Reception of Psychoanalysis in Buenos
Aires, 19101943, Hispanic American Historical Review 77 (1997), 4950.
33 E. A. Zimmermann, Racial Ideas and Social Reform: Argentina, 18901916, Hispanic
American Historical Review 72 (1992), 37.
34 Ingenieros, La Locura en la Argentina, 2345.
 Psychiatric reform in Argentina, 18901946 233

these regimens in their asylums by the 1870s.35 Like their counterparts else-
where, doctors understood moral therapy to include the fostering of safe and
home-like environments, isolation of patients from harmful inuences, and the
development of activities that would redirect patients back to mental health.36
The lack of appropriate indoor space for recreational activities hindered moral
therapys full development at the womens hospital; the mens hospitals pro-
gramme was curtailed, among other factors, by a lack of appropriate indoor
spaces and by the absence of a perimeter wall to prevent outdoor activities from
turning into mass escapes.37
Work therapy broadly understood to include a variety of tasks, was suc-
cessfully employed at the hospitals. Male patients essentially built the Casa de
Dementes, and the asylums rst director created a number of patient workshops
that continued to earn revenue for the hospital at least through the 1940s.38
Female patients sewed uniforms for the military, and were actively engaged
in a range of domestic tasks that allowed the hospital to continue running.39
In addition to work that fullled putative therapeutic ends, the hospitals also
utilized patients as unpaid orderlies.40 Because of these challenges, as well as
for reasons of hospital demographics and broader ideological reasons, the most
prominent and long-lasting aspect of this approach was work therapy. In ad-
dition to justifying work therapy as a crucial component of recovery, directors
also credited workshops for providing indispensable nancial boosts to paltry
hospital budgets.41 This was particularly true of male patients who engaged in
a number of lucrative enterprises and workshops. In addition, their labour was
instrumental to the construction of the original Hospicio de las Mercedes in the
1870s and the construction of a mens rural facility that opened in 1899.42

35 On moral therapy, see G. Grob, The Mad Among Us: A History of the Care of Americas Mentally
Ill (New York, 1994), 91.
36 Little, The Society of Benecence in Buenos Aires, 18231900, 25961. See R. Porter, The
Greatest Benet of Mankind: A Medical History of Humanity (New York, 1997), 502. Already
by 1838, the French alienist Jean-Etienne Dominique Esquirol was arguing for the therapeutic
benets of isolation. Memoria del Hospicio de las Mercedes Correspondiente al Ano 1893
(Buenos Aires, 1900), 31.
37 Hospicio (1893), 14; Crider, Modernization and Human Welfare, 61, 1034, 151; Little, The
Society of Benecence in Buenos Aires, 263.
38 Memoria del Hospicio de las Mercedes Correspondiente al Ano 1893 (Buenos Aires, 1900), 4.
39 Ingenieros, La Locura en la Argentina, 189.
40 Crider, Modernization and Human Welfare, 151.
41 The economic incentive of these programmes was so overpowering that the annual report of the
mens hospitals rural colony read more like a business report than of a hospital. Colonia Nacional
de Alienados: Memoria Medico-Administrativo Correspondiente a los Anos 19081910 (Buenos
Aires, 1911).
42 Vezzetti, La Locura en la Argentina, 75; Meyer, Los Comienzos del Hospicio de las Mercedes,
339; L. Iacoponi, El Hospital Interzonal Colonia Dr D. Cabred y el Metodo Open Door para
asistencia y rehabilitacion de pacientes psiquiatricos, in Centenario de la Fundacion: Hospital
Interzonal Psiquiatrico Colonia Dr Domingo Cabred (Province of Buenos Aires, 1999), 64.
Iacoponi argues that patients were selected for placement in the colony as much for medical
234 Jonathan D. Ablard

This emphasis on work therapy, which lasted well into the 1940s, dovetails
the broader historical relationship between public health (and psychiatry in
particular) and immigration. As previously mentioned, Argentine statesmen
and elites recognized that a modern public-health system, and particularly
the systematic control of epidemics, would make Argentina more appealing
to migrants.43 On the other hand, the government and leading intellectuals
feared that an overly generous system would attract malingerers and so-called
defectives in search of the easy life. This concern was particularly marked
with respect to psychiatric care, where, as psychiatrists looking at the prob-
lem of malingering readily admitted, it was not always easy to distinguish the
insane from the simulator. Briey, work therapy was understood as a means to
distinguish the sick from the lazy.44
Work therapy was not the only manifestation of elite desire to curtail ex-
penses. As was true of many other institutions for women and children, the
voluntary work of elite women and of Catholic sisters bolstered faltering bud-
gets at the HNA. First, the hospital was administered free of charge by the elite
womens Society of Benecence. Although many doctors considered this to
be an anachronistic arrangement, the societys prominent position in the deliv-
ery of public-health care enjoyed government support well into the 1940s. A
cornerstone of their administration was the work of an Italian based Catholic
order, the Sisters of Charity. The sisters proved tireless supervisors of the largely
untrained staff and served also to check pilfering, at a fraction of what it would
have cost to hire professional nurses.45

Hospital reform
Despite an increasingly strong ideological imperative to re-order Argentine
society and contain and control the growing immigrant population, by the 1880s,
the mens and womens asylums were plagued by overcrowding, obsolete phys-
ical plants, an inability humanely to segregate violent patients, shortages of
doctors and trained staff, and unreliable state support. In point of fact, the hos-
pitals had existed in a state of perpetual crisis since their foundation. They had
grown in physical size only through the haphazard addition of new buildings
and wings and lacked any formal hospital design. The absence of clear legal

reasons as for particular skills that they possessed. Abuse of patient labour in the late nineteenth
century is implied by the need in 1893 to regulate its practice. See Proyecto de Reglamentacion
del Trabajo y Peculio de los Alienados del Hospicio de las Mercedes, in Memoria del Hospicio
de las Mercedes Correspondiente al Ano 1893.
43 Escude, Health in Buenos Aires in the Second Half of the Nineteenth Century.
44 Vezzetti, La Locura en la Argentina, 709.
45 Archivo Hermanas de Caridad-Hijas de Mara Senora del Huerto, Hospital Nacional de
Alienadas.
 Psychiatric reform in Argentina, 18901946 235

guidelines for the connement, treatment and release of persons thought to be

insane further complicated the systems ability to treat patients effectively.
Reforms of public health began to gain momentum by the early 1880s, spurred
in large part by a series of fairly serious epidemics in earlier decades. In 1883, the
municipal Public Assistance was created and charged to deliver public-health
services to the city of Buenos Aires. It ran several of the citys hospitals, in-
cluding the Hospicio until 1905, and also supervised preventative public-health
programmes. Financial and political upheaval in the 1890s further reinforced
the impulse to reform all public institutions in Argentina.46 The imperative to
modernize the hospitals was also impelled by the fact that they were located in
a neighbourhood that originally was on the citys outskirts but as the city grew
up and around the old asylums, it became increasingly difcult to ignore their
presence.47
At the height of the push to reform and renovate Argentine society, the citys
two asylums appointed new directors who each, in their own way, reected the
spirit of the times. Domingo Cabred (director from 1892 to 1916) and Antonio
Pinero (director from 1890 to 1905), of the mens and womens asylums respec-
tively, embarked on a series of reforms that proved highly successful in the short
term. By Argentinas centennial in 1910, for example, the two asylums enjoyed
reputations as model institutions, enviable by western European standards of
care.48 While providing important symbolic capital to the Argentine elite and
middle classes, the renovated asylum would provide humanitarian treatment
for those deemed mentally ill.
Cabred and Pinero received their medical training in Buenos Aires, but before
and during their tenures as director, they embarked on voyages to Europe in
search of models of psychiatric care that were applicable to Argentina.49 In
addition to visiting a wide assortment of urban and rural hospitals, as well as
medical schools, the two doctors appear to have been well versed in European
psychiatric literature. Although they seemed rarely if ever to coordinate their

46 E. A. Zimmermann, Los Liberales Reformistas: La Cuestion Social en la Argentina, 18901916

(Buenos Aires, 1994), 68; 1058. This period also witnessed increased concern for a whole host
of social ills that were often associated with Argentinas transition towards modernity and the
market economy. Alcohol abuse, crime, prostitution and sexual deviance, insanity and housing
were the principle issues of concern for the new generation of moral reformers. See R. D.
Salvatore, The Normalization of Economic Life: Representations of the Economy in Golden-
Age Buenos Aires, 18901913, Hispanic American Historical Review 81 (2001), 144.
47 Scobie, Buenos Aires: Plaza to Suburb, 18701910, 56: The presence of hospitals, like that of
garrisons and cemeteries, suggested that you were reaching the outskirts and the least desirable
residential zones of the city.
48 For photographs of the hospitals in 1910, see J. Carlos Stagnaro and J. Mara Gonzales Chaves,
Hospicio de las Mercedes: 130 Anos (Buenos Aires, 1993); Ministerio de Relaciones Exteriores
y Culto, Colonia Nacional de Alienados: Lujan (Provincia de Buenos Aires) (Buenos Aires,
1910); Album Historico de la Sociedad de Beneciencia, 18231910 (Buenos Aires, n.d.).
49 O. Loudet and O. Elas Loudet, Historia de la Psiquiatra Argentina (Buenos Aires, 1971).
236 Jonathan D. Ablard

proposals, they shared a desire to reform the legal, medical and institutional
frameworks of Argentine psychiatric care.
One of the most vexing problems facing the hospitals was the absence of
a modern legal framework to guide the connement and release of patients.
As matters stood, patients were admitted and released from the hospitals with
little or no oversight from the courts. Furthermore, although the national civil
code of 1871 included several sections on connement of the insane, they were
unwieldy in their application and in practical terms made emergency conne-
ments possible only by circumvention of the law. As a result of these discrepan-
cies, a large percentage of patients (precise statistics were never produced) did
not enjoy the benet of legal protection against wrongful connement. Many,
perhaps a majority, suffered undue delays in release, and even theft of their
possessions while under the care of the hospitals. Unlike in western Europe,
the United States or Great Britain, there were no highly publicized cases of
wrongful connement in Argentina that might explain the motivation behind
the proposals. It is clear, however, that Pinero, Cabred, and others, believed
that a well crafted law would protect doctors from accusations of abuse and
give patients and families great condence in the legal transparency of con-
nement. Reformers likewise believed that the creation of legal protections for
patients would improve Argentinas international reputation, and comparisons
with western Europe permeated their discussion.50
In addition to concerns about inadequate legal guidelines, Pinero and Cabred
had inherited obsolete institutions that had never met contemporary standards
of care. The womens asylum, for example, had been forced to close in 1881
when its patient population was nearly double its 200-bed capacity.51 Cabreds
annual report from his rst year as director, 1893, noted that the newer wards
for tranquil and paying patients, created during an earlier spate of reform by his
predecessor Lucio Melendez, were in good shape. However, he noted that the
overall condition of the hospital was poor, and that agitated and violent patients
were housed in a primitive cellblock.52 As such, these reform-minded doctors
worried that their institutions primary function had become custodial and not
curative.53 One of their principal goals, then, was to separate the patients who
were deemed curable from those whose condition was believed to be irreversible
and chronic. Overcrowding, of course, only made the task of separation all the

50 See J. D. Ablard, Law, Medicine and Connement in Twentieth-Century Argentina, in M. Ben

Plotkin (ed.), Argentina on the Couch: Psychiatry, State and Society in Modern Argentina
(Albuquerque, N. Mex., 2003).
51 Ingenieros, La Locura en la Argentina, 194; Loudet and Loudet, Historia de la Psiquiatria
Argentina, 436.
52 Memoria del Hospicio de las Mercedes Correspondiente al Ano 1893. For conditions under
Cabreds predecessor, Lucio Melendez, see Crider, Modernization and Human Welfare, 61.
53 For the United States, see R. W. Fox, So Far Disordered in Mind: Insanity in California,
18701930 (Los Angeles, 1978), 401.
 Psychiatric reform in Argentina, 18901946 237

more difcult to achieve and had inhibited the adequate development of a variety
of therapies.54
Segregation of patients along diagnostic and behavioural criteria required
both the modernization of existing facilities and the creation of new auxiliary
hospitals in rural areas. Aware of the development of psychopathic hospitals in
western Europe and the United States, the directors sought to transform what
they viewed as decaying and inhumane asylums into modern urban institutions
for the short-term care of patients. Smaller urban institutions would also serve
as teaching hospitals and centres of medical research.55
Pinero and Cabred embarked on ambitious reforms of their hospitals. The
womens hospital was completely renovated all of the old buildings were
eventually replaced with buildings modelled on the latest hospital designs in
Europe. In July 1898, the rst buildings were inaugurated with great fanfare
and publicity. The plan called for an 800-patient facility that would include
a central kitchen, general dormitory wards, as well as wards for the agitated
and violent, recreation and work shops, and wards designed exclusively for
pensionistas, paying-patients.56 Modications of the mens hospital were more
modest, but also included the development by 1910 of a clinic for acute patients
and a faculty of psychiatry.57
Obviously, none of these reforms could work without transforming a small
and untrained staff into one that could provide professional and reliable super-
vision of patients. Thus, hand in hand with the push to modernize the physical
structures of the institutions, Pinero and Cabred sought to improve the quality
of their staffs. Professional nurses were few in Argentina. The womens hospital
had traditionally recruited its staff from recently arrived female immigrants
often going down to the docks when ships arrived. Thus, there was a strong
imperative to develop training schools on hospital grounds, and improve the
professionalism of existing staff.58

54 Little, The Society of Benecence in Buenos Aires, 2515. For the Hospicio, see Hospicio
(1893).
55 Cabred specically referred to the work of Gresinger and his idea of the small urban clinic. D.
Cabred, Discurso Inaugural de la Colonia Nacional de Alienados, Revista de Derecho, Historia
y Letras 1 (Buenos Aires, 1899), 61920.
56 Loudet and Loudet, Historia de la Psiquiatra Argentina, 211; La Prensa, 1 August 1898. The
new hospital was designed with wards to accommodate the segregation of patients according to
diagnosis and class.
57 D. Cabred, El Instituto Clnica de Psiquiatra de la Facultad de Medicina de Buenos Aires
(Buenos Aires, 1919). By the 1930s, due to severe overcrowding and staff shortages, the clinic
ceased to function as Cabred had hoped.
58 Hospicio (1893), 50; En el Hospicio de las Mercedes-Distribucion de premios a los enfermeros,
Caras y Caretas 6: 224 (17 January 1903); Sociedad de Benecencia de la Capital, Memoria del
Hospital Nacional de Alienadas, 1900 (Buenos Aires, 1901). Training included making sure that
all nurses were literate. Hospital regulations imposed nes on staff if patients hurt themselves
or ran away.
238 Jonathan D. Ablard

Pinero and Cabred strongly believed that urban short-term facilities could
only thrive if there were rural institutions for the care of chronically mentally ill
patients. They hoped that recovery rates for acute patients at the urban institution
would improve by being segregated from chronic patients. To that end, Cabred
who had visited non-restraint and cottage-system asylums in Scotland and
Germany during the 1880s and 1890s, lobbied the national government for
nancial support. Likewise, Pinero published a treatise in 1893 on the Russian
psychiatrist Kovalesky, in which he advocated work therapy and a rural-colony
asylum.59 In 1899 the Colonia Nacional de Alienados (National Colony for
Insane Men), was inaugurated.60 Pinero obtained funding for a similar facility
for women in 1904, but it did not open until 1908, several years after the end of
the doctors tenure as director.61 Well into the 1940s, both institutions operated
as auxiliary hospitals to the older urban hospitals. In theory they were intended
for patients in need of long-term care, as well as for those for whom some time
in the countryside was seen as benecial prior to their release.
Pinero and Cabred further recognized that one of the principal impediments
to the development of their hospitals into modern institutions was that there
was no national bureaucracy to address psychiatric or general-health problems.
Of paramount concern was the fact that before 1914, there were no psychiatric
institutions outside of Gran Buenos Aires, an area that included both the city
and province of Buenos Aires.62 The absence of public asylums in the majority
of the nations provinces was considered a problem of grave consequence for
both national development and for the health of the nations provincial insane.
And, because of the geographic concentration of psychiatric resources in
Buenos Aires, other provinces sent the mentally ill there for treatment.63 This
practice tended to have deleterious effects on the capacity of urban hospitals
to keep patient numbers down, and also tended to encourage the abandon-
ment of provincial patients, who often ended up far from family-support net-
works. Nationalization of the administration of psychiatric care promised to
both expand the reach of psychiatric medicine to areas hitherto ignored, and to
help the existing urban hospitals better serve patients within the surrounding
areas.

59 Loudet and Loudet, Historia de la Psiquiatra Argentina, 146.

60 Cabred, Discurso Inaugural de la colonia Nacional de Alienados, 61516. Cabred was par-
ticularly impressed by what he referred to as the open door colonies in Scotland: Argyll,
Fife, Kinross, Inverness, Haddington and Perth. Cabred also had visited the asylum at Gheel,
Belgium.
61 Loudet and Loudet, Historia de la Psiquiatra Argentina, 148.
62 In addition to the HNA and the Hospicio, the province of Buenos Aires operated a small asylum. It
received its rst patients in 1881 under the name Melchor Romero. See, E. A. Balbo, El Hospital
Neuropsiquiatrico Melchor Romero durante los anos 18841918, in Peset (ed.), Ciencia, Vida
y Espacio en Iberoamerica, 5375.
63 Crider, Modernization and Human Welfare, 21213.
 Psychiatric reform in Argentina, 18901946 239

In their proposals, reformers made frequent reference to the French law

of 1838, which had nationalized both the criteria for connement and had
also ordered each department to establish an asylum.64 More generally, they
were impressed by the sheer number of asylums in Germany, the United States
and England as compared with Argentina. In 1906, at Cabreds urging, the
federal government created the Advisory Commission on Regional Asylums
and Hospitals.65 The commissions mission was to develop a plan for a national
network of hospitals and asylums and to supervise their operation. During the
next two decades, in addition to a number of general hospitals, the commission
built a rural colony for the mentally retarded in Torres, Buenos Aires Province
and a rural co-ed psychiatric facility in the western province of Cordoba, in the
small village of Oliva.66
For his part, Pineros proposal for the reform of Argentinas health system
were more ambitious in scope and also more politically controversial. Since his
arrival at the HNA, Pinero had joined a long line of well-established medical
doctors who challenged Argentina to modernize its medical infrastructure. A
particular target was the Society of Benecence, whose control of porteno
medical and charitable institutions for women and children was near hegemonic.
Although he worked for the society in his capacity as director, Pinero repeatedly
challenged its central role in the administration of health-care in Buenos Aires.67
The conict with the society came to a head in 1905, when he was relieved of
his post. The following year, the doctor issued a stinging attack on the society
in the halls of congress in which he urged the centralization of all public-health
institutions under the Ministry of the Interior.68

Limits of reform
Despite the fact that their efforts coincided with a favourable national economic
climate, Cabred and Pineros reform bore little fruit. Indeed, by the early 1940s,
hospital directors were writing memoranda complaining about the same legal,
administrative and medical problems that the earlier reformers had tried to cor-
rect. Increasingly, psychiatrists and social commentators recognized that with-
out greater nancial commitment from the national state, few reforms would
64 I. Dowbiggin, Inheriting Madness: Professionalization and Psychiatric Knowledge in
Nineteenth-Century France (Berkeley, 1991). The 1838 law was expanded in 1909.
65 The commission was Argentinas rst effort at national co-ordination of health care until the
creation in 1943, of the National Department of Health.
66 Moses Malamud, Domingo Cabred (Buenos Aires, 1972) 3946; D. Cabred, Asilo Colonia
Regional de Retardos, Archivo de Psiquiatra y Criminologa 7 (1908), 735.
67 Leandri, Medicos, Damas y Funcionarios, 85. See also Crider, Modernization and Human
Welfare, 389; Mead, Oligarchs, Doctors and Nuns, 4252.
68 On his dismissal, see La Nacion, 10 November 1905; AGN-SB-HNA, Legajo 221, Expediente
Libro 190507, Elementos de Juicio para Comprobar las Inexactitudes en que ha Incurrido
el Dr A. F. Pinero en su Articulo Publicado por La Nacion del 8 de Abril 1906.
240 Jonathan D. Ablard

prove durable. As a result, during the next three decades patients experienced
increased suffering, while doctors saw the status of the profession crumble.
The failure to affect a national programme of psychiatric care condemned the
existing institutions to overcrowding. Excessive patient population, in turn, pre-
vented the development and implementation of progressive and modern medical
techniques. Behind the failure to implement lasting reforms lay ideological and
structural causes.
Most devastating to the long-term reform of the hospitals was the continued
shortage of provincial and regionally based psychiatric care. This was in fact an
old problem, but one that took on increasing importance as Argentinas network
of railways developed and as the rural populace increasingly had easier access
to Buenos Aires.69 An early and important success by Cabreds commission
had been the opening of the Co-ed Regional Colony Asylum for the Insane in
1914. Located in the village of Oliva in Cordoba province, the Oliva asylum was
envisioned within a larger project to provide asylums throughout the interior
provinces. Oliva had been designed to full two somewhat contradictory goals;
it was to both receive patients from the older urban institutions and also serve
as a regional facility for the entire northwest sector of the country. With the
plan only partially completed, the Oliva asylum found itself even more over-
burdened than the older facilities. Reecting the economic imbalance between
the provinces and Buenos Aires, Oliva operated with very meagre government
allocations. At the end of 1934, Olivas patient population was 4,000 but it
only had capacity to treat 1,200 men and women.70 By 1939, Olivas director
reported that throughout the hospitals history, [Oliva] has served as an escape
valve for the metropolitan hospitals, while also receiving patients from both the
capital and all the provinces close to Cordoba.71 Ironically, the metropolitan
hospitals often complained that Oliva lacked the capacity to handle their patient
overow.72
The absence of a comprehensive network of hospitals throughout the re-
public affected not only Oliva but the metropolitan hospitals as well. Isolated
and lacking in services, provinces continued to send their mentally ill on the
long journey to Buenos Aires. The womens hospital, for example, found itself
constantly reminding northwestern provincial governors to send their female
patients to Oliva. The requests were rarely honoured. In 1914, for example,
the director of the womens asylum sent out a memorandum to the gover-
nors of the northwestern provinces to send their insane to Oliva.73 Compliance
69 On the relationship between Buenos Aires and the provinces, see L. Sawyers, The Other
Argentina: The Interior and National Development (Boulder, Colo., 1996).
70 Bulletin of the Oliva Insane Asylum 3 (March 1935), 110.
71 E. Vidal Abal, Twenty-Five Years of the Oliva Asylum, Bulletin of the Oliva Insane Asylum 7
(JuneAugust 1939), 24350.
72 AGN-SB-HNA, Legajo 90, Transfer of Patients, 19141933 (19 November 1917).
73 AGN-SB-HNA, Legajo 233, Libro March 15 December 16, 1915 (11 August 1915).
 Psychiatric reform in Argentina, 18901946 241

was sporadic, however, as witnessed by the repetition of the request as late as

1926.74
Both hospitals also faced the constant pressure from the province of Buenos
Aires. The province had had a provincial facility since the 1880s, but it was
quite small, and was located in a rural area.75 Furthermore, the majority of the
provinces population resided in urban areas contiguous to the city of Buenos
Aires and also linked by transportation networks. In addition to the problem
of dumping by provincial police, families frequently sought to have relatives
conned in the city hospitals because they were more accessible than their own
provincial institution. For these reasons, bonarenses (residents of the province
of Buenos Aires) were the most numerous of the hospitals provincial patients.76
These migrations (that paralleled the better known migration of provincial
peasants to Buenos Aires in search of work) negatively impacted on the medical
situation of many patients.77 Writing on the national context of psychiatric care
in 1933, the director of the Hospicio described the impact that long journeys
had on patients mental well being:
Evidently the insane from all over the Republic come to these hospitals; this is prejudicial
to the material and moral condition of the patient. Distance obliges in the majority of
the cases, that the patient undergoes the primary evolution of his disease in the heart
of the family, and in general is poorly observed and lacks correct treatment; in the best
of cases this leads to the individual being brought to the local police station, where the
saber replaces the bromide, or the local jail where they are placed in cells while they
await transfer to a psychiatric hospital, when the number of insane grows to the point
that it is economical. The prejudicial effects of this system are obvious . . . including the
separation of the patient from his family. The proximity of the family is not only helpful
for the patient, but also for the doctor for whom this is often the only way to acquire full
knowledge of the patients personal and family antecedents.78
Poor distribution of psychiatric care continued well into the late 1950s.79
The shortage of hospitals translated into chronic and perennial overcrowding
of existing hospitals. The housing of numbers of patients far in excess of hospital
capacity produced a vicious cycle infectious disease spread quickly, curable
patients recovery was delayed by the chaos of the institutions, and also by
the inability of doctors to attend to, or even keep track of, their patients. A
media expose of the HNA in 1918, that was based on reports by a former
74 AGN-SB-HNA, Legajo 199, Traslado de Enfermas, 19141933, (3 August 1926). Dr Julio
Nogues to Senoras Inspectoras.
75 Balbo, El Hospital Neuropsiquiatrico Melchor Romero durante los anos 18841918, 5375.
76 SB, Memoria Correspondiente al Ano 1940 (1941), 385.
77 On the question of the interior provinces economic development, and its impact on Argentina
as a whole, see Sawyers, The Other Argentina.
78 G. Bosch, El Pavoroso Aspecto de la Locura en la Republica Argentina [The Spectre of Madness
in the Argentine Republic] (Buenos Aires, 1931).
79 S. Bermann, Analisis de Algunos Datos de Estadstica Psiquiatrica, Acta Neuropsiquiatrica 5
(1959), 15060.
242 Jonathan D. Ablard

doctor, noted that female patients with a range of physical and psychiatric
ailments continued to be housed indiscriminately in large dormitories.80 A 1925
internal memorandum from the womens hospital, written when the institution
was almost 800 patients over capacity, eloquently expresses the scope of the
problem:
What would we say of a surgeon who operated in the old chambers of the Mens
Hospital or of a service for sick children where patients with pneumonia, whooping
cough, and measles were all mixed together? The same should be said of a psychiatric
hospital in which 700 patients are treated in a ward built for 250, where the excited,
depressed, persecuted and anxious are all mixed together.81
Similarly, a 1923 congressional investigation of the Hospicio, reported that
the hospital was unable to separate patients with communicable diseases from
the other patients. Likewise, overcrowding and a deteriorating physical plant
precluded separate wards for patients with different psychiatric diagnoses.82
In this respect, the case of patients who were considered violent was of par-
ticular concern. The cell-blocks for violent patients were only razed after both
Pinero and Cabred had left their posts; the womens Media Luna (Half-Moon),
was only torn down in 1913 and that of the Hospicio only in the 1920s.83 Vio-
lence likewise remained a topic of great concern both in the medical literature
and in the popular press. In addition to a spate of murders of doctors by patients
and of patients by staff, there was also a small uprising in the mens hospi-
tal which further brought home the point of the level of chaos inside national
psychiatric institutions.84
Ironically, efforts to segregate patients were frustrated by delays in the
completion of Pinero and Cabreds reforms. As early as 1911, the HNAs
director Dr Esteves complained that the as yet unnished project initiated by his
predecessor in 1894 was already obsolete. From his perspective, the plan
called for too many dormitories, which would end up housing a population in
excess of the hospitals therapeutic capacity. In sum, the old plan reinforced the
hospitals tendency to admit large numbers of patients.85 Even the more modest
physical plant reforms at the Hospicio were delayed through the end of Cabreds
tenure as director.86
80 Hospicio Nacional de Alienadas No Hay Legislacion Sobre esta Material, La Union,
24 July 1918.
81 AGN-SB-HNA, 19231947. Expediente 6323, Senoras Inspectoras del HNA from Presidenta
del SdB, Feb. 7, 1925.
82 Argentina. Congreso Nacional. Daily Sessions of the Chamber of Deputies. Diputados (14
March 1923), 45760.
83 Balbo, Argentinian Alienism from 1852 to 1918, 185.
84 Violent incidents in the hospitals rarely made it to the professional journals. For newspaper
reports about violence in the hospitals, see Ablard, Madness in Buenos Aires, 184.
85 AGN-SB-HNA, Legajo 221, Expediente Libro 19101911, Dr Jose Esteves to Senoras Inspec-
toras, 16 February 1911.
86 Memoria Correspondiente al Ano 191314 (1915), 56970.
 Psychiatric reform in Argentina, 18901946 243

Miserable conditions also hampered the nancial solvency of the hospitals.

Since their foundation, both hospitals had relied on a small number of paying
patients to bolster meagre hospital budgets. As early as the 1880s, the Hospicios
director had advised the city government that improving the hospitals physi-
cal conditions would help attract paying patients, whose nancial contribution
would in turn help keep the hospital solvent.87 Despite often precarious condi-
tions, both hospitals at the beginning of the twentieth century, were attracting a
healthy number of paying patients. At the HNA, for example, 20 per cent of all
patients were from rst- to fourth-class pensioners. By 1920 the last year that
statistics were kept in this category however, the number was down to a paltry
7 per cent.88 At the Hospicio, the administration was unable to acquire the funds
necessary to construct a ward for paying patients, which in turn diminished the
institutions appeal to paying patients.89
Similarly, and in large part because of problems of overcrowding and budget
constraints, neither institution was able to offer attractive work conditions or
professional opportunities to hired staff or doctors. A 1923 report by the director
of the HNA complained that the pay scale for his nurses and aides was lower
by a third than at comparable municipal hospitals: All the best ones leave, and
those who replace them are increasingly worse. Often they are women just off
the boat, who have never cared for an ill person. Worse still, our desire not
to hire illiterates is made impossible by the slim choices available.90 Doctors
also suffered, as witnessed by a 1935 womens hospital report on the careers of
psychiatrists in public facilities. The report complained that most doctors in
public facilities worked without the benet of a salary.91 Rural hospitals faced
the additional challenge that they were often located in isolated areas that offered
few if any amenities that the average middle-class Argentine might expect. Once
again, low levels of economic development in the interior worked against the
possibility of creating viable hospitals.
The crisis of public psychiatric care, from both the local and national per-
spective, was aggravated by the failure of psychiatrists to convince congress to
pass laws governing the connement of the insane. No national law governing
the connement of the insane passed congress until 1983 despite repeated ef-
forts by some psychiatrists. The lack of clear legal guidelines, as psychiatrists
complained, gave the public all the more reason to suspect hospitals as being

87 Crider, Modernization and Human Welfare, 151.

88 Sociedad de Benecencia, Memorias del Ano 1903 (Buenos Aires, 1904); Sociedad de
Benecencia, Memoria del Ano 1920 (Buenos Aires, 1921).
89 Hospicio de las Mercedes: Memoria Medico-Administrativa Correspondiente al Ano 1925
(Buenos Aires, 1926), 113.
90 AGN-SB-HNA, Legajo 201, Expediente 8051 (30 December 1923). Dr Esteves to the Senoras
Inspectoras.
91 AGN-SB-HNA, Legajo 208, Expediente 8172, HNA-Reglamentacion de la Carrera Hospitalaria
en el Establecimiento (12 April 1935).
244 Jonathan D. Ablard

dangerous places. It was, after all, common knowledge, that most patients in
public and private institutions were conned and released without the benet
of judicial oversight.92

Conclusions
The failure of the national state to expand and improve psychiatric care in
Argentina had profound repercussions on both patients and doctors. For patients,
continued overcrowding and a shortage of qualied staff and doctors resulted in
excessively prolonged hospital stays which were often characterized by physical
discomfort, neglect, and even danger. While the ideal of institutionalizing all
mentally handicapped persons had great currency in Argentina by the 1930s,
the hospitals found themselves unable to accommodate existing patients.
The promise and failure of the porteno mental-health system ts into a larger
political, administrative, and social history of twentieth-century Argentina. The
cause of the hospitals decline can be attributed to a number of factors of which
overcrowding was but a symptom. First, the hospitals operated within an ad-
ministrative arrangement that probably fostered indifference at top levels of
government. Until the creation of the National Department of Health within the
Ministry of the Interior in 1943, oversight for the two hospitals was under the
Ministry of Foreign Relations and Religion. Although the particular arrange-
ments differed for the two institutions, it is clear that public health had been
appended to a ministry with little time or expertise to devote to such matters.
This administrative anomaly tted into a broader pattern of health-care pro-
vision in Argentina, wherein authority for medical establishments was widely
dispersed among federal and municipal bureaucracies.93
Furthermore, the fact that the national government failed to provide direct
or nancial assistance to the countrys most needy had a negative impact on
the hospitals nances and may explain the high ratio of indigent to paying
patients in the hospitals. As historian John Fogarty has observed for this period,
A characteristic of the Argentine approach to welfare is that it was concerned
overwhelmingly with the welfare of working people rather than the destitute,
and it was generally implemented on an industry-by-industry basis rather than
universally.94 Even under Juan Peron, social security remained closely linked
to workplace and union afliation, and therefore was limited in its reach.95 The

92 Ablard, Law, Medicine and Commitment in Twentieth-Century Argentina.

93 H. Recalde, La Salud de los Trabajadores en Buenos Aires (18701910) a Traves de las Fuentes
Medicas (Buenos Aires, n.d.), 322.
94 J. Fogarty, Social Experiments in Regions of Recent Settlement: Australia, Argentina and
Canada, in Platt (ed.) Social Welfare, 18501950: Australia, Argentina and Canada Compared,
190.
95 M. Ben Plotkin, Politics of Consensus in Peronist Argentina (19431955), PhD thesis,
University of California at Berkeley (1992), 290318.
 Psychiatric reform in Argentina, 18901946 245

pattern of neglecting the most needy was even worse in those provinces that
did not share the prosperity of Buenos Aires. For economic, political and social
reasons many regions of the republic lacked adequate psychiatric facilities and
thus contributed every year a large proportion of the hospitals patients. This
trend was probably accentuated by the increasing ood of provincial migrants
coming to Buenos Aires in the 1930s in search of work in the burgeoning
industrial sector.96
Matters were made worse by the fact that much of the hospitals funding
came from national lotteries rather than a xed and stable budget. Usually, the
expansion of a hospital or the construction of a new one was at least partially
funded through lotteries. The Santa Fe provincial asylum in Oliveros that opened
in the late 1930s, for example, was funded largely from the earnings of the
provincial lottery.97 Likewise, the hospitals remained dependent on fees paid
by pensioners and the value of products made by indigent patients.
The hands-off attitude of successive governments to the health needs of
its citizens is further illustrated by a series of curious exchanges between the
national government and the Society of Benecence. Despite the precarious
existence of the HNA, in 1931, and again in 1942, the Ministry of Finance
offered the society administrative responsibilities for all facilities that were
currently under the Advisory Commission on Regional Asylums and Hospitals.
In both cases, the president of the Society conferred with the Minister of Foreign
Relations and Religion and decided that the vagaries of national budgets made
additional responsibilities imprudent. The attempt to dump additional health-
care responsibilities on the society is shocking since generations of medical
doctors had criticized the societys control of so many hospitals and other
welfare institutions.98
The desire to reorganize and modernize Argentine health care became a
political topic throughout the 1930s and 1940s. In September 1933 Socialist
deputy Angel M. Gimenez proposed the creation of a National Department of
Social Welfare to be run out of the Ministry of the Interior. Like other critics,
Gimenez noted that health care in Argentina was disorganized and lacked co-
ordination. For Gimenez, the impact of the world depression on Argentina
had brought into clearer focus the decits of health care; increased poverty
and desperation had had a residual effect on the functioning of hospitals and
asylums.99 Furthermore, Argentina relied excessively on antiquated notions of
96 Sawyers, The Other Argentina, 1834.
97 Argentina. Congreso Nacional. Diario de Sesiones de la Camara de Diputados (12 September
1941), 365. For lottery funding at the HNA, see Sociedad de Benecencia, Memoria Corre-
spondiente al Ano 1942, 23.
98 Sociedad de Benecencia, Memoria Correspondiente al Ano 1942, 1517.
99 A. Gimenez, Por la Salud Fsica y Mental del Pueblo 2 (Buenos Aires, 1938), 50. La situacion
se ha agravado en los ultimos tiempos con la profunda crisis, la masa enorme de desocupados y
la casi pauperizacion del proletariado argentino con salarios insucientes y condiciones de vida
precaria.
246 Jonathan D. Ablard

charity that, while often well intentioned, did not allow for the development of
an efcient, modern and preventative health system. On the last point, Gimenez
was adamant, and he noted that we make [natural] selection in reverse, with
the best intentions we bastardize the race. Medical help always arrives too
late, when the condition is irreversible.100 Gimenez, clearly inuenced by
eugenics, continued that the responsibility of the modern state was to help keep
its t citizens healthy; charity tended only to take notice at the point when an
individual was often too far gone to benet from care.101
To correct the situation, Gimenez proposed the creation of a national health
ofce that would oversee the diverse health establishments; while respecting
the autonomy of such institutions as the Society of Benecence and private
hospitals, the new ofce would assure better co-ordination of services and
hopefully eliminate extraneous or duplicated services. Interestingly, Gimenez
afforded guarded respect for the work of the society; citing his own earlier
attack on the society from 1915, Gimenez acknowledged that the society ran
good hospitals and that their ofcers rarely interfered with decisions made by
medical professionals.102 By contrast, Gimenez was highly critical of Domingo
Cabreds creation, the Advisory Commission of Regional Asylums and Hospi-
tals. The commission had deviated far from its original purpose of proposing
and funding the construction of hospitals, and in the last decade had become
a sui generis ofce of national public assistance.103 Gimenez further noted
that the commission tended to construct identical institutions, a one size ts
all policy that ignored the specialized needs of distinct institutions and their
clientele.
The groundswell for a reorganization of national health care was also found
in more conservative writers. Eduardo Crespo of the daily La Nacion com-
plained in 1936 that there was administrative disorganization in all Argentine
health care. The hospitals operated under the ministry of Foreign Relations and
Religion, an ofce ill-suited and uninterested in the task. The creation of a new
ministry would have required an amendment to the constitution a task too dif-
cult to risk. Crespo pointed out that half of all patients in porteno hospitals were
immigrants, and a full quarter came from outside the city limits. Clearly then
provincial governments and immigrant and ethnic mutual-aid societies and hos-
pitals were not pulling their weight. In addition, Crespo noted that only 10 per
cent of all hospitalizations in Argentina were private, whereas in the United
States the gure was closer to 30 per cent.104
100 Ibid., 49. Hacemos una seleccion al reves, con los mejores propositos bastardeamos la raza,
llegando tarde, cuando el mal es irreparable.
101 Ibid., 49. 102 Ibid., 56.
103 Ibid., 51. Destinada a asesorar y construir obras, por decretos sucesivos, se le ha dado atribu-
ciones directivas, tecnicoadministrativas de los establecimientos que creaba, viniendo a con-
stituir una sui generis asistencia publica nacional.
104 E. Crespo, Nuevos Ensayos Politicos y Administrativos (Buenos Aires, 1938), 11324.
 Psychiatric reform in Argentina, 18901946 247

Argentine scholar Hugo Vezzetti has asserted that for doctors the hospi-
talized insane are an emblem of the advances of western civilization, and the
necessary price for the construction of a modern nation and a vigorous race.105
Mid-nineteenth-century social reformers had claimed that barbarity, understood
as the antithesis of modern European civilization, produced mental imbalance.
Yet throughout the rst half of the twentieth century, by many psychiatrists
reckoning, Argentine psychiatrists increasingly viewed modernity as the cause
of mental imbalance. And as modern as Argentina was, it lacked the resources
to alleviate the consequences of its own social transformation.

105 Vezzetti, La Locura en la Argentina, 225.

10 Becoming mad in revolutionary
Mexico: mentally ill patients at the General
Insane Asylum, Mexico, 19101930

Cristina Rivera-Garza

On 18 July 1921, Modesta B., a thirty-ve-year-old single woman, arrived at

the General Insane Asylum the largest state institution devoted to the care of
mentally ill men, women and children in early twentieth-century Mexico.1 Days
earlier, a police agent had apprehended her because she was allegedly involved
in a street ght. As she did not calm down in gaol, authorities called on the
expertise of a licensed doctor who diagnosed her as mentally unstable. Mod-
esta B. passionately rejected his diagnosis but, poor and lacking a supportive
network, her escalating agitation was only used as further evidence of mental
derangement. Following a standard procedure, the government of the Federal
District then issued an order requesting her committal to the asylum. Located in
Mixcoac a village to the south of the capital city where members of the elite
relaxed over the weekends the once imposing medical facilities lingered in
utter decay.2 Indeed, little if anything was left of the glamour that surrounded
the inaugural ceremony of the massive architectural complex on 1 September
1910 an act that opened the nationalistic festivities of the centenary of the
Independence of Mexico under the vigilant gaze of aging president Porrio
Daz.3 During his thirty years in ofce, General Daz led the nation through an

1 Modesta B., 1921 from research conducted at the Archive of Public Health, General Insane
Asylum, section of clinical les, box: 105, le: 6639, 1921 (hereafter cited as AHSSA), F:MG;
S:EC; C:105; Exp:16 (6639). Last names of inmates have been omitted. For a ctional recreation
of this patients life in early twentieth-century Mexico, see C. Rivera-Garza, Nadie me Vera
Llorar (Mexico, 2000); No One Will See Me Cry (Curbstone, 2003).
2 For an oral history of the Mixcoac neighbourhood in Mexico City, see P. Pensado and L. Correa,
Mixcoac. Un Barrio en la Memoria (Mexico, 1996). An analysis of urban development in Porrian
Mexico City is Ariel Rodrguez Kuri, La Experiencia Olvidada. El Ayuntamiento de la Ciudad
de Mexico: Poltica y Gobierno, 18761912 (Mexico, 1996). Also, M. Johns, The City of Mexico
in the Age of Daz (Austin, Tex., 1997); P. Picatto, Urbanistas, Ambulantes, and Mendigos: The
Dispute for Urban Space in Mexico City, 18901930, in C. A. Aguirre and R. Bufngton (eds.),
Reconstructing Criminality in Latin America (Wilmington, Del., 2000).
3 The event received a lot of attention. See G. Garca, Cronica Ocial de las Fiestas del primer
Centerario de la Independencia de Mexico: Apendice (Mexico, 1911), 5860; M. Tenorio-Trillo,
1910 Mexico City: Space and Nation in the City of the Centenario, Journal of Latin American
Studies 28 (1996), 75104; I. Ruiz Lopez and D. Morales Heinen, Los Primeros Anos del
Manicomio General de la Castaneda (19101940), Archivo de Neurociencia 1(1996), 12429;
S. Ramrez Moreno, La Asistencia Psiquiatrica en Mexico (Mexico, 1950); G. Calderon Narvaez,

248
 General Insane Asylum, Mexico, 19101930 249

era of rapid social transformation based on growing involvement in the global

economy and centralization of political power, which came to an end with the
outbreak of the Mexican revolution in November 1910.4 Drastically affected by
the social upheaval, the state asylum faced severe nancial decits that resulted
in chronic overcrowding, physical ruin, and poor stafng. This was the place
in which Modesta B. became ofcially mad in that summer of 1921.
As with all human experiences, Modesta B.s internment was unique. Not
all inmates, for example, were so adamant against a doctors diagnosis and few
left the lengthy narrative she produced while in connement.5 Yet, admission
registers show that her age, civil status, and class standing were common among
the population served by the institution. Furthermore, ofcial documents also
demonstrate that her pathway into the insane asylum was fairly representative
of the bureaucratic and medical procedures used to justify committal during
the early revolutionary period in Mexico. While informative, these trends only
raise new questions. What were the continuities and discontinuities in strate-
gies of connement in an institution that bridged the Porrian regime and the
revolution, eras usually construed as oppositional in Mexican history? Did Por-
rian ideology, which permeated the planning and construction of the asylum,
inuence admission policy after 1910? What was revolutionary about the pro-
cedures through which men and women became asylum inmates from 1910 to
1930? More generally, how did men and women become mad in early revo-
lutionary Mexico? This chapter attempts to answer these questions by using
admission registers and medical les of the asylum from 1910 to 1929, the year
in which, mirroring larger social processes, the institution underwent medical
and administrative reform.
The case of the Mexican asylum is particularly important to the histori-
ography of connement because it shows the peculiar malleability of institu-
tions of mental health especially when they emerge, as did the General Insane
Asylum, in a time of profound social transformation.6 An expensive project that

Hospitales psiquiatricos de Mexico. Desde la Colonia hasta la actualidad, Revista Mexicana de

Neurologa y Psiquiatra 7 (1966), 11143.
4 Scholarship on the transition from Porriato to revolution is large in modern Mexican history, see
J. Hart, Revolutionary Mexico. The Coming and Process of the Mexican Revolution (Berkeley,
1989). While controversies abound regarding chronology, most scholars agree that the early
period of the revolutionary war extended from 1910 to 1917, the year in which a new Mexican
constitution was issued. While the armed conict tended to decrease in the following years,
most scholars have argued that it was not until the presidency of Lazaro Cardenas, 193440, that
the revolution came to an end with the emergence of agrarian reform programmes. Still others
have argued that, while interrupted, the revolution continues to the present day. See A. Gilly, La
Revolucion Interrumpida: Mexico 19101920. Una Guerra campesina por la tierra y el poder
(Mexico, 1971).
5 Modesta B. called her writings diplomatic dispatches.
6 Historical studies of psychiatric practice in Latin America include P. Farmer, The Birth of the
Klinik: A Cultural History of Haitian Professional Psychiatry, in A. D. Gaines (ed.), Ethnopsy-
chiatry. The Cultural Construction of Professional and Folk Psychiatrists (Albany, NY, 1992).
250 Cristina Rivera-Garza

developed over a period of twenty-four years, the asylum embodied almost to

perfection the modernizing agenda of the Porrian regime.7 Asylum designers
who perceived themselves as heralds of a new era in the late nineteenth century
emphasized, for example, their skillful use of foreign sources in the conception
of the institution. Likewise, as positivist thinkers, they stressed the thorough
empirical research that led to the asylums planning and construction.8 In the
same pragmatic vein, they accentuated the medical over the merely charitable
functions of the modern welfare establishment.9 Furthermore, both its nal lo-
cation in the periphery of Mexico City and its monumental architectural design
reected concerns with order and progress, a dyad intimately associated with
the Porrian era.10
Soon, however, the Mexican revolution reshaped the destiny of both asylum
and nation. A complex phenomenon that mobilized peasants, workers and mem-
bers of the middle classes throughout the country, the Mexican revolution left
little untouched in the nation.11 The asylum was no exception. In fact, by 1914,
the expanding meadows of the institution became battleelds in the conict.12
The conditions of the facilities deteriorated throughout the rst decade of the
twentieth century and did not improve when the armed phase of the revolution
came to an end in 1917 with the issuing of the Mexican constitution. Facing
immediate budgetary problems, the General Insane Asylum became a forsaken
entity where a reduced number of physicians could hardly treat, much less cure,

