Understanding Madness: Some Approaches to Mental Illness Circa 1650-1800
Total Page：16
File Type：pdf, Size：1020Kb
UNDERSTANDING MADNESS: SOME APPROACHES TO MENTAL ILLNESS CIRCA 1650-1800 by Michael George Hay A Thesis Presented for the Degree of Doctor of Philosophy University of York, Department of Sociology December 1979 CONTENTS Page Introduction 1 Chapter 1 Experience and Observation 14 Chapter 2 Metaphors of Madness 42 Chapter 3 Dimensions of Disorder 82 Attention and Association 87 Memory and Imagination 93 Passion 101 Dreaming 107 Chapter 4 Rationales of Confinement 126 Chapter 5 The Asylum 163 Chapter 6 Madness and the Community: A Case Study 207 Conclusion 248 Bibliography 262 ACKNOWLEDGEMENTS I should like to thank Arthur Brittan and Andrew Tudor for supervising this thesis, over a long period, with great patience; I am most grateful for their advice, criticism and support. Peter Sedgwick and Martin Kayman have read sections of the work and made valuable criticisms. The staff of theScottish Record Office and the National Library of Scotland, in Edinburgh, were unfailingly helpful, and Dr. A. Murray, of the SRO, guided me to the records upon which Chapter Six is based. Mrs. Esme Hill has typed successive drafts with remarkable accuracy. I should especially like to thank Amanda who, having persuaded me to finish the thesis, bore the consequences with unstinting generosity and kindness. ABSTRACT The thesis examines some approaches to madness in England and Scotland in the period 1650-1800. It does so at a number of different levels but does not attempt to be comprehensive. The various approaches to madness selected for discussion are those which shed light on the developing tendency to seclude the mad in asylums. Attention is focussed primarily on the separation of madness from other types of social disorder and its emergence as a subject of medical enquiry. The treatment of insanity in literature, for example, is not extensively discussed. The main source material for the first part of the thesis is a number of English medical texts. Attempts by the medical profession to subject lunacy to rational enquiry are discussed, as is the general view of the disorder which emerged from this enquiry. Particular attention is given to the use of metaphor by physicians. A growing emphasis on the therapeutic power of self-restraint and self-discipline is seen as particularly significant, both for changing methods of treatment and the establishment of asylums. The refinement of therapeutic methods and principles is also discussed. It is argued, however, that the emergence of asylums cannot be explained simply in medical terms. The thesis examines the tendency to confine lunatics alongside other social deviants in response to a perceived growth in crime and argues that problems of overcrowding, disruption and the unsuitability of placing 'curable' lunatics in the same institutions as criminals and other social transgressors must also be considered. It is further suggested that the growing distinction between public and private behaviour is of relevance. In a final, more speculative chapter the importance of this distinction is traced in some eighteenth century Scottish court cases and the response to insanity at the level of everyday social life is considered. iv INTRODUCTION Throughout the nineteenth century and for the greater part of the twentieth century, those suffering from psychiatric illness have been placed in mental hospitals to be cured of their disorder or, where the illness proved particularly stubborn, to be safely looked after. In these special institutions, many of them purpose built, the mentally ill have been attended by those who have a particular expertise in dealing with this distinctive disorder. In terms of both institutional provision and medical care the mentally ill have been treated as a distinct population and, at least until relatively recently, it was believed that the most effective way of dealing with their disorder was to remove them—albeit temporarily—from the wider community. In the last decade or so both the principle of segregation and the very concept of mental illness have been challenged but such questioning has not seriously eroded the special and separate status accorded to psychiatric disorder. For the purposes of legislative control, social policy and medical training madness, in all its forms, is regarded as a distinctive medical and social problem. In many respects it is simply a truism to assert the distinctiveness of mental illness, and its separate status as a category of social dis- ability, but it is a truism of relatively recent origin. The mad have not always been treated as a separate group requiring particular treatment, separate legal provision and special status in the framing of social policy. On the contrary, the victims of mental disorder were for a long time accorded no special status, particularly so far as their general custody and treatment were concerned. Throughout the seventeenth century and for the greater