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Suicide, Lunacy and the Asylum in Nineteenth-Century England

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Suicide, Lunacy and the Asylum in Nineteenth-Century England SUICIDE, LUNACY AND THE ASYLUM IN NINETEENTH-CENTURY ENGLAND by SARAH HAYLEY YORK A thesis submitted to The University of Birmingham for the degree of DOCTOR OF PHILOSOPHY The History of Medicine Unit School of Health and Population Sciences The University of Birmingham December 2009 University of Birmingham Research Archive e-theses repository This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder. ABSTRACT Suicidal patients constituted a significant proportion of the annual admissions to nineteenth-century public lunatic asylums. They formed a distinct patient category that required treatment and management strategies that were capable of frustrating their suicidal propensity and alleviating their mental affliction. Yet despite being relatively large in number, the suicidal population of public asylums has received only nominal attention in the history of nineteenth-century psychiatry. This thesis examines the admission, discharge, treatment and management of suicidal lunatics over the course of the nineteenth century. It locates suicide and suicidal behaviour within the context of the asylum and uncovers the experiences of patients, their families and asylum staff. There is a distinct appreciation of the broader social and political context in which the asylum operated and how this affected suicide prevention and management. This thesis argues that suicidal behaviour, because of the danger associated with it, triggered admission to the asylum and, once admitted, dangerousness and risk continued to dictate the asylum’s handling of suicidal patients. Rather than cure and custody, it was protection and prevention versus control that dominated the asylum’s treatment of suicidal lunatics. Conclusions are drawn based on evidence from five asylum case studies and contemporary publications. ACKNOWLEDGEMENTS First and foremost, I would like to express my sincere gratitude to my supervisor Dr Leonard Smith. His continuous support, enthusiasm, patience, and immense knowledge have made this work possible. He has provided endless advice, ideas and suggestions which have inspired and enriched my research. His dedication and constant encouragement have kept me motivated during the last five years. I am indebted to him more than he knows. I also wish to express my appreciation to Dr Jonathan Reinarz, Director of the History of Medicine Unit, for taking a keen and supportive interest in my research. I owe a considerable debt to the Wellcome Trust, which supported me financially for two years. The trustees funded a Research Expenses Grant which eased the burden of research and travel costs. I must also thank the staff of several record offices and libraries who have provided valuable assistance. These include the Bodleian and Wellcome Trust libraries, and the National Archives. Archivists have been enormously helpful at Birmingham Central Library and the record offices for the counties of Leicestershire, Lancashire, Staffordshire, Warwickshire, and Worcestershire. Finally, I would like to express special thanks to my parents for their never-ending support and encouragement. LIST OF CONTENTS LIST OF CONTENTS i ACKNOWLEDGEMENTS ii ABSTRACT iii INTRODUCTION 1 CHAPTER ONE SUICIDAL BEHAVIOUR 47 The ‘Standard view’ 50 The ‘Psychiatric view’ 56 Melancholia 63 Mania 70 Puerperal Insanity 77 Other Diagnostic Categories 82 The Favoured Means of Suicide 86 CHAPTER TWO THE INCIPIENT PSYCHIATRIC PROFESSION AND SUICIDE 94 The Medical Profession and Insanity 96 The Psychiatric Profession 99 Changing Attitudes to Asylum Care and Treatment 111 Changing Attitudes to Risk and Suicide 128 CHAPTER THREE THE ADMISSION AND DISCHARGE OF SUICIDAL LUNATICS 140 The Admission Process 141 ‘Facts indicating insanity’ 152 ‘Other facts indicating insanity’ 157 Recovery and Discharge 160 Leaving the Asylum 169 CHAPTER FOUR THE MANAGEMENT OF SUICIDE IN THE ASYLUM 180 Asylum Architecture 182 Classification 196 Constant Watching 201 Mechanical Restraint 215 Seclusion 231 CHAPTER FIVE THE STRUGGLE BETWEEN CONTROL AND THERAPY 245 Moral Treatment 246 Moral Management 261 The Challenge of Non-Restraint 264 Chemical Restraint 278 CHAPTER SIX THE COMMISSIONERS IN LUNACY AND SUICIDE PREVENTION 296 The Lunacy Commission and Suicide Prevention 300 The Process of Investigation 311 The Commission and Private Asylums 318 CONCLUSION 329 APPENDICES 1 Favoured Means of Suicide used Prior to Admission 