Also, A. Ruiz Zevallos, Psiquiatras y locos. Entre la Modernizacion Contra los Andes y el
Nuevo Proyecto de Modernidad. Peru: 18501930 (Lima, 1994). For an intellectual history of
psychoanalysis in Argentina, see M. Plotkin, Freud, Politics, and the Portenos: The Reception of
Psychoanalysis in Buenos Aires, 19101943, Hispanic American Historical Review 77 (1997),
4574. A social history of insane asylums in Argentina is J. Ablard, Madness in Buenos Aires:
Psychiatry, Society, and the State in Argentina, 18901983, PhD thesis, University of New
Mexico (2000).
7 For cultural analyses of the process of Porrian modernization in Mexico, see M. Tenorio-Trillo,
Mexico at the World Fairs: Crafting a Modern Nation (Berkeley, 1996); W. Beezley, Judas at
the Jockey Club and Other Episodes of Porrian Mexico (Lincoln, Nebr., 1987).
8 For an analysis of positivism in Latin America, see B. Burns, The Poverty of Progress. Latin
America in the Nineteenth Century (Berkeley, 1980). For the case of Mexico, see C. Hale,
Mexican Liberalism in the Age of Mora 18211853 (New Haven, Conn., 1968).
9 See J. Felix Gutierrez del Olmo, De la caridad a la asistencia. Un enfoque de la pobreza y la
marginacion en Mexico, in J. Felix Guiterrez del Olmo (ed.), La Atencion Materno-Infantil.
Apuntes Para su Historia (Mexico, 1993), 951.
10 C. Rivera-Garza, An Architecture of Mental Health: the Planning and Construction of the
General Insane Asylum, 18841910, manuscript.
11 G. Joseph and D. Nugent (eds.), Everyday Forms of State Formation: Revolution and the Ne-
gotiation of Rule in Modern Mexico (Durham, NC, 1994); A. Knight, The Mexican Revolution
(Cambridge, 1986); R. Ruiz, The Great Rebellion: Mexico, 19051924 (New York, 1980); Hart,
Revolutionary Mexico.
12 Diversos. La ocupacion del establecimiento por fuerzas zapatistas, AHSSA. F:BP; S:EH;
Se:MG; Lg:4; Exp:28. Diversos. Tiroteo zapatista, AHSSA. F:BP; S:EH; Se:MG; Lg:4;
Exp:19, 1. Diversos. Ocupatcion Zapatista y Constitucionalista, AHSSA. F:BP; S:EH; Se:MG;
Lg: 4; Exp: 37.
 General Insane Asylum, Mexico, 19101930 251

increasing numbers of patients suffering mostly from chronic conditions. Even

then, the revolutionary regimes led by generals Alvaro Obregon (19204) and
Plutarco Elas Calles (192832) did not opt for closing its doors. Not only had
the new constitution included an article granting the right to health care for
all Mexicans, but the revolutionary regimes also infused welfare ideology with
notions of social justice and reform.13 Indeed, according to the board respon-
sible for the management of welfare institutions the future of the nation rested
on state enterprises, such as the asylum, in which individuals could be treated
and rehabilitated in order to become useful citizens. Thus, while the institu-
tional framework of the asylum remained unaltered between 1910 and 1930, a
growing focus on the welfare responsibilities of the state brought new social
and medical demands to the establishment. In carving a place in revolutionary
Mexico, asylum authorities slowly but surely underscored the strategic position
of the institution as a centre for mental rehabilitation and social reform, an
effort especially evident in the attempts to reorganize the asylum according to
the principles of work therapy that began in 1929. This process, however, not
only came as a response to external pressures. Asylum actors patients and
doctors, authorities and staff members actively participated by engaging in
an animated debate about the dening characteristics of mental illness and the
social meanings of the institution designed to treat it. This debate was particu-
larly visible in the set of ofcial and unofcial rules that determined admission
verdicts. Based on an exploration of inmates proles, this chapter rst argues
that, from 1910 to 1930, asylum authorities, police agents, and members of the
community transformed the institution to better t the welfare ideology and
practice of early revolutionary Mexico.
While the singularities of the Mexican asylum were many, this establishment
also shared basic characteristics with state mental-health institutions worldwide.
As in these other asylums, Mexican state agents played an active role in the
detection, apprehension and connement of men and women suspected to be
mentally ill.14 In 1910, for example, some 85 per cent of admissions involved
a government order a document usually issued at the request of the po-
lice, welfare authorities, or city gaol ofcials.15 This gure remained roughly
13 For a detailed description, see A. Mazzaferi, Public Health and Social Revolution in Mexico:
18701930, PhD thesis, Kent State University, Ohio (1968). Also, El derecho del hombre a la
salud, in J. Alvarez Amezquita et al. (eds.), Historia de la Salubridad y la Asistencia en Mexico
(Mexico, 1960), 72.
14 Noting different levels of state agents participation, similar procedures have been detected in
California, Ireland, Nigeria, England, and Argentina. See R. W. Fox, So Far Disordered in Mind.
Insanity in California, 18701930 (Berkeley, 1978); J. Sadowsky, Imperial Bedlam. Institutions
of Madness in Colonial Southwest Nigeria (Berkeley, 2000); M. Finnane, Insanity and the Insane
in Post-Famine Ireland (London, 1981); J. K. Walton, Lunacy in the Industrial Revolution: A
Study of Asylum Admissions in Lancashire, 18481850, Journal of Social History 13 (1979),
122; J. Ablard, Madness in Argentina.
15 Based on a random sample of 100 les from 1910. Means of arrival.
252 Cristina Rivera-Garza

unchanged over the next two decades. Nevertheless, in at least 15 per cent of
the internments, family members mothers and fathers, husbands and sisters
played signicant roles too, adding complexity to views that represent asylums
as mere institutions of state control.16 Just as in Europe and the United States,
these Mexican gures have raised new questions about the social nature of in-
sane asylums as well as the various and contesting ways in which governments
and patients have appropriated these medical institutions over time and across
cultures.17 This chapter adds to this debate arguing that, in the Mexican case,
both families and the state placed social and medical demands on the asylum,
which ultimately dened the roles of the institution as both a site of control and
a place of refuge and assistance in early revolutionary Mexico.
Because information about the planning and construction of the Mexican
asylum is both scarce in Mexican historiography and relevant to this inquiry,
this chapter rst traces the medical and social debates that shaped the design and
construction of the institution from roughly 1884 to 1910. It then explores the
ways in which revolutionary politics affected the medical and welfare services of
the establishment. Such analysis leads into further exploration of the actors that
gave life to the institution, especially the men and women who became inmates
and whose social and demographic characteristics greatly shaped the various
roles played by the asylum in society at large. Further, an analysis of asylum
diagnoses illustrates the changing ways in which doctors, patients and families
dened mental illness in early revolutionary Mexico. Special attention is given
to cases of epilepsy, mental retardation and alcoholism, the largest diagnostic
groupings during this era. While cases of moral insanity were not as numerous,
examination of these les illuminates medical and social discussions about the
place of women in revolutionary society. The chapter ultimately argues that asy-
lum inmates proles shed light on the negotiation through which state agents
and family members dened mental illness, an aspect of growing importance
for revolutionary regimes concerned with the reconstruction of the nation. In
fact, paraphrasing the discourse of revolutionary welfare authorities that per-
ceived physical health as a national asset, asylum authorities soon claimed that

16 A representative selection of views of insane asylums as institutions of social control includes

M. Foucault, Madness and Civilization: A History of Insanity in the Age of Reason (New York,
1965); D. Rothman, The Discovery of the Asylum. Social Order and Disorder in the New Republic
(London, 1971); E. Goffman, Asylum: Essays on the Social Situation of Mental Patients and
Other Inmates (New York, 1962).
17 As research on the history of asylums grows, views of mental-health institutions have become
more complex. A representative sample of revisionist literature includes E. Dwyer, Homes for the
Mad. Life Inside Two Nineteenth-Century Asylums (New Brunswick, NJ, 1987); G. Grob, Mental
Institutions in America: Social Policy to 1875 (Basingstoke, Hants., 1973); A. Digby, Madness,
Morality and Medicine: A Study of the York Retreat 17961914 (Cambridge, 1985); L. Bachrach,
Asylum and Chronically Ill Psychiatric Patients, American Journal of Psychiatry 141(1984),
9758; A. Goldberg, Sex, Religion and the Making of Modern Madness. The Eberbach Asylum
and German Society, 18151849 (Oxford, 1999); Sadowsky, Imperial Bedlam.
 General Insane Asylum, Mexico, 19101930 253

caring for the mental health of the community was central to the future of the
country.18

The modern asylum: the rise of the General Insane Asylum,

18841910
The history of mental-health care in Mexico dates back to the early colonial
times when private parties with the support of the Catholic church established
the San Hipolito and the Divino Salvador, hospitals devoted to the care of
mentally ill men and women respectively.19 Almost four centuries later, the
emergence of the General Insane Asylum in 1910 represented the transition
from custody and charity to therapy and correction.20 While the hagiography
of the asylum usually presents this change as a result of a compelling moment
of realization, the history behind the walls of the modern medical facilities
was long and less spontaneous.21 In fact, the planning of the institution in-
volved a complex process which included translating foreign sources mostly
documents from insane asylums located in the United States and France and
a careful consideration of local conditions in which both the improvement of
psychiatric treatments and concerns with the ordering of society played impor-
tant roles. These social and medical variables produced paradoxical views of
institutions for the insane as both sites of control and places of refuge. From
beginning to end, then, there was an ambivalence as to the exact nature of the
asylum project.
The early inception of the asylum took roots in a stable society that enjoyed
high rates of economic growth. Known as the golden era of the Porrian regime,
the last two decades of the nineteenth century witnessed the emergence of a
myriad of urban, medical and social projects with which Porrio Daz and his
cabinet formed by self-named cientcos (scientists) expected to ratify the
modern character of the regime.22 The costly drainage works that saved Mexico
City from recurrent oods, the erection of public buildings bearing the inuence
of French architecture, the implementation of the telephone system, and even

18 A. Torres, El Manicomio General, Revista de la Benecencia Publica, 348 (1917), 302.

19 For a brief history of the San Hipolito hospital, see J. S. Leiby, San Hipolitos Treatment of
the Mentally Ill in Mexico City, 15891650, The Historian 54 (1992), 4918. For a history of
the Divino Salvador hospital, see C. Berkstein Kanarek, El hospital Divino Salvador, thesis,
Universidad Nacional Autonoma de Mexico, 1981.
20 See Gutierrez del Olmo, De la caridad a la asistencia, 951.
21 S. Ramrez Moreno, a well-known psychiatrist in early revolutionary Mexico, referred to the
inception of the asylum as a moment in which Porrio Daz realized that something had to
be done to treat the insane in proper ways, in La Asistencia Psiquiatrica en Mexico, 9. (All
Spanish translations into English are by the author.)
22 The cientcos were also known as the wizards of progress. See Tenorio-Trillo, Mexico at the
World Fairs.
254 Cristina Rivera-Garza

the renaming of the streets turned the capital city into the showcase of the era.23
However, while supporters were generally optimistic, the rapid pace of social
change also produced anxiety and trepidation. Massive land dispossessions in
the countryside and industrial growth in urban areas prompted a migration of
peasants into Mexico City. Dark-skinned and poor, immigrants soon became
a source of concern among city designers and social commentators for whom
their ethnicity, class origins and lifestyles not only embodied the antithesis of
modernization but also represented a social threat. Porrian analysts thus un-
leashed an unprecedented effort to identify and control potentially dangerous
members of society, especially targeting criminals, prostitutes, alcoholics and
the insane.24 Committed to the protection of society, experts unabashedly sup-
ported the creation of institutions able to contain the pernicious inuence of
what they perceived as wayward men and women. Authorities of the Public
Welfare Administration, which had been secularized since 1861, quickly re-
sponded to the challenge. Unlike religious welfare institutions that worked on
the principles of charity, Porrian welfare ideology developed a rm conviction
on the benets of seclusion and the possibilities of correction.
It was in this context that the federal government nanced and published El
Manicomio (The Insane Asylum), a report written by physician Roman Ramrez
in 1884, which included an extensive and comparative collection of documents
concerning the construction and management of insane asylums in the United
States and Europe.25 Interested in pragmatic information that could be put to use
in Mexico, Ramrezs selection of documents was partial to the United States
and to therapies that involved seclusion. Thus he included the translation of
standards of construction and rules of governance for insane asylums created
by the Association of Medical Superintendents of American Institutes for the

23 See B. A. Tenenbaum, Streetwise History: The Paseo de la Reforma and the Porrian State,
18761910, in W. Beezley et al. (eds.), Rituals of Rule. Rituals of Resistance. Public Celebra-
tions and Popular Culture in Mexico (Wilmington, Del., 1994), 12750; T. Morgan, Proletarians,
Politicos, and Patriarchs: The Use and Abuse of Cultural Customs in the Early Industrialization
of Mexico City, 18801910, in Beezley et al. (eds.), Rituals of Rule, Rituals of Resistance,
15172; V. Cuchi Espada, La ciudad de Mexico y la Compana Telefonica Mexicana. La con-
struccion de la red telefonica, 18811902, Anuario de Espacios Urbanos. Historia. Cultura.
Diseno (Mexico, 1999), 11760.
24 C. Roumagnac, Por los Mundos del Delito. Los Criminales de Mexico. Ensayo de Psicologa
Criminal (Mexico, 1904); J. Guerrero, La Genesis del Crimen en Mexico. Ensayo de Psiquiatra
Social (Mexico, 1901); M. Macedo, La Criminalidad en Mexico. Medios de Combatirla (Mexico,
1897). For contemporary studies on criminology see R. Bufngton, Criminal and Citizen in
Modern Mexico (Lincoln, NE, 2000); Aguirre and Bufngton (eds.), Reconstructing Criminality
in Latin America.
25 See R. Ramrez, El Manicomio: Informe Escrito por Comision del Ministro de Fomento (Mexico,
1884). Ramrezs interest on social aspects of mental health was also developed in his Resumen
de Medicina Legal y Ciencias Conexas para uso de los Estudiantes de las Escuelas de Derecho
(Mexico, 1901).
 General Insane Asylum, Mexico, 19101930 255

Insane, a professional organization founded in 1844.26 Equally relevant were

asylum records and superintendent reports from various American institutions,
notably the New York Lunatic Asylum, the Illinois and Iowa Hospitals for
the Insane, and the Alabama Insane Hospital. Systematic in approach and rich
in detail, Ramrezs report was the rst introduction to the inner workings of
modern mental-health facilities ever to appear in Mexico. Providing information
about both mental-health treatments and the management of asylums, Ramrez
placed his work in that ambiguous realm in which science and social concerns
converged. In translating documents from both areas, Ramrez fullled the
role of a cultural policy translator a task of increasing relevance in a regime
committed to modernity at all costs.
Ramrezs evident support for mental-health treatments that emphasized so-
cial segregation clearly responded to ongoing anxieties about the urban poor.
However, increasing concerns among the psychiatric community over the ef-
ciency of existing institutions for the insane also played a role. Indeed, while
small in numbers, physicians with working experience at local mental-health
hospitals continuously requested improvement of medical treatments and living
conditions of the mentally ill. Supported by foreign medical theories, mostly
the exible language of degeneration theory, Mexican physicians published
articles in Mexico City medical journals where they explored in detail the de-
plorable status of the mentally ill.27 They did not forget, however, to praise
the methods used for their treatment abroad. As academic interest in men-
tal pathologies grew, the School of Medicine offered an upper-level elective
class on psychiatry for the rst time in 1887. Taught by doctor Miguel Al-
varado, the director of the Divino Salvador hospital, this class marked the be-
ginning of the psychiatric profession in Mexico.28 Seven years later, doctor Juan
Peon Contreras, a physician from the province of Yucatan, occupied the rst

26 For a history of the AMSAII, todays American Psychiatric Association, see W. E. Barton, The
History and Inuence of the American Psychiatric Association (Washington, DC, 1987). Also,
American Psychiatric Association, One Hundred Years of American Psychiatry (New York,
1944).
27 For a study on the emergence and uses of degeneration theory, see I. R. Dowbiggin, Inher-
iting Madness. Professionalization and Psychiatric Knowledge in Nineteenth-Century France
(Berkeley, 1991). This author describes degeneration theory as a steady though not necessarily
irreversible hereditary deterioration over the course of four generations . . . [Including] symptoms
such as moral depravity, mania, mental retardation, and sterility. Physicians ascribed a variety of
causes to degeneracy, including alcoholism, immorality, poor diet, and unhealthy domestic and
occupational conditions. However, the principal cause of degeneracy that physicians cited was
heredity. For an analysis of degeneration theory in the Latin American context, see D. Borges,
Puffy, ugly, slothful and inert: Degeneration in Brazilian Social Thought, 18801940, Jour-
nal of Latin American Studies 23 (1993), 23556. Also see C. Rivera-Garza, Dangerous Minds:
Changing Psychiatric Views of the Mentally Ill in Porrian Mexico, 18761911, Journal of the
History of Medicine and Allied Sciences 6 (2001), 3667.
28 G. Somolinos DArdois, Historia de la Psiquiatra en Mexico (Mexico, 1976).
256 Cristina Rivera-Garza

ofcial professorship in the eld of psychiatry.29 The asylum project developed

conjointly.
By 1896, a group of lawyers, engineers, welfare agents and two physicians
who had worked at mental-health hospitals constituted the ofcial board charged
with building the asylum. After analysing both international and local condi-
tions, they made recommendations to the authorities that disclosed medical
strategies to treat insanity, spatial tactics to prevent contagion, and social poli-
cies to preserve the order and progress of society at large fundamental values
of the Porrian regime.30 First, they recommended that the asylum be located
away from populated areas to create a division between the world of reason and
the world of madness, thus avoiding confusion and the possibility of contagion.
Second, they recommended that authorities implement a strategy to classify
inmates, both medically and spatially, within asylum walls. They advocated
the creation of a department of admission and classication in which doctors
could observe and examine inmates carefully because, as they were acutely
aware, insanity lacked a characteristic mark and could go easily undetected
or misdiagnosed.31 They too backed the division of the asylum into separate
wards, each housing inmates suffering from the same ailment. In addition, to
protect the nances of the institution, they suggested that inmates be classied
according to rst and second categories, giving priority to paying inmates. The
committee attached blueprints of administrative ofces, wards, workshops, li-
braries and other facilities to illustrate how the architectural design of the asylum
reected medical concerns with classication and order. A condent committee
concluded the report by stating that the humanitarian nature of the enterprise
would only ratify the levels of modernization already achieved by the Porrian
regime. A year later, the Public Welfare Administration bought the 485,700
square metres of land that eventually housed the asylum in the periphery of the
sprawling metropolis.32
In the following years, as the Porriato became a stable dictatorship, support
for public works grew, especially for those projects which, like the asylum,
29 For a biography of Jose Peon y Contreras, see F. Fernandez del Castillo, Antologa de Escritos
Historico-Medicos, 2 vols. (Mexico, 1952), 10578. Also, E. Aragon, Biografa del Dr Juan
Peon del Valle (Sr), Mis 33 Anos de Academico, i (Mexico, 1943), 99105.
30 Named by the Minister of the Interior, General Manuel Gonzalez Coso, the 1896 board in-
cluded a president (Dr Vicente Moreales, inspector from the Welfare System), a secretary (Dr
Manuel Alfaro, the creator of the highly controversial 1867 Regulation of Prostitution), and four
additional members (Dr Antonio Romero, who had been director of the San Hipolito hospital;
Ignacio Vado, a doctor with working experience at the Divino Salvador hospital; Dr Samuel
Morales Pereyra; and Luis L. de La Barra, an engineer from the welfare system). See S. Morales
Pereyra and A. Romero, Exposicion y proyecto para construir un manicomio en el Distrito
Federal, Memorias del Segundo Congreso Medico Pan-Americaono vericado en la Ciudad de
Mexico, Republica Mexicana, noviembre 1619 de 1896 (Mexico, 1898), 88896.
31 Ibid., 896.
32 Departamento de construccion y conservacion de edicios del Manicomio General, AHSSA.
F:BP; S:EH; Se:MG; Lg:13; Exp:11, 1.
 General Insane Asylum, Mexico, 19101930 257

clearly embodied the ideology of the regime. Thus, in 1905 engineers De La

Barra, who worked for the welfare system, and Salvador Echegaray drafted a
long and persuasively argued document which came to constitute the denitive
study leading to the construction of the General Insane Asylum.33 The narrative
strategies used in the document reected a careful process of cultural negotia-
tion. Divided into four sections general plan of the asylum, general services,
services for inmates and general organization of the asylum the project in-
cluded guidelines following a consistent formula. First, they presented a brief
yet insightful overview of foreign sources, a section called theoretical condi-
tions. Unlike the 1884 report which emphasized documents from the United
States, this section drew heavily from French sources, especially reports from
commissions in charge of asylum construction under the rule of famous ad-
ministrator Baron Georges-Eugene Haussman, the prefect of the department
of Seine during the second empire and responsible for the transformation of
Paris.34 Second, in a section titled programme, the authors introduced the
specic needs of the Mexican setting, resorting when possible to data from
the San Hipolito and Divino Salvador hospitals. Lastly, they concluded each
proposal with a suggested solution, usually a compromise between the for-
mer two. Thus, as true modernizing agents, Echegaray and De La Barra drew
information from foreign asylums, but they did it in a critical fashion, adapting
lessons and experiences to the local conditions of Mexico.
However persuasive the document was, experts in the elds of psychiatry,
engineering, criminology as well as state bureaucrats recommended further
modications. Some were concerned with nances, others wanted to dispense
with architectural ornamentation, still others strove to acquire the best equip-
ment for the hospital. While numerous, the recommendations made by the
Council of Public Buildings and members of a new asylum committee formed
by lawyer and criminologist Miguel Macedo, engineer Alberto Robles, and psy-
chiatrist Juan Peon del Valle, did not alter the 1905 document in fundamental
ways. Twenty months later, on December 1906, engineer Salvador Echegaray
was ready to submit yet another document, with additional blueprints attached,
to the Ministry of the Interior.35 Then, three years later, on June 1908, the
Ministry of the Interior and engineer Porrio Daz Jr, the son of the president
of the republic, signed a contract to begin construction.36 The asylum would

33 Memoria sobre el proyecto de Manicomio General para la ciudad de Mexico, AHSSA. F:BP;
S:EH; Se:MG; Lg:49; Exp:1.
34 For an analysis of European urban planning and its impact on the design of Latin American cities,
see J. E. Hardoy, Theory and Practice of Urban Planning in Europe, 18501930: Its Transfer
to Latin America, in R. M. Morse and J. E. Hardoy (eds.), Rethinking the Latin American City
(Baltimore, Md., 1988), 2049.
35 Modicaciones al proyecto presentado por el ingeniero Don Salvador Echegaray, AHSSA.
F:BP; S:EH; Se:MG; Lg:1; Exp:10.
36 Contrato, AHSSA. F:BP; S:EH; Se:MG; Lg:49; Exp:2.
258 Cristina Rivera-Garza

include twenty-ve buildings, counting inmates wards, doctor residences, in-

rmaries, and the general services building whose imposing facade of classical
lines became the hallmark of the institution.
The General Insane Asylum replicated values and hierarchies of the city in
which it was built. Echoing fears of disorder and contagion characteristic of
the Porrian political imagination, the physical layout of the institution secured
separate areas for men and women, dividing them with fences disguised with
bushes and plants to avoid the appearance of a gaol.37 Mirroring social hierar-
chies, the asylum also allocated the front areas, those closest to the gardens and
the entrance, to paying inmates who lived in single rooms. Behind them, the
common wards for indigent inmates began. The 848 female and male inmates
arriving from the existing mental-health hospitals in 1910 were distributed in
seven wards, including those for tranquil, dangerous, alcoholic, epileptic, idi-
otic, elderly and paying inmates.38 Social order was further embedded in the
governing rules of the institution, which placed a physician-director at the top,
followed by an administrator, the medical staff including both doctors and
nurses, and attendants. Written by an inspector from the Public Welfare System
and the directors of ve hospitals, the asylum regulations of 1913 included rules
to provide inmates with the best psychiatric assistance available while securing
the administrative order and scientic status of the institution.39 Enforcing these
rules, however, proved a monumental task. The institutional order was limited
by the rapidly changing social context in which the asylum emerged.

Revolution and the asylum: 19101930

The revolution a social upheaval that took over one million lives in the coun-
try impacted on the General Insane Asylum shortly after ofcial inaugura-
tion. Indeed, without the economic and political investment that gave it birth,
the asylum soon faced mounting nancial dilemmas, which affected both its
administrative and medical branches, forcing a gradual redenition of the in-
stitution as a whole. Rather than the medical and research institute envisioned
by modernizing Porrians, the establishment quickly reverted to its custodial
functions.
As in state-run asylums abroad, the Mexican institution soon faced the prob-
lem of inmate overpopulation a phenomena that reected the growing demand
for asylum accommodation during the early revolutionary era. Indeed, careful
demographic calculations had resulted in the provision of 1,330 beds in 1910
730 reserved for women and 600 for men but the demand outstripped the
37 Memoria, AHSSA. F:BP; S:EH; Se:MG; Lg:49; Exp:1, 27.
38 Data appear in J. Luis Patino Rojas and I. Sierra Mercado, Cincuenta anos de Psiquiatra
en el Manicomio General (Mexico, 1960).
39 Reglamento Interior del Establecimiento, 1913, AHSSA. F:BP; S:EH; Se:MG; Lg:3; Exp:25.
 General Insane Asylum, Mexico, 19101930 259

supply of beds by 1911.40 This gap decreased during the 1920s, but grew back
over time.41 Authorities faced a dilemma. While they acknowledged that the
number of inmates had to be reduced, they were also aware that this situation
stemmed form the very welfare principles that ruled the institution, including
the stipulation to provide care to all individuals regardless of sex, age, religion,
and social status.42 Also, as the most important national institution in the eld,
the asylum not only admitted boarders from the capital city, but also from the
provinces of Mexico and, at times, even from foreign countries. In addition,
most admitted patients suffered from chronic conditions that required long peri-
ods of hospitalization. These three variables became aggravated by the needs of
the revolutionary era. In a time of change and dislocation, where violence and
starvation were not rare, the asylum accommodated great numbers of destitute
patients who, for the most part, had nowhere else to go.
Social indifference and governmental neglect also affected the physical struc-
ture and the quality of the asylums general services, both of which deteriorated
throughout the armed phase of the revolution. For example, by 1916, inspectors
from the public welfare system noted that inmates wore inadequate garments
and ate small pieces of bread that did not even weigh 40 grams.43 By 1920,
asylum problems went far beyond clothing and food supplies, including the lack
of mattresses, electricity and basic medications, as well as leaking roofs and
the deterioration of hardwood oors, doors and windows of most buildings.44
Sensing fertile ground for sensationalist news, journalists visited the asylum
and described it as a ravaged landscape, an institution in complete desolation,
lacking hygiene in the kitchen, providing inmates with poor and scant meals,
supplying indigent inmates with miserable clothing. [In sum] wards, isolation
rooms, gardens, streets and patios were completely forsaken.45
The ominous state of the institution was not limited to its welfare services.
The lack of nancial support also compromised its status as a medical estab-
lishment, for the scientic personnel soon became insufcient. Despite internal
regulations, by 1912 only one intern bore full responsibility for the care and
treatment of ninety-eight inmates in the ward of tranquil inmates A, a situa-
tion that was the norm, rather than the exception throughout the hospital.46 The
limited number of nurses and poorly trained attendants seriously aggravated
the problem. Only two years after opening, each asylum nurse took care of an

40 Data appear in Patino Rojas and Mercado, Cincuenta Anos de Psiquiatra.

41 According to Patino Rojas and Mercado, the number of enrollments in 1910 was 1, 004. In 1920
connements went down to 697. By 1930 the asylum housed 1, 001 inmates. Despite this data,
complaints against overcrowding remained high throughout this period.
42 Reglamento interior del establecimiento, 1913, 2.
43 Informe de Inspectores, 1916, AHSSA. F:BP; S:D; Se:DG; Lg:18; Exp:21, 132.
44 Informe del Manicomio, 1920, AHSSA. F:BP; S:EH; Se:MG; Lg:10; Exp:24.
45 Diversos. Nota del Universal, 1918, AHSSA. F:BP; S:EH; Se:MG; Lg:8; Exp:27.
46 Presupuesto, 1912, AHSSA. F:BP; S;EH: S:MG; Lg:3; Exp:7, 7.
260 Cristina Rivera-Garza

average of 150 inmates in various wards. Similarly, eighty-six attendants su-

pervised 1,024 inmates, roughly half as many as the director determined were
needed to provide adequate attention.47 Under these circumstances, emphasis
on the custodial functions of the institution increased.
Although neglected, the asylum remained open throughout the early rev-
olutionary era fullling important welfare functions. As new regimes intently
rearticulated welfare ideology and practice to suit the needs of revolutionary so-
ciety, asylum authorities began the reorganization of the institution based on the
principles of work therapy. Led by Samuel Ramrez Moreno and Manuel Gue-
vara Oropeza, physician-directors of the institution between 1928 and 1932, this
administrative and medical reform signicantly coincided with the emergence
of political organizations linked to the state such as the National Revolutionary
Party a national party that, under different names, remained in power to the
end of the century.

A view from within: inmate proles

While designers and authorities infused the asylum project with specic ide-
ologies and aspirations, the General Insane Asylums varied role in Mexican
society was ultimately shaped by the population it served. For some, like Luz
M. de S., whose husband conned her against her will trying to divorce her, the
asylum was a gaol that reinforced uneven gender relations.48 For others, like
Esperanza T., who became an inmate at three different times in her life, the asy-
lum came to rescue her from the harsh life of a beggar on Mexico City streets.49
Still for others, like Merino G., who was conned after hitting a municipal presi-
dent in his hometown, the asylum eventually turned into a liminal arena, namely
a place he left when feeling well and returned to in times of need.50 Some in-
mates, like Modesta B., found a job in there and, while opportunities to escape
abounded, remained within its walls for thirty-ve years.51 For some families,
such as the Q.s, the asylum was the last resort to treat the unruly behaviour of
a spirited daughter.52 Others, like Altagracia G., returned to her family in the
province of Aguascalientes recovered from a nervous breakdown.53 Many more
found nothing but death within its walls, a condition resulting from poisoned
food and neglect rather than mental illness per se. While highly diverse, the
population that made the asylum also shared a set of social and medical char-
acteristics which, put together, reect the various social meanings ascribed to
the asylum.

47 Ibid., 8. 48 Luz D. de S., 1911, AHSSA. F:MG; S:EC; C:22; Exp:63.

49 Esperanza G., 1911, AHSSA. F:MG; S:EC; C:101; Exp:15.
50 Merino G., 1921, AHSSA. F:MG; S:EC; C:97; Exp:67.
51 Modesta B., 1921, AHHSA. F:MG; S:EC; C:105; Exp:16 (6339).
52 Guadalupe Q., 1911, AHSSA. F:MG; S:EC; C:6; Exp:35(404).
53 Altagracia F. de E., 1920, AHSSA. F:MG; S:EC; C:106, Exp:12.
 General Insane Asylum, Mexico, 19101930 261

During its early years, the asylums purpose in society was especially open
to denition a situation that both the state and the community used to place
a variety of demands on the institution. While Porrian designers had envi-
sioned the asylum as a medical establishment where both the wealthy and the
destitute could secure care, paying boarders constituted a rare minority from
the start. Most surely, they found medical assistance at the Lavista Clinic, a
private hospital located to the south of Mexico City, or at the small sanatorium
owned by psychiatrist Samuel Ramrez Moreno in Coyoacan.54 Indeed, the
state asylum admitted all women and a high percentage of men as free and indi-
gent inmates during the 1910s, a trend that remained roughly unchanged in the
following decades.55 Further, as in asylums in Nigeria, Ireland and Argentina,
most inmates were committed involuntarily.56 A government order preceded the
committal of 86 per cent of women and 68 per cent of men during the 1910s.
Public-welfare authorities played an active role in the commitment of 2 per cent
of female and 6 per cent of male inmates. In addition, prisoners constituted 10
per cent of the male population of the asylum.57 In these cases, the intervention
of the police and welfare ofcials was crucial in detecting and apprehending
people suspected to be mentally ill a process that, as attested by the case of
Modesta B., usually began on the streets and in other institutions of the welfare
system. Thus, in relieving the streets from men, women and children deemed
insane, the asylum contributed to the social order of city and community.
However, state agents were not always involved in asylum connements.
First, while mostly resting on the judgement of police members or other repre-
sentatives of state order, governmental requests also involved, at least in some
cases, the participation of the family. Cresencia G., for example, came to the
asylum after the municipal president of her hometown in the state of Mexico
requested her committal.58 Yet, her familys concern for her mental health she
had become increasingly violent after the death of one of her sons prompted
the ofcial request in the rst place. Similar processes were not rare, particularly
when impoverished families proved unable to care for relatives or when violent
behaviour threatened family dynamics. Thus, families actively participated in
connement procedures even when state authorities ofcially initiated commit-
tal processes. Second, families initiated the internment of 12 per cent of female
and 16 per cent of male inmates.59 In these cases, relatives and neighbours were
instrumental in the identication of mental illness and the initial evaluation of
54 Interview with Mexican psychiatrist Luis Murillo, San Diego, Calif., May 2000.
55 Based on a random sample of 100 les from 1910. Status of inmates.
56 For the case of Nigeria, see Sadowsky, Imperial Bedlam. For Ireland, see Finnane, Insanity and
the Insane in Post-Famine Ireland; also N. Scheper-Hughes, Saints, Scholars, and Schizophren-
ics. Mental Illness in Rural Ireland (Berkeley, 1979). In Argentina, the participation of the police
was higher in the connement of men than women. See Ablard, Madness in Buenos Aires.
57 Based on a random sample of 100 les from 1910. Means of arrival.
58 Cresencia G., 1920, AHSSA. F:MG; S:EC; C:105; Exp:46.
59 Based on a random sample of 100 les from 1910. Means of arrival.
262 Cristina Rivera-Garza

methods for treatment. Some came to the asylum as a last resort, looking forward
to being relieved from the burden of care. Others brought their relatives to the
asylum hoping to nd a cure, their faith in the capabilities of modern medicine
ickering through letters and telegrams asking for signs of improvement or a
discharge date. The pathways into the asylum thus illustrate the varied ways
in which state and families appropriated the institution for different purposes,
which at times were not necessarily compatible or complementary.
The diversity of functions fullled by the asylum reected the variety of
inmates it assisted for, while generally poor, the asylum population was hardly
homogenous. First in the observation room and later in the wards, psychia-
trists came in contact with the cargo carrier who worked for a couple of cents in
Mexico city markets and with the singer hit by misfortune. They talked with the
eloquent, if somewhat misguided, pharmacist, and with the tailor and shoemaker
whose skills came in handy in the establishment. Likewise, they evaluated the
mental health of students and teachers, washerwomen and prostitutes. While
indeed the contingent of unskilled workers formed by day labourers, street ped-
lars and clerks was more numerous, the asylum also admitted artisans as well as
professionals from the middle classes, such as lawyers and teachers.60 While the
occupations of female inmates were not as varied some 60 per cent of women
were responsible for unpaid domestic chores they also included domestic
servants, seamstresses and washerwomen. Those listed as unemployed 16 per
cent were generally prostitutes, an occupation mindful administrators did not
dare to acknowledge.61 Perhaps, as psychiatrist John Conolly once claimed,
insanity was indeed a great leveller, but in the case of Mexico, the social
dislocation brought about by the revolutionary war clearly contributed to this
process.
As in state asylums serving destitute patients in Ireland and England, New
York and California, the Mexican asylum most frequently admitted people in
the early and middle stages of their adult life.62 Only 6 per cent of the asy-
lum population was under the age of twenty, and only 10 per cent above the
age of seventy. Most inmates ages ranged from twenty to forty years. While
some variation occurred during the rst three decades of the twentieth century
female inmates were mostly in their twenties and thus relatively younger dur-
ing the 1920s while, during the 1930s, they were mostly in their forties
age-specic admission rates remained nearly unaltered.63 The relative youth
60 Based on a random sample of 100 les from 1910. Occupations of men.
61 Based on a random sample of 100 les from 1910. Occupations of women.
62 Similar trends are noted by Finnane, Insanity and the Insane, 130; Walton, Lunacy in the
Industrial Revolution. Also, J. K. Walton, Casting Out and Bringing Back in Victorian England:
Pauper Lunatics, 184070, in W. F. Bynum, R. Porter, and M. Shepherd (eds.), Anatomy of
Madness. Essays in the History of Psychiatry, 2 vols. (London, 1985), 13248; E. Dwyer, Homes
for the Mad, 244.
63 Based on a random sample of 100 les from 1910. Ages of inmates.
 General Insane Asylum, Mexico, 19101930 263

of asylum population was matched by the lack of family support. Indeed, 66

per cent of female and 78 per cent of male inmates were either single or wid-
owed during the 1910s.64 Further, while most lived in Mexico City, 64 per
cent of men and women were born in the provinces of Mexico.65 Singleness
and migration might have not necessarily meant social isolation, but in the
context of the Mexican revolution they evidently increased the vulnerability to
committal.
During the rst three decades of the twentieth century, thus, the insane from
Mexico were relatively young and, according to institutional statistics, more
likely to be women than men.66 In the midst of the revolutionary war that
brought popular armies from the north and indigenous armies from the south
to central Mexico, lack of family support and migration made men and women
more susceptible to connement. Because the social upheaval not only affected
the very poor, but also people from other classes, the asylum opened its doors
to a range of social groups affected by economic hardship and depravation.
The General Insane Asylum fullled ambivalent roles in Mexican society. On
the one hand, uplifting its status as an institution of social control, the asylum
contributed to the urban order of Mexico City by conning people deemed
as insane by state authorities. On the other, the General Insane Asylum also
proved helpful for families unable to care for relatives suffering from mental
illness. The permanence of the asylum as a welfare institution through the early
revolutionary period doubtlessly responded to its dual role as both a site of
control and a place for social assistance.

A view from within: diagnoses

While mostly fullling welfare functions, especially custodial care, the General
Insane Asylum also strove to provide inmates with medical attention. Asylum
authorities used a basic spectrum of symptoms to place inmates into specic
wards with separate buildings for men and women. For example, violent or agi-
tated patients were placed in the ward for dangerous inmates, as were prisoners
who required special surveillance. Patients suffering from chronic mental dis-
eases went to the wards for tranquil inmates, indigents to section A, located
in a back ward, and paying boarders to section B, located in front rooms

64 Based on a random sample of 100 les from 1910. Civil status.

65 Based on a random sample of 100 les from 1910. Place of birth and place of residence.
66 Throughout the rst three decades of the twentieth century, women were more numerous than
men. In 1910, men constituted 38.54 per cent of asylum population, women 57.76 per cent,
children 3.68. In 1920, men constituted 33.14 per cent of asylum population, women 57.67
per cent, children 6.59 per cent. In 1930 men constituted 33.46 per cent of asylum population,
women 62.63 per cent, children 3.89 per cent. Patino Rojas and Mercado, Cincuenta Anos de
Psiquiatra.
264 Cristina Rivera-Garza

surrounded by gardens.67 Unlike asylums that differentiated between the men-

tally ill and the feeble minded, the Mexican asylum admitted inmates who suf-
fered from mental conditions that affected their intelligence, placing them in
the ward for imbecile inmates. Epileptics, among whom women predominated,
went to the ward of the same name. Alcoholics, among whom men predomi-
nated, went to the ward of the same name. Most elderly patients were allocated
to a ward for senile inmates. Lastly, while the asylum admitted children, the
institution lacked a ward especially devoted to them. The social, medical and
spatial classication of inmates attempted to secure the internal order of the
institution, validating, in passing, hierarchies prevailing in society at large.
However, while the number of wards was limited, the amount of diagnoses
grew over these three decades of the twentieth century. In fact, betraying the lack
of standardized psychiatric language, asylum doctors recorded about eighty dif-
ferent diagnoses during the early revolutionary era.68 Because doctors reached
a diagnosis after observing and interviewing inmates and, when possible, his
or her families, these medical interpretations of mental health usually involved
a social dialogue. Particularly involving the identication of the range of be-
haviours that led men and women into asylum grounds, these dialogues were
hardly transparent or conict-free. In fact, close scrutiny of the content of these
dialogues sheds light on the changing social and medical mores that contri-
buted to the revolutionary denition of mental illness in early twentieth-century
Mexico.
Like the San Hipolito and Divino Salvador hospitals, the General Insane Asy-
lum admitted great numbers of male and female inmates suffering from epilepsy
during the 1910s evidence of the lingering legitimacy of Porrian denitions
of mental illness in early twentieth-century Mexico. Indeed, asylum designers,
who had had access to the records of pre-revolutionary hospitals, noted that
while epileptic patients constituted about 15 per cent of the hospitals popu-
lation, the gure increased remarkably among female patients. Thus, because
28.41 per cent of women suffered from epilepsy at the Divino Salvador hospital,
they planned a larger area for them at the General Insane Asylum.69 Data from
the institution proved them right, at least during the rst decade of the twentieth
century when 28 per cent of female inmates and 22 per cent of male inmates were

67 For an analysis of the architecture of the mental-health institution, see Rivera-Garza, An Ar-
chitecture of Mental Health, manuscript.
68 See Patino Rojas and Mercado, Cincuenta Anos de Psiquiatra, 5. For an analysis of psychi-
atric classicatory issues, see G. E. Barrios, The History of Mental Symptoms: Descriptive
Psychopathology since the Nineteenth Century (Cambridge, 1996). Also G. E. Barrios, Obses-
sional Disorders during the Nineteenth Century: Terminological and Classicatory Issues, The
Anatomy of Madness (London, 19857), 16687.
69 Data on diagnoses from the Divino Salvador and San Hipolito hospitals appear in M. Ri-
vadeneyra, Apuntes para la estadstica de la locura en Mexico, BA thesis, Escuela Nacional
de Medicina de Mexico (1887).
 General Insane Asylum, Mexico, 19101930 265

listed as suffering from this condition, becoming the most numerous medical
grouping in asylum grounds.70 In a setting dened by violence and depravation,
chronic illnesses such as epilepsy placed especially heavy economic burdens
on the family of the patient, which the asylum relieved.71 The large number of
connements associated with epilepsy also disclosed that the stigma of this ill-
ness outlived the Porrian era. In fact, asylum doctors wrote scant comments in
the les of these patients, generally accepting diagnoses made by family mem-
bers or the police. When time or interest allowed it, doctors detected similar
sufferings in the family of the inmate, adding ubiquitous comments about the
hereditary legacy of this ailment.72 Likewise, doctors provided these sufferers
with little in terms of treatment, allowing peaceful inmates to work in the work-
shops of the institution or, when necessary, prescribing sedatives for agitated
patients. Nevertheless, doctors became increasingly unwilling to admit or to
diagnose inmates with this condition over time. During the 1920s, for example,
only 18 per cent of women and 17 per cent of men remained at the institution as
epileptics.73 By the 1930s, female epileptics constituted only 7.52 per cent of
asylum population, while male epileptics amounted to 10.86 per cent.74 While
the armed phase of the revolution had dwindled by then, the economic stag-
nation and agitated negotiation of rule that characterized early revolutionary
regimes did not justify such a dramatic decrease in epilepsy diagnoses. Greater
awareness about this condition among the psychiatric community contributed
to the declining gures, but only to a certain degree.75 Much more crucial was,
however, asylum doctors waning emphasis on chronic mental illnesses for
which they could offer little in terms of treatment and cure.
A similar process occurred regarding the diagnosis of mental retardation
and dementia praecox. During the rst decade of the twentieth century, Gen-
eral Insane Asylum doctors diagnosed a great number of patients with mental
retardation a condition variously referred to as idiocy, mental debility and
imbecility. Constituting 16 per cent of female patients and 18 per cent of male

70 Based on complete entries in the registry books from 1910. Diagnoses for men and women.
71 See E. Dwyer, Stories of Epilepsy, Hospital Practice, 30 (1992), 6592. For a comparative
analysis of epilepsy, see A. Kleinman, The Social Course of Epilepsy. Chronic Illness as Social
Experience in Interior China, in Writing at the Margin: Discourse Between Anthropology and
Medicine (Berkeley, 1995), 14772.
72 Degeneration theory was particularly inuential during the Porrian era. Its inuence, however,
continued throughout the early revolutionary period. See Rivera-Garza, Dangerous Minds.
Also see N. L. Stepan, The Hour of Eugenics. Race, Gender, and Nation in Latin America
(Ithaca, NY, 1991).
73 Based on complete entries in registry books from 1920. Diagnoses for men and women.
74 Based on complete entries in registry books from 1930. Diagnoses for men and women.
75 Mexican psychiatrist Ignacio Ruiz argues that asylum doctors from the early twentieth century
frequently misdiagnosed epilepsy. In his opinion, numbers decreased during the 1920s and 1930s
because doctors interpretative apparatus allowed them to correct past mistakes in these years.
Interviews with Ignacio Ruiz, May 1995, Mexico City.
266 Cristina Rivera-Garza

inmates, this set of mental conditions was the second in importance in the
Mexican asylum.76 Because Porrian doctors working at the San Hipolito and
Divino Salvador hospitals failed to include this category in their medical group-
ings, admissions based on mental retardation reected the use of new psychi-
atric categories to classify mental imbalance in revolutionary Mexico. As with
epilepsy, however, gures too declined over the next two decades. Likewise,
dementia praecox, a term coined by Emil Kraeplin, a German psychiatrist who
exerted great inuence in institutional Mexican psychiatry during the early rev-
olutionary period, affected some 9 per cent of female inmates and 11 per cent
of male inmates in 1910.77 Diagnoses of dementia praecox too decreased in the
next decade.
By contrast, during the 1920s, and increasingly in the next decade, asylum
doctors paid exacting attention to mental illnesses associated with alcohol and
drug consumption, two socially originated conditions that they perceived as
curable. Because the Divino Salvador and, especially, the San Hipolito hospi-
tal predominantly housed alcoholics, this tendency did not constitute a radical
break from Porrian understandings of mental illness.78 Indeed, medical experts
had readily connected alcohol consumption with criminality and mental illness
during the Porrian era.79 However, the social meanings of alcoholism, and drug
addiction for that matter, underwent social scrutiny in revolutionary Mexico.
In the context of state reconstruction, revolutionary regimes insistently called
for the creation of a social medicine, namely a preventive medicine which was
a juridical, technical, and administrative branch of the federal government; an
adequate tool to protect the physical and mental health of all the citizens of
the country and to safeguard their lives when they are threatened by diverse
unhealthful causes.80 Simultaneously, revolutionary regimes showed increas-
ing interest and growing commitment to eugenic views of the population.81
Inspired by these projects, doctors pushed, for example, to change the legal
status of alcoholism, from an extenuating circumstance in criminal cases to
76 Based on complete entries in the registry books from 1910. Diagnoses for men and women.
77 Based on complete entries in the registry books from 1910. Diagnoses for men and women.
For an analysis of the evolution of this diagnosis, see P. H. Wender, Dementia Praecox: The
Development of the Concept, American Journal of Psychiatry 119 (1963), 114351.
78 According to data collected by Rivadeneyra, alcoholics constituted some 55 per cent of the
patient population at the San Hipolito, a hospital devoted to the care of mentally ill men. While
diagnoses of alcoholism only amounted to 6 per cent at the Divino Salvador, a hospital devoted
to the care of mentally ill women, alcohol consumption was listed as the cause of mental illness
in 40 per cent of the cases. See Rivadeneyra, Apuntes.
79 See P. Piccato, El Paso de Venus por el Disco del Sol: Criminality and Alcoholism in the Late
Porriato, Mexican Studies/Estudios Mexicanos 11 (1995), 20341. Also P. Piccato, No es
Posible Cerrar los Ojos: El discurso Sobre la Criminalidad y el Alcoholismo Hacia el Fin del
Porriato, in R. Perez Monfort (ed), Habitos, Normas y Escandalo. Prensa, Criminalidad y
Drogas durante el Porriato Tardo (Mexico, 1997), 75134.
80 Amezquita et al., (eds.), Historia de la Salubridad y la Asistencia en Mexico, 72.
81 See Stepan, The Hour of Eugenics.
 General Insane Asylum, Mexico, 19101930 267

an aggravating one. Likewise, in 1919, doctors not only supported a ban on

the cultivation of marihuana but also encouraged the incorporation of drug
addiction as a health crime in the Mexican penal code.82 Further, the 1924
Sanitary Code, which helped expand the scope of activities of public-health
ofcials at both local and national levels, importantly included strategies to
combat the spread of social diseases, among which they counted alcoholism.83
Asylum doctors tendency to diagnose poor inmates as alcoholics took place
in a politically charged context in which the physical and mental health of the
citizens came to constitute national assets. Indeed, doctors diagnosed 15 per
cent of asylum inmates as alcoholics in 1910.84 By contrast, a decade later,
some 41 per cent of inmates received this diagnosis.85 Thus, the number of
inmates listed as alcoholics in 1920 more closely resembled Porrian diagnosis
patterns from the San Hipolito and Divino Salvador hospitals. Further, as their
Porrian counterparts, revolutionary asylum doctors diagnosed 29.37 per cent
of male inmates and 11.66 per cent of female with alcoholism a gure that
contributed to the construction of this condition as a typically masculine mental
illness.86
The principles of social medicine also encouraged revolutionary regimes
from the early twentieth century to extirpate practices and behaviours contrary
to the health of the community, especially in the terrain of sexuality.87 Health
ofcials thus conducted an animated debate about the dangers associated with
unrestricted sexuality, particularly represented by prostitution, which they saw
as conducive to syphilis. In fact, public-health physicians committed to the
creation of national programmes against the spread of syphilis and to the crim-
inalization of this illness, collected and published statistics showing that the
number of syphilis-related deaths in the country had grown from less than 1
per cent in 1916 to almost 2 per cent in 1925.88 During the same period, asy-
lum doctors increasingly detected cases of progressive paralysis, the tertiary
stage of syphilis, among asylum inmates. In 1910, cases of progressive paral-
ysis constituted a mere 0.47 and 3.79 per cent of diagnoses for female and
male inmates respectively.89 A decade later, doctors diagnosed 4.44 per cent of