part of the eighteenth century the records show that the insane were confined alongside an array of social 1 transgressors whose idleness, vagrancy or criminality brought them to the attention of the Justices of the Peace. In the houses of correction, workhouses and jails to which the insane were dispatched they were simply one among many categories of social deviant similarly confined. This is not to say, however, that madness was not recognized as a separate species of disability or that its sufferers were regarded as if they were no different from those who were locked up because they lacked employment, were poor, or had been convicted of criminal offences. Although lunatics were, throughout the period of this study, somewhat arbitrarily confined with a heterogeneous group of social transgressors this does not mean that no distinction at all was drawn between lunatics and their fellow workhouse inmates. Indeed, the evidence suggests that at the level of day-to-day administration of the workhouse, distinctions were made and, moreover, that there were attempts to curb the disruptive behaviour of the insane by placing them in specially built cells or other rooms adapted to their custody. In other words, workhouse superintendants and those in charge of local jails or houses of correction recognized madness as a distinctive and peculiar disorder and one that required, on occasions, special measures to control it. But such measures that were taken represented an ad hoc response to the problem and at best constituted a temporary solution. It was not until the latter half of the eighteenth century that separate provision on any significant scale was made for lunatics. Before the middle of the eighteenth century madness was not identified as an im- portant and unique social problem, and one that cannot be dealt with by the institutions developed to accommodate the idle, unemployed or criminal. The important point therefore is not the recognition—at the day-to-day level of workhouse administration—of the special problems posed by the insane but rather the emergence of lunacy as a significant social problem in its own right. By their inability to observe the conven- tional limits of social life, and the associated failure to internalize appropriate norms of social conduct, the insane are thought—at least by the late eighteenth century—to represent a particular type of social problem; one that must be controlled, curtailed and, where possible, 'cured'. And it is in the purpose built lunatic asylums of the late eighteenth century that these objectives are most likely to be realized. As John Aikin noted in his Thoughts on Hospitals (1771), "by placing a large number of them [the insane] in a common receptacle, they may be taken care of by a much smaller number of attendants; and at the same time they are removed from the public eye to which they are multiplied objects of alarm, and the mischiefs that they are liable to do themselves and others, are with much greater certainty prevented". 1 Underpinning Aikin's proposal is the assumption that the insane consti- tute a distinct group requiring special provision. They are to be segregated into large asylums and, once secluded from society, an attempt should be made to eliminate their malady and rehabilitate them. Between 1650 and 1800 madness emerges as a separate social problem requiring specific legal, institutional and therapeutic provision. During this period it also emerges as a separate branch of medical enquiry. From the middle of the eighteenth century onwards madness comes within the orbit of medical enquiry. Before this date certain physicians devoted their attention to the problem and, indeed, the belief that madness is a disease can be traced back to the Greeks. But during the course of the eighteenth century an important development occurs. Madness is finally removed from the realm of theological and astro- logical enquiry as the perspective provided by medicine becomes pre- eminent. By the late eighteenth century what may be called a 'medical' explanation of the disease has superseded other explanations that present the disorder in terms of divine or demonological possession, or the atrophying of those faculties that distinguish man from animals and perhaps savages. Seventeenth century 'medical' accounts of madness do of course exist but as the subsequent analysis will show many of these accounts are based on imaginative insights rather than founded upon the reliable data furnished by observation and experience. During the course of the eighteenth century madness appears, to physicians at least, to shed something of its mystery and as with other branches of enquiry so too in medicine the widening horizons of scientific understanding seem to encompass an ever increasing range of phenomena: madness among them. In Locke's view there exists a "large field for knowledge proper for the use and advantage of men" and certainly by the middle of the eighteenth century madness came 2 within the boundaries of that 'field'.