344 (male patients) 2 Favoured Means of Suicide used Prior to Admission 345 (female patients) BIBLIOGRAPHY 346 ABBREVIATIONS BCA Birmingham City Archives GA Gloucestershire Archives JMS Journal of Mental Science LCRO Leicestershire County Record Office LRO Liverpool Record Office NA National Archives NCA Nottinghamshire County Archives StaCRO Staffordshire County Record Office SCRO Suffolk County Record Office SRO Shropshire Record Office WCRO Warwickshire County Record Office WRO Worcestershire County Record Office INTRODUCTION The history of psychiatry and institutional care has attracted considerable attention during recent decades from both social historians1 and psychiatrists.2 Each group has contributed to the narrative of the rise of the lunatic asylum and the professionalisation of ‘psychiatry’. The historical inquiries and the methodological approaches adopted by the two fields have led to interpretations that often question, and conflict with, each other. Social historians have emphasised the need to place ‘alienists’3 and the asylum in their social context. This enables changes in social structures and relationships to be determined and their influence on professional interests to be assessed. Psychiatrists, or amateur historians as they are sometimes 1 A. Scull, Museums of Madness: The Social Organisation of Insanity in Nineteenth-Century England (London, 1979); D.J. Mellett, The Prerogative of Asylumdom: Social, Cultural and Administrative Aspects of the Institutional Treatment of the Insane in Nineteenth Century Britain (London, 1982); A.Digby, Madness, Morality and Medicine: A Study of the York Retreat, 1796-1914 (Cambridge, 1985); R. Porter, Mind Forg’d Manacles: A History of Madness in England from the Restoration to the Regency (Cambridge, 1987); ; J. Busfield, Managing Madness: Changing Ideas and Practice (1986); C. MacKenzie, Psychiatry for the Rich. A History of Ticehurst Private Asylum, 1792-1917 (London, 1992); P. Bartlett and D. Wright (eds.), Outside the Walls of the Asylum: The History of Care in the Community 1750-2000 (London, 1999); 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 & New York, 2004); L. Smith, Lunatic Hospitals in Georgian England, 1750-1830 (London, 2007); R. Houston, Madness and Society in Eighteenth Century Scotland (Oxford, 2000). 2 R. Hunter and I. Macalpine, Three Hundred Years of Psychiatry;1535-1860 (Oxford, 1963); R. Hunter and I. Macalpine, Psychiatry for the Poor. 1851 Colney Hatch Asylum: Friern Hospital 1973 (London, 1974); G.E. Berrios and H. Freeman (eds.), 150 Years of Psychiatry, 1841-1991 (London, 1991); G.E. Berrios and H. Freeman (eds), 150 Years of British Psychiatry, 1841-1991, vol.II, The Aftermath (London, 1996); A. Walk, ‘Some Aspects of the “Moral Treatment” of the Insane up to 1845’, Journal of Mental Science, vol.C (1954), pp.807-838; T. Turner, ‘”Not worth powder and shot”: The Public Profile of the Medico-Psychological Association, c.1851-1914’, in G. Berrios and H. Freeman (eds.), 150 Years of British Psychiatry, vol.I (London, 1991), pp.3-16.; T. Turner, ‘A Diagnostic Analysis of the Case Books of Ticehurst House Asylum, 1845-1890’, Psychological Medicine Supplements, no.21 (1992); J. Crammer, Asylum History: Buckinghamshire County Pauper Lunatic Asylums – St John’s (London, 1990); W. Parry-Jones, The Trade in Lunacy: A Study of Private Madhouses in England in the Eighteenth and Nineteenth Centuries (London, 1972). 3 Alienist was the nineteenth century term for psychiatrist. Medical men specialising in the treatment of mental illness preferred this title as it disassociated them from the negative connotations of the ‘mad- doctor’. Throughout this study the term alienist will refer to the medical men who cared for and treated insane persons. 1 labelled, have tended to construct their work within a medical model that attempts to legitimise the activities of present day psychiatry. Psychiatric history written from this perspective is consequently dogged by questions of partiality and concerns that the narrative may be compromised and distorted. Despite these potential shortcomings, psychiatrists possess an important attribute that can strengthen their historical writing. The medical knowledge they hold means they tend to understand mental illness and its treatment in greater depth than social historians. John Crammer describes Andrew Scull’s application of the terms madness, insanity and mental illness, in his sociological account of institutionalisation, as ‘confused’. Scull’s confusion about the difference between lay, legal and
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