82 Amezquita et al., (eds.), Historia de la Salubridad y la Asistencia en Mexico, 145.

83 Ibid., 250.
84 Based on complete entries in registry books from 1910. Diagnoses for men and women.
85 Based on complete entries in registry books from 1920. Diagnoses for men and women.
86 Based on complete entries in registry books from 1920. Diagnoses for men and women.
87 See C. Rivera-Garza, The Criminalization of the Syphilitic Body. Prostitutes, Health Crimes,
and Society in Mexico, 18761930, in C. Aguirre and G. Joseph (eds.), Crime and Punishment
in Latin America (Durham, NC, 2001). Also, K. Bliss, The Science of Redemption: Syphilis,
Sexual Promiscuity, and Reformism in Revolutionary Mexico City, Hispanic American His-
torical Review 79 (1999), 140.
88 B. Gastelum, La persecusion de la slis desde el punto de vista de la garanta social, AHSSA.
F:BP; S:AS; Se:DAES; L:1; Exp:11, 7.
89 Based on complete entries in registry books from 1910. Diagnoses for men and women.
268 Cristina Rivera-Garza

female inmates and 13.94 per cent of male inmates with this condition.90 By
1930, women suffering from progressive paralysis amounted to 13.24 per cent
and men to 16.59 per cent.91 As with the case of alcoholism, asylum doctors
increasingly dened syphilis-related mental illnesses as masculine conditions.
Sharing dominant medical views, they perceived women, especially prostitutes,
as agents of this illness, and men, all men, as victims of unrestricted female
sexuality.
Doctorpatient relationships within asylum walls involved a certain degree
of tension and distance. This was especially true between male doctors, who
composed the totality of the medical staff at the General Insane Asylum, and
female patients.92 In exploring the medical stories of female inmates, asylum
doctors paid special attention to their sexual history, asking questions about
menarche, intercourse, abortions and menopause. As Porrian experts in the
past, they believed that there was a connection between the female genitalia
and mental illness.93 This linkage had led to diagnoses of moral insanity among
patients of the Divino Salvador hospital and helped produce similar diagnoses
during the rst decade of the twentieth century in the grounds of the General
Insane Asylum.94
A term originally coined by English physician James Prichard during the
early nineteenth century, moral insanity described a condition in which patients
recognized good and evil impulses, but were unable to resist the latter.95 While
no longer in use in most asylums from the early twentieth century, Mexican
psychiatrists employed it to explain female behaviours that violated implicit
rules of decency and domesticity. Diagnoses of moral insanity only amounted
to some 2 per cent among female inmates in 1910, but doctors mentioned it as
an important component in cases of alcoholism, violent jealousy, and mental

90 Based on complete entries in registry books from 1920. Diagnoses for men and women.
91 Based on complete entries in registry books from 1930. Diagnoses for men and women.
92 Labour records from the General Insane Asylum show that only one female doctor worked at
the institution between 1914 and 1915. She was Rosario M. Ortiz, rst an external doctor and,
months later, an intern. See, Relacion de personal de 1914 a 1915, AHSSA. F:BP; S:EH;
Se:MG; Lg:4; Exp:23, 23.
93 On the emergence of Mexican sexual science, see Rivera-Garza, The Criminalization of the
Syphilitic Body. A good example of Porrian views of the relation between sex and mental
illness is M. E. Guillen, Algunas Reexiones Sobre la Higiene de la Mujer Durante su Pubertad,
BA thesis, Facultad de Medicina de Mexico (1903).
94 On diagnoses of moral insanity at the General Insane Asylum, see Rivera-Garza She Neither
Obeyed Nor Respected Anyone: Inmates and Psychiatrists Debate Gender and Class at the Gen-
eral Insane Asylum, Mexico 19101930, Hispanic American Historical Review, forthcoming.
95 Prichard dened moral insanity as a form of madness consisting in a morbid perversion of the
natural feelings, affections, inclinations, temper, habits, moral dispositions, and natural impulses,
without any remarkable disorder or defect of the intellect or knowing and reasoning faculties,
and particularly without any insane illusion or hallucination. See J. Prichard, A Treatise on
Insanity and Other Disorders Affecting the Mind (New York, 1973), 16. Originally published
in 1837.
 General Insane Asylum, Mexico, 19101930 269

illnesses that involved the category of sex.96 By 1930, however, asylum doctors
no longer diagnosed women with this ailment, a trend that replicated the declin-
ing use of this category in foreign psychiatric circles. Morally insane women
ceased to exist in early twentieth-century Mexico when feminist discourses that
advocated gender equality and more complex understandings of womens place
in society grew at a steady pace. For example, in the 1916 Feminist Congress
that took place in Yucatan, male and female feminists called for and used
a denition of femininity that clearly transcended easy associations between
women and sex the basis on which diagnoses of moral insanity were made
in Mexico.97 Simultaneously, however, the asylum admitted women at higher
rates during this decade, amounting to 63 per cent of the inmate population.98
Nevertheless, asylum doctors who so readily listed men as alcoholics were less
self-assured when observing female inmates. Indeed, in 1930, roughly equal
numbers of female schizophrenics, epileptics and syphilitics were admitted in
asylum wards. Further, the number of female inmates listed as mentally healthy
or without diagnoses was as high as each one of the diagnostic groupings men-
tioned above.99 Ongoing debates about the female question, which affected
revolutionary society at large, seemingly impaired asylum doctors ability to
produce a typically female mental illness. Female inmates played a role in this
process. Unlike journalists, writers and political activists who used different
arenas to campaign for gender equality, female inmates articulated the stories
of their lives to confront or, more accurately, to evade psychiatric labelling. The
unfolding of these stories, which usually unnerved doctors, revealed the conic-
tive domestic context especially spousal abuse in which familial diagnoses
of mental illness rst emerged.100
As with Mexican society at large, diagnoses at the General Insane Asylum
underwent dramatic, although not linear, change between 1910 and 1930. While
Porrian understanding of mental illness permeated diagnoses during the rst
decade of the twentieth century, especially in cases of epilepsy, revolutionary
practice and ideology more clearly informed medical identication and diag-
noses of what they referred to as social mental illnesses during the 1920s and
beyond. Yet, at least in the case of alcoholism, such a revolutionary remaking
96 Based on complete entries in registry books from 1910. Diagnoses for men and women.
97 A. Macas, Against All Odds: The Feminist Movement in Mexico to 1940 (Westport, Conn.,
1982).
98 See Patino Rojas and Mercado, Cincuenta Anos de Psiquiatra en Mexico.
99 Based on complete entries in registry books from 1930. Diagnoses for women. According to
asylum data 7.52 per cent of female inmates were schizophrenics; 12.18 per cent were epileptics;
11.46 per cent suffered from progressive paralysis; 8.96 per cent were alcoholics; and 8.24 per
cent were listed as healthy or without diagnoses. However, different types of schizophrenia
were noted, which together amounted to 23.54 per cent of the female population of the asylum.
100 E. Dwyer noted that, occasionally, asylums were used to shield individuals from highly con-
icting families, especially in cases of domestic abuse. See E. Dwyer, Homes for the Mad, 94.
270 Cristina Rivera-Garza

of mental illness did not depart from but rather worked within Porrian psy-
chiatric frameworks. In accordance with the revolutionary commitment to the
principles of social medicine, asylum doctors readily identied social mental
illnesses, especially alcoholism and, at times, drug addiction. Likewise, reect-
ing the increasingly debatable status of women in revolutionary society, doctors
found it difcult to diagnose growing numbers of female inmates with moral
insanity, a dubious category by psychiatric standards of the early twentieth
century that, in the Mexican setting, described women who did not ascribe to
traditional denitions of female domesticity and submissiveness. Because both
state agents and families initiated connement processes, identifying mental
illness before the asylum doctor classied it and treated it, variation in asylum
diagnoses reected changing denitions of accepted and deviant behaviours in
early revolutionary Mexico.

Revolution, mental illness, and the nation

While elite Porrians generally greeted the inauguration of the General Insane
Asylum as an achievement of modern science, the black legend of the institution
grew at a steady pace in revolutionary Mexico. Nevertheless, both supporters
and detractors of the asylum have tended to present it as a homogenous institu-
tion. A careful analysis of its history as well as its internal dynamics suggests
that the General Insane Asylum was, on the contrary, a highly heterogeneous
establishment, fullling important roles as an impromptu gaol for drunkards
and vagabonds, a welfare centre where destitute patients found custodial care,
and a medical establishment where doctors paid close attention to promising
cases. In fact, rather than a single institution, the asylum was many institutions
at once a reality that became readily evident in 1968 when the Mexican gov-
ernment replaced the asylum with seven different hospitals. They included a
hospital for acute mental patients with 600 beds, a hospital for 200 children,
three rural hospitals with 500 beds each, and two home-hospitals for incurable
patients with 250 beds each.101
While not at the centre of revolutionary debates about the nations future,
the asylum both reected and illuminated societal change. Porrian designers,
for example, envisioned the asylum as a medical institution where psychiatrists
would treat patients from different classes and backgrounds, fullling scientic,
corrective, and humanitarian functions. Soon, however, as the revolutionary war
developed in city and countryside, the asylum proved unable to attract profes-
sionals in the eld. Further, the asylum mostly served destitute patients ha-
bitually suffering from chronic conditions. Lack of funding, scant medication,
overcrowding and poor stafng forced the asylum to offer custodial rather than

101 Calderon Narvaez, Hospitales Psiquiatricos de Mexico, 121.

 General Insane Asylum, Mexico, 19101930 271

medical care to its patients. But the 1910 revolution not only affected the asylum;
it also reshaped it. Once the armed phase of the revolutionary struggle declined,
new regimes ruled the country aiming for the reconstruction of the nation. By
the early 1920s, the governments of Alvaro Obregon and Plutarco Elas Calles
placed increasing emphasis on welfare establishments, among which the asylum
was the largest and most neglected. Asylum authorities and medical staff, who
strove to produce a niche for psychiatry in revolutionary society, responded by
adapting diagnoses and treatments to the needs of the new era. On the one hand,
growing emphasis on the welfare responsibilities of the state and revolutionary
commitment to social medicine prompted asylum doctors to diagnose socially
originated mental illnesses among asylum inmates. The increasing number of
alcoholics and drug addicts among asylum inmates after 1920 serves as a case
in point. On the other hand, revolutionary ideology also played a role in the
decreasing number of women diagnosed as morally insane inside the asylum
a result of the careful, spirited and increasingly complex scrutiny of womens
roles in society. While the latter clearly represented a discontinuity between
Porrian and revolutionary psychiatry, that was not the case of the former. In
fact, the growing number of diagnoses of alcoholism during the 1920s more
closely resembled Porrian diagnoses from the San Hipolito and the Divino
Salvador hospitals. Asylum doctors training, which clearly took place in Por-
rian Mexico, as well as the modernizing agenda of the revolutionary regimes
contributed to this continuity in psychiatric practice in early twentieth-century
Mexico. Furthermore, emphasis on the social dimension of illnesses, speci-
cally mental illness in this case, allowed revolutionary doctors and the welfare
institutions in which they worked to offer treatments that were both medical
and social in nature. Because doctors and bureaucrats perceived social illnesses
as fundamentally curable, they were able to present society with a clear and
scientically based avenue for reform.
The asylum, nevertheless, not only reected social change; it also contributed
to shape such change, albeit in subtle, peripheral ways. During the late 1920s,
when the era known in Mexican history as the Maximato began, the asylum
played an important role in supporting and giving scientic legitimacy to state
discourses about work and the place of the poor in early revolutionary Mexico
an issue of political importance in a regime intently trying to co-opt a mobilized
working class through the creation of labour unions and peasant leagues. Indeed,
under the leadership of strong man and Maximum Chief, General Plutarco Elas
Calles, the regime brought new attention to the role of the state not only as
protector but also as a moral guide for the destitute. For this reason, welfare
authorities from the early revolutionary era used state facilities not only to
treat but also to improve, that is to reform, the habits and behaviours of the
poor hereby, the political relevance of the implementation of work therapy
throughout the asylum in 1929.
272 Cristina Rivera-Garza

For all the linkages that went from the asylum to society and vice versa,
the institution was hardly an apparatus of social control. Lack of funding as
well as overcrowding and poor stafng clearly limited the role of the asylum as
a model for social order. Also, revolutionary regimes from the early twentieth
century used the asylum to produce and propagate revolutionary understandings
of health and work but only in indirect ways. The typical inmate from the
revolutionary era was not a political activist conned against his or her will, but
the destitute patient suffering from chronic illness who placed heavy economic
burdens on family or city agencies. In fact, asylum doctors were especially deaf
to medical histories that involved political activism and military participation
in the revolution, which were not rare in asylum les. Doctors, for example,
failed to diagnose, or even to mention, war shock in their diagnoses.102 Lastly,
while the asylum changed to better t the needs and expectations of society,
this accommodation signicantly involved the participation of both state and
families, the major initiators of connements. Further analysis of these variables
at both quantitative and qualitative levels will help clarify the ambivalent roles
of the asylum in early revolutionary Mexico.103

102 Kleinman, Violence, Culture, and the Politics of Trauma, Writing at the Margin, 17389.
103 See C. Rivera-Garza, Mad Narratives: Inmates and Psychiatrists Debate Class, Gender, and
Nation at the General Insane Asylum, Mexico, 19101930 (Lincoln, Nebr., forthcoming).
11 Psychiatry and connement in India

Sanjeev Jain

The establishment of lunatic asylums is indeed a noble work of charity, and will
confer greater honor on the names of our Indian rulers than the achievement
of their proudest victories.1

The history of asylums in India provides an opportunity to study the spread of

ideas about mental illness, and notions of care and responsibility for the mentally
ill across cultures and time. Although there are suggestions that hospitals have
been known in the south Asian region2 from antiquity, there is little documentary
proof of their existence. References for institutions for the sick and needy can
be found during the reign of Ashoka (268231 BC).3 Travellers accounts of
AD 400 mention similar services established by rich merchants and nobility.4
Mental hospitals had a long history in the Arab world, and the growing Muslim
inuence in India lead to the establishing of similar hospitals.5 However, the
prevailing social situations have led some authors to suggest that these were
seldom used except by soldiers and foreigners.6 Medical care in medieval
India was based on Ayurvedic (derived from the Charak Samhita and other
classical Indian and largely pre-Islamic texts, thus predominantly Hindu)7 and
Unani (the Muslim school of medicine), and derivative systems, delivered by

I would like to thank the Wellcome Trust and the Wellcome Institute of History of Medicine, the
Commonwealth Trust, and the Department of State Archives, Government of Karnataka for help
in preparing this manuscript. I would also like to thank Dr Vivek Benegal, Dr Satish Chandra,
Dr Melvin Silva, Mr D. M. Joseph, Mr G. Vidyadhar, and Mr C. C. Silva for help with material
and suggestions.
1 W. Forbes, Review of Practical Remarks on Insanity in India, Psychological Medicine and
Mental Pathology 6 (1853), 35667.
2 L. P. Verma, History of Psychiatry in India and Pakistan, Indian Journal of Neurology and
Psychiatry 4 (1953), 13864.
3 S. Dhammika, The Edicts of Ashoka (Kandy, Sri Lanka, 1993).
4 Fa Hein, A Record of Buddhist Kingdoms, trans. J. Legge (Oxford, 1886).
5 J. G. Howells (ed.), World History of Psychiatry (New York, 1968).
6 L. P. Verma, Psychiatry in Unani Medicine, Indian Journal of Social Psychiatry 11 (1995),
1015.
7 D. Wujastyk, The Roots of Ayurveda (New Delhi, 1998).

273
274 Sanjeev Jain

professionals trained by study and apprenticeship. These professionals were

most often attached to the court, or provided services for a fee. Religious and
caste divisions perhaps did not allow a public space for uniform treatment for
the ill to exist.
The growing European inuence in the second half of the millennium had a
profound impact. During the rst half of this period, between 1500 and 1750,
there was a growing awareness of European medicine. European practitioners
were often attached to the courts of kings all over India, including the Mughal
Emperor. The Portuguese established a hospital in Goa, which served the needs
of their sailors and soldiers. Garcia dOrta, perhaps one of the earliest European
physicians in India, established a herbarium, and was renowned for his medi-
cal skills, and published his colloquies in 1563.8 He interacted with the local
Indian physicians and learnt about the Indian pharmacopoeias. However, after
his death it was discovered that he was a Jew, and had transgressed existing laws
regarding the travel of Jews on Portuguese ships. His body was exhumed and
burnt at the stake.9 It is also suggested that his consorting with the heathens
and acknowledging their knowledge systems could have added to his heretical
status. It is not known whether the Portuguese hospitals made a specic provi-
sion for the mentally ill. Several other European doctors did make their mark in
India. Manucci, a Venetian, became a self-proclaimed doctor, towards the end
of the seventeenth century, and describes treating a few mentally ill patients
with leeches, cupping and various native medicines, often with success.10
The British gained ascendancy over all the other European powers in India
by the end of the eighteenth century. The East India Company is alleged to
have obtained permission to set up a trading post in Calcutta, which proved to
be the most important for its long term interests, as a favour for medical help
provided by Boughton, an English physician, to ladies of the Court of Shah
Shuja, the brother of the Mughal Emperor, in 1638.11 Almost a century later,
another physician, William Hamilton, was to provide medical help to the then
Emperor, and was rewarded with further concessions in Madras and Surat.12
Throughout the colonial period, medicine and politics would continue to be
linked.
Perhaps the rst establishment for treating the mentally ill was the one es-
tablished by Surgeon George M. Kenderline in Calcutta in 1787. However, it

8 J. Barros, Garcia Da Orta his Life and Researches in India, in B. V. Subbarayappa and
S. R. N. Murthy (eds.), Scientic Heritage of India, Mythic Society (Bangalore, 1986).
9 C. R. Boxer, Two Pioneers of Tropical Medicine, Wellcome Historical Medical Library, Lecture
Series 1 (London, 1963).
10 N. Manucci, A Pepys of Moghul India (Srishti, 1999).
11 Lt. Gen. Sir Bennett Hancie, The Development and Goal of Western Medicine in the Indian
Sub-Continent (Sir George Birdwood Memorial Lecture), Journal of the Royal Society of Arts
25 (1949).
12 D. G. Crawford, History of the Indian Medical Service 16001913 (London, 1914).
 Psychiatry and connement in India 275

could not be granted ofcial recognition as the surgeon had been previously
dismissed from service for neglect of duty. Soon after, William Dick in Calcutta
established a private asylum for insane ofcers and men, and civilians of var-
ious stations, in 1788. Others in Bombay and Madras followed. The asylum
at Madras was ordered to be built in 1793, for sixteen patients, and given a
generous endowment and land, on the provision that no rent was to be paid
as long as the building was devoted to public purposes.13 Assistant Surgeon
Valentine Connolly, wrote to the medical board saying that: want of an asylum
on the coast has been long a matter of regret, and in some instances it has been
attended with dreadful consequences. Suggestions for the asylum included
detailed plans for buildings and staff, with a payment from the company for
each patient admitted to the asylum. Connolly later privatized this arrange-
ment and began paying a rent of pagodas 825 to the company, and nally sold
it to Surgeon James Dalton in 1807 for pagodas 26,000. It was long known
as Daltons madhouse, and is now part of the medical college.14 By this time
the asylum accommodated fty-four Europeans, and a staff of fteen keepers.
Asylums within Bengal (Murshidabad, Dacca), Madras (Chittoor, Tiruchirapalli
and Masulipatanam) and the Bombay (Colaba) presidencies were set up.
Prior to this, patients, especially those whose symptoms lasted for more
than a year, were to be transported to England. John Reading, a doctor in
Chingleput near Madras, writing to George McCartney,15 recommends that
one Mr Porter, who has been suffering from a maniacal complaint, be sent
home. He also mentions that several such patients now live in Madras. The hot
tropical climate was often to blame, and a voyage home held out the promise of
a cure. Allegations of exorbitant charges and corruption in contracting private
hospitals were already being made.16 Financial irregularities, and overcharging
the company (expenses are proportionate to the number of surgeons, rather
than the number of sick) for the care of the ill was a frequent concern, as were
poor maintenance and misuse. Prompted by this, the East India Company in
1802 ordered asylums to be built for the wandering insane in all its territories.
Indian kingdoms were not very encouraging. However, Hoenigberger, a German
doctor, who travelled overland and lived in Punjab, did establish a small asylum
in Lahore early in the nineteenth century.17 This was paid for by the court at
Lahore, but had been ordered by the British Commissioner. It existed for a
few years, and was staffed by European doctors, but it fell into disuse once
Hoenigberger returned to Europe.
13 H. D. Love, Vestiges of Old Madras 16401800 (Madras, 1996).
14 D. V. S. Reddy, The Beginnings of Modern Medicine in Madras (Calcutta, 1947).
15 George McCartney 17371806, First Earl McCartney, Governor and President of Fort St George,
Madras. Correspondence and papers concerning medical services at Madras 17827. MS 5746,
Wellcome Library, London.
16 Ibid. James Hodges to McCartney, 17 April 1783.
17 J. M. Hoenigberger, Thirty Five Years in the East (London, 1852).
276 Sanjeev Jain

In this period, before the Indian Mutiny (which occurred in May 1857),
approximately thirteen asylums had been established in various parts of the
companys dominions. By this time, the British directly controlled several
large portions (the Calcutta, Madras and Bombay presidencies) and had admin-
istrative control over other areas through bilateral agreements between them
and the rulers of independent states. The sub-continent was thus broadly di-
vided between princely or native kingdoms, and the British possessions. The
contrasting outcomes in the various asylums, and differences in the cost of
maintaining them, led to one of the rst ofcial enquiries in 1818, and has
been summarized earlier.18 The select committee had raised similar issues
in the United Kingdom in 1815/16. The concept of the asylum was dened
as a retreat, providing for the tender care and recovery of a class of inno-
cent persons suffering from the severest of afictions to which humanity is
exposed.19 Gross deviations from this noble aim were observed. Most asy-
lums were seen to be a cluster of ill-constructed and poorly maintained build-
ings, resembling gaols rather than asylums. Conditions within were deplorable,
with indifferent staff, unwholesome food, inadequate clinical classication
and care.

The native clientele of the asylums

While most asylums were established as distinct establishments, in Bangalore in
southern India, a somewhat different approach was taken. The city of Bangalore,
lying almost in the centre of peninsular India, was of considerable strategic
importance. It was also noted for its salubrious climate and was used as a
convalescent base for the Crimean, Afghan, the First and Second World Wars.
It was felt that the climate is particularly congenial to the European constitution;
sores quickly take on a healthy action, and convalescence from acute diseases is
rapid, often in a remarkable degree; and the protracted convalescence and low
chronic state of disease, seen in other parts of India, are seldom met with at this
station.20 The British had moved the Mysore division of the Madras army here
from Seringapatanam, after the White mutiny of 1809, and also because of
the high rates of fevers at that place. A large cantonment was built, which had
elaborate hospitals. Dragoons (cavalry), European infantry, Indian soldiers and
civilians were provided with separate hospitals. The Garrison hospital, which
had both European and Indian soldiers, was considered the best.

18 W. Ernst, The Establishment of Native Lunatic Asylums in Early 19th Century British India,
in G. J. Meulenbeld, D. Wujastyk and E. Forsten (eds.), Studies on Indian Medical History
(Groningen, 1987).
19 Ibid.
20 McPherson Report on the Medical Topography and Statistics of the Provinces of Malabar and
Canara (Madras, 1844).
 Psychiatry and connement in India 277

The city was administered between 1831 and 1881 by appointed Commis-
sioners, one of whom was Sir Mark Cubbon. A man of considerable foresight, he
initiated a number of; public-health services. At the time of rendition21 in 1881,
when the administration reverted to the Maharaja of Mysore, a total of three
general hospitals, seventeen dispensaries, two maternity hospitals, eight gaol
dispensaries, ten railway hospitals and two special asylums (leper and lunatic)
had been established in the kingdom.22 Rates of various diseases were quite
high. Dysentery, hepatitis and delirium tremens were frequent causes of illness
in European soldiers. Between 1829 and 1838, in the 15,590 European sol-
diers, the commonest diseases were syphilis (25 per cent), wounds and injuries,
dysentery, fever, hepatitis and chest diseases. The Indian troops (70,000) had
much lower rates of illness. Fever, diarrhoea, wounds, chest diseases, rheuma-
tism and syphilis (2.1 per cent) were recorded, but not at the high rates as were
noted for the European soldiers. Excessive drinking and wanton behaviour
were often blamed for the high rates of hepatitis. Ebrietas (drunkenness) was
recorded as a diagnosis for more than a hundred European soldiers every year
between 1834 and 1838, but not even once for an Indian soldier.23
Dr Smith, who appears to have been a physician to Sir Mark Cubbon, in addi-
tion to being a public doctor, began his diary in 1833. He provides one of the rst
detailed case notes of psychiatric diseases, and suspects that a large proportion
of them are caused by organic factors.24 He describes patients who show de-
pressive symptoms, progress to dementia and after death are discovered to have
inammatory changes in the brain, or spicules surrounded by inammation.25
These provide the rst descriptions of neurocysticercosis, which was formally
described only several years later.
Dr Smiths casebook has several case histories. One patient became suspi-
cious of European and native ofcials and shot dead a native in order to force
attention upon himself. Another maintained an exemplary life in the ofce for
fourteen years, but was otherwise eccentric to the point of madness and sud-
denly became acutely disturbed and Dr Smith was obliged to put him in a
straitjacket. Of the 138 patients with mania treated by Dr Smith, thirty-eight

21 Rendition: the kingdom of Mysore was under direct British rule through a commissioner between
1831 and 1881. At the time of taking control in 1831, Britain had contracted that the kingdom
would revert to native rule in fty years. As a result, the administration reverted to the Maharaja
of Mysore in that year (1881), but the British retained control of large tracts of land, and part of
the city of Bangalore (the cantonment).
22 B. L. Rice, Mysore: A Gazetteer Compiled for Government (London, 1887).
23 McPherson Report on the Medical Topography and Statistics of the Provinces of Malabar and
Canara, 20.
24 S. Jain, P. Murthy and S. K. Shankar, Neuropsychiatric Perspectives from 19th Century India:
The Diaries of Charles Smith, History of Psychiatry (forthcoming).
25 Charles Irving Smith, commonplace book, containing medical notes, MS 7367, Wellcome
Library, London.
278 Sanjeev Jain

died, putting these symptoms at par with ascites and paralysis in terms of prog-
nosis. Given the number of mentally ill patients that he treated at the Hospital
for Peons, Paupers and Soldiers, he was able to convince Sir Mark Cubbon
about the need to establish a ward for the mentally ill at this hospital in 1847,
and eventually an asylum.26 In 1850, the asylum was moved out of the hospital
into the gaol, and subsequently a new building was constructed on an elevation
near a large lake. This facility, and its successors, would have an important
role in the growth of psychiatry in India. He was not averse to using native
medicines. He prescribed limejuice and pepper for an attack of rheumatism to
Mark Cubbon, and strongly recommended coconut water as a blood purier.
Asylum reports form the bulk of historical sources of psychiatry in India. The
asylum in Delhi, as the report pointed out in 1870,27 was situated just outside
the ramparts, close to the gaol and Feroze Shahs tomb. This asylum lay in the
path of the mutineers marching towards Delhi from Meerut, and on 11 May
1857, all 110 inmates escaped.28 After the mutiny, the asylum was reorganized
and lasted until 1861, when it was moved to Lahore. Bad conditions, and the
barbarous practice of using jails as asylums was often a cause for complaint.
Chemical and bacteriological examination of the water supply in 1867 revealed
that the water was unt, and new sources were identied. In the 1850s, G.
Paton introduced a very strict discipline in the Delhi Asylum. Servants could be
dismissed if the wards were dirty. Tobacco was to be given only when patients
performed active work. Food was diversied, so that those who worked got
better food than those who did not. The patients were employed in laying out
and maintaining extensive gardens. Economic incentives could also be offered.
Medical treatment consisted of blistering the head and neck, cold and warm
baths, and tonic and aperient medicines (both native and European). In 1873,
the superintendent of the Delhi Asylum opines that the insane lose all caste
prejudices, and thus could be housed in common wards. This is important,
as western hospitals, and doctors in general, were viewed as unclean under
orthodox beliefs. The superintendent, however, lamented that there was one
baniya (a member of the merchant caste), who was very rigid and refused to
accept food from his hand (being British). Some of the other Hindu patients
refused meat, but accepted chapattis (bread) from everyone. In 1873, Mr and
Mrs Gilson, a British couple, lived with the patients, and shared the food.
They got glowing tributes by successive superintendents, and much regret was
expressed upon their transfer to Agra.
It was felt that amusement helps to cure lunacy as [much as] anything else,
besides having a humanising effect on the violent patients. An orchestra by the
patients was organized, with a sitar, tabla, etc. and there was much singing in
26 Ibid.
27 Annual Report of the asylum at Delhi,1867, V/24/1718, India Ofce Library, London.
28 Annual Report of the asylum at Delhi, 1872, V/24/1719, India Ofce Library, London.
 Psychiatry and connement in India 279

the wards.29 Pets were a particular passion, and the patients maintained cats,
pigeons and monkeys in the wards. On prominent festival days like Dussehra,
the patients were dressed up in ne clothes, several bullock carts were hired,
and they were all taken to the fair in front of the Red Fort. It was felt that contact
with the wider community would be effective in reducing the prejudice against
the insane. By 1877, it was reported that there was a gradual improvement
in the quality of the deputy superintendents, and in time, it would be possible
to bring the asylum as near to the English standard as the circumstances of
the country permit. There seems to have been some attention to administrative
probity, as some of the British staff was suspended for laxity in discipline, or
stealing money from patients.
Clinical descriptions are also quite illuminating. In 1877, an Irish soldier
claimed that he was a general and alleged that the government had stolen his
pay and spent it on oranges.30 He converted to Islam and announced at the
Jama Masjid (the main mosque of Delhi where the Mughal emperors offered
prayers) that the Russians were on their way, and that all Muslims should get
ready to help them. He was admitted to the asylum, but there was a public
outcry, as it was felt that he was being considered insane for converting to
Islam, while conversions to Christianity were not similarly viewed. Faced with
an uncomfortable situation, and with the population of Delhi excitable, Mr
H. was quickly transferred to Colaba in Bombay, where there was a holding
asylum for Europeans while they were on their way to the Ealing Asylum in
England. Another instance is of a Sikh soldier, who was admitted in 1883 after
being caught eating the dead body of a child. The soldier explained that he
belonged to a particular sect, that forbade him to work or beg for food, and
he was supposed to eat whatever providence brought his way. Walking along
the riverside, he saw some jackals eating the body, and after chasing them away,
he did the same. It was decided that he was not insane, and he was set free.
Other clinical vignettes describe behaviour in some detail, suggesting a close
interaction between the doctors and the patients.
Elsewhere in northern India, for instance, in the Punjab, asylums had a che-
quered history.31 After the annexation of Punjab in 18489, the twelve patients
in the asylum set up by Hoenigberger were handed over to the British. After
much debate, disused barracks in Anarkali in Lahore were converted into an
asylum. Faced with huge costs, some people were of the opinion that the cost
should be spread over twenty-ve years to get a true estimate, and the running
of asylums should reect the highest credit upon the Government for work of
such great importance. As Lahore became the Paris of the east the suburb

29 Annual Report of the asylum at Delhi, 1883, V/24/1720, India Ofce Library, London.
30 Annual Report of the asylum at Delhi,187677, V/24/1720, India Ofce Library, London.
31 W. Lodge Patch, A Critical Review of the Punjab Mental Hospitals 18401930, Punjab Record
Ofce, Monograph 13, V/27/858/9, India Ofce Library, London.
280 Sanjeev Jain

of Anarkali became fashionable and the asylum had to be moved away. By

the end of the nineteenth century, nancial prudence was strictly enforced. In
1896, it was ordered that only two meals per day were to be served, salaries
were reduced and it was regretted that a secretary had compared the cost of
mental health care across India and decided that it was too expensive. As early
as 1867, an opinion was expressed that large central asylums were a mistake
and the separation from the family was not good. It was also suggested that
admission to an asylum was necessary for a brief period to establish diag-
nosis, after which patients could be sent back to village colonies. Though
sceptical of home and family care, there was some merit seen by now in emu-
lating the Italian reforms of 1905 that recorded cases of insanity and monitored
their care in the community.32 These and other instances across India perhaps
show some of the earliest thoughts about adapting community care for the
mentally ill.
Reports from the asylums in the Madras presidency (187780) suggest that
up to 20 per cent of the inmates were Europeans or Eurasians. Unlike Delhi,
it was reported that caste and religious prejudices were as yet too powerful.
A number of patients suffered from an acute mania, which had an excellent
prognosis, with almost a third recovering entirely. It was again pointed out
that insanity more often [arose] out of depraved bodily condition, rather than
overstrained mind. In proportion to moral causes, twice as many patients with
physical causes were admitted in Madras (289:100), as compared to rates in
Europe (129:100). It was suggested that the European . . . is subject to restless
mental activity, keen sensibility and susceptibility to emotion . . . to which [the
Hindu] . . . is a stranger.33 It was also suggested that asylums should be for cure,
and harmless imbeciles and lunatics can be cared for in huts, attached to mofussil
[district] dispensaries, and under medical supervision. Drugs used by now
included bromide of potassium, hydrate of chloral, morphia, digitalis tincture,
etc, but it was also mentioned that wine or a little arrack often proves to be a
good hypnotic, and avoids use of opiates.34 The sameness of mental symptoms
was emphasized, and the point made that different classes and different nations
have identical symptoms. Depression was found to be very common, especially
with respect to moral causes. Entertainment at the asylum included a fortnightly
band and open house where patients mingled with the public; cricket twice
a week for Europeans and once a week for Indians, and the occasional circus.
It was commented that the native warders were generally indifferent, and on
occasion some were suspended for striking a patient. The guiding principle was
provided by a quote from Maudsley that the true treatment of the insane lies
in still further increase in their liberty.
32 Ibid.
33 Records of the Madras Asylum, V/24/1704/Madras, India Ofce Library, London.
34 Ibid.
 Psychiatry and connement in India 281

On the west coast, asylums in the Bombay presidency35 also had diverse exp-
eriences. Inmates of the asylum in Ahmedabad showed signicant evidence of
caste prejudice, and never entered each others rooms. The asylum in Poona
was utterly devoid of the most evident requirements of a medical institution;
the condition in Dharwar no credit to Surgeon Major MacKenzie; while in
Haiderbad (Sind) there was an increase in population after having seen for
themselves how kindly and carefully the patients are treated, to the credit of Dr
Holmstead. Costs in the asylums in Bombay itself reected the differences in
care. Europeans were budgeted at Rs 400 per annum, Parsis and Jews at Rs 263,
while the Hindus and Muslims at Rs 213. Annual diet costs were Rs 64 for
Hindus and Muslims, but Rs 200 for Europeans. These were the holding asy-
lums, earlier described by Ernst.36 A superintendent here was to report that
the Europeans are not inclined to work . . . and it would be difcult and not
without danger to employ them in the same shed as natives . . . as insane people
are almost always full of prejudices and conceits, and are possessed of irritable
and hasty tempers.37
The annual reports of the asylum in Bangalore38 during the same period show
a gradual increase in the number of admissions, and the size of the asylum. It ul-
timately offered accommodation for 260 patients, at approximately 50 feet per
person. The buildings were described as being simple, but airy. The asylum
was at an elevation, close to a lake; and adequate water supply and dry earth
conservancy were provided. The annual reports repeatedly emphasize the im-
portance of moral inuence, and the dreary misery enlivened by amusements
suited to their condition and capacity. Work was emphasized, and a number
of opportunities like gardening, rope weaving and domestic work were offered.
The asylum was administered by doctors of the Indian Medical Service, with
a number of Indian assistants. After the transfer of power to the kingdom of
Mysore, in 1881, it became the only asylum that was supported by a native
kingdom.
Work at the Bangalore Asylum was given enough prominence by the adminis-
tration. Difculties were frequently encountered. The pettah (old city) hospital
and the asylum were three miles from the cantonment, and Dr Henderson, the
superintendent of the asylum, complained in 187139 that it was difcult to com-
plete rounds of all the establishments, as he was also in charge of the general
hospital. In addition, he was also expected to see European and Eurasian pa-
tients at home. The chief commissioner ordered that since duties at the asylum

35 Records of asylums in the Bombay presidency V/24/1708, India Ofce Library, London.
36 W. Ernst, Mad Tales from the Raj: The European Insane in British India (London, 1991).
37 Records of asylums in the Bombay presidency V/24/1708, India Ofce Library, London.
38 Annual Report of Special Hospitals in Mysore (1877).
39 Medical 1870, 1/1870 117, Reorganization of Civil Medical Establishment at Bangalore,
Karnataka State Archives, Bangalore.
282 Sanjeev Jain

are of a very different nature moral and disciplinary to a much larger extent
than purely medical, Dr Henderson could decide on his own time for rounds.
This was a signicant departure from rules, as morning and evening rounds
by the doctor, were compulsory. It was suggested that the arrangement was
practicable without in any way compromising the interests of the lunatics.40
Overcrowding became evident very soon. In 1868, the number of lunatics
in the Asylum had reached one hundred, against a projected maximum at that
time of 150. Staff shortages was a frequent complaint. Dr Oswald complained
in a letter to the government in April 1868 that though the Madras Presidency
Asylum had one peon for every three to ve lunatics, the Bangalore Asylum
had ve permanent and two temporary peons for one hundred patients. The
seriousness with which this complaint was viewed is reected in the speed of
decision-making. The Viceroy in faraway Calcutta sanctioned more posts in
June 1868. It was also observed in 1872 that a large number of paupers were
being admitted for humane reasons. Going through the records reveals the fa-
mous diversity of India. Patients religious and national identities were recorded,
and Armenians, European Catholics, Italians, Irish, English and people from
all parts of India were represented in the patient register. Although it may be
advisable to provide additional accommodation for caste patients . . . [it] should
be done without prejudicing the interests of those who look of European mind,
suggested one ofcial communication.41 While cognizant of local social mores,
the administrators were also becoming aware of the changes occurring in Indian
society by the advent of western medicine. The diagnoses were very varied, but
were consistent with those in use in asylums in the UK at this time. Although
the bulk of the patients were classied as having one form of mania or the other,
there were a few diagnosed as morally insane (mainly Europeans). Alcohol and
cannabis (ganja) are listed as common physical causes.

Academic responses
Although the East India Company doctors were supposed to have some knowl-
edge of Indian languages,42 the doctorpatient contact would often have to be
through interpreters. The ofcial recognition of Indian languages, and by exten-
sion, indigenous knowledge, was still evolving.43 Administrative records could
be faulted for not paying enough attention to the voices of the mentally ill,
especially those of the native. However, since there are no known rst-person
accounts from the nineteenth century, these records provide at least some insight

40 Ibid.
41 Medical 1870, 117, letter from secretary to chief commissioner, 29 February 1872; Karnataka
State Archives, Bangalore.
42 D. G. Crawford, History of the Indian Medical Service 16001913 (London, 1914).
43 B. S. Cohn, Colonialism and its Forms of Knowledge (Delhi, 1997).
 Psychiatry and connement in India 283

into the workings of institutional psychiatry in India. Given this handicap, it

is quite interesting that the details of the diagnosis and the clinical vignettes
contain psychopathological material at all.
Doctors who were to serve in India, had been asked by the company to pro-
duce a certicate of having diligently attended, for at least three months, the
practical instructions given at one of the asylums for the treatment of the in-
sane, as well as to acquire a knowledge of Hindustani before coming over.44
By 1855, accounts of insanity in India began to be published.45 This account,
written by the superintendent of the Dacca Asylum, was replete with case
notes, and suggestions about the etiology. It was also to set the tone for sub-
sequent discussions. One of the aims of psychiatry was to determine whether
the dark races of man are susceptible to the mental and moral inuences nec-
essary to the production of various forms of insanity . . . and cured by the same
plan of treatment as in Europe. Excessive studying, and a rapid change from
a less civilized state, were attributed as causes. It was also observed that,
contrary to expectation, signicantly smaller numbers of the mentally ill were
seen in a country where the mental faculties were so less cultivated. A pre-
liminary attempt at calculating rates was also made, and the total of 157 lu-
natics under treatment in the Dacca circle (population 9.8 million) was much
smaller than the 13,400 under treatment in England and Wales (population 17.9
million). The much higher incidence in Europe was caused by the spread of
education and the generally more nervous temperament. Winslow Forbes, the
editor of Psychological Medicine and Mental Pathology, acerbically pointed
out many of the facts presented are interesting, but full of error . . . views that
are unsubstantiated.46 Forbes disagrees with Wise that the Hindoos [sic] are
perhaps in a lower state of mental development than even the rudest savages. He
found this untenable, as evinced by the literary and architectural achievements
in India. Indeed, he was critical of the major role mercantile and military inter-
ests were playing in India, and the neglecting of the development of the liberal
perspective.47
Case reports and reviews in the nineteenth century also began discussing
issues related to psychiatry in India. Organic causes were often identied, as
in the case of a chronic mania who recovered after developing symptoms of
effusion of the brain,48 and a soldier who developed symptoms of paranoia after
developing an ischio-rectal abscess.49 A soldier who drove a nail into his head
44 Crawford, History of the Indian Medical Service.
45 T. A. Wise, On Insanity in Bengal (Edinburgh, 1852).
46 Forbes, Review of Practical Remarks on Insanity in India.
47 W. Forbes, Moral Sanitary Economics, Psychological Medicine and Mental Pathology 6
(1853).
48 Indian Medical Gazette 13 (1878), 140.
49 D. M. Moir, Mental Depression, Hallucinations and Delusions Associated with Ischiorectal
Abscess, Indian Medical Gazette 26 (1891), 79.
284 Sanjeev Jain

while intoxicated with cannabis, and died after a delirium lasting two weeks,
was found to have a clot on post mortem.50 Case reports, for example, the one by
C. K. Swaminath Iyer51 of an acutely ill twenty-year-old male, who recovered
after passing a roundworm, suggests that Indian medical personnel were also
beginning to contribute to the scientic literature.
Psychological issues were also described, as in the case of a man who de-
veloped a brief psychosis after watching a oat that had actors masquerading
as being decapitated during a Moharram procession.52 Chetan Shah, an Indian
assistant surgeon, gave an account of hysteria in a fourteen-year-old boy, who
could not walk and complained of pain at regular times everyday.53 Since the
boy seemed to be devout, an attempt was made during an intermission to pro-
duce a deep impression and to invoke the Gurus help. Dr Shah opined that
hysteria in young men was not as rare as mentioned in the textbooks, and felt
that faith had a signicant role in its cure. Another Indian,54 Dr Pandurang,
reported a case of hysteria that was helped by deva-rishis (native faith healers,
but sorcerers in the original report) after his treatment with various drugs and
a wine-and-egg mixture had failed. Dr Ram C. Mitter, at the Arrah Charitable
Dispensary, treated a case of acute mania in a fourteen-year-old married girl
with blistering of the head, purgatives, and cold baths with complete recovery
over a week.55
The emphasis was on physiological and organic causes of insanity. This was
in keeping with the tenor of psychiatry in England in the nineteenth century.56
There was an ambiguous approach to neurology, but simultaneously an unwill-
ingness to view mental disorders other than manifestations of a brain disease.
There was a reluctance to explore psychological models, and thus the absence
of much of this in writings from India is not surprising. Emphasis was placed
on moral therapy, and that is the predominant theme in the asylums in India.
All these anecdotes, and administrative reports notwithstanding, the initial
impetus for providing services was not maintained. Discussing the possibility of
employing native staff, an editorial comment in the Journal of Mental Science
regretfully observed that the race prejudice had become the most important
fact in the social state of India . . . a conquered country, ruled by a dominant
race, not unlike the relation between the races in the citizens of America.57
The imperial expansion, and wars in the Crimea, Afghanistan and various parts
of India needed large amounts of money. There was also widespread famine in

50 Indian Medical Gazette 15 (1880), 71.

51 Indian Medical Gazette 19 (1884), 78.
52 Dr B. L. Rice, Indian Medical Gazette 13 (1878), 112.
53 Chetan Shah, Indian Medical Gazette 23 (1888), 302.
54 Dr Pandurang, Indian Medical Gazette 4 (1869), 556.
55 R. C. Mitter, Indian Medical Gazette 2 (1867), 225.
56 W. F. Bynum, Theory and Practice in British Psychiatry from J. C. Prichard (17861848) to
Henry Maudsley (18351918), in Teizo Ogawa (ed.), History of Psychiatry (Tokyo, 1979).
57 Reports on East Indian Asylums, Journal of Mental Science 5 (1859), 21822.
 Psychiatry and connement in India 285

the 1870s. In an order in 1879, it was stated that nancial exigencies forced the
government to cut back on non-essential expenses.58
By the end of the century, things were not in a good shape. An effort to
tabulate the services revealed that there were 3,246 insane patients in British
India, in twenty-one asylums, and conditions were apparently somewhat better
than earlier.59 The presidential address by T. W. McDowall60 to the fty-ninth
meeting of the Medico-Psychological association focused on the insane in India
and their treatment. Dr McDowall regrets that only 4,311 places for patients
exist in the asylums of British India, for a population of 23 million. Even more
disturbingly, apart from Mysore, none of the other native states, with a total
population of 75 million, had an asylum. Rather than a low rate of insanity,
he feels it is neglect of patients and want of services that are revealed in these
gures. There was no lunacy board; army medical ofcers with no particular
training in psychiatry administered the asylums, there were frequent changes
of staff, the pay was decient, work irksome and full of petty detail. In general,
there was a systemic failure of the administration, annual reports had become
worthless and there was no attempt to develop an efcient policy for treatment.

