Medicine, Disease and Society in Britain, 1750 - 1950. Confinement of the insane. Lecture 17. Lecture Outline and Themes. The phenomenon of increased institutionalisation of the insane - The growth of public asylums in the C19 Explanations for this - social & medical, historiography
So, for essays.....
Increase in numbers of Private madhouses (licensing returns)
Provinces 45 139
London 16 40
Increase in number of recorded lunatics (county returns)
- Insanity believed to be curable
- Emphasis on kindness and calm
- Minimal use of restraint
- Domestic setting created in the asylum
- Reinforced normal social routines, e.g. meals, conversation, recreation, work
- Rural setting - encouraged walking and exercise
Asylums Patients Av.No.
1827 9 1,046 116
1850 24 7,140 297
1860 41 15,845 386
1870 50 27,109 542
1880 61 40,088 657
1890 66 52,937 802
1900 77 74,004 961
Pauper patients % Curable
County Asylums 4,244 15%
Provincial Licensed houses 1,920 33%
County Asylums 17,432 11%
Provincial Licensed houses 2,356 15%
County Asylums 27,890 8%
Provincial Licensed houses 2,204 13%
Even within same broad approach, there is disagreement
1. Emphasis on Social and Economic Factors
Investigating ‘social control’ – disagree with Foucault
2. Emphasis on Medical Factors
Fewer historians emphasis purely the medical.
Conclusion- that medical men were more willing to label a greater range of conditions as insanity and recognised chronic conditions, old age, incurability in insane populations.
William Adie: asked what he considered shell-shock to be “....I should say any state of mind or body engendered or perpetuated by fear, which renders the soldier less efficient or enables him to evade his duty with impunity...all these conditions are either engendered by fear, or having been engendered by something else, such as concussion, are perpetuated by fear. ...many of us were suffering more or less from ‘shell shock’, which made us not so efficient, and yet we remained in the line...all sorts of people got out of the line with so-called ‘shellshock,’ and the result was that they evaded their full duty and yet were not punished.”
Partly to do with morale among the troops
2 battalions side by side...(one) had practically no men going down with ‘shell shock’. The other battalion was sending ten men away at a time. “You could have foretold that it would be so by looking to the men’s appearance. In the good battalion the men were always smart, but the others were bad soldiers with bad officers. That is the crux of the matter. Keep up the morale of the troops and you will not have emotional ‘shell shock,’ at least you will reduce it enormously.”
(Evidence to Committee of Enquiry into Shell Shock 1922 quoted Brunton (ed.) (2004) p.267)
‘Dr. Rivers, asked what he thought of the term ‘shell shock’, said he objected to it root and branch. The reason why he objected to the term was that so far as he could see the main factor had been stress, and the shock in most cases was merely the last straw....break down after long and continual strain. These were the men who, especially in the early stages of the war, after some shell explosion or something else had knocked them out badly, went on struggling to do their duty until they finally collapsed entirely. Cases of that kind presented especially severe symptoms. All these cases were much of the same order, only people who broke down before they went over to France did not want stress to cause them to break down; they were ready to break down immediately. The man who got to France had stress. There is no question of that; perhaps, for him, a very big stress indeed. The case of the man totally unfitted for warfare finding himself in the trenches meant a very big stress for him. Stress is relative...
Asked whether there was any doubt in his mind as to the existence of a mental wound arising from emotional shock in contradistinction to any concussion, the witness said he should be inclined to put it in this way, that when a man began to have a series of disturbances of different kinds, such as loss of sleep, etc., he either consciously or more of less unconsciously looked for an explanation, and this tended to centre around some particular experience, in many cases a comparatively trivial experience.’
(Evidence to Committee of Enquiry into Shell Shock 1922 quoted Brunton (ed.) (2004) p.268-9)
- used the Freudian concepts of 'repression' and 'the unconscious’
- treated the soldiers with 'autognosis' which involved dream analysis
- called shell shock 'anxiety neurosis' and he used catharsis and re-education by telling his patients how much faith he had in them in order to make them well again. Rivers used the power of suggestion to create self-belief in the patients.
Matthew Thompson, ‘Status, Manpower and Mental Fitness: Mental Deficiency in the First World War’ in Roger Cooter, Mark Harrison and Steve Sturdy (eds.), War, Medicine and Modernity (Thrupp: Sutton Publishing,1998) 149-66):