Census reports early attempts at developing an epidemiology

of psychiatry
The Indian census, one of the largest demographic exercises in the world, was
initiated in 1872, and conducted every ten years, with the exception of the war
years. It was meant to assist the government in planning services and provide
insight into social conditions all over India.
Since 1881, the census listed the mentally ill as a separate category, and a
statement of number of persons of unsound mind by religion, age and sex (form
XIV, census 1881) was to be provided by the returning ofcers. The governor
general of India had requested in 1867, that the number of insane in the provinces
be counted.61 Between 1881 and 1951, the census reports included estimates of
the number of mentally ill. Doubts were frequently raised about the quality of
information, as, for example, by Dr Deakin of the North-West Province who felt
that non-professional enumeration might not identify mild or periodic forms of
insanity.62 However, despite these drawbacks, it still provides a window into the
status of services available. Huge variations were seen within India, and between
India and the UK. In the 1881 census, more than 80,000 insane were identied
in British India.63 Consanguinity, brain disease and disappropriate ambition

58 The Punjab Reference Book for Civil Ofcers, 14 (1879), 425.

59 H. C. Burdett, Asylums History and Management vol. I: Hospitals and Asylums of the World
4 volumes (London, 1891).
60 T. W. McDowall, The Insane in India and their Treatment, Journal of Mental Science 53 (1897).
61 Patch, A Critical Review of the Punjab Mental Hospitals 18401930.
62 Census of British India, 1881 (London, 1883). 63 Ibid.
286 Sanjeev Jain

and intense application to study were listed as causes. At the same time, the
fact that rates were a sixth of those in England and Wales (but almost the same
as Italy, a less developed European country) was consequential to the fact that
mental work (and) intense competition of an active civilization is completely
unknown. In 1881, the census ofcer of Mysore suggested that some amount
of insanity could be attributed to the habit of marrying with relatives, which
was a compulsory obligation in certain classes and castes.64 Addressing this
question, the census ofcer of Assam in 1921 reported that this was not likely,
as rates of insanity were the same in exogamous and endogamous tribes.
Geographical, religious and cultural differences were explored in several
subsequent census reports, and a ten-fold difference in rates between Coorg in
southern India and Burma was observed. By 1921, it was evident that the role
of these factors was not substantiated. More importantly, as per estimate, 14 per
cent of the insane were already housed in twenty-three asylums of British India.
This was important, as it was felt that in the community the lunatics [lives
are] not happy . . . [they] receive little sympathy . . . [are] bound hand and foot
or [have] a heavy log fastened to the ankle.65 Till this point, mental hospitals
were to be the mainstay of psychiatric care in India. No data was available for
the native states and it was feared that most mentally ill were conned to gaols.
These census reports provide very crude data, but at the same time reect a
concern for establishing the nature of the burden of mental illness, and match-
ing the provision of services to the numbers expected to utilize them. Several
epidemiological studies were conducted after Independence, to establish the
same issues, with equally disparate results.
Increasing amounts of admissions to the asylums was now causing signicant
overcrowding. A signicant development was the establishing of the hospital
for the European insane in 1918 in Ranchi. Though the most modern, its super-
intendent, Colonel Berkely-Hill noted that those responsible for the original
design were obsessed with its custodial function so as to sacrice most, if not all,
of its remedial potentialities . . . it has anything but an agreeable appearance.66
Occupational therapy, psychoanalysis, amusements, organotherapy and, rarely,
hypnotics were used. A follow-up study of discharged patients was attempted,
and some effort made to study whether patients recovered sufciently. One of
the best accounts of the state of institutional care in India in the early part of the
twentieth century can be found in the reviews of Mapother (1938)67 and Moore
Taylor (1946).68
64 B. L. Rice: Census of Mysore.
65 Census of British India, vol.1, 1921 (Calcutta, 1921).
66 O. Berkely-Hill, The Ranchi European Mental Hospital, Journal of Mental Science 52
(1924).
67 Report of Professor Edwin Mapother to Sir John Migaw, the president, medical board, India
Ofce, 1938; Archives of the Bethlem Hospital.
68 Summarized in Quality Assurance in Mental Health, National Human Rights Commission,
1999.
 Psychiatry and connement in India 287

Mapother report
Professor Edwin Mapother, was requested to visit Ceylon in 1937 and suggest
reform of the psychiatric services. For this, he visited India, and submitted
a report, which the medical board of the India House decided was not to be
published but used exclusively as a background to suggestions for improving
services in Ceylon. In the years before this, he had been instrumental in estab-
lishing the Institute of Psychiatry at the Maudsley Hospital in London, one of
the principal responsibilities of which was to develop services in the British
Empire.
It would be difcult to afrm that with respect to psychiatry, the bearing of
the white mans burden has been adequate, notes Professor Mapother at the
beginning of his report.69 In London, there was a psychiatric bed for every 200
individuals, while in India there was one bed for 30,000. Within British India,
while in Bombay presidency there was one bed for every 12,000, in the Bengal,
Bihar and Orissa region, there was only one bed for every 57,000 individu-
als. While there were ve psychiatric beds for every eight beds for physical
disease in London, there was only one bed for psychiatry to every seven in
India. There was overcrowding in almost every asylum, and a general shortage
of staff. The inadequacy was increased by the ignorance and indifference of
most medical men and a tactful reticence . . . about defects that cruder persons
might publicly call scandalous he remarked. The asylum buildings, Professor
Mapother caustically notes, were a permanent monument to brutal stupidity,
perhaps guided by a PWD70 concept of a lunatic . . . (one ward) a replica of
the accommodation for tigers at the Regents park Zoo and some a desolate
waste, based on the assumption that the insane are indifferent to discomfort and
ugliness, and are destructive. He rated the asylums on a grade of badness,
with only the Asylums of Ranchi (for Europeans) in British India, and the one
in Bangalore in the Kingdom of Mysore having anything to commend them.
However, he wondered at the waste of money on an asylum for Europeans,
recently established by Berkely-Hill with much triumph, based on a concept
of race that in practice is unreal, and does not correspond to education, mode
of life or any valid claim. On the other hand, the asylum in Bangalore, he
told Sir Sikander Mirza, the dewan of Mysore, was a monument to the vision
and wisdom of all those responsible for the mental defectives in the East. The
Institution is almost unique among mental Hospitals in India . . . it is quite evi-
dent that modern methods of diagnosis and treatment are available and freely
used.71 The impending transfer of power into India hands was of no great con-
cern, indeed many British psychiatrists stated that it was easier to obtain money
69 Report of Mapother to Migaw.
70 The Public Works Department (PWD) that was responsible for the design, construction and
maintenance of government buildings.
71 Sir Mirza Ismail, My Public Life: Recollections and Reminiscences (London, 1950).
288 Sanjeev Jain

from provincial governments than when the health services were under direct
British control. In most places, Indian doctors were managing the asylums, and
several had received training in England or the USA.
Professor Mapother72 was also well aware of the complexity of the Indian
social and political situation. While admitting the need for more trained spe-
cialists, he was sceptical about the possibility of bringing adequate numbers
of Indians to train in the UK or USA in view of the colour prejudices. There
was therefore an urgent need to develop a school in India, and the asylum at
Bangalore was [is] structurally the only center which yet exists that is t to
house a post-graduate school. In addition to its professional capabilities, it
had the benet of an enlightened native administration, religious harmony and
an appeal to nationalism by being established in a native kingdom, Mapother
said. Another asylum could be established in Delhi in the future, under British
control. The post-graduate school could serve the entire region for training
specialists. He also suggested reforms for psychiatric services in India. Easier
access, reduction of legal procedures, setting up of visitors committees and
an urgent need to increase the number of beds, irrespective of all pressures,
were the major recommendations. He also suggested that psychiatric wards be
provided in all general hospitals, and only chronic cases be sent to the asylums.
The quality of undergraduate education needed to be improved, and training in
psychiatric social work and rehabilitation was to be introduced.
These suggestions, unfortunately, could not be executed at it was felt that
other needs must have priority and that economic reasons forbade these de-
fects being rectied.73 Mapother regretted that any criticism of the system was
countered with the need for nancial prudence, and the need to maintain the
security and prestige of the British Raj. As an example of misplaced priori-
ties, he wonders how an expense of 18 million (of a total budget for India of
60 million) can be justied for building New Delhi for ceremonial entertain-
ment. It was quite evident by now that reform and improvement would not be
carried out in British India.

The case of Mysore native asylum in the British Empire

The kingdom of Mysore was administered directly by the British between
1831 and 1881, after which rule reverted to the maharaja of Mysore. At the
time of rendition, a policy paper was prepared concerning medical services
under the new administration. The future medical arrangements must partake
of a European character, because there is no native system to fall back upon . . .
the Principal charges are the Civil Hospital, Lunatic Asylum and Medical

72 Report of Mapother to Migaw.

73 Ibid.; Conversation between Mapother and Megaw.
 Psychiatry and connement in India 289

Stores, and experienced and well-trained men be placed74 was the considered
advice.
The asylum continued to provide services to the Indian population and the
British residents of the army cantonment of Bangalore. Until the early part
of the twentieth century, Indian and European women were housed together,
but the overcrowding of female European lunatics necessitated the setting up
of separate wards for European women in 1913. A gradual increase in the
number of patients led to additional wards being constructed, but by 1914 no
further expansion was possible. It now accommodated 200 patients, including
twenty-seven Europeans and Eurasians. The number of people being admitted
every year continued to increase, so that by the second decade of the twentieth
century, more than a hundred admissions were made every year.75 Exclusively
Indian staff managed the asylum by now. By 1920, it was evident that a new
building for the Lunatic Asylum is absolutely necessary . . . there will have to
be specialists in nervous diseases.76 Dr Francis Noronha had recently been
deputed to train in England, where he worked at the Maudsley Hospital with
Dr Mott, from where he returned in 1921. Work was deferred for almost a
decade because of lack of funds, but a new building was ready by 1932 in a
sprawling campus on the outskirts of the city. Modelled on the plans of the
Bethlem Asylum at the Lambeth site, it had four large pavilions, an interior
courtyard garden and extensive lawns.
Dr M. V. Govindswamy, a medical graduate from the Mysore Medical Col-
lege also began working at the mental hospital, and was also sent abroad to the
USA and to the Maudsley Hospital, for further training in psychiatry. In London,
he met Professor Willi Mayer Gross, who had been brought over from Germany
under the Rockefeller programme. The two shared common interests in phi-
losophy and medicine, and this acquaintance was to guide the development of
academic psychiatry in India. Upon his return to India, Dr Govindswamy was
an active researcher. He began using cardiazol induced convulsions,77 insulin
coma,78 and later, psychosurgery,79 almost as soon as these were available in
Europe. A scholar of Sanskrit and English, he also taught himself some German
to read the original texts. He was instrumental in maintaining high standards of
care, and systematic notes and medical evaluations became a routine at the hos-
pital. Laboratories, rehabilitation services and psychological testing was also

74 Medical 18801, le 1, series 12, Karnataka State Archives, Bangalore.

75 Report of the Mysore State Asylum, Bangalore, 1916; medical 49/17/2 34523453 (December
1917), Karnataka State Archives, Bangalore.
76 Medical 42/22, serial 15, 1922, Karnataka State Archives, Bangalore.
77 M. V. Govindswamy, Cardiazol Treatment in Schizophrenia, Lancet (1939), 506.
78 M. V. Govindswamy, Insulin Shock and Convulsion Therapy in the Tropics, Lancet (1939),
1232.
79 M. V. Govindswamy, Rao BN Bilateral Frontal Leucotomy in Indian Patients, Lancet (1944),
466.
290 Sanjeev Jain

introduced. He also felt the need to apply concepts of Indian philosophy to the
description of psychopathology, over and above the practice of ayurvedic and
other traditional forms of medicine.80 After Independence, the recommenda-
tions of the Sir Joseph Bhore committee in the preceding years to establish a
centre for post-graduate education were to be executed.
The only centres thought adequate were the ones at Bangalore and the erst-
while European Asylum in Ranchi. Professor Mayer Gross, who had recently
retired in the UK, was invited as a visiting Professor, to Bangalore. Here he
helped develop a curriculum for post-graduate training. Dr Govindswamy was
convinced that basic neurosciences were crucial to understanding disorders
of the brain and mind. He developed a programme that included clinical ser-
vices in neurology and neurosurgery (in addition to psychiatry, psychology
and psychiatric social work), and basic sciences. This hospital was designated
as the All India Institute for Mental Health, and began training students for a
diploma in psychological medicine, and in clinical psychology in 1956. Unlike
the western, especially American experience, psychoanalytical viewpoints were
not reected in the development of psychiatry. Dr Govindswamy himself felt
that psychoanalysis was a strain on ones credulity,81 as did Edwin Mapother,
who said of a certain analyst that he represented the greatest danger to the
development of psychiatry in India.82 This Institute was redesignated as the
National Institute of Mental Health and Neurosciences in 1974. It was indeed
ironical, and a tribute to Sir Mapothers perspicacity, that a native-administered
asylum, rather than one of the colonial establishments, proved to be the most
adept at synthesizing western and Indian approaches, and developing a com-
prehensive approach to neurosciences and psychiatry.

Case notes at the Bangalore Mental Hospital

Records at this hospital in Bangalore extend to the beginning of the twentieth
century. We have tabulated these registers, and have tried to prole the clinical
details. In 1903, the asylum had 258 patients (201 males, fty-seven females)
who had been there for an average of seven years. While a few were there from
1865, most had been admitted in the decade after 1895. Mania acuta and Mania
longa were the commonest diagnosis and accounted for almost 60 per cent of
the patients. Melancholia was also frequently diagnosed. Organic causes such as
epilepsy, and acute and chronic dementias accounted for sixty-two admissions,
almost 25 per cent of the total cases. Rarer diagnoses included chronic mania,
chronic delusional states and idiocy. Seven individuals were declared not insane,
80 M. V. Govindswamy, Need for Research in Systems of Indian Philosophy and Ayurveda with
Special Reference to Psychological Medicine, Journal of the Indian Medical Association 18
(1949), 2816.
81 Ibid. 82 Report of Mapother to Migaw.
 Psychiatry and connement in India 291

but not before they had spent an average of fourteen months in the asylum.
Following the records of these patients, it was seen that eighty-seven (34 per
cent) died. More than half of those admitted with idiocy, chronic dementia or
epileptic dementia died. A signicant number of those with mania recovered
entirely, although a fourth of these patients also died over the next seven years.
Of all the individuals admitted between 1895 and 1903, at the end of 1910 only
thirty-ve were still in the asylum. Eighty-eight had been discharged as cured
or improved, while fty-ve had died.
We also analysed records of the new patients admitted in the years 19034.
Relatively small numbers were admitted afresh forty-two in 1903, and thirty-
seven in 1904. This had remained relatively static for several years, for instance
there had been thirty-eight admissions in 1878. Their average age was in the
early thirties and a signicant number had sought treatment earlier from the
asylum. We could chart the outcome of these new cases through the casebooks
of the successive years. Mania acuta and Mania longa were still the most
common diagnoses. The large majority of these recovered or were discharged
to the care of the family, and only ve patients stayed on till 1910. Half of the
new admissions stayed in the asylum between six and seven months, and mania
acuta had the best recovery rate. Some died soon after admission, but most of
these were suffering from epilepsy or idiocy.
Religion, caste and social background were recorded, and were representative
of the population of Bangalore. Hindus accounted for 70 per cent of admissions,
Muslims 21 per cent and Christians 8 per cent (including Europeans and native
Christians). While most new cases who were discharged were from the city of
Bangalore, a larger proportion of those who stayed in the asylum for longer
periods were from more distant places in the kingdom.
In 1878, there were only eight diagnostic categories, but by 1904, nineteen
diagnostic categories were in use. The case notes were reviewed, and quite often
the diagnosis would be changed a few months after admission. New categories in
1904 included hypochondriac melancholia, and several categories of dementia.
This probably reected a better understanding of the causes of dementia by this
time in medicine.
Changes in diagnostic practice are quite evident in cannabis-related psy-
chosis. In 1879, ganja was identied as a cause in 75 per cent of the admissions.83
Of the patients resident in 1903, ganja use was a factor in ten cases of mania,
and a few of dementia. However, after 1900, ganja-induced psychosis as a diag-
nosis decreases substantially in the records. The closing years of the nineteenth
century had seen a huge interest in cannabis. From the initial curiosity regard-
ing its possible use in treatment,84 there had been growing concern about its

83 Annual Report on special hospitals in the province of Mysore for 1879.

84 W. B. OShaughnessy, On the Preparations of Indian Hemp or Gunjah (Calcutta, 1839).
292 Sanjeev Jain

role in causing madness.85 The nal report of the Indian Hemp commission,
after interviewing a number of Indian and European experts, stated that there
was insufcient reason to identify ganja as a cause of psychosis. By 1900, this
opinion was widely shared, thus accounting for the rapid decline in rates of
diagnosis.
Case notes from the 1930s included detailed psychopathological observa-
tions, family history, social functioning and a thorough medical review. Patients
were seen everyday for the rst few days after admission, and less frequently
later. Laboratory tests such as the Wasserman reaction, blood counts and x-ray
were available. Drugs in use included opium, chloral, paraldehyde, bromides,
antipyrin and Jamaican dogwood. The residency surgeon, from the British
Army, justied the expense in a letter to Dr Govindswamy, stating that a large
number of cases are due to organic causes . . . the more patients are cured, the
less will be the recurring expenses. In other words, it is better to spend money
on drugs that cure, rather than on maintenance, that does not.86

The development of the asylum in Bangalore encapsulates the various trends in

institutional care in India. It started as a ward in a general hospital for civilians, as
part of the services by the British Army in the rst half of the nineteenth century.
It became an institution, acquired a building, full-time staff and, after 1881,
was administered by an Indian kingdom. Western medicine by now had gained
social and intellectual acceptance, and Indian doctors managed the asylum
well. Advances in medicine were incorporated quickly, and there was only
minor evidence of any deliberate attempt to maintain social distinctions. Other
asylums were not so fortunate.

The Royal Indian Medical Psychological Association

India by this time was well on its way to independence, and the Second World
War was looming. A growing number of specialists in psychiatry were now
practising in the hospitals and asylums. In 1936, a move to establish an Indian
division of the Royal Medical Psychological Association (RMPA)87 had been
initiated, allegedly the rst in the Empire, outside the UK. Dr Banarsi Das,
superintendent of the Agra Mental Hospital, wrote to Dr R. Worth, the president
of the RMPA, with a plan for the association and an estimate of the costs
involved. It was also suggested that all those who had worked in asylums for a

85 J. H. Tull-Walsh, On Insanity Produced by the Abuse of Ganja and other Products of Indian
Hemp, Indian Medical Gazette 29 (1894), 3337, 36973.
86 Mysore Residency Files 621/1, 1937, correspondence regarding a grant to the Mental Hospital,
Bangalore for purchase of European medicines for the treatment of the mentally ill patients of
the Civil and Military station, Bangalore. Karnataka State Archives, Bangalore.
87 Records of the Indian Division of the Royal College, Royal College of Psychiatry, London.
 Psychiatry and connement in India 293

long time but had not acquired specialist degrees (at that time, this was possible
only from the UK) be allowed to become members. This was not permitted by
the RMPA. Eventually, the Indian division came into existence and held two
meetings in Agra (1938) and Lahore (1941). At the rst meeting, Dr Thomas,
the superintendent of the Hants County Mental Hospital in England, represented
the RMPA, thus signifying some degree of co-operation between the psychiatric
professions in the two countries.
The issues discussed were overcrowding of the hospitals, training of hospital
attendants, improved undergraduate education and opportunities for postgradu-
ate study, and the design of single cells best suited for use in India. The need for
reform and expansion was thus acutely felt, both by the practitioners in India
and visitors from abroad. The members of this association were the superinten-
dents (by now largely, but not exclusively, Indian) and the growing number of
psychiatrists in general hospitals and medical colleges.
After the death of Dr Banarsi Das in 1943, Lt. Col. Moore Taylor, superin-
tendent of the European Mental Hospital at Ranchi, took over as president. By
this time the war and the Indian political unrest was well on its way. In 1946,
moves had been made to establish a separate Indian society. In April 1947,
Taylor resigned as he felt that the Indian division was being allowed to die. The
Indian Psychiatric Society with Col. Davis as its secretary had already been
established, and the Indian division of the RMPA had ceased to function as
such, as Dr Davis told the RMPA during a visit.88 By November 1947, a few
months after Independence, the Indian division was dissolved. Despite its short
life, this association afrmed the close links between the Indian and the British
medical professions, and their similar preoccupations.

Bhore Committee and the Moore Taylor Report

The Health Survey and Development Committee 1946 (Sir Joseph Bhore Com-
mittee) included reform of psychiatric services in its ambit and Colonel Taylor
was asked to survey the mental hospitals. His report was based on his obser-
vations of nineteen mental hospitals with 10,181 beds. His ndings were quite
similar to those of Mapother a decade earlier. Asylums were designed for custo-
dial care and not for cure. The worst of them were the Punjab Mental Hospital,
the Thana Mental Hospital, the Agra Mental Hospital and the Nagpur Mental
hospital . . . conditions of many hospitals in India today are disgraceful and have
the makings of a major public scandal. Increasing bed capacity, without con-
comitant increase in personnel, lack of attention to training and education at all
levels, inadequate provision for rehabilitation, and poor liaison with medical
services were pressing problems, and it was time he felt for Government to

88 Ibid., undated note.

294 Sanjeev Jain

take account of stock, overhaul resources, and rechart the course for the next
30 years.89
The Bhore Committee chronicled the dismal state of health services in
India.90 There were only 73,000 medical beds in the whole of British India
(0.24/1,000), the doctor population ratio 1/6,000, and the nurse population
ratio 1/43,000. Life expectancy was only twenty-six years, compared to above
sixty years in other parts of the empire, like Australia and New Zealand; and
infant mortality rates were ve times higher. However, the committee made
sweeping suggestions for the development in forty years, of an integrated,
preventive and curative National Health Service embracing within its scope in-
stitutional and domiciliary provision for health protection of a reasonably high
order. Loosely planned on similar reform in the UK, these suggestions had
been hinted at by Dr Dalrymple-Champneys91 (an adviser to the Bhore Com-
mittee) and Professor A. V. Hill92 in the early 1940s. The Committee envisaged
the setting up of a health administrative unit for every three million population,
with primary health centres for every 20,000 and a specialist general hospital
with 2,500 beds that would include care of the psychiatrically ill. The estimated
cost would be Rs 2 per annum. However, as a unit, the costs were several times
lower than those budgeted for similar services in England, prompting some to
question the feasibility of it all.93
Suggestions for increasing the number of asylums, and beds for psychiatric
services were made. However, progress was slow. By 1980, the number of
mental hospitals had been increased to thirty-seven, but there were only 18,918
beds. The post-Independence expansion of services in India coincided with the
introduction of pharmacological treatments. These became available widely
in India very quickly, and were the mainstay of treatment by the end of the
1950s. Indeed, the rst workshop of medical superintendents on improving
mental hospitals called for a restraint in the use of tranquilizers! The growing
awareness of the drawbacks of aslylum-based long-term care was also evident.
As a result of all these diverse inuences, between 1951 and 1961, only ve
more asylums were added, with approximately 2,500 beds.94 However, the
number of admissions increased several fold, as did the number of discharges.

89 As quoted in Quality Assurance in Mental Health: National Human Rights Commission (New
Delhi, 1999).
90 Lt. Gen. Sir Bennett Hancie, The Development and Goal of Western Medicine in the Indian
Sub-Continent (Sir George Birdwood Memorial Lecture), Journal of the Royal Society of Arts
25 (1949).
91 Sir Weldon Dalrymple-Champneys, Health Review of India, GC 139/H2, Wellcome Library,
London.
92 A. V. Hill, Health, Food and Population in India, International Review 21 (1945), 4050.
93 Ibid.
94 S. Sharma and R. K. Chadda, Mental Hospitals in India: Current Status and Role in Mental
Health Care (Delhi, 1996).
 Psychiatry and connement in India 295

In the rst two decades after Independence, the emphasis on asylum-

based care for the mentally ill continued. Hospitals were added in Amritsar,
Hyderabad, Srinagar, Jamnagar and one of the last in Delhi in 1966. Surpris-
ingly, the one in Delhi was nally built at a site identied almost a century
earlier to replace the asylum destroyed during the Indian Mutiny. Institutional
care in India now consists of these forty-odd hospitals, with a total of 20,000
beds. Dr Vidyasagar in the Amritsar Mental Hospital introduced one of the most
remarkable innovations in mental hospital care in the early 1950s.95 He erected
tents in the grounds, and encouraged families to live with the patients, until
they recovered. He shared almost all his working hours with the patients and
their families. Principles of mental health, derived from religious and medical
sources, were shared. This signicantly reduced the stigma of mental illness,
and demonstrated the feasibility of community care.
The rapid availability of pharmacological treatments for psychiatric disorders
allowed the government to envisage that care for mental disorders could be
successfully amalgamated into the general health services, as perhaps suggested
by the Bhore Committee.
A series of public interest litigations in the 1980s has led to sporadic attempts
at reform. A review by the National Human Rights Commission96 in 1999
pointed out the deciencies in the system. This report again highlighted the
exceedingly disparate standards of care, commented upon a century-and-a-
half earlier.97 The cost of maintaining a patient varied from Rs 19 ($ 0.3) to
Rs 275 ($ 7) per day, an average of Rs 106 ($ 2.5). More than a third were
still housed in converted gaols, with all the custodial trappings of a century
ago. Twenty per cent lacked any investigation facilities at all, and the wide
range of services for psychosocial intervention and rehabilitation were woefully
inadequate. Despite the increase in budget . . . utilization is so variable . . . no
appreciable improvement in many hospitals observed the review.

Conclusions
Although hospitals are an article of faith by several historians, there is little
to suggest that they were widely available before the advent of European, and
specically, British inuences.98 Medical care was provided by trained doctors
at patients homes, and social divisions perhaps precluded any creation of a
common public space for care. However, the choice of physician was often

95 M. K. Isaac, Trends in the Development of Psychiatric Services in India, Psychiatric Bulletin

10 (1995), 13.
96 Quality Assurance in Mental Health: National Human Rights Commission (New Delhi, 1999).
97 Ernst, Native Asylums in Colonial India.
98 A. L. Basham, The Practice of Medicine in Ancient and Medieval India, in C. Leslie (ed.)
Asian Medical Systems (Berkeley, 1976).
296 Sanjeev Jain

very eclectic and Ayurvedic, Unani and European doctors would be consulted
with equal felicity. Traditional medicine also suffered from a lack of acceptance
of insanity. It has been suggested that the insane lost all caste distinctions, and
were considered deling, and pious householders and Brahmins were advised
not to look at insane persons.99 Islamic societies (and medieval India was ad-
ministratively an Islamic society) did not make a specic provision for public
institutions and services for the poor. Although the notion of charity allowed
the setting up of poorhouses, these were often run on private donations and not
systematically supported.100 Troublesome lunatics were often locked into gaol,
while harmless ones wandered the streets and joined the poor and vagabonds
near the mosques and temples.101
Medicine was often outside the traditional social systems, as doctors, by the
nature of their profession, had to handle unclean substances. The practice of
medicine both by the professions and the people did not conform to the rigid
demands of religious dogmas. The origins of European medicine, and its use
by a wide section of the population in India, were thus no surprise. In essence,
in public approaches to illness, whatever was empirically effective, was used.
Charles Smith, at the Hospital for Peons, Paupers and Soldiers referred to earlier,
was able to document 23,406 consultations between 1836 and 1849, and in 1849
alone had 4,336 admissions through the year, from a population of only 100,000
in Bangalore. And this despite the fact that rich Indians and Brahmins seldom
used the hospital. Despite other allegations of colonial imposition, hospitals and
asylums thus proved quite popular and acceptable to the population of India.
Medical colleges were established in 1835 in India, and created a large body
of Indian professionals trained in western medicine. Leaving service conditions
and administrative rules aside, this implied that western notions of hospital care
became a part of social and intellectual life. Rich businessmen offered to fund
special facilities, such as the special wards for Parsees in the Pune Asylum
which was a charming villa for 40 patients,102 or donations to the asylums.
Medicine was seldom seen as a tool of Empire, unlike the railways.103 There
have been suggestions to the contrary, but there is little evidence that colonizing
the mind was as useful (or successful) an enterprise as colonizing the body.104
The growing Indian medical elite identied themselves closely with the Raj, as

99 M. Weiss, History of Psychiatry in India: Towards a Culturally and Historiographically In-

formed Study of Indigenous Traditions Samiksa 40 (1986).
100 M. W. Dols, Majnun: The Madman in Medieval Islamic Society (Oxford, 1992).
101 B. Pffeiderer, Mira Datar Dargah: the Psychiatry of a Muslim shrine, in Imtiaz Ahmed (ed.),
Ritual and Religion among Muslims of the Sub-Continent (Lahore, 1995).
102 Report of Mapother to Migaw.
103 D. R. Headrick, The Tools of Empire (New York, 1981).
104 D. Arnold, Colonising the Body: State Medicine and Epidemic Disease in 19th-Century India
(Delhi, 1993).
 Psychiatry and connement in India 297

seen in the attempts to create an Indian association aligned to the Royal Society,
just years before Independence.
The East India Company passed laws regarding the detention of the insane
in its territories several years before similar Poor House Acts were enforced in
England. The nineteenth century was marked by a frenzy of asylum building.
Although it has been suggested that these were symbols of imperial domination,
their actual utilization by the Indian people was quick. The prevailing ideas
about the causes of insanity were extrapolated to the region. Though racial
issues were recognized, it was equally evident that a considerable degree of
effort to understand and improve the services was made. There is little evidence
that a systematic denial of the psychological space of natives was attempted.
This was a reection of the trends in psychiatric care in the UK in the nineteenth
century.
Other issues in medical science and technology are also important. Until
the early part of the nineteenth century, there was a signicant give and take
between the healing traditions of India and the British. However, scientic ad-
vances increased the distance between the two approaches. Unlike Canada and
Australia, a comprehensive techno-scientic education was not provided, but
one more akin to achieving technical skills and a PWD type of education.105
In the absence of this broad scientic background, progress in medicine was
slow. The lack of adequate sharing of scientic knowledge was to prompt a
severe rebuke by A. V. Hill.106 This was quite apparent in medical services, and
perhaps equally true of psychiatric care.
By the early twentieth century, there was an increasing dependence on Indian
professionals, and provincial governments in any case were responsible for
health care. This perhaps prevented the kind of formal analysis of the issue of
race as a factor in mental illness that was to bedevil African psychiatry. The
rst asylums in Africa were established only towards the end of the nineteenth
century and the early years of the twentieth, and social contacts between the
two cultures were not as complex as had been established in the Indian sub-
continent over the past 300 years. There is seldom any use of metaphors of race
in describing the Indian insane, nor is there a difference in their symptoms.
The sameness is repeatedly emphasized, although differences on account of
geography, climate and organic disease are often suggested.
In the nineteenth century, moral treatment was sought to be extended to all
the citizens of British India. Although initiated as an exercise to reduce public
nuisance, it was soon regarded as a noble work. However, by the end of the
nineteenth century, increasing reparations to the UK, and the costs involved,

105 D. Kumar, Science and the Raj (Delhi, 1997).

106 A. V. Hill, India-Scientic Development or Disaster, in The Ethical Dilemma of Science and
other Writings (New York, 1960).
298 Sanjeev Jain

proved prohibitive. Endless debates about separate asylums for Europeans cul-
minated in two buildings: one in Berhampore (which was quickly discarded as
it turned out to be too much like a gaol), and at Ranchi.
For most of this period, asylum populations remained almost static at below
15,000 beds for a population of several hundred million. Financial and admin-
istrative lacunae (parsimony and neglect) were blamed for this appalling state.
But the great incarceration simply never happened.
This was to have several consequences for services in India. Unlike the West,
where social psychiatry and community care evolved as extensions of the asy-
lum, there were no comparable services. The ancillary professional staff
psychologists, psychiatric social workers, mental-health nursing, etc., were
woefully inadequate. Prompted by developments in pharmacology and inno-
vations in community care, asylums began playing a diminishing role in the
provision of care, reserved only for the destitute and abandoned. General hos-
pital psychiatry units, established in only half of the medical colleges, attended
to acute cases, and chronic cases fell into the background. Sporadic attempts
at reform have been partially successful, and a few of the asylums have been
made autonomous, and provided increased funds to improve the quality of
care. It is quite likely that no new facilities will be established, though the need
for long-term care is quickly being lled up by private asylums and halfway
homes that were permitted under the revised Indian Mental Health Act of 1987.
Whether these will go the way of the private madhouses of the eighteenth and
nineteenth centuries remains to be seen. Economic reforms have increased the
role of the private sector in health provision, and have been accompanied by
reduced funding for public health. This raises questions about the retreat of the
state from the responsibility of care for the chronically ill, and these are likely
to intensify in the future as families become smaller, society more industrial
and the demands for care more complex.
Colonial institutions in India include the railways and the parliament, as well
as the asylums. Though setting up of each of these was prompted by the needs
of the colonial administration, they have been incorporated into all aspects of
contemporary Indian life. There is constant debate about the relevant adaptations
of each of these to the needs of the Indian society. As perceptions about the
nature of psychiatric disease and care changed over the past two centuries,
so did attitudes towards institutional care. The sheer paucity has sometimes
been viewed as an advantage, as the ills of chronic institutionalization were
avoided. The needs of the chronic mentally ill are still woefully neglected, and
a more responsive institutional care service will perhaps be necessary. Asylums
in India will necessarily have to reinvent themselves to continue to be relevant.
12 Connement and colonialism in Nigeria

Jonathan Sadowsky

In a recent article Shula Marks has asked, what is colonial about colonial
medicine?1 The answer, of course, depends in part on what one considers colo-
nial to mean. One of the benets perhaps unexpected of the growth of studies
of colonial medical institutions in recent years has been a growing appreciation
of the diversity of colonial contexts, the recognition that colonialism was not
the same in all places. This chapter seeks to contribute to that understanding by
posing the question, what was distinctively colonial about the connement of
the insane in Nigeria, with an emphasis on institutions in the southwest of the
country?
The history of Nigerias asylums re-enacted developments common in the
comparative history of psychiatric institutions, but also illustrates themes pecu-
liar to the politics and priorities of colonialism. In the beginning, the institutions
were, like many colonial imports, already obsolete by metropolitan standards,
replicating many of the faults British psychiatry had come to pride itself on
overcoming. For most of the early twentieth century, colonial ofcials in Nige-
ria lamented the state of the asylums and planned tfully to reform them. But
when reform was achieved in the late 1950s and early 1960s, it was contempo-
rary with Nigerias gradual shift to independence, and the reform was largely
accomplished through the initiatives of Nigerians.
Victorian Britain enacted a series of dramatic changes in lunacy policy, in-
cluding increased institutionalization, the rise of moral treatment and other
optimistic therapies. There was, however, a growing disillusionment with in-
stitutional options by the early twentieth century. With each of the changes,
the psychiatric establishment radiated an image of progress. Michel Foucault
and others have, of course, argued that the reforms of modern psychiatry have
spawned cultural hegemonies and forms of social control all the more insidious

This chapter is based on my monograph, Imperial Bedlam: Institutions of Madness in Colonial

Southwest Nigeria (Berkeley, 1999), especially chapter three. The research was funded by the
US Social Science Research Council. All the acknowledgments made in the monograph apply
here.
1 S. Marks, What is Colonial About Colonial Medicine? And What has Happened to Imperialism
and Health?, Social History of Medicine 10 (1997), 20519.

299
300 Jonathan Sadowsky

for seeming benign. But for most of the colonial period in Nigeria this view
would have little applicability. The colonial lunatic asylums of Nigeria were
simply not benign enough to be insidious. Nor would a view of colonial asylums
as panoptic really be apt.
Roughly, colonial asylum policy in Nigeria can be periodized as follows:
asylums were established in the rst decade of the twentieth century, shortly
after the establishment of a colonial state incorporating most of the country
now known as Nigeria a country whose borders were drawn according to
agreements made in Europe without regard to the natural or human geography
of Africa.2 For the rst two decades, the asylums were used as purely custodial
institutions, with colonial ofcials having no higher aspiration for them. By the
late 1920s, there began to be calls for a reformed, curative hospital, calls that
were received with scorn from most in the government at rst, but with more
sympathy starting in the mid-1930s. Once the government determined that a
hospital would be desirable, though, inertia carried the day, until near the end of
the Second World War. Development of therapeutic facilities quickened in the
mid-1950s, as Nigerian psychiatrists began to staff the institutions, which were
then re-named hospitals. By examining the material conditions in the asylum,
the social processes of admission and discharge, the ideological conicts in
debate over asylum reform and, nally, the process of reform itself, we can see
how colonial policies for the connement of the insane reect the contradictions
of the colonial policy of indirect rule.

The beginnings of Nigerias asylums

Neither insanity nor psychiatric care were new to Nigeria when the colonial era
began. Yoruba is the dominant language in the region that is the focus of this
chapter, and the language contains not only a word for madness, were, but a
number of more specic diagnostic categories used by mental healers.3 Tradi-
tional psychiatric healing among the Yoruba resembled western psychiatric care
of the late twentieth century more than that of the time of the European occupa-
tion in a number of key respects. For example, Yoruba healers used an effective
psychotropic drug derived from the plant rauwola that is chemically similar to
the phenoziathines used in western countries to treat psychosis since the 1950s.
Yoruba healers also combined therapeutic ritual with the use of drugs, similar
to the combination of psychotherapy and medication now highly esteemed in
western psychiatry, and recognized heredity as a major risk factor for mental
illness. For these reasons, traditional Yoruba psychiatric care can be said to
2 See A. I. Asiwaju, Western Yorubaland Under European Rule, 18891945 (London, 1976), on
some of the effects of European boundary-making in Africa.
3 See Sadowsky, Imperial Bedlam, chapter three, and R. Prince, Indigenous Yoruba Psychiatry,
in A. Kiev (ed.), Magic, Faith, and Healing (New York, 1964).
 Connement and colonialism in Nigeria 301

have been at least as developed as that practised in Europe a century ago

certainly more so than the strictly custodial model that was imported under
the colonial regime. Yoruba healers have employed chains and other forms of
restraint for patients, but the region had no tradition of large-scale connement
prior to colonialism.
Other European imports had been familiar near the Bight of Benin for cen-
turies before formal colonialism, and European medicine made its rst sig-
nicant intrusions with the Christian missions in the middle of the nineteenth
century. The asylum came only in the rst decade of the twentieth century, after
the establishment of formal British rule. The growth of the colonial state was
accompanied by a growth of the urban centres of the country, and by the late
nineteenth century these centres had growing numbers of vagrant insane. Both
Africans and the European administrators began to argue that the state needed
to take some responsibility for them.
Large institutions for conning the insane have existed in Europe since the
Middle Ages.4 The British diffused these institutions with the growth of their
global empire in the modern era. There were, for example, asylums in operation
in India by the mid-eighteenth century.5 These housed the European insane, for
fear they would become vagrant or otherwise compromise British prestige. The
asylums in British Africa, by contrast, mostly conned Africans. Asylums were
used in Southern Africa by the early nineteenth century; these included ones at
Robben Island, a predecessor of the notorious prison in which Nelson Mandela
was conned.6 West African asylums in Kissy (Sierra Leone) and Accra (the
Gold Coast) were in use by the late nineteenth century.
The southern provinces of Nigeria launched an asylum policy in the rst
decade of the twentieth century, with the enactment of laws for conning lu-
natics. The Lunacy Ordinance of 1906 empowered the government to establish
a lunatic asylum when necessary, and dened a lunatic as any person of
unsound mind, including idiots.7 Any medical ofcer could detain an indi-
vidual as a suspected lunatic for up to a month. Local magistrates could also

4 Midlefort suggests that asylums were not a European innovation, but were developed by Arab
societies and imported to Christian Europe by way of Spain. E. C. Midlefort, Madness and
Civilization in Early Modern Europe: A Reappraisal of Michel Foucault, in B. Malament (ed.),
After the Reformation: Essays in Honor of J. H. Hexter (Philadelphia, 1980).
5 See W. Ernst, The European Insane in British India 18001858, in D. Arnold (ed.), Imperial
Medicine and Indigenous Societies (Manchester, 1988), and W. Ernst, Mad Tales from the Raj:
The European Insane in British India (London, 1991).
6 J. Iliffe, The African Poor: A History (Cambridge, 1987), 100; H. J. Deacon, Madness, Race
and Moral Treatment: Robben Island Lunatic Asylum, Cape Colony, 18461890, History of
Psychiatry 7 (1996), 28797. Institutions would also later be used in Nyasaland and Kenya. On
Nyasaland, see M. Vaughan, Idioms of Madness: Zomba Lunatic Asylum, Nyasaland, in the
Colonial Period, Journal of Southern African Studies 9 (1983), 21838.
7 Government of Southern Nigeria, Government Gazette, 7 November 1906. With the amalgama-
tion of Nigeria in 1916, a colony-wide ordinance was enacted with much the same language.
302 Jonathan Sadowsky

hold hearings regarding a persons sanity. The district commissioners (local

colonial ofcials) would have ultimate authority for designating lunatics, and
were to hold hearings, call witnesses, and appoint medical supervisors to that
end. The medical supervisor was required to certify the individual as a lunatic
and proper subject for connement, and to specify what warranted the cer-
ticate. The rst buildings designated exclusively as asylums were the Yaba
Asylum in Lagos and the Calabar Asylum in southeastern Nigeria.
Nigerias colonial prisons and asylums were functionally equivalent: they
conned deviant or troublesome individuals, and refrained from cure, rehabil-
itation, or otherwise normalizing their inmates for return to the outside.8 Yet
administrators distinguished carefully between the two. Asylums lay in the
middle of a spectrum between prisons and hospitals, reecting an ambiguity
in colonial rhetoric as to whether lunatics were essentially a health or social
control problem.9 Literal overlaps between the asylums and the prisons existed
as well. By 1915, for example, with the Yaba asylum already overcrowded,
several cells in Lagos prison were converted into a lunatic asylum.10 In 1906,
the Yaba Asylum was developed in the former headquarters of the Nigerian
Railways.11 Dr Crispin Curtis Adeniyi-Jones, a Nigerian physician who served
in the Lagos Medical Service became the rst director of the asylum. Adeniyi-
Jones wrote two reports about the Yaba Asylum in November and December of
1907, which provide impressions of what it was like at that early date.12 As of
the 31 October, fourteen lunatics: eight women and six men, had been admitted,
and an additional female inmate was admitted in November.13 Adeniyi-Jones
noted that The classication as to forms of insanity has not been decided in
every case. The asylum already had physical defects, including broken locks,
gutters and fences. Adeniyi-Jones wrote a number of letters to superior medical
ofcers during his tenure as head of the asylum; they show him to be diligent
but already embattled by the lack of resources the government was willing
to devote. A European, Thomas Beale Browne succeeded him in 1909, and
Europeans would direct the asylum until Nigerias transition to independence
in the late 1950s.14
8 The number of people conned in colonial asylums in Nigeria was always much smaller than
the number in prisons.
9 In the Gold Coast, in fact, lunatics were generally placed in prisons until the 1940s. R. C. Brown,
Report III On the Care and Treatment of the Mentally Ill in British West African Colonies
(London, 1938).
10 Nigerian National Archives, Ibadan (hereafter NAI) AI CSO N1210/1916. These were cells that
had previously housed European convicts.
11 T. Asuni, Aro Hospital in Perspective, American Journal of Psychiatry 124 (December 1967),
76370.
12 For more on Adeniyi-Jones, see A. Patton, Jr, Physicians, Colonial Racism, and Diaspora in
West Africa (Gainesville, Fla., 1996), 1923.
13 Yaba Lunatic Asylum, Monthly Report for November, 1907, from personal collection of Dr
Alexander Boroffka.
14 Adeniyi-Joness letters are available at the Contemporary Medical Archives Centre, Wellcome
Institute for the History of Medicine, London, GC/146/1.
 Connement and colonialism in Nigeria 303

Material conditions
From the inception of the asylums, critics drew attention to their revolting
conditions, referring mainly to dirt and overcrowding. In 1928, in the rst major
report to the government on lunacy in Nigeria, visiting alienist Bruce Home
described dark, congested cells, poor bathing facilities, lack of basic supplies,
and the use of chains.15 He added that the asylums in Calabar and Yaba were
little better than the prisons. In Calabar, he said the unfortunate patients are
exposed to view, and are objects of amusement to the public. Later reports
by other visiting alienists such as Robert Cunyngham Brown (in 1938) and by
J. C. Carothers (in 1956) echoed Homes with regard to material conditions.
The disgust repeatedly led to calls for reform, but little action.
Although asylums in other regions of the country did not suffer quite as much
overcrowding as in Yaba and Calabar, most of them were not much more at-
tractive. Some ofcials thought lunatics were better off left in the streets!16 The
Port Harcourt prison extension was especially dreadful; an ofcial witnessed
several violent lunatics shivering naked in damp, dark cells, chained like an-
imals to a ring in the oor; others also naked, wandered aimlessly around a
barbed wire enclosure.17 Brown observed that the asylum in Kano resembled
a fortress rather than an asylum. The one exception was in Zaria, where The
reporter found the asylum clean, tidy and, according to native requirements,
proper in every way.18
In order to deal with overcrowding, the Yaba and Calabar asylums tried to
exclude so-called harmless lunatics. This did not mean that all the inmates
were criminal. On the contrary, the distinction between criminal and civil
lunatics was a carefully kept marker of the inmates identity. Criminal lunatics
were those who had been arrested, usually for violent crimes, and found unt
to stand trial because of their mental state. Civil lunatics were usually people
who were considered public nuisances, but who had not committed any crime,
or at least no serious crime. Whenever possible, the government preferred to
leave these people in the care of relatives.19 The material conditions were made
more alarming by the expectation that many more lunatics would need to be
conned. In 1928, Home calculated that provision would have to be made for
4,000 cases of insanity, one quarter of which would require urgent care.20 The
word calculated requires quotation marks because there was no basis for his
numbers. He was probably trying to stress that a lot of beds were needed, to
draw attention to the problem.
15 B. Home, Insanity in Nigeria (Lagos, 1928), 5.
16 NAI New File MH (Fed) 1/1 3313, 6970.
17 NAI New File MH (Fed) 1/1 3313, Lunatics, Care of, 31, inspection notes by J. G. C. Allen,
Senior Resident, 18 July 1955. See also MH (Fed) 1/2 MH 59 vol 2, 54.
18 Brown, Report III, 40.
19 See, for example, NAI CSO 26 26793, Abeokuta Mental Hospital, vol. 1, 7.
20 Home, Insanity, 6.
304 Jonathan Sadowsky

Therapy was obviously not a priority in these conditions. It is possible that

the physical health of some inmates may have improved, as the Annual Medical
Report for 1927 claimed.21 This was plausible, given that many of the inmates
were impoverished, undernourished vagrants, who received regular meals upon
admission. Also, medical examinations were given every three months.22 Still,
a number of factors may have worsened the health of inmates. Exposure to
rain and unsanitary conditions, for example, may have undermined some of the
benets.
Regardless of attempts to maintain the physical health of the inmates, there
were barely any attempts to cure any psychiatric problems they faced for most
of the colonial period. Very modest occupational therapy was all Yaba offered
until independence.23 In the 1950s the asylum began selling the inmates handi-
work, with dual goals of raising money and reducing the stigma attached to the
mentally ill.24

The contradictions of Indirect Rule

Ofcial colonial policy in British Africa called for Indirect Rule, which entailed
the recognition of local political leaders (though in some cases these were
installed by the colonial government itself) and an ofcial ethos that there
should be as little interference in African ways of life as possible. But the policy
was contradictory, since colonialism was also intended to benet the metro-
politan country nancially, and bring the alleged benets of civilization for the
colonized people, two goals that made interference inevitable. Asylums even
dreadful as they were were associated with the benets of civilization. The
expense of a truly modern asylum, though, was incompatible with the economic
goals of colonialism. At the same time, nancial restraint was justied by the
goal of preserving the African way of life.
The directive to preserve tradition was followed more rigorously in the north
of Nigeria; as a result the northern provinces relied on small native adminis-
tration asylums throughout the colonial period. In 1928, the acting secretary of
the northern provinces attached a scathing review to Homes call for expanded
therapeutic services. He invoked the authority of a colonial medical ofcial
named Cameron Blair to support his disdain for Homes plan, quoting at length

21 Public Records Ofce (hereafter PRO) CO 657 20, 419. In 1936, Brown also reported that the
physical health of inmates was quite satisfactory, even nding that the asylum patients in
the south were generally more robust than their counterparts in the small native administration
asylums in the north; see Brown, Report III, 28 and 35.
22 PRO CO 657 24, 46667.
23 NAI CSO 01507/ S.2, Yaba Asylum, 1113.
24 PRO CO 657 24, 467; PRO CO 657 69, 27. Traditional healers in the region also sometimes
employed patients in farm work, but this was more typically as payment after treatment, not for
any possible curative effect.
 Connement and colonialism in Nigeria 305

from a world-weary 1926 letter written by Blair. Blair, an alienist, wrote with
cynical acumen; his comments merit extended quotation, to provide a sense of
the tone with which asylum reform was derided:
I hear a dreadful rumour to the effect that the question of adopting a systematic lunacy
policy has cropped up again and is being seriously entertained but trust this not be true;
for if it be, the results are likely to be disastrous. Here, I know what I am writing about;
for I was an alienist myself for over nine years. If such a policy be adopted, this is the sort
of thing that will happen To begin with, the Director of Medical and Sanitary Services
will have to devote, at least, a paragraph of his annual report to Lunacy. In due course his
report will as usual, be passed on by the Secretary of State to the Medical and Sanitary
Advisory Committee. When that body arrives at the Lunacy section of the report, the
Chairman will call a halt and deliver himself after this fashion: Gentlemen, I trust some
of you know something about Lunacy; for I am sure I dont. The long odds are that the
other members will declare themselves in the same boat. Then the Chairman will say:
Well, gentlemen, I propose we have this section extracted and pass to our colleagues,
the Commissioners of Lunacy . . . for the favour of their comments. This motion will be
carried unanimously: and then the fact [sic] will be on the re with a vengeance. The
commissioners will sputter over it, looking at the question from home standards; their
comments will establish a state of panic; the Secretary of State will share in it; and the
panic will nd relief in imposing extravagant expenditure on unfortunate Nigeria. In a
very few years we shall have some twenty-ve thousand certied lunatics under public
control, at a minimum charge of ten shillings a week per head . . . You can imagine what
this means with Nigerias revenue; and the only people who will prot will be the native
lawyers and the food contractors who will charge extravagant prices for the supply of
food-stuffs, in not a few cases for the feeding of their own insane relations whom they
can well afford to feed at their own cost.25

As the appendix continues, it becomes clearer that this debate was not merely
over the need of resources for accommodations, but cut to the heart of what
colonialism was about. The secretary added that the loyal cooperations of the
local authorities
might be construed as a polite euphemism for dragooning natives of the Northern
Provinces into alien ways and ignoring what is serviceable in their own, or in other
words, pursuing the gospel of Direct Rule . . .

The assumption that there is no middle course between native administration

gaols and the expenditure of some 500,000 a year on providing European
comforts and architecture is wholly illogical and wrong.26
These responses to Homes recommendations embodied the contradictions
of indirect rule. They justied parsimony in the name of cultural preservation,
and assailed reform as an imposition on the native way of life. Underlying this
stance was the crucial self-deception that one could, somehow, have colonialism

25 Home, Insanity, appendix, 2. 26 Ibid., appendix, 3.

306 Jonathan Sadowsky

without making any impositions. The government more by deferring deci-

sion than through articulated policy followed a middle course, avoiding both
a signicant investment in treatment, and a strict hands-off policy. Nigeria
therefore ended up with institutions that had none of the potential advantages
Home called for, and all the disadvantages his opponents predicted.
Browns 1936 report, though similar to Homes, had a different reception.
There is no record of his recommendations receiving the derision that Homes
report did. Instead, the tenor of his report was echoed in virtually all subsequent
memoranda and reports.27 In just ten years, the recognition of the need for ex-
panded accommodation, and the desirability of a curative institution, became
conventional wisdom. This change reected shifts in both colonial and psychi-
atric thinking. The Colonial Development Act of 1929 signalled the beginning
of a move to greater planning and centralization from the colonial state. At
the same time institutional psychiatry in Britain itself was becoming more pro-
active, increasingly admitting voluntary patients from the 1930s.28 But these
changes in thinking were not reected in signicant institutional reform in
Nigerias asylums. As Falola notes, the 1929 Act achieved little in its eleven-
year history because the depression and the Second World War inhibited capital
investment, and so the intense emphasis on promoting exports continued.29 But
the arguments against expanded and improved psychiatric facilities no longer
ridiculed such reforms as incompatible with the very nature of colonialism
itself, but rather more defensively, they cited budgetary restraints.30
There were several nancial obstacles to a mental hospital. The salaries
needed for a trained staff and the large amount of water supplies required
were seen as prohibitive expenses. Besides the inherent expense, there were
competing considerations when the rst calls for a curative programme were
made in the late 1920s on the eve of the worldwide depression. In the 1940s,
of course, the British government was preoccupied with the Second World War
and its aftermath. A mental hospital was also more expensive than other public-
health projects. In 1930, the Nigerian government requested a public-health
budget from the Colonial Ofce in which the cost of a mental hospital (33,700)
was almost a third of the total (107,000).31 The other items for which funds
were requested were training centres for midwives and sanitary inspectors,
ambulances, grants to native dispensaries, the leper colony in Benin, general
sanitary improvements and research. None of these items alone approached the
cost of the mental hospital.

27 See, for example, PRO CO 657 47, 231.

28 K. Jones, The Culture of the Mental Hospital, in G. E. Berrios and H. Freeman (eds.), 150
Years of British Psychiatry, 18421991 (London, 1996), 2324.
29 T. Falola, Development Planning and Decolonization in Nigeria (Gainesville, Fla., 1996),
1723.
30 NAI CSO 26 1507/S.1/T.1 31 NAI CSO 01507, vol. 4, 412c.
 Connement and colonialism in Nigeria 307

Financial expediency was the main reason a curative institution was delayed,
but it dovetailed with ideological inhibitions. One was the belief that a men-
tal hospital was inappropriate for Africans. As Anne Phillips has remarked,
British colonial practice seemed to pride itself on retarding rather than hasten-
ing change.32 This pride was misplaced, since there was no way the economic
goals of colonialism could be met without hastening change. The theory of indi-
rect rule acknowledged that economic, political, kinship and religious systems
were interrelated parts of African life. One goal, therefore was not only to sup-
port those they acknowledged as traditional rulers, but also to preserve systems
of land tenure.33 But the encouragement of cash crop cultivation to serve the
economic goals of colonialism, along with missionary activity and western ed-
ucation, were causing signicant disruptions.34 The ideology of indirect rule
what Freund has called the cult of tradition35 nevertheless had signicant
effects; one result of the contradiction between ideology and practice was half-
measures like asylums measures which dimly recognized the social changes
colonialism incurred, but also denied responsibility for them.

Getting in, getting out

The social processes of determining who was a lunatic can be studied by looking
at the processes of connement and discharge. Cases where Africans and Euro-
peans disagreed outright on the madness of a case seem to have been rare. Most
of the conned seem to have been people who caused considerable distress and
confusion to those around them. For the most part, patients were not brought
in voluntarily by themselves or their families, but involuntarily by police or
other relative strangers. Asylum administrators were usually willing to release
patients if someone would care for them, though there were exceptions to this.
Some ofcials were aware that the labelling of insanity was problematic,
especially in a colonial situation. In 1950, an ofcial named J. H. Pottinger
provided guidelines for detention. A careful diagnosis must be made, he said,
because lunatics should not be lightly deprived of liberty. Pottinger also argued
that asylum life would worsen the chance of recovery for a patient:

32 A. Phillips, The Enigma of Colonialism: British Policy in West Africa (London, 1989), 3. It may
not yet go without saying that this African way of life was frequently imagined and constructed
according to colonial convenience.
33 The political organizations of indirect rule did not so much preserve existing forms as transform
them and even substantially create them in many places. This is a very well documented aspect of
colonial history, but for one treatment see M. Chanock, Making Customary Law: Men, Women,
and Courts in Colonial Northern Rhodesia, in M. J. Hay and M. Wright (eds.), African Women
and the Law: Historical Perspectives (Boston, Mass., 1982).
34 My discussion here draws on J. Coleman, Nigeria: Background to Nationalism (Berkeley, 1968),
53.
35 B. Freund, The Making of Contemporary Africa (London, 1984), 79.
308 Jonathan Sadowsky

Life under detention is regular, food and drink appear at stated times without effort on
the part of the individual and shelter and clothing are available. The patient therefore
tends to lose initiative . . . He gets out of touch with the life he has previously known,
and after a prolonged detention becomes positively unt for any other kind of life.36

Family members wrote letters to administrators requesting the release or con-

nement of patients.37 There were very few requests to conne family members;
despite occasional colonial complaints about families dumping unwanted lu-
natics into the asylums, this was not typical. There were apparently occasional
instances of families or communities who, frustrated with attempts to manage
chronic cases, sought the states help, but this was exceptional. Most of the
letters request the release of a patient, and of these, the majority concede the
insanity of the conned but urge home care instead. The le also contains let-
ters from administrators containing requests for release, and in most cases the
requests were granted.
Another striking aspect of these letters is the rarity of dispute over the madness
of the inmate in question. Rather than deny that the patient was insane, most
letters proposed that a local healer should care for the patient. This may have
been a rhetorical gambit; letter writers may have thought their chances of getting
someone released were better if they conceded the madness, and this may have
even become known as a formula for procuring release. But I think it more likely
that the concession to the inmates madness was sincere. Asylum inmates were
likely to be the most unambiguous cases that is, people whose dramatically
anomalous behaviour caused widespread apprehension.38
While Nigerians did not always question the ability of colonial institutions
to recognize madness in Africans, they did frequently question the institutions
ability to care adequately for mad persons, and traditional treatment was sought
as an alternative. In many cases, authorities agreed that the patients would be
better served by traditional healers and released them.39 Ofcial support for
local healers was partly a matter of convenience; the more patients who were
handled by healers, the fewer who burdened the asylums. There was, though,

36 NAI Oyo Prof. 1015, Lunatics, Oyo Province, vol. 2, 147. Pottinger thus claimed a secondary
gain which inhibited recovery. As for the regularity of food, there was at least one recorded
case of a patient starving to death while under detention; Elizabeth A. was conned in Osogbo
prison, due to lack of asylum space, and died in May 1956, as a result of chronic starvation,
self-neglect, and cardiac failure. Her starvation may have been a form of protest, but this can
only be speculated. NAI Oshun Div. 1/1 86/13, 15.
37 Starting in the 1970s a number of studies have stressed the importance of the complex social
processes by which patients and their families determine their therapeutic options in pluralistic
medical settings. Landmark treatments include J. Janzen, The Quest for Therapy in Lower Zaire
(Berkeley, 1978); S. Feierman, Struggles for Control: The Social Roots of Health and Healing in
Modern Africa, African Studies Review 28 (1985), 23 and 73147; and L. Mullings, Therapy,
Ideology, and Social Change: Mental Healing in Urban Ghana (Berkeley, 1984).
38 See NAI Comcol 1 735/S. 1, vol. 1, Lunatics, General Matters Affecting, 406.
39 See NAI Comcol 1 735/S. 1, vol. 1, Lunatics: General Matters Affecting, 1820.
 Connement and colonialism in Nigeria 309

some concession to the abilities of healers. Conversely, when petitions for

release were turned down, medical ofcers sometimes claimed that native cure
had been tried and failed, even if this was not the only reason for the denial.40
Ofcials based the release of patients more on their harmlessness than on their
health. If someone assumed the care of the patient, and the patient was not
considered a public danger, release was granted even when the symptomatic
behaviour was still present.
Criminals were probably only a small minority of asylum inmates. Many of
the so-called civil lunatics, were also detained by police or other authorities for
being nuisances, if not exactly criminals. Often these were people who walked
naked in public, urinated or defecated in the open, or threatened people for no
apparent reason. While the behaviour could be simply odd, such as giving away
money at random, it was usually bothersome to other people. Sometimes, entire
communities petitioned to conne a threatening person.41

Decolonizing psychiatry
While Nigerias colonial asylums were scandals even to the very people re-
sponsible for them, their successors the mental hospitals of the independence
period developed a number of innovations that have made them famous in
world psychiatry. These therapeutic innovations and their timing perhaps high-
light all the more the negligence that characterized the colonial period.
By the 1950s, there was ofcial recognition that the custodial model of care
that had characterized colonial policy needed to be abandoned. In the early
1960s Lagos, Yaba Lunatic Asylum became Yaba Mental Hospital. A German
psychiatrist, Alexander Boroffka, came to oversee the transformation and Yaba
began employing a battery of therapies, including drugs and electro-convulsive
therapy, derived from western psychiatry. But it was the Aro Mental Hospital
which had paved the way in the 1950s, and which deserves close examination
because of its innovative treatment plan.
Funds were rst committed, and planning begun, for the development of Aro
in the 1930s.42 Brown noted then that the Alake [king] of Abeokuta is actively
interested in the welfare of the insane of Abeokuta . . .;43 the Alake had, in
fact, offered a lease of land at nominal rent, for the hospital as early as 1929.44
But some ofcials continued to believe that a mental hospital for Africans
was an extravagance, some arguing for public-health initiatives directed more
40 NAI Comcol 735/ S. 1, vol. 2, Lunatics: General Matters Affecting, 61527.
41 A 1950 letter requesting someones incarceration came from a compound in Ibadan with fty-
seven signatures and several thumb-prints. The man, the petitioners complained, wielded cut-
lasses against pedestrians. NAI Oyo Prof. 1 1015, vol. 2, Lunatics Oyo Province, 129. For
another example, see NAI Oshun Div. 1/1 86/10, 1.
42 NAI Comcol 1 735 vol. 1, Lunatic Asylum, 130.
43 Brown, Report III, 60. 44 NAI CSO 26 01507, vol. 4, 496.
310 Jonathan Sadowsky

towards infectious diseases.45 The Second World War provided the essential
catalyst for the Aro project, because of the repatriation of soldiers who served
with the Allied forces.46 West African soldiers received free medical care for
disabilities resulting from service, as well as employment assistance, upon their
repatriation.47 Rehabilitation centres were set up in Lagos, Freetown and Accra,
which dispensed articial limbs manufactured by Italian prisoners of war. Upon
repatriation, ve mentally ill Nigerian soldiers were transferred to Abeokuta
from Yaba, where they could not be accommodated due to overcrowding.48
The responsibility the government assumed for insane soldiers highlights the
element of bad faith in the prior claim that Europeans could not treat mental
illness in Africans. The returning soldiers were too many to stay in Yaba. And it
would have been an impressive feat of ideological rationalization to deny them
treatment altogether. After their experiences ghting for the Allies in Asia, pre-
servation of their African way of life could hardly be seen as a pressing aim.
The soldiers were lodged in a building formerly used as the Abeokuta convict
prison at that time also an overcrowded institution the name of which was
changed to Lantoro Lunatic Asylum.49 Lantoro, which became the nucleus for
Aro, was a curative institution, and excluded all cases associated with crime or
violence.50 Nigerian psychiatrist Tolani Asuni has referred to the unfortunate
circumstances of Lantoros origin, which, he said resulted in a stigma being
attached to the patients there.51 Lantoro was, however, kept as a relatively
closed extension of Aro, for what Asuni described as the most disturbed and
uncooperative patients.52
Civilian patients were admitted to the Lantoro site beginning in 1946.53
Construction of Aro began in the early 1950s about seven miles from the Lantoro
site. The initial staff of Aro consisted of thirteen attendants transferred from

45 NAI CSO 52898, Mental Hospital (Aro Site) Abeokuta, 519.

46 Several thousand Nigerian soldiers, most of them from the south of the colony, served with
Allied forces in the Second World War. The majority served in Burma, some in the Middle East,
and a small number in the European theatre. See also PRO 657/56, 934.
47 NAI Oyo Prof. 2/3 C.311, Resettlement of Ex-Soldiers After the War.
48 Geoffrey Tooth, a psychiatrist working in the Gold Coast, noted that in Accra, an unduly large
proportion of lunatic asylum admissions in the post-war period were ex-soldiers. NAI MH (Fed)
1/1 2nd Accession 5280B, Research in Mental Illness and Juvenile Delinquency, A1. See also
NAI Oyo Prof. 2/3 C.311, Resettlement of Ex-soldiers After the War, vol. 1, 90.
49 NAI Oyo Prof. 1. 2188, Unication and Stafng of the Colonial Prisons Service, Ibadan Native
Authority System, 9. Lunatic soldiers were transferred to Lantoro from Yaba; see NAI MH
(Fed) 1/1 3420, 23.
50 NAI CSO 52898/S. 1, Lantoro Lunatic Asylum (Abeokuta), 1.
51 Asuni, Aro Hospital in Perspective, 769.
52 T. Asuni, Development in Mental Health Care in Africa with Special Reference to West-
ern Nigeria, Proceedings of the IV World Congress of Psychiatry (Madrid, September 1966),
10678.
53 Aro Mental Hospital, 40th Anniversary of the Establishment of Aro Neuro-Psychiatric Hospital
Complex (Ibadan, 1984), 9.
 Connement and colonialism in Nigeria 311

Yaba.54 Although there were still no psychiatrists in attendance, medical ofcers

from the Abeokuta General Hospital supervised. The professional staffs of
both Aro and Yaba at this time were still dominated by Europeans. In 1951,
Abraham Ordia, the rst Nigerian trained as a psychiatric nurse, began working
at Yaba. Ordia, who had spent thirty-two years in mental-health nursing in
Holland, England, Sweden and Switzerland, helped oversee the beginning of
the transition of Yaba from asylum to hospital.55
Work on Aro Mental Hospital proceeded slowly, and it was not completed
until 1958. In the early 1950s, reecting the continued sense of alarm about
the number of psychiatric cases, T. A. Lambo decided to take up psychiatry
as a specialty. He studied psychiatry at Maudsley Hospital in Great Britain
and assumed authority over Aro in 1954. He remained at Aro until becoming
chair of the department of psychiatry at the University of Ibadan in 1963. Aros
physical plant was not yet completed in 1954, but Lambo, whose enthusiasm and
commitment were becoming legendary, was not to be stopped. He devised the
Aro village scheme, an outpatient care system which permitted the beginning
of treatment.
Lambos roots in Abeokuta were crucial. He persuaded a number of families
near the Aro site to allow mental patients to live with them in exchange for
work, mostly help in farming, and a lodging fee. The patients could go to the
hospital for treatment in the morning, and work in the farms in the afternoon.
In addition to the rents the villagers were able to charge, they received several
public-health benets: piped, puried water, pit latrines, and a mosquito control
squad.56 Nurses were available to the patients on a 24-hour basis.57 Landlords
were able to borrow money from the hospital in order to build extensions to
their houses so they could accommodate patients.58
Lambo was acutely aware of the ways in which the mental hospital was
alien to African cultures. Understanding how cultural familiarity was critical
to mental-health interventions, and also strongly convinced of the therapeutic
efcacy of local medicines, he travelled across Nigeria and handpicked fteen
traditional healers from different cultural backgrounds to serve as mediators
between the hospital staff and the patients. The hospitals treatment programme,
though, strongly emphasized interventions which were then state of the art in

54 Asuni, Aro Hospital in Perspective.

55 According to Alexander Boroffka, Two psychiatrists were working with him for one year each
(Cameron 1955 and Campbell Young 1958) but did not contribute much to this task, lacking Mr
Ordias optimism and zest. Boroffka, History of Psychiatry in Nigeria, Psychiatry 8 (1985),
70914.
56 See T.A. Lambo, Patterns of Psychiatric Care in Developing African Countries: The Nigerian
Village Program, in H. David (ed.), International Trends in Mental Health (New York, 1966),
149.
57 Aro Mental Hospital, 40th Anniversary, 11.
58 Ben Park, The Healers of Aro (16 mm lm, New York: United Nations, 1960).
312 Jonathan Sadowsky

western psychiatry: electro-convulsive therapy (ECT), insulin-coma therapy,

psychotropic drugs such as largactil, and interactive psychotherapy, as well as
an expanded occupational therapy programme.59 The village system became a
model for mental-health care in a number of African countries, including Ghana.
At a time when the world psychiatric community was searching for alternatives
to institutionalization, the Aro plan offered an imaginative compromise out-
patient care which could help the patients re-integrate into society, in close
proximity to the medical technology of the hospital.
The Nigerianization of psychiatric institutions provides an example of the
creative energy for which independence provided greater scope. At the most
basic level, the transformation of the asylums from near-prisons into hospitals,
while indeed a change in the form of social control of the mentally ill, was a de-
parture from the most crudely coercive and dehumanizing form of control. And
this change needs to be understood in the context of Nigerias independence,
not only because it provided more opportunity for Nigerian physicians to use
their expertise publicly, but because the welfare initiatives which characterized
colonialism in the 1950s represented, as many in the government themselves
understood, a collapse of the basic logic of colonialism itself. The Aro village
plan merits particular recognition as a signicant achievement. The village
system was not completely novel; it resembled, for example, Belgiums Geel
Colony, where lunatics travelled in search of cure and lived in the community,
and which was a model for some tful experiments in Britain in the nineteenth
century.60 Out-patient care was a growing trend in European psychiatry when
Lambo was studying psychiatry, as anti-psychotic medications came into use;
in Britain, this trend was represented by the development of Maudsley Hos-
pital, which was a reaction to the large, long-term custody mental hospital.61
There was also an African precedent in the out-patient care developed by Dr
Tigani El-Mahi at the mental hospital in Khartoum, which Lambo had observed
rst-hand. The use of traditional healers in active conjunction with biomedical
care was also not completely innovative; Alexander Leighton, Lambos collab-
orator on Psychiatric Disorder Among the Yoruba, promoted a similar plan in
the 1940s among the Navaho.62 But while there were precedents for the Aro

59 Asuni, Aro Hospital in Perspective, 765.

60 W. Ll. Parry-Jones, The Model of the Geel Lunatic Colony and Its Inuence on the Nineteenth-
Century Asylum System in Britain, in A. Scull (ed.), Madhouses, Mad-Doctors, and Madmen:
The Social History of Psychiatry in the Victorian Era (Philadelphia, 1981).
61 See P. Allridge, The Foundation of Maudsley Hospital, in Berrios and Freeman (eds.), 150
Years of British Psychiatry. See also D. Bennett, The Drive Towards the Community, in the
same volume.
62 New York Herald Tribune, 27 December 1942. See the Alan Mason Chesney Medical Archives,
Johns Hopkins University, biographical le on Alexander Leighton.
 Connement and colonialism in Nigeria 313

plan, Lambo executed it with a practical conscientiousness that made it justly

famous.
A measure of this care can be gained by comparing the Aro plan with the
de-institutionalization movement in the United States. De-institutionalization
was no doubt well intentioned in some aspects, and in some respects successful.
It too frequently, though, failed to think through exactly what community care
should mean what was the community? What was in it for the community?
Indeed, the combination of a desire for scal restraint and an often blithe invoca-
tion of the merits of community care in the de-institutionalization movement
inadvertently echoed the rhetoric of Nigerias colonial policies. If this seems a
harsh charge against de-institutionalization, consider how specically criticism
of Homes report anticipates the language of the de-institutionalization move-
ment. Advocates of de-institutionalization also saw hospitals as impositions, as
a form of cruelty worse than the disorders they were supposed to correct. In the
United States, the critique of institutions dovetailed conveniently with the desire
to cut government budgets. Many advocates of de-institutionalization also re-
jected disease models of mental illness to begin with, just as Homes opponents
sought to decouple mental abnormality from sickness. And, just as the critic
hoped to solve the problem more simply with medication, de-institutionalization
became viable in part because of developments in psychotropic drugs during the
1960s which offered the hope of less involved, less expensive care away from
large hospitals.63 Many critics of de-institutionalization have noted that while
the rhetoric of the policy called for community care, in only a few instances
was a community carefully identied, consulted and articulated with the plan-
ning in a meaningful way.64 This was precisely the merit of the Aro-village plan,
and a principal reason why the village system there has been maintained and
even expanded to the present.65
If colonial asylums were not subtle enough in their social control function
to merit a Foucaultian approach, it is in the reforms of the late colonial period
that one might think to adopt such an approach. But especially in light of the
negligence of the asylums under colonialism, the reforms of the late colonial and
early independence period are more appropriately described straightforwardly
as achievements. Warwick Anderson has recently suggested that in a sense, all
modern medicine is colonial.66 He presumably is referring to the intrusiveness
of modern medicine, the ways it comes to dominate more and more spheres

63 See A. B. Johnson, Out of Bedlam: The Truth about De-Institutionalization (Boston, 1990).
64 For a scathing indictment of de-institutionalization, published before such critiques became
common, see A. Scull, Decarceration: Community Treatment and the Deviant A Radical View
(Englewood Cliffs, NY, 1977).
65 From the 1970s onward, other areas near the hospital have taken part in the housing of patients.
66 W. Anderson, Leprosy and Citizenship, Positions 6 (1998), 70730.
314 Jonathan Sadowsky

of life, colonizing our consciousness, as we medicalize practices and adopt

medical idioms to understand our sufferings and predicaments. Discussions of
such processes often ascribe to psychiatry a central place. Yet what is striking
about colonial asylums in the Nigerian context is how little they were colonial
in this sense. Foreign rule resulted in a reluctance to provide medical care even
from administrators who overtly recognized the need for it.
13 Irelands crowded madhouses: the institutional
connement of the insane in nineteenth- and
twentieth-century Ireland

Elizabeth Malcolm

In 1921 the popular Irish novelist known as George A. Birmingham1 published

a short story entitled A Lunatic at Large. This concerns a young Englishman
working as a dispensary doctor in the west of Ireland.2 Although only recently
appointed to the post, Dr Lovaway has already been startled at the number of
lunatics he is being called upon to certify, especially by the police. Indeed, as
the story begins he is in the process of attempting to compose an article entitled,
The Passing of the Gael. Irelands Crowded Madhouses for the British Medical
Journal. He ponders various explanations for this startling phenomenon.
He balanced theories. He blamed tea, inter-marriage, potatoes, bad whisky, religious
enthusiasm, and did not nd any of them nor all of them together satisfactory as expla-
nations of the awful facts. He fell back nally on a theory of race decadence. Already ne
phrases were forming themselves in his mind: The inexpressible beauty of autumnal
decay. The exquisiteness of the decadent eforescence of a passing race.3

The doctors musings are interrupted by the arrival of a member of the Royal
Irish Constabulary, announcing that, according to information received from
his aunt, a young labourer on a distant and isolated farm is in immediate need
of committal.
Accompanied by the police constable and also the local sergeant, Dr Lovaway
makes an arduous journey in pouring rain to the farm. There, however, he nds
the labourer exhibiting no signs of mental illness at all, or of violence either,

I would like to thank the Wellcome Trust for funding much of the research upon which this
chapter is based.
1 G. A. Birmingham was the pen-name of Canon J.O. Hannay (18651950), who was born in
Belfast and served as Anglican rector of Westport, Co. Mayo, from 1892 to 1913. He worked as
an army chaplain in France during the First World War and then spent much of the rest of his
career in various English parishes. Between 1905 and 1950 he wrote nearly sixty novels, most
of them about Ireland and most of them comic.
2 For the Irish dispensary system, by which government-paid doctors provided free medical care
to the poor, see R. D. Cassell, Medical Charities, Medical Politics: The Irish Dispensary System
and the Poor Law, 183672 (Woodbridge, Suffolk, 1997).
3 G. A. Birmingham, A Lunatic at Large, in P. Haining (ed.), Great Irish Detective Stories (London
and Sydney, 1994), 110.

315
316 Elizabeth Malcolm

although the doctor concludes that the boy is evidently of weak mind.4 Yet
the labourer and his aunt, strongly supported by the sergeant, are extremely
anxious for his committal. The sergeant assures the doctor that the boy will be
out of the asylum in two weeks, and his uncle chimes in to announce that he
has to be, as he is needed at home for the spring planting. The doctor is puzzled
by their demand that he certify when it is obvious that the boy is not insane. He
therefore refuses to sign the committal papers.
In the denouement to the story it is revealed that the police, supported by
the community generally and even with the connivance of Dr Lovaways Irish
predecessor, have been scouring the country . . . searching high and low and in
and out for anyone, man or woman, that was the least bit queer in the head.
The doctor is paid a guinea for every lunatic certied. The community want
to encourage the doctor to stay and his predecessor, who is serving in the
army medical corps, aids them in this endeavour. Thus there is concern and
bewilderment when the doctor refuses in a number of instances to sign the
medical certicate and so collect his fee. The English is a queer people,
concludes one of the locals.5
Birminghams story humorously proposes that it is the Irish who are more
canny and less queer than the English, contradicting Dr Lovaways eloquent
scientic theories of race decay. Over and above this, the story touches upon
a number of key issues concerning the connement of the insane in nineteenth-
and early twentieth-century Ireland. It suggests that there were high rates of
committal to mental institutions in the west of Ireland by the First World War
when the story is set. This phenomenon, moreover, was causing alarm and
there was speculation in the British medical press as to the reasons for it, with
eugenicist theories of racial degeneration being employed. Further, according
to the story, committals were generally instigated by families and carried out
by the police,6 with doctors playing an essential but basically subsidiary role.
Yet, at the same time, the story subverts this picture by portraying doctors and
institutions as being manipulated by the community for its own purposes. Thus
the message conveyed is that Irish committal rates are not necessarily a reliable
index of the levels of mental illness in the society. Through an examination of
the connement of the insane in Ireland over the past two centuries, this chapter
will test the validity of each of these assertions.

4 Ibid., 111.
5 Ibid., 119.
6 The role of the police in the committal process is not examined in any detail in this chapter,
although in Ireland it was an important one. Other chapters in this volume look more closely at
police involvement, in particular Coleborne on Australia. Given that Australian colonial police
forces were modelled on the Irish police, it is not surprising to nd them playing leading roles
in committal. For Irish inuence on Australian policing, see E. Malcolm, What would people
say if I became a policeman: the Irish Policeman Abroad, in O. Walsh (ed.), The Irish Abroad:
Politics and Professions in the Nineteenth Century (Dublin, 2003), 95107.
 Insane in nineteenth- and twentieth-century Ireland 317

I
Although set in a remote part of the province of Connacht, Birminghams story
shows that there was a local asylum. In addition, the community was well
aware of its function and seemingly not at all averse to having family members
committed, at least for short periods. This is a fair reection of the fact that
Ireland supported a well-developed asylum system from the early nineteenth
century and that large numbers of people were conned in it, frequently at
the instigation of their families. And, in fact, this system with the same high
committal rates, often to the very same hospital buildings continued to function
into the latter half of the twentieth century.7
There were some private asylums in eighteenth-century Ireland which re-
ceived government grants as well as a certain amount of haphazard local-
authority provision for the insane.8 However, growing public and political
alarm at an apparent rapid increase in mental illness after 1800 led the British
government9 to begin building a network of state asylums, well in advance of
the comparable English system. The rst of these hospitals was the Richmond
Asylum opened in Dublin in 1815 with 250 beds.10 A select committee, initiated
by the young and innovatory Irish chief secretary and later British Tory prime
minister, Robert Peel, investigated relief of the lunatic poor in 1817 and recom-
mended the establishment of a system of district asylums throughout Ireland.
The system, moreover, was to receive central-government loans and was also
largely to be regulated centrally.11 Thus it was not permissive or decentralized
as was the English model of the time.12

7 For the architecture of Irish asylums and the history of the buildings, see M. Reuber, Staats-und
Privatanstalten in Irland: Irre, Arzte und Idioten, 16001900 (Cologne, 1994); M. Reuber, The
Architecture of Psychological Management: The Irish Asylums, 18011922, Psychological
Medicine 26 (1996), 117989; F. ODwyer, Irish Hospital Architecture: A Pictorial History
(Dublin, 1997), 1013, 334.
8 E. Malcolm, Swifts Hospital: a History of St Patricks Hospital, Dublin, 17461989 (Dublin,
1989), 16103.
9 Ireland was ruled by Britain as part of the United Kingdom from 1801 until 1922, when the
south of the country achieved independence. A local administration based in Dublin Castle, and
generally referred to as Dublin Castle, carried out British policies. It was composed of a civil
service and was headed by a lord lieutenant and a chief secretary, representing respectively the
crown and the political party in power in Britain.
10 For histories of the Richmond Asylum, subsequently re-named St Brendans Hospital, Grange-
gorman, see J. Reynolds, Grangegorman: Psychiatric Care in Dublin since 1815 (Dublin, 1992);
B. OShea and J. Falvey, A History of the Richmond Asylum (St Brendans Hospital), Dublin,
in H. Freeman and G. E. Berrios (eds.), 150 Years of British Psychiatry, volume II: The Aftermath
(London, 1996), 40733.
11 Report from the Select Committee on the Lunatic Poor in Ireland, H. C. 1817, viii, 430.
12 For the public asylum system in England, before the establishment of asylums was made manda-
tory in 1845, see L. D. Smith, Cure, Comfort and Safe Custody: Public Lunatic Asylums in
Early Nineteenth-Century England (London and Washington, DC, 1999).
318 Elizabeth Malcolm

As a result of the select committees report nine asylums with a little over
1,000 beds were built between 1824 and 1835, while a further twelve with
nearly 3,500 beds were erected between 1852 and 1869. Together with the
Richmond in Dublin, the Irish public asylums had some 7,600 beds by the
early 1870s and, after major extension, by the mid-1890s they had 13,600 beds,
which rose to 16,600 beds shortly after the turn of the century. In 1904 the
asylums in Belfast, Cork and Ballinasloe had well over 1,000 beds each, while
the Richmond dwarfed them all with over 3,000 beds, or some 19 per cent of
all Irish public asylum accommodation.13
Yet these massive increases in asylum provision have to be set against a
background of limited industrialization and urbanization, and as well, from the
late 1840s, a steadily declining population.14 The Irish population, according
to census gures, fell from 8.2 million in 1841 to 6.5 million in 1851, largely
due to famine, but continued to decline over the next half century reaching 4.4
million in 1901. This of course meant that the number of persons per asylum
bed fell dramatically: from 713:1 in 1871 to 270:1 by 1904.15
Therefore, although Dr Lovaway may have been misled into believing that
mental illness in Connacht was worse than it actually was, he was nevertheless
right to be startled at the level of committals to Irish asylums. And his spec-
ulations as to the causes of this phenomenon accurately reect much of the
contemporary debate.

II
Before considering this debate, it is necessary to look a little more closely at
the workings of the Irish asylum system. To begin with, beds were by no means
evenly distributed throughout the country. The province of Leinster with 26 per
cent of the population in 1901 had nearly 36 per cent of asylum beds; while
in the province of Ulster these percentages were almost reversed: Ulster had
13 M. Finnane, Insanity and the Insane in Post-Famine Ireland (London, 1981), 227. The present
chapter deals with the patient populations of Irish public asylums, but not all lunatics and idiots
were held in these institutions. According to the 1891 census only 58 per cent of them were
conned in public and private asylums, while 23 per cent were at large and 19 per cent were
in workhouses. In 1851, 3 per cent of this group had been in Irish prisons. The chapter also
focuses on lunatics, whereas in 1891, 8 per cent of the total asylum population were classed as
idiots. Census of Ireland for the Year 1891. General Report. Part II, 45 [C.6780] H.C. 1892,
xc, 61.
14 That Ireland experienced a massive growth in asylum accommodation without substantial in-
dustrialization or urbanization contradicts some of Andrew Sculls theories as regards the devel-
opment of the asylum system in England. For a discussion of this issue, see E. Malcolm, The
House of Strident Shadows: The Asylum, the Family and Emigration in Post-Famine Ireland,
in G. Jones and E. Malcolm (eds.), Medicine, Disease and the State in Ireland, 16501940
(Cork, 1999), 1778.
15 Finnane, Insanity and the Insane, 227; W. E. Vaughan and A. J. Fitzpatrick (eds.), Irish Historical
Statistics: Population, 18211971 (Dublin, 1978), 3.
 Insane in nineteenth- and twentieth-century Ireland 319

36 per cent of Irelands population but only 27 per cent of asylum beds. The
other provinces, Munster and Connacht, had asylum facilities largely in line
with their proportions of the general population. The differentials in Leinster
and Ulster reected in particular the situations in the cities of Dublin and Belfast.
The Richmond Asylum in Dublin, as we have seen, was by far the largest in the
country and had in 1904 a bed to district population ratio of 1:179. Yet the com-
parable ratio for the Belfast Asylum was 1:482.16 Indeed, the Belfast Asylum
was notorious for its overcrowding throughout the latter part of the nineteenth
century.17
The less generous provision in Belfast highlights, among other issues,18 local
concerns about the funding of Irelands extensive asylum system. Asylums were
costly to build and expensive to operate. It has been estimated that the twenty-
one asylums built between the 1820s and the 1860s cost some 1.14 million.
To put this gure in perspective: a comparable sum of money was spent in the
late 1830s and early 1840s to build 130 workhouses in Ireland.19 Central gov-
ernment advanced the capital to erect asylums, but the thirty-two Irish counties
were obliged to share the cost of repaying these advances within fourteen years.
Such outlays were clearly a substantial nancial burden upon Irish ratepayers.
While some towns had initially appreciated the employment and trade that a
local asylum generated,20 as the century advanced complaints about the cost

16 Ibid.
17 In 1889, for instance, Belfast Asylum had 103 patients more than the 550 it had been built to
house. Yet, despite this serious overcrowding, Belfasts complement of beds remained static
between 1886 and 1896, while nationally the number of beds increased by nearly 47 per cent.
The workhouse was used more extensively to house the insane in Belfast than in any other Irish
asylum district. Close to 50 per cent of lunatics and idiots were in the workhouse, where they
were cheaper to accommodate, compared to a level of around 20 per cent for the country as a
whole. H. C. Burdett, Hospitals and Asylums of the World, vol. I (London, 1891), 245; Finnane,
Insanity and the Insane, 227; Malcolm, House of Strident Shadows, 189n.21, 179.
18 Sectarianism was also clearly a feature of the operation of the Belfast Asylum. The governors,
who were overwhelmingly protestant, preferred, as already indicated, to keep many lunatics,
who were disproportionately catholic, in the workhouse. At the same time they opposed the
appointment of a catholic chaplain for many years. O. Walsh, The Designs of Providence:
Race, Religion and Irish Insanity, in J. Melling and B. Forsythe (eds.), Insanity, Institutions
and Society, 18001914: A Social History of Madness in Comparative Perspective (London
and New York, 1999), 22833; Malcolm, House of Strident Shadows, 179; D. V. Grifths and
P. M. Prior, The Chaplaincy Question: The Lord Lieutenant of Ireland Versus the Belfast Lunatic
Asylum. I would like to thank Dr Prior for providing me with a copy of this unpublished paper.
19 Finnane, Insanity and the Insane, 33.
20 Even well into the twentieth century, mental hospitals could make signicant economic contri-
butions to Irish provincial towns. The Connacht District Asylum was opened in Ballinasloe in
1833; and this is the asylum to which Dr Lovaway would have been sending patients. It was
re-named St Brigids Hospital after independence in the 1920s. According to the 1951 census,
however, the town of Ballinasloe had a population of 5,596, of whom 2,078 were mental-hospital
patients and 439 full-time employees of the hospital in other words, as late as the 1950s, an
extraordinary 45 per cent of those resident in the town were conned in or employed by the
mental hospital. D. Walsh, Mental Health Care in Ireland, 194597 and the Future, in J. Robins
320 Elizabeth Malcolm

and lack of effectiveness of asylums became increasingly common. Costs spi-

ralled after 1850. Spending on patient maintenance, for instance, leapt from 6
per head of the general population in 1852 to 123 by 1914. During the same
period per capita spending on the dispensary medical service had increased
from 9 to 48 and on the poor-law system from 139 to 238.21 In 1874, in
response to repeated complaints, the British government agreed that the cost
of the maintenance of asylum patients should be met in part by the treasury,
which would contribute four shillings per head per week for all paupers housed
in public asylums.22 Although the contribution uctuated somewhat over the
years, during the 1880s and 1890s it generally amounted to somewhat over
40 per cent of total maintenance expenses. Nevertheless, by 1898 Irish ratepay-
ers were still contributing nearly 217,000 per annum to support the asylum
system.23 Yet Irish asylums were far from generously funded. A knowledge-
able contemporary observer commented in 1890 that boards of governors, being
non-representative, were timid as to expenditure, so that a spirit of econ-
omy existed which would not elsewhere be considered consistent with due
provision for the insane.24
The issue of cost was closely related to the issue of control. The cost was paid
out of the county rates, known as the cess, which were levied on all occupiers
of land. Yet, at the local level, asylums were directed by boards of governors
appointed by the lord lieutenant, who headed the Irish administration based
in Dublin Castle. Such boards were dominated by local protestant landowners
and gentry. As a means of trying to curb expenditure, ratepayers increasingly
demanded that they be represented on asylum boards. In 1888 the government
conceded that half the membership of boards should consist of the nominees
of local authorities. When Irish local government was radically reformed in
1898, the system of asylum administration also changed substantially. The un-
representative grand juries, which had controlled counties for centuries, were
replaced by popularly elected county councils.25 They were charged with pro-
viding and maintaining accommodation for pauper lunatics, with appointing
and removing asylum ofcers and with regulating expenditure. In future, asy-
lum boards of governors were to be selected by local councils. However, despite

(ed.), Reections on Health: Commemorating Fifty Years of the Department of Health, 194797
(Dublin, 1997), 127.
21 Finnane, Insanity and the Insane, 228.
22 V. Crossman, Local Government in Nineteenth-Century Ireland (Belfast, 1994), 39.
23 Local funding continued well into the twentieth century. In the south of Ireland it was not fully
matched by government until 1947 and local rates were not nally abolished until 1978. Finnane,
Insanity and the Insane, 230; OShea and Falvey, A History of the Richmond Asylum, 411;
Burdett, Hospitals and Asylums of the World, 242, 244.
24 Burdett, Hospitals and Asylums of the World, 244.
25 For the role of county grand juries in Irish local government, see Crossman, Local Government
in Nineteenth-Century Ireland, 2541.
 Insane in nineteenth- and twentieth-century Ireland 321

this decentralization of power over asylums, the governments subsidy to the

system was still to be determined at the centre by Dublin Castle.
This battle over funding and control illustrates the fact that the asylum sys-
tem in nineteenth-century Ireland was administered and regulated in a complex,
confusing and, it could be argued, counter-productive manner. The asylum ex-
pert H. C. Burdett summed up the administrative code regulating Irish asylums
thus:
As far as any glimmer of a general principle can be seen through it, its design seems to be
to exemplify the cunning motto of the old Roman, Divide et impera, for, unless it has been
framed for the express purpose of giving perpetual opportunity for the intervention of the
central powers, it is impossible to see why it should contain, as it does, numerous enact-
ments, manifestly intended to produce a perpetual state of unstable equilibrium . . . The
rules, besides, have the faults ordinarily found in regulations drawn up by persons en-
tirely ignorant of the matters to be regulated. They often contradict each other.26

Government enquiries recommended major administrative restructuring in 1878

and again in 1891, but until 1922, when the south achieved independence, no
such reforms were introduced.27 Aside from the British government, Dublin
Castle, local authorities and boards of governors, there were powerful inspec-
tors of lunacy regulating asylums and also asylum medical superintendents
represented by their own professional body, the British Medico-Psychological
Association. All wielded signicant inuence and all competed to shape the
development of Irish asylum-system.
The lunacy inspectorate grew out of the prison inspectorate established in
1787 with a remit to inspect madhouses as well as prisons. But the prison inspec-
tors were generally military men with little interest in, and even less knowledge
of, the insane.28 By an Act of 1845 a separate two-man lunacy inspectorate
was created, based in Dublin Castle, and staffed by medical practitioners. Two
inspectors were appointed as it was decided that one should be catholic and one
protestant. Only ve men lled these positions during the nineteenth century,
reecting the fact that several of them served for thirty or forty years.29 Such
lengthy service did not encourage radical thought or innovation; and especially
in the 1880s, due to age and ill health, neither inspector was fullling his job
properly. Their response to the increasingly overcrowded state of Irish asylums,
which was becoming evident as early as the 1840s, was to build more asylums.
The inspectors consistently advised government from the 1860s through into

26 Burdett, Hospitals and Asylums of the World, 253.

27 R. B. McDowell, The Irish Administration, 18011914 (London, 1964), 174.
28 O. MacDonagh, The Inspector General: Sir Jeremiah Fitzpatrick and Social Reform, 17831802
(London, 1981), 320.
29 Dr George Hatchell served as an inspector from 1847 until his death in 1889, while Dr John
Nugent served from 1857 until his retirement with a knighthood in 1890. Hatchell was ill for a
number of years prior to his death, while Nugent was eighty-four at the time of his retirement.
322 Elizabeth Malcolm

the 1910s that institutionalization was the only answer to Irelands apparently
high levels of mental illness.
The appointment of medical practitioners as inspectors in the 1840s hastened
the medical takeover of patient management in asylums. From the 1830s med-
ically trained asylum managers, who were in the minority, began to campaign
for the abolition of lay managers. By the 1860s all Irish public asylums were
headed by medical superintendents appointed by the lord lieutenant. Yet, while
boasting a medical degree, few of these men had any specialist training in the
treatment of the mentally ill. Their appointments were also often the result of
patronage rather than merit. Pointing out that the Irish medical profession over
the previous forty years had made not one signicant contribution to the lit-
erature on insanity, Burdett claimed in 1890 that the ofce of asylum medical
superintendent was given away almost wholly from political considerations
and that, in fact, there is no ofce under the Crown for which there is more can-
vassing, direct and indirect, personal and political. Like the lunacy inspectors,
many asylum medical superintendents served for lengthy periods. For instance,
at the Richmond Asylum in Dublin, later re-named St Brendans Hospital, only
ve men lled the position of medical superintendent from the 1850s up to the
1990s.30
Visiting physicians to asylums continued to be appointed in Ireland into
the 1890s, forty years after the ofce had disappeared in England. Their ap-
pointments were in the gift of boards of governors, who were jealous of their
powers of patronage. In 1890 about half of Irish public asylums had in addition
assistant medical superintendents, also appointed by boards of governors. As
regards their appointment, according to Burdett: Canvassing, instead of being
forbidden, as it ought to be, is expected, if not demanded, and inuence decides
the matter.31 Clearly patronage played a signicant role in the appointment of
asylum medical personnel. Thus it is not surprising to discover that Dr George
Hatchell, the longest-serving lunacy inspector of the nineteenth century, whose
own appointment was the result of patronage, had two sons both employed
as asylum medical superintendents.32 Severe nancial constraints, confusing
regulations, divided authority and corrupt appointments inevitably produced a

30 The doctors, with their periods of service, were Joseph Lalor (185786), Conolly Norman
(18861908), John OConor Donelan (190837), John Dunne (193766) and Ivor Browne
(1966).
31 Burdett, Hospitals and Asylums of the World, 254, 256, 258. The asylums, however, were
not unusual in this regard. Patronage and nepotism were the rule rather than the exception in
Irish hospital appointments throughout the nineteenth century and beyond. In the earlier years
especially, such jobs were openly bought and sold. For the career of a leading catholic doctor,
who made his way in a protestant-dominated profession partly through buying and selling
appointments, see E. OBrien, Conscience and Conict: A Biography of Sir Dominic Corrigan,
180280 (Dublin, 1983), 678, 79, 823, 956.
32 Finnane, Insanity and the Insane, 52n.108, 64.
 Insane in nineteenth- and twentieth-century Ireland 323

far from satisfactory asylum system. This state of affairs became most evident
visually: in the deterioration of the buildings themselves.
By the 1890s some asylum buildings were seventy years old, while even the
newest were between twenty and thirty years old. There were suggestions that
some of the oldest were so inadequate that only demolition and the erection
of new buildings on totally different designs could provide satisfactory accom-
modation. Despite the large sums spent on erecting them, asylums were often
shoddily built and, due to funding restrictions, their maintenance left a lot to be
desired. Burdett condemned them roundly.
That they are plain to the verge of wanton ugliness might perhaps be defensible on the
ground of frugality, if they were at the same time suitable in other respects; but this,
unfortunately, cannot be said at least of most of them. Everywhere the windows incline
to be too high from the ground: in many places they are too small . . . Flagged corridors
are not unknown, nor were agged single rooms till very recently. All internal stone
and wood work is of the rudest and poorest description. Means of ventilation are quite
primitive. In most asylums there are no means of heating single rooms and dormitories . . .
The sanitary appliances in some of the institutions have recently been found to be in
a truly shocking state. Whitewash is freely used . . . and communicates to everything
around its own inevitable chill and pauperising tone. Kitchens, laundries, and other
ofces are usually on a par with the wards in faulty construction and defective ttings.33

Burdett was also struck by the meagre furnishing of wards and day rooms. Plain
deal tables and deal forms without backs comprised the main furniture of day
rooms; oor coverings were rare; and windows seldom had blinds or curtains.
He concluded: It is probable that no workhouse in England presents nowadays
so gaunt and cheerless an appearance as may be found in many Irish asylums.
Indeed, perpetual reminders of the prison were everywhere.34
Younger and more active inspectors were appointed in 1890 and, as already
mentioned, elected local councils took over the running of the asylums after
1898. But the inspectors were still committed to asylum building and in the late
1890s new asylums were erected in Antrim town and Portrane, Co. Dublin, to
take pressure off the large Belfast and Dublin asylums. Moreover, local councils,
dominated by farming and shopkeeping interests, were even more determined
than the old gentry-dominated grand juries to keep down the cost of asylums.
In the rst decade of the twentieth century a number of county councils and
asylum boards petitioned the British government requesting that the state take
full responsibility for the funding of asylums. But in each case the government
refused. Thus, despite the creation of a more representative form of asylum
administration after 1898, buildings continued to deteriorate, facilities were
not improved and overcrowding increased during the rst two decades of the
twentieth century. As Mark Finnane has written:

33 Burdett, Hospitals and Asylums of the World, 243. 34 Ibid., 2434.

324 Elizabeth Malcolm

The balance of power had tipped from Dublin Castle to popularly-elected local gov-
ernment authorities. With this change the emphasis of asylum politics shifted, from the
mid-century obsession of the inspectorate with conning all the insane, to the provincial
preoccupation of the early twentieth century with reducing numbers of inmates and cer-
tainly costs. The interests of the conned themselves were largely ignored in the course
of this shift of power.35

Yet, despite the best efforts of penny-pinching local councils, the numbers of
patients in Irish public mental hospitals continued to rise during the rst half of
the twentieth century, reaching a peak in 1958. In that year there were 21,046
mental hospital patients, comprising 0.5 per cent of the population of the Irish
Republic. In 1961 about one in seventy residents of the country aged twenty-
four and over was a patient in a mental hospital.36

III
How then were lunatics committed to Irish asylums? Again, Birminghams short
story offers a good deal of accurate information. Complaints, often about violent
behaviour, were made to the constabulary, usually by relatives, sometimes by
friends or neighbours. The person complained of would then be taken into
police custody, summoned before magistrates and, up until the 1870s at least,
probably committed to prison.
Before the mid-1840s asylum inspectors were also prison inspectors. Burdett
in 1890, as already mentioned, drew a parallel between the Irish asylum and the
prison. This all points to the close connection that existed in Ireland during the
nineteenth century between institutions to house the insane and institutions to
house criminals. Or, as one historian has commented, rather than insanity being
associated with poverty through the poor-law system, as in England, in Ireland
there was an intimate link between insanity and criminality.37 This link was
apparent in the legislation that governed Irish committal procedures for over a
century.
Committal to an asylum was regulated by two major Acts: one passed in 1838
(1 & 2 Vic. c.27) and one in 1867 (30 & 31 Vic. c.118). The latter superseded the
former, but, signicantly, both carried the same title: the Dangerous Lunatics
Act. Their provisions continued to govern Irish committal procedures, at least
in the south of the country, until 1945. The 1838 act empowered two magistrates

35 Finnane, Insanity and the Insane, 82.

36 Walsh, Mental Health Care in Ireland, 194597, 126; The Psychiatric Services, Planning for
the Future: Report of a Study Group on the Development of Psychiatric Services (Pl.3001,
Dublin, 1984), 2.
37 Walsh, Designs of Providence, 225. For the English situation, see P. Bartlett, The Poor Law of
Lunacy: the Administration of Pauper Lunatics in Mid-Nineteenth-Century England (London
and Washington, DC, 1999).
 Insane in nineteenth- and twentieth-century Ireland 325

to commit anyone they deemed a dangerous lunatic to prison. There the lunatic
would remain until discharged by the magistrates or transferred to an asylum
under an order of the lord lieutenant. The magistrates in making their decisions
could call for a medical opinion, but they were not obliged to do so. In addition,
a lunatic could be committed directly to an asylum by a relative or friend.
In this instance a medical certicate was required, as well as a declaration
from a magistrate or clergyman that the lunatic was a pauper. Also, under this
procedure, the person committing had to agree to take the lunatic back when
the asylum decided that he or she was ready for release. The same obligation
did not apply if the lunatic was committed by magistrates.
As a result of this legislation, over the following thirty years, a large pro-
portion of those committed to Irish asylums were committed as dangerous
lunatics. In addition, at any one time, there was a signicant proportion of lu-
natics housed in Irish prisons. The lunacy inspectors were critical of this act,
arguing that families used it so as not to be obliged to take unwanted members
back, that magistrates made committal orders in a cavalier fashion, and that a
period in prison could only further harm a persons mental health. The 1867
act was intended to rectify these shortcomings. It did not, however, achieve this
goal. It allowed magistrates to commit dangerous lunatics and idiots directly
to an asylum, but a medical certicate from a dispensary doctor conrming a
diagnosis of mental deciency was now an essential requirement. This is the Act
that would have governed the actions of dispensary doctors like Dr Lovaway.
Yet, despite the inspectors intentions, under the 1867 Act, the proportion of
the Irish insane committed as criminals actually increased substantially: from
around 42 per cent in 18602 to fully 66 per cent forty years later in 19002.
Thus under the new Act, while few of the mentally ill were now actually sent to
prison, larger numbers of them were criminalized. They were generally taken
into custody by the police after a complaint from relatives; they were certied
by one doctor normally untrained in mental-health matters; they appeared in
court before local landowners and businessmen acting as magistrates, where an
indenite sentence of committal was passed; and they were transported by the
police to an asylum. There they had no right to have their diagnosis or committal
reviewed. If and when they were released depended upon the decision of a lay
board of governors, advised by a medical ofcer who might have no training
in the treatment of mental illness. All in all the Irish committal process gave
enormous powers to the ignorant and the potentially malicious. It criminalized
the mentally ill and allowed them few if any avenues of redress. It was a formula
for abuse that operated from the 1830s into the 1940s.
Lovaway and doctors like him sought explanations for what they perceived
as extraordinarily high rates of mental illness among the Irish in theories con-
cerning race, religion and society. Perhaps they would have been better advised
to have investigated the legislation governing Irish asylums and the manner in
326 Elizabeth Malcolm

which the system was administered. The inadequacies and conicts inherent
in these go some way at least towards explaining why so many people were
committed so easily and why so few of them were ultimately released.

IV
By the late nineteenth century the overcrowding of Irelands large asylum sys-
tem, as well as the apparently high rates of committal to asylums among the
Irish abroad,38 had given rise to a heated debate about Irish mental health.
This debate was not restricted to the medical profession and it continued well
into the twentieth century. In 1909 the nationalist MP and historian, R. Barry
OBrien, identied the three scourges, which afict Ireland as Emigration,
Tuberculosis and Lunacy.39 But were the Irish especially prone to mental ill-
ness, and, if so, why? Dr Lovaway rehearsed some of the popular aspects of this
debate in his proposed article, quoted at the beginning of this chapter. Was Irish
mental illness the product of race decadence or was it due to social factors,
such as peculiar marital practices, excessive alcohol consumption or oppressive
religiosity?
In 1903 a special conference was convened at the Richmond Asylum, com-
posed of representatives from most Irish asylums, to discuss the causes of
the apparently high rates of Irish mental illness. Heredity, intemperance and
emigration were highlighted. Hereditary mental defects among isolated rural
families, accentuated by intermarriage and alcoholism, were identied as es-
pecially signicant. In addition, emigration was seen as draining away from
such communities the brightest and most energetic members, leaving behind
those more mentally inadequate or vulnerable. As a solution to the problem,
the conference perhaps not surprisingly, given that most of those attending
worked in asylums came out in favour of further hospital building. It consid-
ered it essential that lunatics should be taken out of their communities, where
they could have a bad inuence on others; and, above all, that they should not
be allowed to marry and reproduce freely.40
In 1911 one of the lunacy inspectors, Dr W. R. Dawson, delivered a wide-
ranging address on Irish insanity and social factors before the annual meeting
of the British Medico-Psychological Association, held that year in Dublin.
Dawson began by noting that at the present time 23,174 persons were con-
ned in Irish public asylums and workhouses as lunatics. This amounted to

38 This phenomenon is discussed in E. Malcolm, A Most Miserable Looking Object: The Irish in
English Asylums, 18511901: Migration, Poverty and Prejudice, in J. Belchem and K. Tenfelde
(eds.), Irish and Polish Migration in Comparative Perspective (Essen, 2003), 11526.
39 R. B. OBrien, Dublin Castle and the Irish People (Dublin and London, 1909), 315.
40 D. Healy, Irish Psychiatry in the Twentieth Century, in Freeman and Berrios (eds.), 150 Years
of British Psychiatry, 26972.
 Insane in nineteenth- and twentieth-century Ireland 327

5.3 persons per 1,000 of the total population. In Waterford this gure was an
enormous 9.2, or nearly one per cent of the countys population of 84,000.41
Dawson then proceeded to search for correlations between these gures and
rates of population density, poverty, emigration, age, death, tuberculosis, crime
and alcoholism in each county. He concluded that: in Ireland insanity tends
to prevail in the agricultural counties, and has a close relation . . . to pauperism,
which also prevails in rural districts. It also bore some little relation to em-
igration, criminality and alcoholism.42 But beyond registering crude statistical
patterns, Dawson made no effort to explain causal links. How rural poverty
related to mental illness, emigration, crime and alcoholism was not explored.
Also, like many writers of the time and since, he regarded institutionalization
as an accurate measure of mental illness. That a signicant number of those
committed might not have been mad and that many lunatics continued to live
in the community does not seem to have occurred to him.
By 1900, even supposed experts were convinced that the Irish exhibited a
proneness to mental illness. An Irish stereotype that highlighted drunkenness,
aggression, fecklessness and poverty had been evident in English colonial dis-
course for centuries. It was reinforced in the mid nineteenth century by new
racial and genetic theories.43 By the latter part of the century insanity had been
added to the traditional list of Irish negative characteristics. The Irish were per-
ceived as being naturally emotional, volatile and irrational. Sometimes these
characteristics were seen in a favourable light: they were what made the Irish
great poets and soldiers.44 But, more often, they were interpreted negatively:
the Irish had a propensity to mental instability that made it more difcult for
them to cope with poverty and hardship. And the high admission rates to Irish
asylums, which became evident in the mid nineteenth century and continued
for over a hundred years, seemed to offer clear evidence of the truth of this
proposition.

41 W. R. Dawson, The Presidential Address on the Relation between the Geographical Distribution
of Insanity and that of Certain Social and other Conditions, The Journal of Mental Science 57
(1911), 577.
42 Ibid., 587.
43 The rst clear presentation of this stereotype occurred as early as the twelfth century; see Gerald
of Wales, The History and Topography of Ireland, trans. J. J. OMeara (rev. edn, Harmondsworth,
1982). For anti-Irish attitudes during the nineteenth century, see L. P. Curtis Jr, Apes and Angels:
The Irishman in Victorian Caricature (rev. edn, Washington and London, 1997).
44 Matthew Arnold in a famous series of lectures On the Study of Celtic Literature, delivered
in Oxford in 1867, identied the Celts generally, and the Irish particularly, as being different
in temperament and culture from the Anglo-Saxon English. They were undisciplined, anar-
chical, turbulent of nature, sensuous and vehemently in reaction against the despotism of
fact. Their temperament made them great poets, but bad politicians. See M. Arnold, On the
Study of Celtic Literature and Other Essays (London, n.d.). For a discussion of the supposed
martial characteristics of the Irish, who were disproportionately represented in the British Army
throughout the nineteenth century, see J. Bourke, An Intimate History of Killing: Face-to-Face
Killing in Twentieth-Century Warfare (London, 1999), 11820, 125, 137.
328 Elizabeth Malcolm

V
Although Ireland underwent a political transformation in the 1920s, with the
division of the country into two states the Irish Free State (from 1948 the Irish
Republic) and Northern Ireland little changed as regards the public asylums,
or mental hospitals as they came increasingly to be called. Before the country
was partitioned Irish political leaders, whether nationalist or unionist, were
preoccupied with constitutional questions, and issues connected with health
and medicine were not accorded a very high priority. In the rst decades after
partition, the new government of the south was attempting to consolidate its
existence amid extremely difcult economic circumstances.45
In the south,46 therefore, it was not until 1945 that a major new piece of
mental-health legislation was passed. This was the Mental Treatment Act (no.19
of 1945) which superseded the 1867 Dangerous Lunatics Act. It allowed for
voluntary admission to mental hospitals, the establishment of out-patients clin-
ics, the boarding out of the mentally ill and the release of involuntary patients
on trial.47 It certainly liberalized committal procedures, but discharge of both
voluntary and involuntary patients was still very much at the discretion of the
medical superintendent of the hospital concerned.
The act, however, had little success in reducing rates of committal, which, if
anything, rose during the 1950s. A commission of inquiry into mental illness,
appointed in 1961, later reported that the Irish Republic in that year probably
had the highest rate of psychiatric bed usage in the world. Whereas the number
of beds per 1,000 of population was 4.6 in the United Kingdom and 4.3 in the
United States, in Ireland the comparable gure was 7.3; while in parts of the
west of Ireland the gure was a remarkable 11.0 beds per 1,000 of population.48
In other words, committal rates in Connacht which Dr Lovaway had considered
alarming during the First World War were even higher half a century later.
Thus the public debate about Irish mental health, begun in the late nineteenth
century, continued well into the late twentieth century. Heredity and social
deprivation were still being put forward as explanations, although new theories
that emphasized politics were also introduced, as anthropologists, sociologists
and historians joined the discussion.
Some psychiatrists identied what they termed an epidemic of schizophre-
nia in the west of Ireland. This interpretation was presented most controversially

45 R. Barrington, Health, Medicine and Politics in Ireland, 190070 (Dublin, 1987), 22, 868,
11012; J. Robins, Fools and Mad: A History of the Insane in Ireland (Dublin, 1986), 18690.
46 Developments in Northern Ireland after 1922 will not be discussed here as they are treated at
some length in P. M. Prior, Where Lunatics Abound: A History of Mental Health Services
in Northern Ireland, in Freeman and Berrios (eds.), 150 Years of British Psychiatry, 292308.
47 Walsh, Mental Health Care in Ireland, 194597, 1278; Planning for the Future, 2.
48 Healy, Irish Psychiatry in the Twentieth Century, 268.
 Insane in nineteenth- and twentieth-century Ireland 329

in 1979 by an American anthropologist, Nancy Scheper-Hughes, in a book en-

titled Saints, Scholars and Schizophrenics: Mental Illness in Rural Ireland.
Scheper-Hughes summed up her argument thus:
I share with other recent ethnographers . . . the belief that rural Ireland is dying and
its people are consequently infused with a spirit of anomie and despair. This anomie is
expressed most markedly in the decline of the traditional agriculture . . . and in the virtual
dependence of the small communities of the west upon welfare schemes . . . The ight
of young people especially women from the desolate parishes of the western coast,
drinking patterns among the stay-at-home class of bachelor farmers, and the general
disinterest of the local populace in sexuality, marriage, and procreation are further signs
of cultural stagnation. Finally, the relative ease with which a growing proportion of the
young, single, male farmers are able to accept voluntary incarceration in the mental
hospital as a panacea for their troubles is a nal indication that western Ireland, one of
the oldest and most continually settled human communities in Europe, is in a virtual
state of psycho-cultural decline.49

At the time of its publication this argument generated a storm of protest in

Ireland, and yet it was far from a new argument. Dr Lovaway had speculated
that high rates of mental illness in the west of Ireland were the sign of a passing
race; and Irish asylum doctors were analysing social deprivation in rural Ireland
as a factor in precipitating insanity at the turn of the century. Professor Scheper-
Hughes even if she did not realize it was offering an interpretation with a
very long pedigree, although her argument was decked out with detailed recent
eld research and the latest elaborate statistics.
An interpretation of Irish rates of mental illness as dramatic and colourful
as Scheper-Hughess, but with more of a political bent, was put forward in
the 1990s by Liam Greenslade, an English psychologist of Irish descent. He
looked at the health of the Irish community in Britain during the last quarter of
the twentieth century. Much of what he said, however, related to Ireland itself
and to a much longer time span. Arguing that illness is a socially constructed
notion, Greenslade declared that the vast majority of mentally ill people are
not ill in the sense proposed by the medical model of illness . . . What such
people are, in fact, are the physical manifestation, the symptoms, of the op-
pression, contradictions and pathologies in the society in which they live. In
the case of Ireland, Greenslade laid the blame for the countrys social and
by implication individual ills squarely at the door of English imperialism. As
a colony, indeed Englands rst colony, Ireland over its history suffered con-
ditions of colonial violence, oppression and expropriation, underdevelopment
and clientism comparable to the worst excesses of imperialism experienced
in Africa, Asia and Australasia. Drawing on the work of the French colonial

49 N. Scheper-Hughes, Saints, Scholars and Schizophrenics: Mental Illness in Rural Ireland

(Berkeley and London, 1979), 45.
330 Elizabeth Malcolm

psychiatrist, Franz Fanon, who postulated that colonialism created a sense of

worthlessness and dependence in the colonized, Greenslade concluded that Irish
mental health would not noticeably improve until Irish people rid themselves
of their historical inferiority.50
Rather more prosaic explanations of the apparently poor state of Irish mental
health have been advanced that also stress the nature of British rule. In Ire-
land, British government was highly centralized and highly interventionist in
social as well as political terms, testing out policies some of which were later
introduced into England itself.51 Thus a large national, public asylum system
was established in Ireland considerably in advance of a comparable system in
England. Some writers have suggested that there were high asylum committal
rates in Ireland simply because the British provided so many asylum beds, and
continued to provide beds even when the Irish population began to decline sub-
stantially from the mid-1840s.52 However, this is to overlook two key facts:
Irish asylums were chronically overcrowded and thus there was an almost con-
stant shortage of beds, not an over-supply; and, secondly, committals were in
the main instigated by families, not by government ofcials or even by doctors.
Another version of this argument suggests that the Irish themselves developed
a love affair with the hospital bed, for not only did Ireland have extremely
high rates of committal to mental hospitals but also extremely high rates of
hospital-bed usage generally.53 Dr Lovaway found that there seemed to be no
stigma attached to short-term committal to an asylum. Some writers have argued
that the Irish came to see the mental hospital as a benevolent institution, which
could help the family in times of crisis, as opposed to the workhouse which was
generally dreaded and shunned.54
Burdett commented on the poor quality of Irish asylum superintendents and
on the apparent lack of interest of the Irish medical profession in insanity. The
claim that Irish training in psychiatric medicine was inadequate and thus, for
ill-informed, over-worked and under-paid doctors, committal was the easiest
option, has been applied to the twentieth century as well.55 Irish universities
were slow to establish chairs in psychiatry, while Irish psychiatrists remained
members of the British Medico-Psychological Association even after political
50 L. Greenslade, White Skin, White Masks: Psychological Distress among the Irish in Britain, in
P. OSullivan (ed.), The Irish World Wide: History, Heritage and Identity, volume II: The Irish in
the New Communities (Leicester and London, 1992), 2025; L. Greenslade, The Blackbird Calls
in Grief: Colonialism, Health and Identity among Irish Immigrants in Britain, in J. MacLaughlin
(ed.), Location and Dislocation in Contemporary Irish Society: Emigration and Irish Identities
(Cork, 1997), 3660.
51 O. MacDonagh, Early Victorian Government, 183070 (London, 1977), 17896.
52 E. Kane, Stereotypes and Irish Identity: Mental Illness as a Cultural Frame, Studies 75 (1986),
53951.
53 Healy, Irish Psychiatry in the Twentieth Century, 283.
54 Finnane, Insanity and the Insane, 129.
55 Healy, Irish Psychiatry in the Twentieth Century, 2812.
 Insane in nineteenth- and twentieth-century Ireland 331

independence, as they showed little enthusiasm for setting up their own inde-
pendent professional body. In addition, the Catholic Church looked askance at
many of the new developments in psychiatric medicine, especially the growing
inuence of psychoanalysis and behaviourism. Child psychology was consid-
ered deeply suspect and there was an outright ban on the use of hypnosis until
the 1950s. Thus able and ambitious Irish medical graduates were unlikely to
opt for a career in psychiatry. Jobs in mental hospitals carried with them little
if any professional prestige.56
It was not until the 1960s that a more sympathetic attitude to psychiatry within
the Irish church began to become obvious. The editors of an important book
on The Priest and Mental Health, published in 1962, were at pains to point out
that, if the priest could benet from knowing something of modern psychiatry,
equally the psychiatrist could benet from knowing more about the religious
dimensions of the patients problems. Dismissing the facile solutions of the
Jungian school, the editors welcomed the fact that in recent times psychiatrists
seemed to have ceased to regard religion itself as a form of mental illness.
They certainly endorsed a recent Vatican ruling forbidding priests to practise
psychoanalysis. Yet, one of the editors, a professor of logic and psychology
at University College, Dublin, who was also a priest, went on to re-interpret
Freud, arguing that far from explain[ing] away the existence of God, he had in
fact thrown light on the complexities of the human attitude to God.57 Although
clearly very sceptical of aspects of modern psychiatry, the book was neverthe-
less an attempt to demonstrate that some knowledge of psychiatry could be of
considerable value to priests in their pastoral work and even psychoanalysis
was not wholly without merits.

VI
Over the last twenty years, after more than a century of almost continuous
growth, Irish specialist institutions for the mentally ill have begun to disappear
and to disappear rapidly. The government commission established in 1961
nally reported in 1966, recommending a move away from large, isolated,
specialist mental hospitals towards smaller psychiatric units based in general
hospitals and community facilities such as day hospitals and clinics, and hostels.
The report suggested that if these recommendations were put into effect the
56 Personal communication to the author from a former medical director of St Patricks Hospital,
Dublin, who entered psychiatric medicine in the 1930s after a bout of TB prevented him from
pursuing a career in more prestigious specialities. In this context it is also interesting to note
that, in the early decades of the twentieth century, a number of Irelands rst women medical
graduates, excluded from leading teaching hospitals, were nevertheless able to secure junior
positions in various provincial asylums.
57 E. F. ODoherty and S. D. McGrath (eds.), The Priest and Mental Health (Dublin, 1962), vvi,
6970.
332 Elizabeth Malcolm

number of psychiatric beds in the Irish Republic could be cut by more than 50
per cent over the following fteen years that is to about 8,000 by 1981. In fact
this goal was not achieved. In 1984 there were still nearly 13,000 patients in
psychiatric institutions, and indeed, admissions had increased from over 18,700
in 1970 to nearly 23,700 in 1982. In the latter year only 4 per cent of psychiatric
beds were in general hospitals.58
In response to the perceived failure of the 1966 report, a study group was
appointed by the Irish government in 1981, which issued a report in 1984
entitled Planning for the Future. Like its 1966 forerunner, this report stressed
the need to develop community-based residential and day-care facilities, to
close large, old mental hospitals and to rehabilitate their long-stay patients.
Unlike its forerunner, however, this report was acted upon. By 1995 the resident
population of public and private Irish psychiatric hospitals and units was down to
a little over 5,800, and plans were well in train to close all specialist psychiatric
hospitals by the year 2005 at the latest.59

VII
Birminghams short story is quite accurate in its depiction of the remarkably
high asylum-committal rates that prevailed in large parts of Ireland during the
early years of the twentieth century. These rates had been increasing for well
over half a century and, indeed, would continue to increase for another half
century. More signicantly, however, the story is astute in its recognition that
committal was a complex process, involving a variety of parties and sometimes
having little to do with actual mental illness. Asylums had social as well as
medical uses.
Serious social and economic deprivation certainly existed in rural Ireland
during this period. A declining population, poverty, physically taxing labour,
isolation, the threat of famine and destitution, an authoritarian family structure,
high levels of emigration especially among young women, low marriage rates,
a puritanical church and recreation largely devoted to heavy drinking, all helped
create a lifestyle that was often bleak and unfullling, if not a positive threat to
both physical and mental health.60 In addition, as has been demonstrated, the
legislation that regulated asylums and later mental hospitals from the 1830s into
the 1940s made committal all too easy. Local authorities certainly struggled
to limit the numbers committed, essentially in order to curb costs, but their
efforts were largely in vain. Families, police, magistrates, clergy and doctors

58 Walsh, Mental Health Care in Ireland, 194597, 1312; Planning for the Future, 14353.
59 The progress achieved since 1984 has been reviewed in Green Paper on Mental Health (Pl.8918,
Dublin, 1992) and White Paper. A New Mental Health Act (Pn.1824, Dublin, 1995).
60 See T. W. Guinnane, The Vanishing Irish: Households, Migration and the Rural Economy in
Ireland, 18501914 (Princeton, 1997).
 Insane in nineteenth- and twentieth-century Ireland 333

co-operated to take advantage of lax procedures so as to rid their communities

of those deemed troubled or troublesome.
Thus the picture that emerges from Ireland is in line with recent research into
the committal process in a number of countries.61 It portrays a system of nego-
tiation between communities and authorities that resulted in large numbers of
individuals being institutionalized over a long period of time. What is perhaps
most distinctive about Ireland is that the numbers and time period concerned
were probably greater than almost anywhere else. While grand theories specu-
lating about racial decline and colonial trauma are unconvincing, the question
of why Ireland used asylums/mental hospitals more intensively and for longer
than most other countries still awaits a wholly satisfactory explanation.

61 See, for example, several chapters in the present volume, especially Murphy on England and
Prestwich on France.
14 The administration of insanity in England 1800
to 1870

Elaine Murphy

Introduction
The social history of insanity has proved a seductive paradigm for students of the
management of the dependent poor in nineteenth-century England. The insane
have been perceived as casualties of class and gender power relations during
the transformation from a paternalistic rural economy into an industrialized
capitalist state. While the Elizabethan Poor Law legislation of 1601 was the
administrative foundation on which the system of care was constructed, until
recently two other themes dominated the historiography of mental disorder:
rst, that of the rise of psychiatry and psychiatrists; and second, the expansion
of the Victorian asylum as societys preferred response.1 A reappraisal of the
revisionist interpretation of events is now underway, however, and a more
complex picture is emerging. Mad paupers are no longer so readily annexed to
political dogma.
Sculls deeply researched and provocative account of the growth of public
asylums2 in nineteenth-century England, published as Museums of Madness
in 1979,3 attributed the expansion of asylumdom to the emerging commercial
market economy and the consequent extrusion of inconvenient non-working
people from the mainstream of family and community life. Scull interpreted
the growing interest in madness by specialist mad-doctors as an unattractive bid
for power and status by a group of nancially insecure members of a profession
still on the threshold of respectability.
Looking back twenty years later, Scull4 acknowledged that his work was
stimulated in part by Foucaults brilliant but awed essays on power relations,

1 J. Walton, Poverty and Lunacy: Some Thoughts on Directions for Future Research, Bulletin of
the Society for the Social History of Medicine 34 (1984), 647.
2 J. Melling, Accommodating Madness, in J. Melling and B. Forsythe (eds.), Insanity, Institutions
and Society, 18001914 (London, 1999), 3.
3 A. Scull, Museums of Madness: the Social Organization of Insanity in Nineteenth Century
England (London, 1979), 25466.
4 A. Scull, Rethinking the History of Asylumdom, in Melling and Forsythe (eds.), Insanity,
Institutions and Society, 295395.

334
 Insanity in England 1800 to 1870 335

Madness and Civilisation.5 Sculls Marxist historical sociology proved to be

a red rag to the mainstream British psychiatric bull and to fans of the asylum
like Kathleen Jones, who viewed Sculls interpretation as a challenge to the
legitimacy of the psychiatric profession, which it was, and a late owering of
the 1960s anti-psychiatry movement, which perhaps it was not. In the early
1990s Jones complained that the social history of mental-health services had
become an academic mineeld, smarting perhaps from Sculls heavyweight
criticism of her analysis of events as a story of progress and social enlightenment
thwarted by backsliding, misunderstandings and incompetence.6
The effect of Sculls challenge was to provoke further analyses of the mean-
ing of the asylum as a solution to managing derangement, facilitated by the
wealth of archival material from the institutions and the county magistracy that
administered them.7 The place of the insane in social welfare provision was
located by Jones and Scull in their early works within the reforming zeal of the
county magistrates, the mid-Victorian Lunatics Acts and the central inspectorate
responsible for policing the Acts, the Commissioners in Lunacy.8 The literature
underplayed the legal and administrative context of the poor law within which
lunacy was managed and paid only glancing attention to the inuence of the
changing role of the state and the growth of nineteenth-century government
administration.
Porter meanwhile was excavating an earlier seam of eighteenth-century evi-
dence, which challenged the notion that the nineteenth-century response to mad-
ness was discontinuous and different from previous centuries. He rescued the
humanity of earlier attempts to care for and cure the mad from the overwhelm-
ingly dismissive accounts of eighteenth-century care as barbaric. He further
challenged the notion that the curative ideal of moral treatment was a solely
nineteenth-century phenomenon.9 Just as importantly though, he reasserted the
5 M. Foucault, Madness and Civilisation: A History of Insanity in the Age of Reason (New York,
1965).
6 K. Jones, Asylums and After (London, 1993), 4.
7 The literature is too large to quote more than a handful of studies here but see A. Digby, Madness,
Morality and Medicine: A Study of the York Retreat 17961914 (Cambridge, 1985); W. F. Bynum,
R. Porter and M. Shepherd (eds.), The Anatomy of Madness (London, 1985); M. Finnane, Insanity
and the Insane in Post-Famine Ireland (London, 1981); C. MacKenzie, Psychiatry for the Rich: A
History of Ticehurst Private Asylum (London, 1992), chapter four; D. J. Mellett, The Prerogative
of Asylumdom: Social, Cultural and Administrative Aspects of the Institutional Treatment of the
Insane in Nineteenth-Century Britain (New York, 1982); E. Showalter, The Female Malady:
Women, Madness and English Culture 18301980 (New York, 1985); N. Tomes, The Anglo-
American Asylum in Historical Perspective, in J. Giggs and C. Smith (eds.), Location and Stigma
(1988), 320; J. Walton, Lunacy in the Industrial Revolution: A Study of Asylum Admissions
in Lancashire 184850, Journal of Social History 13 (1979), 122.
8 K. Jones, Lunacy, Law and Conscience 17441845 (London, 1955); Scull, Museums of Madness.
9 R. Porter, Medicine and the Enlightenment in Eighteenth-Century England, Bulletin of the
Society for the Social History of Medicine 25 (1979), 2741; R. Porter, Was There a Moral
Therapy in the Eighteenth Century?, Lychnos (19812), 1226; R. Porter, The Rage of Party: A
336 Elaine Murphy

value of a pragmatic analysis of events in the context of a broader cultural ap-

proach. The madman, his family, the parish and the poor law moved centre
stage.
Over the past fteen years, largely through the work of Bartlett, Wright,
Smith, and Forsythe and Melling,10 the asylum and mad-doctors have been
repositioned on the periphery of a target that places the administration of the
poor law at its centre. The authors own studies in east London supplement this
recent literature using administrative sources from a metropolitan geographical
patch a world away from Mellings leafy Devon and the Middle England where
Bartletts, Smiths and Wrights studies are set.11 This new generation of histori-
ans, released from the imperative of chasing Foucaults shadow, have continued
the search for an understanding of institutions in the management of the poor
and disadvantaged during the process of social and political development of the
modern state. What emerges is that even at their peak of expansion, asylums
were only part contributors to a broad spectrum of institutional and domestic
supervisors of care, orchestrated by the multi-layered poor law administrative
system.
Detailed local studies have unpicked a complex and geographically diverse
weave of relationships and motives. Old certainties about the social class of in-
mates, the economic and commercial drivers of institutionalization, the central
role of a status-crazed embryonic psychiatric profession and the tidy chrono-
logical progression from local parish bumbling to central state control and
regulation must now be abandoned, or at least substantially modied.
The important role of kinship and family ties in the admission, discharge and
negotiation of patients care are revealed by Wrights work on the Bucking-
hamshire asylum, harking back to Waltons earlier work on the importance of
family preferences in the committal process. Placement is now regarded as far
more the outcome of contractual and bargaining negotiations between family,
poor-law ofcials and doctors, between the community and authority, than
an imposed medical solution. In this respect the care of the insane does not
look so very different from the care of the dependent aged in Richard Smiths
exposition of the balance of domestic and institutional care driven by rational

Glorious Revolution in Psychiatry?, Medical History 29 (1983), 3550; R. Porter, Mind Forgd
Manacles: A History of Madness in England from the Restoration to the Regency (London,
1987).
10 P. Bartlett, The Asylum and the Poor Law: The Productive Alliance, in Melling and Forsythe
(eds.), Insanity, Institutions and Society, 4867; D. Wright, Getting Out of the Asylum: Under-
standing the Connement of the Insane in the Nineteenth Century, Social History of Medicine
10 (1997), 13755; L. Smith, The County Asylum in the Mixed Economy of Care, in Melling
and Forsythe (eds.), Insanity, Institutions and Society, 3347; B. Forsythe, J. Melling and R.
Adair, The New Poor Law and the County Pauper Lunatic Asylum: The Devon Experience
18341884, Social History of Medicine 9 (1996), 33555.
11 E. Murphy, The Administration of Insanity in East London 18001870, PhD thesis, University
of London (2000).
 Insanity in England 1800 to 1870 337

economic necessity.12 Furthermore for many patients, incarceration was not per-
manent and could be a fairly short-lived affair. Wright found that approximately
50 per cent of all Buckinghamshire asylum patients were eventually discharged,
and that of those who were discharged, three-quarters left the asylum having
stayed fewer than twelve months.13

The birth of county asylums

Len Smiths detailed studies of the rst county asylums established follow-
ing Wynns Act of 1808 (which enabled county justices to construct county
asylums) but before the comprehensive Lunatics Acts of 1845 (which obliged
county justices to build public asylums), suggest that a competitive mixed econ-
omy of provision existed long before 1808 and continued to be important long
afterwards.14 Porters eighteenth-century melting pot of commercial competi-
tion, soaring scientic ambitions and multi-faceted world of personal motives
and exible public rules survived far longer into the nineteenth century than
has been acknowledged. The language of entitlement, rights and contractual
commitments of the old poor law gave way only slowly to the Victorian new
poor-law rhetoric of virtue, vice and exclusion. Smiths work documents in fas-
cinating detail the daily life in early asylums of keepers, patients, managers and
the internal/external relationships of administrators and parish ofcials that is
also evident in the constant negotiation over pauper patients in east London.15
The rst county asylums were no larger and usually considerably smaller
than the existing pauper madhouses used by the parishes. Smith suggests that
the early public asylums were a natural development of embryonic quasi-public
hospitals like St Lukes Hospital and Bethlem rather than a new phenomenon.16
Porter had also concluded there was greater continuity of customs in managing
the mad between the seventeenth, eighteenth and nineteenth centuries than was
generally acknowledged.17 Smith points to the difculties the new asylums had
in nding a place in a market economy of parish purchasers, private providers
and voluntary hospitals.18
12 R. Smith, Charity, Self Interest and Welfare: Reections from Demographic and Family
History, in M. Daunton (ed.), Charity, Self Interest and Welfare in the English Past (London,
1996), 238; R. Smith and P. Horden, Introduction, The Locus of Care (London, 1998).
13 D. Wright, The Discharge of Pauper Lunatics from the County Asylums in Mid-Victorian
England: The Case of Buckinghamshire, in Melling and Forsythe (eds.), Insanity, Institutions
and Society, 93108.
14 L.D. Smith, Cure, Comfort and Safe Custody: Public Lunatic Asylums in Early Nineteenth
Century England (London, 1999), Introduction, 111.
15 Murphy, Administration of Insanity, 84118.
16 Smith, Cure, Comfort and Safe Custody, chapter one.
17 Porter, Mind Forgd Manacles, 27880.
18 Smith, Cure, Comfort and Safe Custody, chapter one; L. D. Smith, The County Asylum in the
Mixed Economy of Care 18081845, in Melling and Forsythe (eds.), Insanity and Institutions,
3347.
338 Elaine Murphy

When the new Middlesex county asylum at Hanwell opened in 1831, even
though Bethlem was fast removing itself from the pauper market, the asylum
was hardly well placed to compete in the east London parishes with the long-
established local licensed houses and local voluntary St Lukes Hospital. The
exible charging system whereby parishes topped-up family resources to fund
places in St Lukes or a licensed house was an added bonus of the old system.
Hanwell only became an acceptable alternative when the cost dropped signi-
cantly below the licensed houses. Local scandals seem to have made remarkably
little difference to the overall use of the private sector; cost was the prevalent
determinant until the 1845 Act made the use of county asylums obligatory. For
the overseers of the poor in east London the new asylum at Hanwell was by
no means the obvious preferred choice in the mixed economy of care between
1808 and 1845. The London unions were initially just as reluctant to ll up
the second county asylum at Colney Hatch when it opened in 1851, to the des-
peration of the magistrates trying to run an economical institution.19 Reducing
the charge was the only way to attract patients since parish supervisors were
happy to leave the insane in the workhouse unless they posed a serious risk.
These London ndings concur with those of Melling and Forsythe in Devon
and Smith in the Midlands that county asylums had to compete for trade largely
on price but also by astute marketing of the advantages of an asylum over the
private trade.20
One of the main aims of the 1834 Poor Law Amendment Act was to impose
national consistency of practice in poor relief. The Act introduced the New
Poor Law, to be administered by boards of guardians of unions of several
parishes. Stricter rules made relief available only on condition of admission
to a workhouse; outdoor relief was meant to be abolished, although the more
punitive aspects of the law were short-lived and largely unworkable. The New
Poor Law was to be monitored by a new central government agency, the Poor-
Law Commission. Central guidance should have produced uniformity in dealing
with the mad. Prior to the Amendment Act there were striking differences
in east London, for example, between the neighbouring Holborn parishes of
parsimonious St Andrews and generous St Sepulchre. There were however
equally striking differences in the decade after the Act between the policies
of the poor-law guardians of sage Stepney, punitive Poplar and generous St
George-in-the-East.21 The guardians of impoverished St George-in-the-East
for example spent double what most of their neighbouring parishes and unions
spent per 1,000 population on specialist lunatic placements in the early 1840s.

19 Circular letter from Benjamin Rotch to Metropolitan Union Guardians, Whitechapel Union
Board of Guardians Minutes BG/Wh/13, 174.
20 Smith, The County Asylum, in Melling and Forsythe (eds.), Insanity, Institutions and Society,
3347.
21 Murphy, Administration of Insanity, 84118, 11985.
 Insanity in England 1800 to 1870 339

Similar diversity between neighbouring boards of guardians is described in

rural and county town Devon by Forsythe, Melling and Adair and by Bartlett in
Leicestershire.22 Some rural areas relied heavily on boarding out single patients
with nurses or keepers, a practice disapproved of by the Commissioners in
Lunacy on the grounds that such patients were outwith the oversight of the
central inspectorate, although they had no direct evidence that the practice was
unsatisfactory.23
The high cost of placing individuals in special asylums had the positive effect
of obliging the rst New Poor-Law guardians to consider individual paupers and
their families just as their predecessors had. However, once the responsibility for
making judgements on where to send people was removed from the guardians
by the growth of county asylum places and the obligation to use them, there was
less reason to consider cases in such depth. The magistrates capital solution
of building county asylums tied the guardians into an inexible system that,
while it had the merit of being cheap per individual case at the outset, proved
expensive in the long term. Bartlett points out that the justices of the peace who
built the county asylums were merely the top tier of poor-law administration.24
Bartletts work on the complex relations in Leicestershire and Rutland between
the justices, the guardians, the asylum administrators and patients families
resonates with Forsythe, Melling and Adairs reading of the shifting nuances
of administrative power at the Devon asylum.25 Mellings group concluded
that the axis of power was balanced between the magistrates and poor-law
ofcials, the Lunacy Commission playing only a small part.26 Waltons study
of the admission process in Lancashire and Wrights on discharges from the
Buckinghamshire asylum also stressed the role of poor-law ofcials in the
lunatics life career.27 A similarly complex picture emerges from the early
days of the New Poor-Law period in east London where the guardians, ofcials
and parish doctors clearly regarded the union pauper lunatics as theirs. Pauper

22 Forsythe, Melling and Adair, The New Poor Law, 33555; P. Bartlett, The Poor Law of Lunacy
(London, 1999), 15196.
23 Fifteenth Annual Report of the Commissioners in Lunacy (1860) Single Patients, 5366, 6970.
24 P. Bartlett, The Asylum, the Workhouse and the Voice of the Insane Poor in 19th-Century
England, International Journal of Law and Psychiatry 21 (1998), 42132.
25 P. Bartlett, The Poor Law of Lunacy: The Admission of Pauper Lunatics in Mid-Nineteenth-
Century England with Special Reference to Leicestershire and Rutland, PhD thesis, University
of London (1993), 278.
26 Forsythe, Melling and Adair, New Poor Law, 3; B. Forsythe, J. Melling and R. Adair, Politics
of Lunacy. Central State Regulation and the Devon Pauper Lunatic Asylum, in Melling and
Forsythe (eds.), Insanity, Institutions and Society, 6892.
27 Walton, Lunacy in the Industrial Revolution, 67; J. Walton, Casting Out and Bringing Back
in Victorian England: Pauper Lunatics 18401870, in W. Bynum, R. Porter and M. Shepherd
(eds.), The Anatomy of Madness: Essays in the History of Psychiatry, vol. II: Institutions and
Society (London, 1985); L. Ray, Models of Madness in Victorian Asylum Practice, European
Journal of Sociology 22 (1981), 22964; D. Wright, The Discharge of Lunatics from County
Asylums in Mid-Victorian England, 93112.
340 Elaine Murphy

lunatics might be on loan to the county asylum or to the private Bethnal Green
Asylum. The guardians might take advice from the asylum doctors on discharge,
although they might not and the rst generation of Lunacy Commissioners was
nothing like as much trouble to them as they might have feared.
The tussle of wills between the guardians, ofcials and parish doctors about
the disposal of pauper lunatics was similarly played out by county asylum of-
cers and the county magistrates (justices) who served on the asylum governing
committees. Parishes and unions resented the justices greater powers and gen-
erous budget creamed off from their own resources without their sanction but
also wanted to shift the management burden of difcult-to-manage paupers.
Dangerousness was the language of negotiation used by all interested par-
ties in east London to convince others of the need to act. Adair, Forsythe and
Melling have also remarked on the importance of the concept of dangerous-
ness as an admission bargaining criterion between poor-law ofcials, doctors
and asylum staff in the Devon county asylum.28 Overseers and guardians at-
tempted to match expense to the paupers perceived level of dangerousness and
behavioural nuisance.
Debates about whether the post-1845 Lunacy Commission was effective or
inuential as an inspectorate depend on whether the question pertains to their
local visitorial or central policy role. Hervey set the Lunacy Commissions work
within the context of changing conceptions of the role of government, the de-
velopment of a central administrative bureaucracy and the rise of supervisory
central agencies designed to oversee and police the implementation of central
government policy through local government.29 Hervey judged the commis-
sioners were effective locally in Kent in their early years, within the narrow
connes of their remit.30 Mellett thought their remit so constrained it prevented
them doing very much at all and Bartlett found their role to be largely concilia-
tory and weak in the East Midlands.31 Forsythe, Melling and Adair in contrast
found the Lunacy Commission authoritative and successful in Devon.32
Local Commissioners had only as much inuence as individual members
could exert through force of personality, negotiating skill and tenacity. Com-
missioners were generally far more constrained in their relationships with poor-
law ofcials and guardians about conditions in workhouses than with public
asylums and magistrates. They failed miserably to get major improvements

28 R. Adair, B. Forsythe and J. Melling, A Danger to the Public: Disposing of Pauper Lunatics in
late Victorian and Edwardian England: Plympton St Mary Union and Devon County Asylum,
Medical History 42 (1998), 125.
29 N. Hervey, The Lunacy Commission 184560 with Special Reference to the Implementation
of Policy in Kent and Surrey, PhD thesis, University of London (1987), 505.
30 Hervey, The Lunacy Commission, 45564.
31 D. Mellett, Bureaucracy and Mental Illness: The Commissioners in Lunacy 18451890, Med-
ical History 25 (1981), 243; Bartlett, The Poor Law of Lunacy, 2667, 294.
32 Forsythe, Melling and Adair, Politics of Lunacy, 6892.
 Insanity in England 1800 to 1870 341

in insane wards of the eastern metropolitan workhouses, compared with the

self-appointed trio of doctors who comprised the Lancet Commission, whose
dynamite journalistic prose battered the complacent London guardians through
a series of well-publicized fortnightly articles in the Lancet through 18656.33
The Lunacy Commission chairman Shaftesbury, however, had sufcient stand-
ing and parliamentary clout to ensure that for twenty-ve years the collective
commission inuenced central government aspirations and the central ideology
of care. Ultimately though, the Lunacy Commissions aspirations to annexe the
universe of imbeciles to their lunatic empire ran aground, although their annual
reports set the moral tone and care standards for a generation of asylums.
While it is clear that rst the county magistrates, then central government in
the form of the Poor-Law Board gradually appropriated the care of the insane
in England, the old mixed economy system survived far longer than has been
recognized. Private licensed houses played an important and respected part in
the grand scheme until the last years of the nineteenth century and very often
received better reports from the commissioners than the county asylums. The
transition from private to public provision occurred in step-wise fashion, the
private sector quick to adopt new strategies as old markets were denied them.
Ultimately public providers triumphed because the legislature was on their side.
Scull retains today his earlier interpretation of the rise of public asylums as a
side effect of the growing capitalist state in which the suspect motives of
nineteenth-century alienists aid and abet the states convenience.34

Lunacy in east London

Public asylums were not only used for paupers. The Devon asylum, Forsythe
and his colleagues found, sheltered the middling class of insane from the stig-
matizing workhouse, with the acceptance of the guardians. While ofcially the
Middlesex county asylum at Hanwell, serving London, took only paupers, and
a declaration to that effect was made by the parish ofcers, in fact the parish
or union was charged by the asylum and then the parish clerks pursued close
relatives for the cost of the placement. Considerable energy was expended in
devising ways of shifting or reducing the costs of lunatic placements through ex-
tracting costs from relatives. In Bethnal Green parish for example, the guardians
minutes for July 1839 record Mr William Young of 76 Church Street came be-
fore the Board to advocate of Mr Mann late of Pollard Row, chairmaker who
was now in a state of insanity and about to be removed to Messrs Warbur-
ton(Bethnal Green Asylum).35 Mann had a weekly pension of 10s. per week
33 Lancet Sanitary Commission, Lancet II (1865), 1422; Metropolitan Workhouses, Lancet II
(1865), 1313; Lancet I (1866), 1046; Lancet I (1867), 21516.
34 Scull, Rethinking the History of Asylumdom, 295315.
35 Bethnal Green Minutes of the Board of Guardians (Be BG) 5: 1 July 1839, 309.
342 Elaine Murphy

from the East India Company to which the guardians had a legal claim to pay
Manns asylum costs.
Mr Young wished a certain portion to be applied for the benet of the wife
but in as much as she did not apply for relief and as her husband was not at
present removed to Hanwell asylum the board suggested the matter had better
remain as it did. Mann nally got his place in Hanwell some two months later,
reducing the cost burden on the parish. Mr Young, accompanied by Manns
son, renewed his application on behalf of Manns wife. The guardians agreed
that the pension would be used to pay Warburtons oustanding bill of 1 17s.
6d. and that the sum of 5s. 6d. a week would be paid from the pension towards
the cost of Hanwell. Manns wife could keep the 4s. 6d. remainder to which
son and Mr Young assented. In another instance, when Sally Bartlett died in
the Bethnal Green asylum in 1839, the guardians placed a charge over her 30
residual estate held in the local savings bank in order to cover Warburtons bill
of 14 15s. 0d. The remainder was handed over to her son-in-law.36
The notion that institutionalization was a manifestation of social control nds
little echo in recent work. The insane with nancial resources were also admitted
to workhouses if parish ofcers decided it was in the individuals best interests
and the relatives were incompetent. Confused old James Lock was admitted
urgently to Stepney Unions Mile End workhouse in the winter of 1838 because
Mr Story, the parish medical ofcer and Mr Warren, the relieving ofcer
found James Lock sitting by the re. It seems he had gone to the necessary [sic] and
having stopped long his daughter went to look for him and found him lying on the stairs
in the yard quite exhausted from cold . . . The only clothing he had on him at the time
was a coat and one shoe and it would seem he was in the habit of going about almost in
a state of nudity. It was a respectable sort of house but there was no vestige of furniture
in his room except a little ock in one corner although his daughter is understood to be
in receipt of 50 per annum. The Relieving Ofcer adds that he considered it safer to
remove him at once to the workhouse than to trust him to the care of the daughter who
by the accounts given her by her neighbours, appears to be addicted to drinking.37

While broadly adhering to the revisionist notion of the asylum exercising a

social control function, Bartlett sets the care of the insane within the compet-
ing administrative models of the punitive New Poor Law and the high moral
paternalism of the Lunatics Acts, illustrating with his studies in Leicestershire
and Rutland that there was no hierarchical power structure but a complex web
of inuence between the guardians, Poor-Law Commissioners, Lunacy Com-
missioners and asylum professionals. Workhouses remained an important part
of the mixed economy of care since crucially, between a quarter and a third of

36 Be BG 5: 30 September 1839; 14 October 1839.

37 Stepney Union Minutes of the Board of Guardians, Response to Complaint to the Poor Law
Commission. St BG/L/3, 145.
 Insanity in England 1800 to 1870 343

those designated lunatics and idiots was cared for in local workhouses. Insanity
was therefore not only of peripheral interest to the guardians.38
The parishes of east London had opted for an institutional solution for the
care of the insane long before the beginning of the nineteenth century. Parish
workhouses and vast urban pauper farms provided care for harmless idiots
and the chronically mad and the huge private madhouses in Hoxton and Bethnal
Green took the most difcult to manage. The individual parish was a small and
feeble unit of administration and was unable to respond to any unusually heavy
nancial burden, but it had humanity and exibility. The handful of insane
people that each overseer and later, the paid assistant, had to deal with annually
meant that each case was handled on its merits. Inconsistency of practice also
allowed adaptability; if the quality of care or costs of a specialist institution
changed in an unattractive way, then it was a relatively simple matter to move
one or two paupers elsewhere. When for example Mr Boak, the parish beadle
of the City of London parish St Andrew Undershaft visited Jonathan Tipples
pauper farm house on Christmas Day 1807 to see the parish handful of dull-
witted, incompetent dependent paupers he found the accommodations very bad
and thought it expedient they be removed.39 The beadle consulted with some
gentleman of the parishes of St Peter and St Michael Cornhill and found that
they maintained such folk at a house in Bethnal Green. St Andrews paupers
were moved when negotiations on terms were completed a month or two later.
The metropolis was unusual in having a workhouse classication system in
place long before the new poor law introduced it as ideology. Pauper farms
have largely been excluded from earlier debates, yet were a crucial part of the
provider system for managing some species of mentally incompetent poor in
the metropolis up to 1834.40 The London pauper farms were part of a continuum
of types of refuge, which also included the licensed houses, refractory and idiot
wards of parish workhouses, houseless refuges for casuals and local prisons.
The shift away from pauper farms to private asylums for lunatic placements
in the rst two decades of the nineteenth century probably reects what Porter
identies as the emergence of a cadre of specialist entrepreneurs of madness
and increasing willingness of the overseers to regard madness as requiring
special expertise that could only be had in asylums.41
Funding systems and revenue cost comparisons with workhouses closed the
city pauper farms that took the foolish and simple unproductive pauper and
transferred their clients to the asylum. When Edward Byas, who kept a four-
hundred-place pauper farm at Grove Hall in Bow, east London, could not get

38 Bartlett, The Poor Law of Lunacy, 197237.

39 Minutes of the Trustees of the Poor, St Andrew Undershaft. Ms. 4120 vol. 6, 6 January 1808.
40 E. Murphy, Mad Farming in the Metropolis: Part I. A Signicant Service Industry in East
London, History of Psychiatry 12 (2001), 24582.
41 Porter, Mind Forgd Manacles, 228.
344 Elaine Murphy

sufcient paupers of this type, he turned in the early 1840s to the conventional
lunatic trade to ll the gap. Then, when he could no longer compete nancially
with the county asylum system, Byas lost most of his union trade and in 1856
turned to the military for their mad trade to ll the void places.42 Grove Hall
was cheap, far cheaper than any other asylum at about 56s. a week in the early
1840s, although the charges went up as it turned more into an asylum and less
a standard pauper farm. By 1842, Whitechapel union was using Byas routinely
for the care of idiots in preference to the workhouse, although John Liddle the
parish doctor responsible for visiting them was dissatised with their care: The
house is not clean or orderly.43
Whitechapel Guardians continued to place a handful of insane paupers at
Grove Hall at a cost in 1845 of 11s. a week, the same cost as Hoxton House and
Peckham private asylums and pricier than Hanwells charge of 8s. 9d. Bow was
after all very convenient geographically and the parish staff knew the institution
ofcers well. In Stepney, when the Poor-Law Commissioners made it clear that
there was a requirement under the new Acts of 1845 to remove treatable lunatics
from workhouses to asylums, the woman workhouse Master Mrs Megson and
her close ally, medical ofcer Daniel Ross, pressed the guardians hard for the
thirteen lunatics in Wapping workhouse to be sent to a proper asylum. They
were shipped off to Grove Hall because there was no room either at Hanwell
or at any of the other local institutions.44

Control over capital

The story in east London ts Sculls interpretation only in part. It was not cap-
italism but the control of capital that was at the heart of shifting institutional
policies. Early restriction of outdoor relief in many poorer London parishes
established an asylum solution to managing diverse kinds of human incom-
petence long before the machinations of meddlesome magistrates. The bur-
geoning poor-relief bill in London consequent upon economic recession after
the Napoleonic wars had a more direct effect on the parishes and unions in-
creasing resort to institutional solutions than the rise of the industrial economy.
Greens parallel arguments for the transformation of artisans to paupers in the
later recession of the 1860s also stresses that an institutional response to the
burden of the poor was an attempt to set limits on relief expenditure.45
Under the old poor-law system the control of capital expenditure and the size
of the capital resource were in the hands of independent madhouse entrepreneurs

42 Murphy, Administration of Insanity, 7384.

43 Whitechapel Union Minutes of the Board of Guardians StBG/Wh/3: April 1839, 143.
44 Stepney Union Minutes of the Board of Guardians StBG/L/10: 11 September 1845.
45 D. R. Green, From Artisans to Paupers: Economic Change and Poverty in London 17901870
(London, 1995), 181209.
 Insanity in England 1800 to 1870 345

who largely determined the service conguration. By the mid nineteenth cen-
tury England was awash with capital available for public works, the fruit of the
burgeoning capitalist economy. The availability of cheap capital allowed the
magistrates and later the central government machine to invest in an attractively
global solution. As the agency where capital expenditure was controlled be-
came more remote from the lives of the mad and their families, the larger and
cheaper the institutional solution became. Emotional and geographical distance
between the decision-makers and the recipients of the service facilitated an ad-
ministrative solution that ignored local families, parish ofcers and union
doctors individually devised solutions and substituted instead benets from
the point of view of the central administration.
Having constructed the asylums it was imperative to keep them full to hold
unit costs down. Financial incentives were rapidly introduced to do just that.
The main increase in institutionalization rates for insanity in Middlesex beyond
that predicted by population growth occurred after the Union Chargeability
Act and the Metropolitan Common Poor Fund in the late 1860s produced irre-
sistible nancial incentives for guardians to use asylums. It is important not to
underplay other reasons for the growth of numbers of patients. There was for
example an inevitable accumulation of chronic cases throughout the nineteenth
century.46 It has already been noted that there was a signicant turnover of
acute cases. There was also a surprisingly high institutional mortality rate and
in east London at any rate, a continuing merry-go-round after 1862, when the
Lunatics Amendment Act made possible the transfer of chronic insane cases
from asylums to workhouses, of omnibuses full of incurables being swapped
for disruptive workhouse recents. Nevertheless these made only a marginal
difference to the long-term resident population.47 It was the remorseless train
of patients, and by 1860 they often were on a train, making their nal passen-
ger station stop that seemed never-ending that was a direct result of nancial
policies. There was no concerted campaign to query the wisdom of further en-
largements and additional asylums. Medical superintendents were ambivalent;
they wanted to respond to the suffering masses currently without benet of their
asylum and there must have been a modest satisfaction in being indispensable.
Professional standing rises when a growing trade is knocking at the door.
The ofcial reasons for the increase in numbers of those requiring asylums
was that there had been a miscalculation of the numbers in ofcial statistics and

46 There is an extended discussion of the chronicity problem in A. Scull, The Most Solitary of
Afictions: Madness and Society in Britain 17001900 (New Haven, Conn., 1993), 26793.
47 For coverage of the dynamic shifts in and out of the Victorian asylum see L. Ray, Models of
Madness in Victorian Asylum Practice, European Journal of Sociology 22 (1981), 22964;
Walton, Casting Out; J. Crammer, Asylum History: Buckinghamshire County Pauper Lunatic
Asylum St Johns (London, 1990), chapter ve; MacKenzie, Psychiatry for the Rich, chapter
four.
346 Elaine Murphy

that hidden cases were emerging from the community as detection and services
increased.48 A likely signicant cause of the apparent increase was the widening
of the denitions of insanity and in particular, what passed as a suitable case
for institutionalization produced by funding incentives.49 The no-mans-land
of disputed cases was peopled with epileptics, idiots and imbeciles, people
with traumatic brain damage, cases of degenerative brain disease and senile
dementia, all groups who in metropolitan London at any rate, if they were not
in an asylum would be in other forms of institutional care.
The tight reciprocal bond between the parish rate-payers contribution and
union expenditure was weakened for lunatics before any other group of paupers
by a clause in the 1853 Lunatics Amendment Act which made unions rather
than parishes the accountable units of administration responsible for paying
asylum fees.50 It was another twelve years before the Union Chargeability Act
of 1865 applied the same ruling to costs of relief for all other classes of pauper. A
second clause in the 1853 Act obliged parish medical ofcers to visit and report
quarterly to the overseers and guardians every pauper who in their judgement
might be properly conned in an asylum. This repeated reporting of cases gave
the parish doctors considerable inuence over their guardians as local moles
of the Lunacy Commission. The doctors had no special interest in keeping the
costs of asylum placements down but a very strong interest in reducing the
burden on workhouse staff and their own time.
The Union Chargeability Act of 1865 provided an even greater advantage,
from the point of view of the poorer parishes, of a more equitable rating system
across rich and poor unions. This enhanced the spending power of unions with-
out drawing further on their beleaguered ratepayers. Two years later the 1867
Metropolitan Poor Act severed the link in London between asylum funding
and rate-payers pockets by the creation of the common poor fund, a central
pot on which unions could draw to place any number of designated cases. The
1867 Act produced immense and disproportionate growth in poor law lunatic
asylums and other forms of poor relief.51 Furthermore, the extra 4s. per week
subsidy for every lunatic placement made available after 1875 was sufcient to
reduce the real cost to the guardians in London of a placement to almost noth-
ing. It is not surprising to nd that almost any pauper with a hint, a suspicion of
eccentricity, indecorous habits or behavioural inconvenience was a candidate
for the asylum.
48 Scull, Most Solitary of Afictions, 340, quotes the fteenth Lunacy Commissioners report of
1861, 79; the Select Committee Reports of 1859 and 1877 and J. Bucknill and D. H. Tuke, A
Manual of Psychological Medicine (London, 1858), 48, 58.
49 Scull, Most Solitary of Afictions, 34452.
50 Lunatics Amendment Act (1853), 16/17 Vict. c 96 & 97.
51 D. Cochrane, Humane, Economical and Medically Wise: the LCC as Administrators of
Victorian Lunacy Policy in Bynum, Porter and Shepherd (eds.), The Anatomy of Madness, vol.
III (London, 1988), 251.
 Insanity in England 1800 to 1870 347

Funding systems designed to facilitate one social policy frequently have

an unwanted effect of stimulating unforeseen changes elsewhere. The drive
in the 1860s to make funding systems fairer and more equitably burdensome
across rich and poor unions had the entirely unexpected effect of inducing
further institutionalization in the poorer unions. Contemporaneously in London
the weekly horrors of the Lancet Sanitary Commission reports on appalling
conditions in workhouse inrmaries, the regular but ineffectual pressure from
poor-law inspectors and the marginally more persuasive Commissioners in
Lunacy urged the extrusion of insane people from the workhouse. The objective
of Gathorne-Hardy, the President of the Poor-Law Board and main champion
of the Metropolitan Poor Act, was to provide sufcient nancial incentives for
the guardians to cede power to the central poor-law bureaucracy. The common
poor fund was the wooden horse that lured the guardians into Troy. Lunatics
became proxy parcels of cash through which centralism was achieved.
The main changes in east London from 1800 to 1871 were transinstitu-
tional shifts from pauper farms to asylums in the old poor-law period and from
workhouses and private asylums to county and imbecile asylums in the New
Poor-Law period. There is no suggestion in the guardians minutes or parish
and union doctors letters that they thought the nature or rate of insanity was
changing. Alienists and asylum inspectors puzzled their heads over the rising
rate of lunacy through the nineteenth-century but the guardians did not.52 Some
interesting questions remain however about nineteenth-century changes in the
epidemiology of syphilitic general paralysis,53 the role of alcohol abuse con-
sequent on cost uctuations in alcohol54 and the changing age demography. A
little-explored area is the possible increase in dementia that would probably
have accompanied the increasing life expectancy through the century and the
rising proportion of indoor paupers who were elderly.55 Modest shifts in the
prevalence of these disorders could have had a major impact on institutional-
ization rates. There is insufcient evidence of a change in the epidemiology
52 Report of the Metropolitan Commissioners in Lunacy to the Lord Chancellor 1844 PP 1844(001)
XXVI.1, 30; W. A. Browne, What Asylums Were, Are and Ought to Be (Edinburgh, 1837), 515;
Bucknill and Tuke, A Manual of Psychological Medicine, 4858; discussion in Scull, Most
Solitary of Afictions, chapter seven.
53 E. H. Hare (posthumous, edited by J. L. Crammer), The Origin and Spread of Dementia Para-
lytica (London, 1998), 3671.
54 The rising availability and uctuations in the cost of alcohol had a marked effect on rates of
alcohol abuse in the twentieth century and may also have had a similar effect in the nineteenth.
M. Sutton and C. Godfrey, The Health of the Nation Targets for Alcohol: A Study of the Economic
and Social Determinants of High Alcohol Consumption in Different Population Groups (York,
1994).
55 While the size of the population of sixty-ve years and over as a percentage of the total rose only
from 3.0 per cent in 1851 to 5.0 per cent in 1901, as a percentage of indoor paupers the sixty-ve
years and over rose from 19.8 per cent in 1851 to 36.5 per cent in 1901. K. Williams, From
Pauperism to Poverty (London, 1981). Statistical appendix table 4.24, Aged Indoor Paupers
185181, 205.
348 Elaine Murphy

of insanity in England during the nineteenth-century to draw rm conclu-

sions. The most likely explanation for the increasing use of the public asylums
was the guardians desire to use available nance as cost effectively as they
could.
The tradition of sending mentally ill people away from their home for treat-
ment in the hope that they would be restored, was established by the sixteenth
century and became increasingly popular as beliefs about mental disorder were
reframed from the religious/mystical to the realm of personal suffering and
illness. Porter cites from numerous examples of parishes as well as private
families seeking expert help in the centuries before the nineteenth.56 By the sev-
enteenth century there were numerous madhouses offering care for all classes
and all purses. Parry Jones pointed out that the cheaper institutions were huge
enterprises catering for hundreds rather than tens of people and that patients
of all classes were sent many miles away from home as a matter of course.57
There was nothing strange or unusual about the magistrates notion of sending
the insane to asylums in pleasant far away places for care.
The early asylums were not built primarily in rapidly industrializing areas
where it might be conjectured that rapid social change might throw out more
human incompetence to be mopped up by the welfare system. They were built
largely because of the determination of a handful of powerful magistrates; in
Devon a small group of Tory land-owners, in Bedford the Brewer-philanthropist
Whitbread, in Middlesex a trio of ambitious humanitarians of diverse political
and religious persuasion. These were men who knew how to raise the necessary
capital nance and knew that the greater the capital investment the cheaper
the running costs, so long of course as there were sufcient patients to ll the
buildings. The rst asylums were built where individual reformers could get
hold of sufcient capital, usually in fact in rural areas, not because of any special
characteristics of the local poor.
The planned size of the early county institutions reected the social en-
trepreneurs perception of the population at which the single institution was
targeted. The Middlesex magistracy made the same global one capital project
decision about its convicted felons and remand prisoners until it became con-
vinced of the wisdom of separating the young remand prisoners from the con-
tagion of evil recidivists. Values that shifted the capital spend from the solution
which would be cheapest on revenue to a more expensive one had to be con-
vincing and widely held, deeply embedded within the culture of the corporate
public body. The magistrates were not exposed to a satisfactory alternative to
the asylum and the only vision they had to provide them with their mission was

56 Porter, Mind Forgd Manacles, 120.

57 W. L. Parry Jones, The Trade in Lunacy: A Study of Private Mad-Houses in England in the
Eighteenth and Nineteenth Centuries (London, 1971), 28192.
 Insanity in England 1800 to 1870 349

that provided by the growing handful of asylum specialists and the evangelical
campaigners detest of the prot motive.58

Concluding remarks
Over the course of the nineteenth century, the subtle complexities of relations
between the family, the poor-law parish, the magistracy and the central agencies
gradually gave way to a dominant centre so removed from the patients that it
ceased to rely on a mission of service provision other than to warehouse huge
numbers of people. The county magistrates were capable of creating sweeping
cheap global solutions in their county asylums. Nevertheless, the shameless cre-
ation of megalithic human warehouses did not really become apparent until the
creation of the imbecile asylums built by the Metropolitan Asylums Board, the
central agency under Poor-Law Board Control established by the Metropoli-
tan Poor Act. The remoteness of the board from day-to-day concerns of the
parishes and unions facilitated the establishment in 1871 of the apotheosis of
cheap barn-like eighty-bed identical dormitories and living rooms designed
for 150 people in the vast and anonymous 2,000-bed institutions at Caterham
and Leavesden.
The public asylum was always only a partial solution to managing the insane,
even at the peak of asylum expansion. The policy of connement of the insane
in England began long before the nineteenth century, having its origins in the
old poor-law parish poorhouses, the widespread practice of farming out the poor
for private care from urban parishes too small to sustain their own poorhouse
and also in the private madhouses, which had grown up to serve the wealthier
classes in the seventeenth and eighteenth centuries. The role and inuence of
families and the fundamental importance of the local poor-law authorities and
increasing power over public policy by central government redenes the im-
portance of the embryonic psychiatric profession and the role of the Lunacy
Commission. Neither seem quite so inuential in the grand scheme of man-
agement as their own reports and trade journals imply. For patients of course,
the care and treatment they received from their workhouse and asylum doctors
and keepers and the inuence the visiting commissioners could exert on their
behalf were vital to determining the quality of the regime in which they lived.

58 Shaftesburys view as expressed to the Select Committee of 1859: When I look into the whole
matter I see that the principle of prot vitiates the whole thing; it is at the bottom of all these
movements that we are obliged to counteract by complicated legislation, and if we could but
remove that principle of making a prot we should confer an inestimable blessing upon the
middle classes, getting rid of half the legislation and securing an admirable, sound and efcient
system of treatment of lunacy. Quoted in D. H. Tuke, Chapters in the History of the Insane in
the British Isles (London, 1882), 193.
 Index

abolitionist movement, 180 Advisory Commission on Regional

Aborigines, 24, 143 Asylums; and Hospitals, 239, 245, 246
abortion, 75, 268 European immigration into, 11, 231, 234
abstinence, 36 Ministry of Finance, 245
Accra, Gold Coast, Africa, 301, 310 Ministry of Foreign Relations and Religion,
addictions, 66, 158, 169, 172 229, 230, 244, 245, 246
alcohol, 158, 266 Ministry of Health and Welfare, 229
drug, 266, 270 Ministry of the Interior, 229, 239, 244, 245
cocaine, 66 National Department of Health, 244
morphine, 66, 169 National Department of Social Welfare, 245
addicts, 65 psychiatric network, 12
alcohol, 35, 57, 66, 96 army medical corps, Ireland, 316
drug, 68, 71, 169, 271 Aro village, Nigeria, 31113
Adeniyi-Jones, Dr C. C., 302 Arrayagaray, L., 232
administrators, 159, 258, 337 Association of Medical Superintendents of
admissions, see connement American Institutes for the Insane, 254
adolescents, 76, 11314, 158, 163, 172; see Asuni, T., 310
also juveniles asylums, 5, 16, 27, 54, 63, 67, 84, 97, 112,
Afghan Wars, 276 1212, 129, 134, 145, 1506, 173, 178,
Afghanistan, 284 182, 197, 199, 200, 209, 211, 212, 260,
Africa, 300, 301 276, 277
British, 13, 24, 301 abuse within, 15, 220, 236
Agich, G., 158 accommodation, 27, 38, 105, 109, 153, 180,
Alabama, USA, 178 186, 187, 194, 203, 2589, 281, 287, 293,
alcoholics, 656, 68, 91, 92, 133, 163, 169, 318, 328, 330, 332
186, 232, 254, 258, 264, 266, 271 administration of, 12, 185, 323
alcoholism, 57, 73, 86, 90, 91, 92, 125, 161, African, 13, 297, 301
171, 252, 266, 26970, 277, 3267 alternatives to, 23, 24, 25, 28, 49, 51, 53, 76,
alienes, 65, 66, 80, 81; see also lunatics; 92, 348
insane; mad; patients American, 173, 191
alienists, 14, 35, 100, 124, 232, 305, 347; Arab, 273
British, 34, 341; see also psychiatrists; architecture of, 13, 54, 55, 64, 107, 108,
medical superintendents; asylum 175, 221, 229, 234, 237, 256, 257, 281,
doctors 287, 289, 305, 323
Alvarado, M., 255 Argentine, 231, 235, 236, 245
ambulances, 306 authorities, 13, 133, 1456, 182, 187, 251,
Amhertsberg, Ontario, 108 252, 260, 263, 271
Amritsar, India, 295 boards of governors, 320, 322, 323, 325
Anarkali, India, 280 British, 15, 41, 46, 124, 130, 282, 347, 348
anti-psychiatry, 4, 81, 83, 335 budgets, 82, 233, 243
anti-slavery, 180 charitable, 12, 239, 253
Argentina, 1112, 16, 39, 111, 22647, 261 for children, 234, 239

350
 Index 351

clothing, 147 permanent, 107

colonial, 22, 300, 313, 314 physical deterioration of, 13
commercial, 21517 provisions, 106
commissioners, 177 private, 47, 65, 97, 118, 145, 173, 185, 196,
conditions within, 160, 236, 249, 302, 203, 212, 213, 21517, 2214, 244, 246,
3034, 323 275, 298, 317, 332, 343, 347
construction of, 106, 107, 173, 180, 183, promoters, 101, 177, 178, 181
186, 202, 249, 250, 252, 254, 257, 319 provincial (France), 95, 96
corruption within, 220 public, 7, 15, 54, 55, 65, 76, 83, 97, 107,
county (England), 337, 344, 347, 348 108, 118, 150, 152, 173, 175, 178, 185,
criminal, 108 186, 201, 202, 203, 21217, 227, 238,
curative, 10, 11, 22, 108, 124, 173, 175, 244, 318, 320, 322, 328, 330, 332, 334,
176, 191, 236, 300, 306, 310 337, 340, 341, 349
custodial, 4, 11, 17, 43, 52, 96, 100, 129, public attitudes towards, 53, 96, 177, 226
131, 173, 174, 176, 188, 191, 192, 236, public condence in, 12
253, 263, 270, 286, 293, 301, 309 recovery rate in, 188
for dangerous patients, 44; see also reform of, 13, 14, 43, 51, 97, 131, 234, 240,
dangerousness 249, 299, 300, 306
development of, 96, 97, 98 regents, 178, 1801, 184
directors of, 233, 235, 238, 239, 240, 241, regulations, 258
260, 271; see also medical directors religious, 12
disciplinary problems in, 30 reports, 278, 280
as discipline and punishment, 16 rise of, i, 16, 101, 202, 209, 217, 2278, 334
district, 317 rural, 131, 151, 238
as dumping ground, 51, 99, 308 southern, 174
establishment of, 22, 239, 301 state, 25, 100, 173, 262, 317
French model of, 12 stigma of, 77
functioning of, 46 substitute (daiyo), Japan, 203, 212, 215,
history of, i, 45, 100, 103, 127, 129, 273, 221, 222
299 success of, 100
humanitarian reasons for, 180 temporary, 107, 130, 186
imbecile, 347, 349 as therapeutic resource, 22, 43, 44, 83, 85,
Indian, 14, 284, 286, 292, 293, 296, 298, 96, 176, 182, 183, 184, 242, 251, 253
301 as treatment facilities, 150, 300
inebriate, 125 under funding of, 12
Irish, 6, 323, 324, 326 under stafng of, 13, 190, 244, 249, 259,
Japanese, 15, 220 272, 282, 287
as medical institutions, 12, 96, 180 as an urban solution, 209
for men, 230 use of, 24, 25, 28, 37, 77, 83, 104, 105
Mexican, 262, 266 vacancy, 28
middle-class facilities in, 25 for women, 12, 229, 230, 234, 238, 239; see
multi-racial, 187 also colonies (medical)
negligence within, 220 asylums (branch), 108, 125
New York, 190 Asylums (state and charitable)
Nigerian, 14, 18, 300, 306, 309 Agra, India, 292, 293
Ontario, 17, 108 Aichi, Japan, 213
outside the, 103, 104 Alabama, USA, 255
overcrowding in, 11, 12, 13, 89, 95, 97, Antrim, Ireland, 323
98, 108, 186, 188, 190, 226, 232, 240, Amristar Mental Hospital, India, 14, 295
241, 243, 244, 249, 258, 272, 287, 303, Ararat, Australia, 1312, 141
321, 326, 330 Aro, Nigeria, 309
Parisian, 83, 85, 86, 92, 96 Ballinasloe, Ireland, 318
patient management within, 2545, 322 Beauport, Quebec, 102
patterns of use, 412, 50 Beechworth, Australia, 131
pauper, 43, 176 Bel-Air, Geneva, 8, 9, 5478
352 Index

Asylums (state and charitable) (cont.) Lantoro, Nigeria, 310

Belfast, 318, 319, 323 Leavesden, England, 349
Belle Epoque Asylum, Paris, 83 Lexington, Kentucky, USA, 173
Bethlem, London, 215, 289, 337 London, Ontario, 102, 103, 104, 108, 109,
Boland, South Africa, 46, 49 112, 118, 121, 124
British Columbia Provincial, Canada, 105, Madras, 275, 280
112 Masulipatanam, Madras, 275
Buckinghamshire, England, 3367, 339 Matsuzawa Hospital (Tokyo Metropolitan)
Calabar, Nigeria, 302, 303 Tokyo, Japan, 15, 196, 201, 209, 212,
Cape Town, South Africa, 8, 21 213, 221
Casa de Dementes, Argentina, 230, 233; see Maudsley Hospital, England, 287, 289, 311,
also Asylums, Hospicio de las Mercedes 312
Castle Hill, Australia, 130 Middlesex (Colney Hatch), England, 338
Caterham, England, 349 Middlesex (Hanwell), England, 338, 3412
Cery, Vaud, Switzerland, 8, 9, 5478 Mimico, Ontario, 125
Chittoor, Madras, 275 Montreal, 102
Colaba, Bombay, 275, 279 Moreton Bay, Australia, 130
Columbia, South Carolina, USA, 175, 187 Murshidabad, Bengal, India, 275
Connacht, Ireland, 317, 328 Nagpur, India, 293
Cork, Ireland, 318 National Hospital for the Female Insane
Dacca, Bengal, India, 275, 283 (Hospital Nacional de Alienadas),
Dalldorf, Germany, 151 Argentina, 1112, 22647
Delhi, 278, 280 New York, 255
Devon, England, 339, 341 Oliva, Cordoba, Argentina, 23940; see also
Divino Salvandor, Mexico, 253, 255, 257, colonies (medical)
264, 266, 268, 271 Orillia, Ontario, 108, 113
Ealing, England, 279 Osaka, Japan, 212
Eastern Virginia, USA, 181 Penetanguishene, Ontario, 125
Fort Beaufort, South Africa, 20, 48 Pennsylvania State, USA, 102, 112
Fort Malden, Ontario, 108 Petite Maison des alienes, Berne, 64
Fremantle, Australia, 131 Port Alfred, South Africa, 20
Fukuoka, Japan, 213 Port Elizabeth, South Africa, 23
General Insane Asylum, Mexico, 24872 Portrane, Ireland, 323
Grahamstown, South Africa, 20, 24, 25, 28, Ranchi, India, 286, 287, 290, 293
31, 32, 35, 37, 45, 48, 50 Pune, India, 296
Hamilton, Ontario, 9, 10528 Punjab, India, 293
Harrisburg, USA, 47 Rheinau, Zurich, 54
Herzberge, Germany, 152 Richmond, Dublin, 317, 322, 323, 326
Hospicio de las Mercedes (Hospice of the Robben Island, South Africa, see Robben
Virgin of Mercy), Argentina, 22647; see Island Asylum
also Asylums, Case de Dementes St Lukes Hospital, London, 215, 337
Hyogo, Japan, 205, 213 Sainte-Anne, Paris, 78, 8099
Illinois, USA, 255 San Hipolito, Mexico, 253, 257, 264, 266,
Iowa, USA, 255 271
Kagoshima, Japan, 213 San Francisco, 21, 37, 42, 51
Kanagawa, Japan, 213 Santa Fe, Argentina, 245
Karl-Bonhoeffer-Heilstatten, Germany, 153; Somerset Hospital, South Africa, 22, 23, 25,
see also Wittenauer Heilstatten 26, 28, 30, 36, 37, 42, 43, 46
Karl-Bonhoeffer-Nervenklinik(KBoN), South Carolina, USA, see South Carolina
Germany, 153, 155; see also Wittenauer State Asylum
Heilstatten State Park, South Carolina, 187
Kew, Australia, 1312, 141, 146 Staunton, Virginia, USA, 173
Kingston (Rockwood), Ontario, 105, 108, Thana, India, 293
114, 115, 124, 125 Tiruchirapalli, Madras, 275
Lancashire, England, 339 Toronto, Ontario, 9, 10328
 Index 353

Toyama Hospital for Lunatics, Japan, 215 relationships with patients, 268, 282
University of Toronto, Ontario, 108 visiting, 322
Valkenberg, South Africa, 20, 25, 26, 35, see also asylum superintendents; medical
37, 38, 48, 50 practitioners; medical superintendents
Vaucluse, Paris, 88, 96 asylum inspectors, 132, 324, 347; see also
Ville-Evrard, Paris, 82, 85, 96 lunacy, inspectors
Villejuif, Parise, 93 asylum keepers, 23, 179, 275, 337, 339
Wittenauer Heilstatten, Germany, see assistant, 29
separate entry see also asylum attendants; medical keepers
Woogaroo, Queensland, 130 asylum management, 15, 107, 131, 133
Worcester, Massachusetts, USA, 173 asylum managers, 322, 337
Wuhlgarten, Germany, 152 asylum ofcials, 95, 181
Yaba, Lagos, 302, 309 asylum patients, see patients
Yarra Bend, Australia, 1312, 137, 139, asylum population, 6, 7, 8, 14, 15, 16, 22, 23,
140, 144, 146 51, 55, 83, 118, 126, 135, 150, 194, 201,
York Retreat, England, 47, 102, 175 204, 207, 209, 212, 226, 236, 260, 262,
Asylums (private), 17, 25, 26, 54, 97, 152 264, 282, 289, 296, 324
Ahmedabad, India, 281 gender ratios, 37, 38, 55
Aoyama Brain Hospital, Japan, 202 asylum segregation, 38, 236, 242
Bangalore, India, 281, 282, 287, 288 by behavioural criteria, 237
Bethnal Green, England, 340, 3412, 343 by diagnosis, 237, 242, 256
Bombay, 275, 281 by disease, 242
Calcutta, 275 by gender, 229, 258, 263
Cremorne, Australia, 145 by race, 289
Homewood, Guelph, Ontario, 102, 118 see also racial segregation
House of Lunatics (Maison des alienes), asylum superintendents, 105, 107, 114, 131,
Switzerland, 64, 65 139, 184, 278, 281
Hoxton, England, 343, 344 deputy, 279
Iwakura Hospital, Kyoto, Japan, 15 Irish, 330
Kyoto Private Mental Hospital (Kawagoe see also medical superintendents; asylum
Hospital), Kyoto, Japan, 212 doctors; alienists; psychiatrists
Miss Durrs, Mowbray, South Africa, 26 asylum staff, 10, 77, 229, 234, 237, 243, 249,
Oji Brain Hospital, Takinogawa, Japan, 196, 251, 271, 276, 289, 306, 31011, 340
197, 2204 Australia, 5, 16, 18, 24, 39, 110, 111, 12948,
Peckham, England, 344 227, 294, 297
Poona, India, 281 colonies of, 129, 131
Tokyo Brain Hospital, Tokyo, 213 Australian Medical Journal, 130, 137, 138,
Tokyo Mental Hospital, Tokyo, 213, 215 144
asylum admissions, see connement Ayurvedic medical practices, 14, 290, 296
asylum attendants, 32, 94, 180, 182, 183,
1901, 243, 258, 25960, 310 Babcock, J. W., 187
female, 138, 143 Bangalore, India, 276, 289, 290, 296
see also nurses; asylum keepers barracks, 279
asylum committals, see connement Bartlett, S., 343
asylum doctors, 7, 33, 35, 81, 82, 84, 85, 86, Beck, Dr, 25
89, 91, 92, 93, 94, 96, 98, 101, 131, 137, Beckett, W. a, 133
154, 188, 1901, 195, 203, 209, 227, 232, beggars, 64
234, 236, 240, 241, 243, 244, 251, 252, Belfast, 319
258, 26470, 2712, 294, 340 Belfast Police Barracks, 143
British, 349 Bengal, 287
Indian, 292 Berhampore, India, 298
Irish, 329 Berlin, 10, 74, 149, 150, 153, 166, 170
murders of, 242 Berlin University, 151
pressures on, 7 Berne, 64, 74
professional status of, 84 Bhore Committee, India, 293, 295
354 Index

Bible, 32, 142 Confederation of (British North America

Biccard, Dr, 32 Act of), 101, 105, 108, 110
Bihar, India, 287 French society in, 102
Birmingham, G. A., 315, 317, 324, 332 Parliament of, 110
Birtwhistle, Dr, 36, 42 Tory politicians, 103, 107
Black Creek, Victoria, Australia, 146 Cape Argus, South Africa, 26
Blair, C., 3045 Cape Colony, South Africa, 2053, 134
Blease, Gov. C., 187 asylums (general), 21, 25, 26, 27, 31, 33, 51
blind, the, 141 gender ratio, 26, 38
Blume, G., 149 mainland asylums, 50, 51
Board of Commissioners, 1078 race ratio, 26
Board of Guardians, England, 339 Cape Town, South Africa, 8, 2053
Board of Inspectors of Prisons and Asylums, cardiac arrest, 166
108 Carothers, J. C., 303, 334
Board of Regents, 177 Cellard, A., 101, 102
boarders, 114 Central Sanitary Bureau (CSB), Ministry of
voluntary, 26 Home Affairs, Japan, 195, 201, 202, 204,
boarding houses, 185 205
informal, 26 certication, see insanity, certication of
private, 15, 20, 173 Ceylon, India, 287
boarding out, 24, 25, 26, 93, 106, 178, 328, 339 chaplains, 303, 36
Borda, J. T., 231 charity, 296
Boroffka, A., 309 religious, 53
Bosch, G., JA vertical, 24
Bow, 343 Charleston, South Carolina, 182, 185
Brahmins, India, 296 Chief Commissioner of Police, Victoria,
brain damage, 346 Australia, 138, 139, 1456
Brandenburg, Germany, 167 children, 10, 41, 94, 108, 113, 141, 146, 161,
Briand, M., 83, 84 169, 172, 230, 261, 264, 270
Britain, 3, 18, 20, 21, 31, 33, 97, 100, 107, church, 32, 53
111, 227, 236, 295, 299, 306, 312, 329 Civil War (American), 11, 17, 175, 178, 181,
asylums in, 42 183, 184, 1867, 188, 191
racism within, 39 classication department, 256
British Columbia, 103 Clemenceau, G., 226
British Isles, 129 clergymen, 325, 332
British Medical Journal, 315 clinics (out-patient), 77, 158, 160, 237, 328
British Medico-Psychological Association, free, 88
321, 326, 330 Lavista, Mexico, 261
Brown, R. C., 303, 306, 309 coercion, 181
Browne, T. B., 302 cold showers, 181
Buch, Germany, 152 seclusion, 181, 189
Bucke, M., 102 see also restraints, mechanical
Buenos Aires, Argentina, 227, 235, 238 Collingwood, Victoria, Australia, 146
Gran Buenos Aires, 238 Collins, D., 129
Public Assistance Department, 235 colonial government, 8
Burdett, H. C., 3201, 323, 324, 330 colonial institutions, 298, 299, 300, 308, 334
Byas, E., 343 colonial medicine, 148, 296, 299, 313
Colonial Ofce, Nigeria, 306
Cabred, D., 2359, 240, 242, 246 colonial ofcials, 300, 302
cages (sashiko), 197, 200, 202, 209 colonial policy, 13, 14, 51, 300, 304, 309, 313
Calcutta, 274, 282 Colonial Secretary, South Africa, 28, 42
California, 104, 111, 262 colonialism, 13, 14, 1718, 299, 301, 304,
Calles, P. E., 251, 271 306, 307, 312, 313, 330
Canada, 9, 10028, 227, 232, 297 medicine as, 1719
census of, 118 psychiatry as, 17
 Index 355

colonies (medical) Indian, 273

agricultural, 96, 97 inequalities in, 38
Co-ed Regional Colony Asylum for the involuntary, 77
Insane, Oliva, Cordoba, Argentina, by judicial ofcials, 66, 6971, 80
2401 legislation of, 6, 9, 30
Geel, Beligium, 312 level of curability, 64
leper, 306 medical motivations of, 72, 89
for the mentally retarded, Argentina, 239 migration and, 120
psychiatric, 15 motivations behind, 34, 63, 679, 72, 77,
rural, 238 104
small, 151 negotiation by patients, 144
village, 280 ofcial (placement dofce), 80, 81, 84,
see also asylums 85, 91
Colonies non-criminal, 36
National Colony for Insane Men (Colonia origins of, i
Nacional de Alienadas), Argentina, 226, of patients, 6972
23840, 258 patterns of, 910, 11, 13, 14, 21, 40,
see also Asylums (state and charitable) 41, 86
Columbia, South Carolina, 187 by petition, 107
Commissioners of Lunacy, Nigeria, 305 by prefecture, 203
committals, see connement pressures for, 22, 23, 63
community assistance programmes, 53 procedures of, 13, 16, 223, 29, 30, 40,
community care, 15, 104, 225, 280, 295, 298, 63, 81, 84, 85, 86, 167, 249, 300,
313 324, 325
connement, 78, 9, 10, 16, 27, 28, 37, 55, 64, processes of, 307
667, 73, 75, 104, 105, 106, 108, 116, for protection, 73, 76
129, 136, 137, 139, 178, 195, 204, 236, provisional, 67
279, 280, 286, 299, 315 public authorities and, 12, 57, 65, 182
by administrative ofcials, 66 public control of, 201
admission volontaire (Switzerland), 66 for punishment, 5564, 81
age of patients, 412, 52, 163, 170 race as a factor of, 135
applications for, 24, 29, 45, 126, 178 rates, 22, 38, 86, 201, 207, 294, 332, 345
authorization of, 65 rates of Irish in, 316, 317, 318, 325, 326,
behaviour leading to, 7, 76, 134, 135, 141, 327, 32833
145, 2613, 264, 270, 309, 324 ratios, 38
categories of, 22, 23, 29 readmission, 82, 90, 93
criteria for, 5478, 120, 239 records, 7
by coercion, 50 by region, 108
conditions of, 63, 160 registers, 13, 22, 30, 31, 34, 40, 88, 115,
cultural factors affecting, 3940, 53 196, 249, 282
department of admissions for, 256 regulation of, 201
diagnoses, 89 for rehabilitation, 64, 251
diagnostic terms, 22 requests, 67, 76, 77
economic factors leading to, 48, 150, 332 requests by administrative authorities, 69
emergency, 67 requests by judicial authorities, 69, 71
in France, 7 requests by medical profession, 77
free, 67, 84 requests by patients, 69, 71
forces driving, 16, 48, 76, 84, 1045, 122, requests by political authorities, 69
127 religion as a factor in, 279
gender differences in, 5, 7, 12, 13, 44, 86, role of asylum authorities in, 6, 63
110, 114, 115, 117, 125, 126, 127, 140 role of criminal justice system in, 24,
gendered, 135 5564, 129
within a global context, i role of communities in, i, 41, 51, 145,
by government order, 13 2513, 309
history of, 249 role of employers in, 24, 87
356 Index

connement (cont.) dangerousness, 49, 68, 132, 134, 137, 340

role of family in, i, 4, 5, 6, 7, 12, 13, 14, 16, as admission criteria, 2930, 52, 63, 64, 68,
24, 28, 39, 42, 456, 51, 72, 79, 80, 81, 76, 77, 91, 109, 170
85, 86, 89, 92, 95, 102, 105, 1223, 129, assessment of, 29, 30, 50, 96, 133, 134, 141
137, 140, 141, 1457, 178, 182, 195, 252, gender ratios of, 31, 44
261, 270, 307, 308, 316, 324, 325, 330, racial stereotypes of, 31, 144
332, 349 see also patients, dangerous
role of friends in, 81, 137, 140, 145, 146, Das, Dr B., 292, 293
324, 325 Davis, J., 181
role of medical practitioners in, i, 51, 63, Dawson, W. R., 326
689, 203, 316, 330, 332 deaf, the, 141
role of neighbours in, 324 Deakin, Dr., 285
role of police in, 56, 13, 15, 16, 21, 39, 65, decarceration, 98
80, 81, 84, 86, 87, 90, 111, 129, 1323, deinstitutionalization, 313
140, 210, 261, 307, 31516, 325, 332 De La Barra, 257
role of psychiatric profession in, 4, 85 Delhi, India, 279, 295
role of religion in, 146 delirium, 71
role of strangers in, 307 delirium tremens, 36, 277
sentence of, 325 delusions, 25, 26, 29, 345, 141, 142, 157
social characteristics of, 7, 21, 105 chronic, 290
social class inuencing, 44, 127 content of, 345, 89
social factors leading to, 48, 72, 91, jealous, 157
326, 332 megalomania, 157
social history of, 15, 193 paranoid, 157
state agents, 13, 16, 251, 252, 261, Del Valle, J. P., 257
270, 330 dementia, 33, 34, 41, 49, 50, 265, 291, 347
stigma of, 37, 40, 44, 66 acute, 290
for therapeutic measures, 76, 81 chronic, 290
voluntary (placement volontaire), France, epileptic, 291
4, 12, 80, 81, 82, 83, 84, 85, 86, 88, 89, senile, 93, 95, 346
91, 92, 95, 97, 98 democracy, 156
voluntary,1458, 53, 667, 72, 78, 328 Department of Justice and Police, Geneva, 9,
Connacht, Ireland, 317, 318, 319 68, 72
Conolly, J., 262 Department of Hospitals for the Insane,
Connolly, V., 275 Australia, 138
Contreras, J. P., 255 Department of Hygiene and Public Assistance
convicts, 130, 131 Switzerland
labour, 51, 186, 231 Department of the Interior, Lausanne,
Cordoba, Argentina, 23940 Switzerland, 9
cottage system, 238 departement of the Seine, France, 7, 80, 81,
Council of Public Buildings, Mexico, 257 82, 86, 95, 97, 257
Court of Chancery, 109 admissions ofce of, 7, 80, 81, 83
Coyoacan, Mexico, 261 depots (police detention cells) France, 80, 84
Crespo, E., 246 depression, 34, 40, 71, 86, 89, 91, 93, 95, 280;
Crimean War, 276, 284 see also melancholia
criminal justice system, 52, 126 De Montyel, M., 82
criminals, 254, 324; see also patients, criminal De Rosas, J. M., 2278
Cubbon, M., 277 destitute, 133
custodian, 199, 203 Detroit, Michigan, 110
house of, 199 deviance, 31
deviants, 3, 302
Daiunji Temple, Iwakura, Japan, 213 sexual behaviour of, 35
Dalrymple-Champneys, Dr, 294 Devon, England, 338, 339, 348
Dalton, J., 275 diagnosis, 7, 40, 90, 15960, 170, 252,
dangerous lunatic warrants, 109 26370, 271, 287
 Index 357

by family, 7, 79, 102, 104, 265, 269 El Manicomio (The Insane Asylum), Mexico,
gendered, 7, 86, 161, 163 254
of injuries, 161 emigration, 3267
and length of stays, 50, 89, 90, 92 employers, 24
mis-, 256 England and Wales, 26, 28, 29, 36, 103, 131,
by neighbours, 79, 261 193, 199, 213, 239, 262, 275, 286, 288,
by non-medical authorities, 7, 79 289, 294, 297, 303, 311, 322, 324, 330,
patterns of, 37, 48, 292 33449
by police, 204, 265 Lancet Commission, 341
procedures, 170 Lunacy Commission, 14, 339, 340, 346,
by psychiatrists, 79, 249, 25872 349
racialized, 39, 40, 144 Lunacy Commissioners, 335, 339, 340, 342,
Diagnostic and Statistical Manual of the 347
American Psychiatric Association, 158 Metropolitan Asylums Board, 349
diagnostic categories, 300 Metropolitan Common Poor Fund, 345, 346
diagnostic classication systems, 158, 1823, epidemics, 231, 234
276, 291 epileptics, 656, 152, 165, 171, 182, 186, 188,
Reichsirrenstatistik, 158 258, 264, 269, 346
Wurzburger Schlussel, 1589, 170 epilepsy, 24, 30, 34, 36, 140, 172, 252, 264,
Daz, General Porrio, 1213, 248, 253 269, 2901
Daz, P. Jr, 257 Esteves, Dr, 242
Dick, W., 275 eugenics, 246, 266, 316
disabled, 64 euthanasia units, 165, 168
disadvantaged, 18
discharge, 14, 46, 478, 50, 90, 94, 98, 124, Fabian, 1
125, 159, 16570, 183, 195, 203, 291, Falconer, J., 137
326, 337, 340 families
petitions for, 309 aiding in treatment, 14, 93, 98, 102, 311
pressure from patients for, 93 better class of, 43
process of, 300, 307 black, 44
trial leaves, 934, 98, 138 as carers, 42, 74, 98, 105, 106, 151, 152,
disease 165, 198, 211, 217, 280
addictive, 161 circumstances of, 37, 116, 1223, 169
brain, 161, 170, 346 dening insanity, 102, 109, 252
infectious, 241 general, 82, 93, 99, 105, 120, 145, 148, 154,
organic, 161, 166, 297 177, 178, 193, 225, 336, 349
dispensaries, 277, 306, 325 household of, 122; see also home care
doctors, see asylum doctors; medical lack of, 120, 263
practitioners mediating treatment, 5, 84, 92, 97, 105,
domestic service, 118 348
DOrta, G., 274 motives of, 85, 111, 210, 211
Dresden, Germany, 151 negotiating release, 33, 85, 924, 96, 97,
Dublin, 6, 319, 326 262, 308
Dublin Castle, Ireland, 3201, 324 paying for asylum treatment, 11617, 174,
dumb, the, 141 185
Dunolly, Australia, 144 social class, 38, 51, 88
dysentery, 277 as support networks, 23, 24, 52, 53, 87, 115,
238, 280, 336
East India Company, 274, 275, 297, 342 use of asylums by, 91, 97, 98, 104, 105, 178,
doctors, 2823 241, 252, 263
Echegaray, S., 257 see also connement, role of family
Edmunds, Dr, 24, 43, 45 Febvre, Dr, 85
elderly, 42, 105, 114, 161, 336, 347; see also feeble-minded, 164, 188; see also idiots;
patients, elderly imbeciles; mentally handicapped;
El-Mahi, Dr T., 312 mentally retarded
358 Index

feeble-mindedness Hall, Dr, 29

congenital, 169 hallucinations, 74
see also idiocy; imbecility; mental Hamilton, Ontario, 110, 115
retardation Hamilton, W., 274
feminists, 127 Hatchell, Dr G, 322
Florida, USA, 178 Haussman, Baron, G.-E., 257
Forel, August, 77 Heales, G. B., 137
Foucault, M., 23, 4, 5, 7, 8, 16, 101, 102, 299, Henderson, Dr, 281
313, 3346 hepatitis, 277
France, 64, 8099, 110, 226, 231, 253 heredity, 300, 326, 328
Frankel, Dr, 36 hereditary diseases, 168
Freetown, Nigeria, 310 Hewlett, T., 137
Freud, S., 2, 331 Hill, A. V., 294, 297
Fulford, Dr, 158 Hill, Col. B., 286
Hirohito, Emperor, 205, 207
gaoler, 145 Hiroshima, 205
gaols, 24, 28, 52, 106, 109, 1256, 130, 134, Hobart, Tasmania, Australia, 131
141, 248, 251, 258, 295, 296 Hoenigberger, Dr, 275, 279
admissions from, 8, 21, 23, 109 Holborn, London, 338
Cape Town, South Africa, 28 Holland, 311
connement in, 129 Holmstead, Dr, 281
discharge of, 130 Home, B., 303, 3056, 313
inmates in, 8, 22, 26, 28 home care, 15, 20, 22, 23, 25, 37, 44, 53, 92,
wardens, 106 96, 98, 122, 167, 185, 197, 204, 209, 217,
see also, prisons 280, 295, 308
Gaols home-custody, 197, 198, 201, 207, 20910,
Geelong, Australia, 140 21112, 217
Pentridge, Australia, 141 rural solution of, 209
York (Toronto), 106, 107 homes for the aged, 125
see also Prisons hospice, 64, 84
Garnier, P., 85 hospitals, 84, 89, 92, 1513, 1678, 176, 188,
Gathorne-Hardy, Mr, 347 245, 292, 295, 296, 302
general paralysis of the insane, 856, 889, 90, auxiliary, 237, 238
91, 93, 347; see also progressive general, 51, 57, 165, 167, 185, 277
paralysis; syphilis maternity, 277
Geneva, 9, 54, 63, 64, 65, 66, 67, 68 mental, see asylums
Georgia, USA, 178 mental wards of, 199, 288, 298, 3312
German Empire, 150, 152 metropolitan, 240
Germany, 16, 14970, 198, 209, 227, 238, pediatric, 270
239, 289 Portuguese, 274
constitution of, 152 psychopathic, 237
Federal Republic of, 152 railway, 277
Weimar Republic, 10, 1556, 158 rural, 243, 270
Ghana, 312 state, 186
Gilman, S., 4 teaching, 7, 54, 55, 237
Gimenez, A. M., 245 voluntary, 337
Gipps Street Wesleyan Church, Victoria, Hospitals
Australia, 146 Abeokuta General Hospital, Nigeria, 311
Govindswamy, Dr M. V., 289, 290, 292 Grand Hopital, Lausanne, Switzerland, 64
great connement, 3, 8, 16, 51, 194, Hospital for Peons, Paupers and Soldiers,
217 India, 278, 296
great famine, 121, 318, 332 Maison de Discipline de lHopital General,
Greenlees, Dr, 35 Geneva, 64
Griesinger, W., 151 University of Tokyo Hospital, 221
Gross, Dr W. M., 289, 290 hospitals (psychiatric), see asylums
 Index 359

hot springs, 213 industrial schools, 141

Houses of Correction, 106 Inrmerie speciales, France, 801, 845
Cape Town, South Africa, 28 inmates, see patients
houses of industry, 113, 114, 125 insane, i, 106, 126, 193, 205, 217, 226, 234,
houses of refuge, 114, 125 254, 324
Hunt, E., 137 acute, 186
Hyderabad, India, 295 administration of, 301, 334
hysteria, 24 African, 24
behavioural disturbances, 29, 30, 34
idiocy, 33, 34, 41, 46, 49, 113, 170, 265, blacks, 27, 178
2901; see also imbecility; certied as, 28, 80, 131
feeble-mindedness; mental retardation chronic, 345
idiots, 8, 108, 113, 182, 186, 188, 25872, colonial, 20
301, 343, 344, 346 connement of, 24, 105, 106, 199, 299, 316,
dangerous, 325 349
mongolian, 144 criminal, 21, 38, 49, 103, 109, 188
see also imbeciles; feeble-minded; mental dangerous, 8, 20, 21, 25, 34, 51, 109,
defectives; mentally handicapped; 203
mentally retarded foreigners, 39
Illustrated Melbourne Post, 131 history of the, 129
Illustrated Sydney News, 130 identication of, 23, 27
imbecility, 33, 34, 412, 49, 50, 170, 265; see male, 26
also idiocy; feeble-mindedness; mental management of the, 116, 197
retardation as other, 4
imbeciles, 25, 40, 108, 186, 264, 280, 341, paupers, 344
346; see also idiots; mental defectives; poor, 106, 177
feeble-minded; mentally handicapped; population, 20
mentally retarded propertied, 26
immigrants, 41, 53, 119, 120, 182, 234, 254 responsibility of community for, 24
British, 43 responsibility of the state for, 24
European, 23, 43, 170 as self, 4
female, 237 threatening, 8
insane, 231 wealthy, 25
Irish, 120, 182 white, 20, 26, 27
male, 232 see also lunatics; alienes; mad; patients
Scottish, 120, 122 insanity
viewed as defective, 12 among convicts, 24, 129, 147
immigration, 104, 120, 127, 227, 228, 234 black, 40
imperialism, 17 certication of, 16, 106, 108, 109, 147
and Western psychiatry, 17 classications of, 33, 302
incarceration, 16; see also connement denitions of, 6, 313, 34, 130, 136, 137,
incurables, 64; see also patients 307, 346
India, 14, 28, 50, 27398 epistemological status of, 2
All India Institute for Mental Health, 290 etiologies, see insanity aetiologies
Bhore Committee, India, 293, 295 experiences of, 6
census of, 285 familial responses to, 79
Governor General of, 285 female, 35, 51
Hemp Commission, 292 gendered meaning of, 51
Mapother Report, 2878, 293 general, 49, 300
Medical Service, 281 history of, 174, 308, 334
Moore Taylor Report, 293 medical diagnoses of, 32, 335, 232
Psychiatric Society, 293 moral, 252, 268, 271, 282
Indian Medical Service, 281 partial, 29; see also monomania
Indian Mutiny, 276 policies towards, 129
Indian Psychiatric Society, 293 religious denitions of, 323
360 Index

insanity (cont.) Tokugawa Shogunate, 198, 213

scientic diagnoses of, 34 Japanese Association of Psychiatrists, 203
social class meaning of, 51 Japanese Association of Public and Substitute
social denitions of, 32, 33 Mental Hospital, 222
social explanation of, 35, 232 Jones, K., 335
syphilis-related etiologies, 10 Journal of Mental Science, 284
temporary, 33 Justices of the Peace, 73, 74, 75, 137, 339
white, 40 juveniles, 161
see also lunacy; madness; mental illness reformatories, 113, 125
insanity aetiologies (causes), 35, 36, 40, 137, see also adolescents
140
age-related etiologies, 41 Kanagawa, Japan, 15
alcoholism as cause of, 36, 77 Kano, Nigeria, 303
hereditary etiologies of, 27, 35, 36, 52, 158, Kashida, G., 201
326 Kenderline, G. M., 274
moral etiologies of, 35, 280 Kentucky, USA, 173
organic etiologies of, 283, 284, 2901 Khartoum, 312
physical etiologies of, 33, 35, 280, 282 King, Sgt, 143
physiological etiologies of, 35, 284 Kingston, Ontario, 110
popular etiologies of, 33 King Williams Town, South Africa, 15, 42
racialized etiologies of, 31, 389, 40, 51, Kirkbride, T., 102
232 Kissy, Sierra Leone, 301
somatic etiologies, 188 Kroll, J., 3
institutional care, see asylums Komine, Dr K., 196, 221
institutionalisation, see connement Komine, S., 221
institutions, see asylums Komine, Z., 221
intemperance, 326 Komine Research Institute for the History of
Ireland, 6, 16, 20, 104, 139, 142, 261, 262, Psychiatry, Japan, 196, 221
31533 Kovalesky, Dr, 238
Irish Free State, 328; see also Irish Republic Kraepelin, E., 266
local councils, 323, 324 Kure, S., 201, 203, 209, 211, 21720
Northern Ireland, 328 Kyoto, Japan, 15, 205, 212, 213
population of, 318, 330
rural, 329, 332 labour, 230
Irish Republic, 324, 328, 332 Ladies Benevolent Society, 146
Islamic societies, 296 Laehr, Dr. H., 151
Italy, 194, 231, 286 Lagos, 309, 310
Iwate, Japan, 205 Lagos Medical Service, 302
Lahore, 279, 293
jails, see gaols; prisons Lambo, Mr, 31113, 334
Jama Masjid, India, 279 Lancaster, England, 104
Jamnagar, India, 295 Lancet, the, 341, 347
Japan, 15, 193225 Lancet Commission, England, 341
Annual Reports of the Department of Lausanne, 9, 55, 61
Hygiene, 195, 204, 223 legal systems, 29
Association of Psychiatrists, 203 legislation, 9, 30, 65, 66, 105, 129, 130, 131,
Association of Public and Substitute Mental 132, 325, 332
Hospital, 222 Legislation
Edo period (16031867), 197, 198, 213 Act (1879), South Africa, 49
House of Commons, 201 Act (1891), South Africa, 31
Komine Research Institute for the History of Act (1897), South Africa, 26
Psychiatry, 196, 221 An Act to Authorize the Connement of
Metropolitan Police, 204, 215 Lunatics in Cases where their being at
Ministry of Health and Welfare, 195 Large may be Dangerous to the Public
National Institute of Mental Hygiene, 194 (1851), Upper Canada, 109
 Index 361

An Act to Authorize the Erection of an identication of, 122, 147

Asylum within this Province for the inspectors, 3212, 325, 326; see also
Reception of Insane and Lunatic Persons asylum inspectors
(1839), Upper Canada, 107 laws, 134; see also legislation
Act for the Better Management of the as a medical problem, 136
Provincial Lunatic Asylum (1853), Upper policy, 299
Canada, 108 popular conceptions of, 135
Asylums (Wynns) Act (1808), England, see also insanity; madness; mental illness
337 lunacy committal, see connement
Berlin Hospital Law, 157 lunacy incarceration, see connement
Colonial Development Act (1929), Nigeria, Lunacy Panic, 28
306 lunacy reform, 103
Dangerous Lunatics Act (1838 and 1867), lunatics, 8, 27, 28, 64, 66, 68, 139, 182, 197,
Ireland, 324, 325, 328 210
Dangerous Lunatics Act of (1843), arrest of, 137
Australia, 132, 137 beneciary, 1856; see also lunatics,
Data protection law, Germany, 150 pauper
Loi sur le placement et la surveillance des better class of, 25, 40
alienes (1838), Geneva, 64 black, 8, 22, 40
Indian Mental Health Act (1987), 298 categories of, 656
Lunacy Ordinance (1906), Nigeria, 301 certication of, 130, 316
Lunacy Statute (1867), Victoria, Australia., civil, 303, 309
132, 134, 136, 138, 139, 140 convict, 44
Lunatics Act (1845), England and Wales, criminal, 28, 31, 50, 51, 65, 130, 202, 303
335, 337, 342, 344 custody of, 198, 200, 203
Lunatics Amendment Act (1853), England dangerous, 31, 64, 109, 130, 198, 2012,
and Wales, 345, 346 325
Mental Hospitals Act (1919), Japan, 193, denition of, 148, 301
196, 201, 202, 204, 209, 212, 217, 221, educated, 43
224 escape of, 1412
Mental Hygiene Act (1950), Japan, 224 estates of, 130
Mental Patients Custody Act (1900), Japan, European, 289
193, 196, 197, 199, 2001, 202, 204, 210, female, 138, 142, 289, 302
217, 220, 224 gaoled, 130
Mental Treatment Act (1945), England and harmless, 303
Wales, 328 identication of, 139, 148
Metropolitan Poor Act (1867), England and identity of, 132
Wales, 346, 349 location of, 146
Poverty Law, Germany, 150 male, 1412, 302
Union Chargeability Act (1865), England management of, 138
and Wales, 345, 346 middle-class, 9
Leicestershire, England, 339 mixed-race, 40, 53
Leighton, A., 312 noisy, 30
Leinster, Ireland, 318 non-violent, 24
lethargy, 33 ordinary, 21, 28, 31
London, England, 14, 18, 215, 287, 289, 336, outdoor, 27
338, 339, 340, 341, 343, 344, 346 pauper, 9, 10, 42, 54, 296, 317, 320, 325,
London, Ontario, Canada, 110 339; see also lunatics, beneciary
Lovaway, Dr, 31516, 3256, 3289 paying, 40
lunacy, 129, 133 population of, 23, 26, 28
board, 285 provisions for, 26
certication of, 122 regulation of, 198
and criminality, 103, 130, 139, 148, 266, slaves, 17, 180
324 transporting, 143, 148, 325
as a criminal offence, 135, 142 troublesome, 296
362 Index

lunatics (cont.) Maryborough, Australia, 144

vagabonds, 296 Massachusetts, 173
violent, 1978, 303 Master-in-Lunacy, 145
white, 36, 43 masturbation, 33
see also insane; mad; alienes; patients Matsuzawa, Japan, 212
lunatic asylums, see asylums McCartney, G., 275
lung infections, 166 McDowall, Dr. T. W., 285
Lunier, L., 83 Media Luna (Half-Moon), Argentina, 242
Lycee Louis-le-Grand, 88 medical board, 28
medical care, 51, 199
Macedo, M., 257 medical casebooks, 132, 139, 141
Macquarie, L., 130 medical certicates of insanity, 33, 67, 68, 69,
mad, the, 18, 336 71, 72, 75, 90, 91, 93, 137, 140, 302, 316,
management of, 5 325
see also insane; lunatics; patients; alienes improper, 199
mad doctors, 334; see also alienists; see also insanity, certication of
psychiatrists; asylum doctors medical colleges, India, 275, 296, 298
madhouses, 3, 130, 181, 215, 298, 315, 321, medical directors, 258; see also asylums,
337, 343, 348, 349 directors
Daltons, India, 275; see also asylums, medical examinations, 304
private medical history, 100, 102, 103, 159, 196
madness, 22, 83, 292 medical journals, 1323, 201, 242
biological basis of, 3, 127 medical keepers, 145; see also asylum
as demonic possession, 3 keepers; asylum attendants
diagnosis of, 83, 135 medical ofcers, 182, 309, 311, 325
history of, 2, 14, 100, 101, 103, 105 resident, 54
life stories of, 197 see also asylum doctors; asylum
meaning of, 6, 127 superintendents
medicalization of, 6, 66, 79, 80, 104, 2012 medical practices, 51, 101, 129, 159
responses to, 103 medical practitioners, 2, 7, 16, 25, 27, 28,
within a Platonic philosophy, 2 88, 109, 127, 132, 137, 1434, 151,
see also insanity; lunacy; mental illness 157, 178, 181, 190, 200, 205, 212,
Madras, 275 233, 239, 245, 247, 255, 295, 321,
magistrates, 134, 135, 1434, 151, 301, 324, 325, 336
325, 332, 33940, 341, 344, 345, 348; see drug-addicted, 169
also Justices of the Peace European, 296
Magnan, V., 7, 80, 83 private, 25, 106
maisons de sante, 92, 96 public health, 230
Malawi, 51 unqualied, 201
Malays, 25, 35 medical prejudices, 51
delusions of, 35 medical procedures, 133
doctors, 24 medical profession, 51, 79, 100, 106, 322, 326,
malnutrition, 167 330
Mandela, N., 301 medical professionals, 246
mania, 33, 34, 36, 49, 91, 1401, 144, medical students, 211
291 medical superintendents, 124, 186, 294, 321,
acute, 141, 280, 284, 2901 322, 328, 345
chronic, 25, 283, 290 assistants, 322
longa, 2901 see also asylum superintendents; asylum;
opiomania, 74 doctors; psychiatrists; alienists
puerperal, 141 medical supervisors, 302
religious, 32 medical testimony, 29
Manning, Gov. R., 191 medical treatments, 278
Mapother Report, India, 2878, 293 with alcohol, 36
Mapother, E., 2878, 290 Dr Forsyths Chemic Health Restorer, 24
Marie, Dr, 93 patents, 24
 Index 363

medicine, 296 mentally retarded, 41, 75, 226; see also idiots;
British, 297 imbeciles; mentally handicapped;
history of, i, 125, 126, 127 feeble-minded
traditional Indian, 296 Mexico, 12, 16, 24872
Meiji Restoration (Japan), 15, 193, 198 constitution, 250
melancholia, 33, 34, 401, 489, 50, 140, 290, Ministry of Interior, 257
291; see also depression Porrian regime, 249, 253, 254, 256, 258,
Melbourne, Australia, 131, 142 261, 264, 266, 268, 26970, 271
Melendez, L., 236 Public Welfare Administration, 254, 256,
meliorists, 4, 100, 101 258, 259
men, 114, 133, 135, 138, 140, 2513, 254; revolution, 1213, 248, 249, 250, 258, 263,
see also insane, male 264, 266, 26970, 271, 272
mental defectives, 184, 234; see also idiots; see also Daz, General Porrio
imbeciles; feeble-minded Mexico City, 13, 250, 253, 260, 261, 262, 263
mental deciency, 34, 325; see also idiocy; medical journals, 255
imbecility; feeble-mindedness; mental Micale, M. S., 3
retardation middle class, 51
mental disability, 33, 265; see also idiocy; Middle East, 231
imbecility; feeble-mindedness Middlesex, England, 345, 348
mental disorders, 160, 207 Midlands, England, 338
age-related, 161, 163, 171 midwives, 306
see also mental illness; psychological migration, 104, 120, 241
disorders; lunacy; madness of families, 120
mental health of patients, 120
services, 14 Minto, Mr, 43
indigenous practices of, 14 Mitter, Dr R. C., 284
mental illness, 65, 67, 78, 87, 91, 127, Mixcoac, Mexico, 248
232, 273 monomania, 29
aetiology of, 2 monomaniacs
characteristics of, 251 arson, 202
class understandings of, 13 dangerous, 202
community denitions of, 51, 94, criminal, 202
104 homicidal, 202
gendered understandings of, 13, rape, 202
140 theft, 202
marital status, 42 Montreal, 110
myth of, 2 Moore Taylor Report, India, 293
rates of, 326 moral management, 8, 22
stigma of, 295, 304 Moreno, S. R., 260, 261
see also insanity; lunacy; madness mosques, 296
mental institutions, see asylums Mott, Dr, 289
mental retardation, 252, 265; see also idiocy; Mowbray, South Africa, 26
imbecility; feeble-mindedness Munster, Ireland, 319
mentally disabled, 656, 161, 165 Muslims, 23, 35, 53, 273, 282, 291
mentally disordered, 194; see also lunatics; burial practices of, 35
insane; mentally ill; patients stereotypes of, 35
mentally handicapped, 83, 96, 244; see also see also Malays
idiots; imbeciles; mentally retarded; Mysore Medical College, India, 289
feeble-minded
mentally ill, 22, 65, 66, 68, 96, 98, 120, 152, Nacion, La, Argentina, 226, 246
228, 232, 248, 264, 274, 348 Nanzenji Temple, Japan, 212
living conditions of, 255 National Health Service, UK, 294
seriously, 28 National Human Rights Commission, India,
see also lunatics; insane; mentally 295
disordered; patients National Institute of Mental Health and,
mentally inrm, 68 Neurosciences, India, 290
364 Index

National Revolutionary Party, Mexico, 260 OBrien, R. B., 326

National Socialism, Germany, 1556 Ogimachi, E., 200
nationalities and races, 23 Oji, Japan, 221
Africans, 22, 23, 24, 37, 38, 44, 52, 53, 301, Okinawa, Japan, 205
307, 308, 309, 310 Ontario (Upper Canada), Canada, 10, 10327
Afro-Argentine, 228 Governor of, 109
Armenian, 282 House of Assembly, 107
British, 145, 282 Omagh county, Ireland, 104
Chinese, 133, 1434, 145 opium, 144
Creole, 228 Ordia, A., 311
Dutch-Afrikaans, 22, 234, 40, 53 Orissa, India, 287
Eurasians, 289 Oropeza, M. G., 260
Europeans, 227, 289, 301, 334 Osaka, Japan, 205
Hindu, 278, 281, 291 Oswald, Dr., 282
Hottentot, 23 Ottawa, Canada, 110
Indian, 228, 275, 280 outdoor relief, 106, 338, 344
Irish, 120, 1212, 144, 145, 282, 316, 324, overseers of the poor, England, 346
326, 327, 332
Italian, 282 Paley, E., 138, 145
Kar, 23 Pandurang, Dr., 284
Khoisan, 23, 52 paralytics, 161, 165; see also general paralysis
Koreans, 205 of the insane
Mestizo, 227, 228 Paris, 7, 16, 18, 80, 82, 96, 98, 257
Mulatto, 227 parishes, England, 336, 348, 349
Navaho, 312 parish medical ofcers, England, 337, 33941,
Nigerians, 299, 308 346
Parsis, 281, 296 Park, Dr, 107
Portuguese, 274 Parramatta, Australia, 130
Scottish, 145 patients, 13, 15, 29, 67, 77, 80, 85, 88, 98, 127,
United Kingdom, 23 146, 148, 149, 153, 175, 204, 241, 251,
Yoruba, 300 252, 285, 311
see also immigrants abuse of, 198
Native Administration, Nigeria, 304, 305 acute, 84, 89, 167, 237, 238, 270, 298, 345
Nazi regime, 154, 168 age of, 36, 579, 126, 158, 167, 169, 259,
neglect, 168 262
nervousness, 24 amusements, 1889, 278, 280
neurological disorders, 161 antisocial, 74, 158
New Jersey, 103 as artisans, 117
New South Wales, Australia, 20, 21, 111, 129, Argentine, 227, 229, 237, 244
130, 131, 133 background of, 104, 110, 115
New York, 18, 118, 262 behaviour of, 105, 127, 167, 170
New Zealand, 20, 111, 129, 146, 194, 294 better class of, 426
Nigeria, 1314, 18, 261, 299314 black, 17, 22, 37, 401, 44, 48, 50, 51,
Medical and Sanitary Services, 305 1867, 18892
Indirect Rule, 300, 304, 305, 307 British, 283, 337, 349
Noh Byoin (brain hospitals), Japan, 15 casebooks, 132, 146
Noronha, Dr F., 289 case les of, 75, 91, 157, 165, 196, 249
North Carolina, 178 caste of, 282, 291
nurses, 88, 154, 159, 234, 237, 243, 258, 259, certied, 15
294, 298, 311, 339; see also asylum characteristics of, 110, 122, 125
attendants children as, 248, 264
nursing homes, 89 chronic, 11, 30, 41, 46, 83, 84, 89, 90, 95,
Nutt, Mr, 29 96, 98, 108, 176, 182, 186, 188, 236, 238,
251, 263, 288, 298, 308
Obrawalde, Germany, 168 civilian, 310
Obregon, A., 251, 271 classication of, 256, 264
 Index 365

communication with psychiatrists, 39 maintenance of, 320

convalescent, 28, 323 marital status of, 37, 40, 42, 44, 50, 52, 59,
convicts, 8, 22, 43, 49 86, 105, 120, 1223, 161, 169, 263
crimes against, 154 medical characteristics of, 5564, 109, 127,
criminal, 28, 29, 36, 38, 41, 50, 303, 309, 139, 260, 264
325 middle class, 22, 37, 434, 50, 51, 96, 118
dangerous, 258, 263; see also dangerousness mortality rate of, 90, 97, 1245, 152, 1657,
curable, 84, 97, 114, 236, 241 168, 170, 183, 18990, 191, 195, 291,
curing, 183 337, 345
descriptions of, 30, 33, 131 murder of, 155, 156, 242
destitute, 259 non-paying, 13, 50, 82, 88, 116, 117, 120
diagnoses of, 9, 158, 167, 169; see also number of stays of, 9, 59, 61, 77, 78
diagnoses occupational backgrounds, 6, 11520, 126,
discharge of, 10, 25, 26, 33, 71, 81, 223, 168, 169, 262
236, 286, 291, 309 occupational status, 24, 49, 87, 88
educational background of, 168, 169 ofcial (France), 92, 95
elderly, 83, 90, 96, 105, 113, 126, 158, 161, ordinary, 31
163, 167, 169, 186, 23840, 258, 264; see pauper, 11, 38, 175, 178, 1823, 185,
also elderly 2445, 258, 259, 261, 263, 282, 320, 337,
ethnic background of, 280 341, 343, 346, 347
see also nationalities and races paying, 8, 11, 37, 40, 43, 44, 45, 50, 82, 87,
ex-slaves, 23, 53 88, 93, 96, 116, 175, 176, 178, 182, 185,
with family attachments, 40 21517, 236, 237, 243, 244, 258, 261,
as farmers, 11617 263; see also patients, private
female, 8, 22, 26, 37, 38, 44, 51, 55, 86, 89, perspectives, 102
90, 92, 93, 95, 103, 112, 11820, 1223, place of origin, 48, 126
125, 126, 129, 133, 161, 163, 165, 167, poor, 15, 48, 176, 184, 185, 190, 202;
180, 186, 188, 190, 223, 233, 240, 242, see also pauper
248, 258, 261, 262, 264, 26770, 271, populations, i, 6, 126, 127, 194, 204, 207,
282, 290 236, 23840, 258, 290, 332, 345
free, 261 prisoners as, 134, 261, 263
gender of, 86, 105, 110, 124, 158, 1678, private, 178, 185, 212, 2224, 246; see also
259; see also patients, male; patients, paying patients
female professional class of, 43, 118
groups, 78 prole of, i, 150, 251, 252, 260
health of, 304 psychotic, 59
history of, 103, 198 publicly supported, 176, 203, 212, 21517,
home-custody, 200 222
housewives as, 43, 45 reintegration into the community, 125
identity, 135 religion of, 126, 128, 259, 291
immigrants as, 246 segregation of, 182
indigent, see patients, pauper selection of, 8
incurable, 11, 36, 84, 89, 97, 108, 124, 168, self-employed, 43
270 senile, 41, 114, 115, 188
involuntary, 328 single, 50, 52
labour, 186, 188, 233 skilled class of, 43
labourers as, 117, 123 social class, 8, 13, 87, 259
length of stay of, 9, 38, 4650, 51, 613, 77, social environment of, 154, 158, 167
78, 86, 89, 95, 97, 1235, 126, 168, 170, social history of, 102, 139, 157, 160, 166,
223, 244 212, 291
living conditions of, 155 social proles of, 46, 197, 260
male, 6, 8, 17, 21, 24, 37, 38, 41, 52, 55, 57, social classication of, 7, 55, 167, 264
86, 89, 90, 923, 95, 115, 122, 125, 129, socio-demographic analysis of, 910, 13,
133, 161, 163, 165, 1689, 180, 186, 187, 104, 10910, 123, 1267, 252
189, 190, 223, 233, 240, 248, 258, 261, socio-economic origins of, i, 6, 48, 1045,
264, 267, 290 123, 169
366 Index

patients (cont.) police practices, 133, 13948

substitute, 212, 215 of detection, 129
suicidal, 177 of intervention, 134
tranquil, 236, 258, 263 of restraining, 138
treatment of, 8, 10, 81, 91, 139 of treatment, 138
unskilled class of, 43 police surveillance, 129, 132, 133, 137, 138,
violent, 96, 188, 234, 236, 242, 263 139, 141, 142, 146, 148, 205
voluntary, 26, 31, 78, 306 gendered, 129, 1403, 145
voluntary(France), 82, 83, 84, 856, 87, racialized, 129, 1435
88, 8990, 923, 94, 95 Police Gazette, 137, 138, 139, 141, 147; see
gender of, 878, 89, 91, 923 also Victoria Police Gazette
wealthy, 15, 177 policlinique, 76
Welsh, 283 poor, 18, 151, 31113, 334
white, 8, 17, 21, 27, 37, 40, 41, 44, 50, 51, Poor Law, England, 106, 336, 338, 344, 347
176, 179, 180, 18992; see also lunatics; administrative system, 324, 336, 339
insane; mad; alienes Board, 341, 347, 349
pauper farms, 343, 347 Commission, 338
Grove Hall, England, 3434 Commissioners, 178, 342, 344
Jonathon Tipple, England, 343 Elizabethan, 334
London, 343 Guardians, 33840, 3423, 346
Peel, R., 317 New, 338, 342, 343
pellagra, 190 ofcials, 177, 185, 336, 339, 349
penal code, Switzerland, 65 relieving ofcers, 342
penal colony, 129, 130 poorhouses, 112, 185, 188, 197, 296
penal reform, 103 Charleston, 176, 178
penal system, 41, 44 parish, 349
penitentiary public, 173
state, 187 poor relief, 38
see also prisons; gaols Port Philip, see Victoria, Australia
Pennsylvania, 118 Porter, R., 3, 335, 337, 343, 348
pensionnat, 96 post-Foucaultian, 98
Peron, J., 229, 244 Pottinger, J. H., 307
persecution, 91, 92 pregnancy, 75, 138
pharmacists, 92 Present State Examination (PSE), 39
pharmacological treatments, 1635, 181, 191, Prichard, J., 268
280, 292, 294, 295, 300, 309, 312, 313 Primrose, Dr, 107
analeptic, 163, 289 prisoners, 64, 310, 348
antibiotics, 163 prisons, 51, 64, 73, 74, 97, 165, 188, 197, 301
antipsychotic, 312 inspectors, 321, 324
sedatives, 163 Irish, 321, 323, 324, 325
tranquillizers, 163, 294 Nigerian, 302
Philanthropic Commission, Argentina, 228, overcrowding of, 22
230 see also gaols; penitentiaries
phrenzy, 33 Prisons
physical ailments, 64, 125, 190, 242 Abeokuta, Nigeria, 310; see also Lantoro
physician Asylums (state and charitable)
general, 75, 82, 92 Port Harcourt, Nigeria, 303
private, 73 Prison de lEveche, Lausanne, 64
Pinero, A., 2359, 242 private care, 14, 25, 26, 37, 76, 96, 349; see
police, 18, 29, 40, 68, 88, 129, 131, also asylums (private); boarding houses
132, 13348, 197, 200, 210, 241, private houses, 8, 26, 27, 198, 200, 202, 210,
248, 251 341
medical role of, 133, 137, 148 idiots in, 21, 27
professionalization of, 148 lunatics in, 21, 26, 27
regulations, 133, 138, 139 see also asylums (private); boarding houses
 Index 367

progressive paralysis, 161, 1635, 171, 267; Parisian, 81, 84, 93, 97
see also general paralysis of the insane; professional dominance of, 2, 5
syphilis see also alienists; medical superintendents;
promiscuity, 35 asylum doctors
prostitutes, 133, 134, 141, 146, 254, 262, 267, psychiatry, 1, 17, 18, 234, 271, 290
268 academic, 151, 289
Prussia, 150, 152 African, 297
psychiatric ailments, 242 Anglo-American, 101, 191
psychiatric care, 238 British, 14, 284, 299
Argentina, 234, 235, 240, 241, 244 comparative studies of, 19
asylum-based, 193, 220 decolonising, 309
charity, 5 diagnostics of, 18, 65
demands for, 80 epidemiology, see psychiatric epidemiology
gendered inequalities in, 38 faculties of, 237
Indian, 286 feminization of, 37
Japanese, 16, 1945, 201, 207, 209, 220, in general hospitals, 296
270, 338 German, 153, 156
mixed economy system of, 5, 14, 15, 98, Greek, 17
203, 337, 341 history of, i, 12, 3, 7, 1213, 14, 16,
Nigerian, 300 1719, 37, 79, 100, 101, 1945, 196,
outpatient, 312 224, 225
private, 5, 14, 220 Indian, 273, 278, 283, 290
public, 14, 243 institutional, 75, 100, 151, 283, 306
state, 2, 5, 51 Japanese, 15, 195, 222, 2245
traditional (Nigerian), 300 journals, 14, 235
units, 1513, 155, 156, 1678, 3312 as a medical speciality, 150
Western, 300 medias respect for, 18
psychiatric case reports, 149, 2834 medical profession and, 1
psychiatric categories, 266 Mexican, 266
Psychiatric Disorders Among the Yoruba, organic, 2
Nigeria, 312 for the poor, 18
psychiatric epidemiology, 204, 285 politicians respect for, 18
psychiatric facilities, 227, 306; see also power, 85
asylums practice of, 21
psychiatric medicine, 137, 238, 3301 profession of, 80, 85, 98, 101, 193, 255,
psychiatric proles, of racial categories, 39 292, 293, 331, 335, 336, 349
psychiatric reform, 156, 226, 239, 287, 288, professors of, 54, 201
298 publics respect for, 18
psychiatric rehabilitation, 288, 295 racism in, 39
psychiatric social work, 288, 290, 298 for the rich, 18
psychiatric symptoms, 3, 127 rise of, 334
psychiatrists, 7, 57, 67, 73, 83, 84, 97, Russian, 17, 279
159, 193, 201, 204, 225, 243, 331, South African, 39
334 structure of, 18, 151
ambitions of, 82 texts, 66, 224
Argentine, 227, 234, 239, 247 therapeutics of, 18
communication with patients, 39 western, 223, 290, 300, 309, 312
British, 287 psychoanalysis, 286, 290, 331
education of, 288, 293 Jungian school of, 331
French, 83 psychological counselling, 32
German, 266 psychological disorders, 163, 170; see also
Indian, 14, 274, 288 mental disorders
Irish, 328, 330 Psychological Medicine and Mental
Mexican, 268, 270 Pathology, 283
Nigerian, 300, 311 psychologists, 298
368

psychology, 290 restraints, 226, 301

child, 331 mechanical, 100, 181, 189, 191
psychopathological observations, 292 non-restraint, 209, 238
psychopathology, 290 revisionists, 101, 102, 334
psychopaths, 66, 68, 74 Robben Island, South Africa, 20
psychopathy, 65, 73, 158, 161, 163, 172 Robben Island Asylum, 8, 17, 2053, 301
psychopharmacology, 77; see also therapy admissions to, 8, 21, 22, 23, 24, 25, 30, 31,
psychosis, 33, 171, 190, 284, 300 32, 34, 35, 36, 40, 412, 46
cannabis (ganja) related, 2912 black patients in, 17, 379, 40, 51, 52
manic-depressive, 163, 172 chronic sick in, 20, 48
somatic, 161 criminals in, 51, 52
psychosurgery, 289 death rates in, 46, 478, 50
public authorities, 198, 211 discharge rates of, 46, 50
public morals, 68 gender bias in patient population, 21, 37, 38,
public opinion, 193 42, 44
public order, 7, 68, 77, 135 General Inrmary, 20
public policy, 127 lepers in, 8, 20
Punjab, India, 275, 279 long-stay patients, 47, 48, 49, 52
lunatics, 20, 23, 29, 30, 130
Quebec, 101, 103, 104, 110 men, 51, 52
patients social prole, 21, 3642, 46, 51
races, see nationalities and races pauper wards of, 28, 30
racial differences, 389 paying patients within, 43
racial hygiene, 155; see also eugenics poor in, 51
racial segregation, 175, 182, 187, 188 population of, 21, 22, 24, 31, 36
racial stereotypes, 39 public image of, 25, 43, 50
racism, 8, 17, 22 racial bias in patient population, 21, 37, 38,
Raj, the India, 296 44, 48
Ramrez, R., 2545 segregated accommodation, 38, 45
Ranchi, Indian, 298 whites in, 37, 43
Rauwola, Nigeria, 300 violence in, 48
reactive disorders, 161, 163 Robben Island Commission, South Africa, 29
Reading, J., 275 Robles, A., 257
Rees, Dr W., 107 Rockefeller Foundation, 289
Reform politicians (Canada), 103, 107 Ross, Dr, 26
rehabilitation centres, 310 Ross, Dr. D., 344
Reichsirrenstatistik, see diagnostic Roth, M., 3
classication systems Rothman, D., 3, 101, 102
Reinickendorf, Germany, 153 Rouillard, Dr., 84
religions and religious denominations Royal Indian Medical Psychological
Anglican, 40 Association, 292
Catholic, 40, 253, 282, 321, 331 Royal Irish Constabulary, 315, 324
Christian, 40, 53, 279, 291, 301 rural facilities, 226
Dutch Reformed Church, 24, 40 co-ed, 239
Hindu, 273, 278, 291 mens, 233
Islamic, 279 Russia, 231
Jewish, 274, 281 Rutland, England, 339
non-Christian, 40
Protestant, 321 St Andrew Undershaft, England, 338, 343
Roman Catholic, 142 St Brendans Hospital, Dublin, Ireland, 322;
support of, 24 see also Asylums (state and charitable),
religious welfare institutions, 254 Richmond Asylum
Report of the Acting Inspector of Lunatic St Michael Cornhill, England, 343
Asylums (1873), Australia, 137, 146 St Sepulchre, England, 338
Republicans, USA, 184 Saga, Japan, 205
 Index 369

Saisei Gakusha Medical School, Tokyo, Japan, reconstruction of, 184, 187
221 southern distinctiveness, 174
Saito, K., 202 State Board of Health, 190
Saito, T., 211 white population, 190
Salvation Army Rescue Home, 24 South Carolina State Hospital (Lunatic
San Francisco, 42 Asylum), 10, 11, 1045, 173, 190
sanitary inspectors, Nigeria, 306 admission of black patients, 11, 175, 176,
sanitary service, Switzerland, 75 178
Sandhurst, Australia, 141 admission of white patients, 11, 176
Scheper-Hughes, N., 329 asylum ofcers, 183, 184, 186
schizophrenia, 39, 72, 74, 149, 161, 163, 168, mortality within, 1657, 168, 170, 183,
169, 172, 269, 328 18990, 191
diagnosis among blacks, 39 cause of, 166, 170
diagnosis among the Irish, 39 political patronage within, 184
School of Medicine, Mexico, 255 population within, 11, 176, 177, 184, 186
Scotland, 238 Spain, 227, 231
Scull, A., 3, 4, 16, 101, 102, 3345, 341, 344 Spandau, Germany, 156
Seine, France, 80, 97 Srinagar, India, 295
segregation, 255; see also asylum segregation Standish, F., 145
settlers sterilization, 10, 66, 75, 76, 155, 165, 168
British, 22, 44, 53 Still, A., 3
Dutch-Afrikaans, 22, 24, 40, 53 Sugamo, Japan, 212
Muslims, 23, 281 suicidality, 29, 33
sexual assault, 25 suicide, 25, 73
Seydel, K. T., 151 attempted, 73, 74, 76, 91, 92, 141, 163
Shaftesbury, Earl of, 341 Supreme Court (South Africa), 26
Shah, Dr C., 284 surgeons, 275
Simms, W. G., 180 district, 28
Sisters of Charity, Argentina, 234 Sweden, 311
slavery, 174 Swiss Romande, Switzerland, 54, 55
slaves Switzerland, 5478, 126, 311
emancipation of, 8, 20, 24, 175, 184 syphilis, 158, 169, 267, 277
ex-, 23 fatal stage of, 86
owners of, 180 tertiary, 86, 125, 267
smallpox, 35 see also general paralysis of the insane;
Smith, C., 296 progressive paralysis
Smith, Dr, 277 syphilitics, 269
social control, 1, 3, 12, 16, 68, 78, 101, 104, Szasz, T., 2, 4, 7
120, 127, 180, 263, 272, 299, 312, 313,
342 Takao, Japan, 207
social policy, 2 Takinogawa, Japan, 196
social security, 170 Tama Hill, Japan, 207
social services, 1 Tasmania, Australia, 130
Society of Benecence, Argentina, 12, 228, Taylor, Lt. Col. M., 293
22930, 234, 239, 2456 Telfer, Dr, 107
soldiers, 276, 277, 279, 283, 310 temples, 296
South Africa, 8, 17, 18, 2053, 111, 134 therapeutic optimism, 173, 175, 181, 188
South Australia, 130 therapy, 15, 154, 163, 167, 168, 170, 177, 237,
South Carolina, 16, 17, 17392 304, 309
African-American population, 174, 175, amusements as, 286
184, 190 bleeding, 181
during antebellum period, 175, 178 blistering, 18190
Department of Mental Health, 10 cupping, 274
morbidity rates in, 190 eclectic, 15
poverty in, 190 electro-convulsive, 161, 163, 309, 312
370 Index

therapy (cont.) Ueno, Japan, 212

European, 14 Ulster, Ireland, 318
home remedies as, 24 Unani medical practices, India, 14, 273, 296
hydrotherapy, 207 unconscious, 2
hypnotic, 286 United Kingdom, 276, 285, 292, 297, 328
insulin coma (shock), 163, 222, 289, 312 census, 118
with leeches, 274 USA, 3, 10, 31, 100, 107, 173, 181, 194, 232,
malaria, 10, 163, 222 236, 237, 239, 252, 253, 254, 257, 281,
moral, 10, 100, 107, 108, 173, 174, 175, 288, 289, 313, 328
177, 181, 182, 188, 232, 284, 297, 299, United States Census Ofce, 188
335 universities
native medicines, 274, 300, 311 (University) College, Dublin, 331
neuroleptic, 59 of Geneva, 54
occupational, 163, 286, 312 of Ibadan, 311
organo, 286; see pharmacological treatments of Lausanne, 54
psychological, 188, 300, 312 of Tokyo, 221
purging, 181 urbanization, 1045
recreational, 233
seclusion, 254 vagrants, 133, 141, 142, 144, 197, 301
shock, 14, 161, 163 Van Breda, Dr P. J., 33
work, 220, 226, 233, 238, 251, 260, 271 Van Diemens Land (Tasmania), see Tasmania
see also treatment Vaud, Switzerland, 54, 634, 65, 67, 69, 71
Third Reich, Germany, 158 Velody, I., 3
Thomas, Dr, 293 Vezzetti, H., 229
Tillman, Gov. B. R., 185 Vidyasagar, Dr, 295
Tokonami, T., 201 Victoria, Australia, 5, 20, 129, 131, 13248
Tokugawa Shogunate, Japan, 198, 213 police, 132
Tokyo, 15, 196, 198, 203, 204, 205, 207, Victoria Police Gazette, 132
21315, 220 Virginia, USA, 173, 178
Tokyo Imperial University, 201
Toronto (York), Ontario, 110, 111, 113, 115, Wales, 194, 286
118 warning out, 106
Torres, Buenos Aires, 239 warrants (of committal), 139
traditional healers, 300, 3089, 311, 312 Wasserman test, 292
training schools, 237 Waterford, Ireland, 327
transcarceration, 1236 Weimar Republic, 10, 1556, 158
transculturation, 38 welfare authority, 170, 251
transfer of patients, 25, 30, 47, 48, 50, 81, welfare institutions, 1
86, 96, 124, 1513, 156, 165, 167, welfare ofcials, 261
170, 325 welfare policing, 148
family intervention in, 92, 956, 97 welfare systems, 88
rates, 95 welfarism, 1
treatment, 33, 174, 2556, 262, 271, 287, 325, were (madness), Nigeria, 300
348 West Africa, 18
community, 116 Western Australia, 130
folk healing as, 201 western medicine, 53, 274, 282, 292, 296
free, 88 Whigs, 1, 4, 102
indigenous healing, 52 Whitbread, Mr, 348
patterns of, 21 Whitechapel Guardians, 344
religious healing as, 32, 201, 213 white supremacy, 187
through isolation, 97, 226 Williamsburg, Virginia, 173
western medical, 52 Wittenauer Heilstatten, 10, 14970
see also therapy patient records, 149, 157
tuberculosis, 190 relationship between medical staff and
Tuke, S., 102, 175 patients within, 154
 Index 371

see also Asylums (state and charitable), World War II, 15, 156, 161, 165, 166, 193,
Karl-Bonhoeffer-Heilstatten; 194, 196, 227, 276, 292, 300, 306, 310
Karl-Bonhoeffer-Nervenklinik(KboN) Worth, Dr R., 292
women, 16, 52, 114, 133, 135, 140, 1467, wrongful connement, 81, 132, 144, 193,
229, 230, 251, 254, 271; see also patients, 1989, 236
female; lunatics, female Wurzburger Schlussel, see diagnostic
workhouses, 97, 106, 319, 323, 326, classication systems
330, 338, 340, 341, 342, 3434,
345, 349 Xhosa speakers, 39
inrmaries, 347
Poplar, England, 338 Yomiuri News, 220
St George-in-the-East, England, 338 Yoshihito, Emperor, 2057
Stepney Unions Mile End, England, 342 Yucatan, Mexico, 255, 269
Workman, J., 108, 124
World War I, 82, 155, 276, 316, 328 Zaria, Nigeria, 303