‘Ideal’ Asylum/Psychiatric Spaces: contemporary parallels with the nineteenth century

I have just finished reading a BBC article titled “How patients might design a psychiatric hospital” by Tom Heyden . I was very interested to hear the proposals that would contribute to the “ideal” psychiatric ward, as this was essentially what I have attempted to uncover for nineteenth century asylum spaces. It has been commented to me that there needs to be a radical shake up of the current spaces of mental health care and treatment, and I was intrigued to read the opinions of service users and what their suggestions might be. I was surprised, however, to read very similar language to that uncovered in my research, with many of the proposals chiming with the work I had explored in my thesis.

Contributors to the project, titled ‘Madlove’, called for a move away from the clinical feel of the internal spaces, wishing for a more ‘home-like’ environment:

There should be big windows and any white walls should be covered with plants, books or maybe patient artwork and poems, says Mataram. “It [would] feel more like a home/space where people can get back on their feet.”

Drawing parallels to the the nineteenth century, the Commissioners were of the belief:

“that the satisfactory condition of an asylum is greatly dependent on the influence which is exercised on its inmates by the circumstances in which they are placed. Experience shows that their behaviour improves with their surroundings; that, when these are comfortable and cheerful, there is less noise and excitement”. (Scottish Commissioners in Lunacy (SCL), 1878:xlii)

Time and again the Commissioners praised this aspect of the institutional spaces created by the district boards, commending, for example, “the civilising effects of floral decoration” ( (SCL), 1876:xxvii) at the Ayr District Asylum, or the extension of the ornamental painting and papering of the walls and the additions to furniture at the Fife and Kinross Asylum. It was stated in 1877 that the decoration of the wards at the Roxburgh Asylum was progressing rapidly and was of a “highly satisfactory and tasteful manner” (SCL, 1877:xxxvi), with much of the work being done by the male attendants and the patients together. Likewise, the Inverness Asylum had two ‘blue rooms’, one for males, the other for females. These spaces were designed as a place where patients could relax, the colour chosen as it was considered to be calming. At the Ayr Asylum, the medical superintendent reported that “the internal appearance and comfort of the House is much improved by papering the walls with pretty lively patterns, hanging numerous coloured pictures, furnishing the windows with valances, and providing additional chairs” (Ayr D.B., A.R., 1872:15). In 1879 a “handsome carpet of good quality” was laid in the female day room, which was said to add “much to the comfort and appearance of the room” (Ayr D.B., M.B., 1879:8), and in the early years of the twentieth century the use of pillows in the beds was commended, as well as the large number of easy chairs, which, “are said to be liked by the patients, and are believed to add to their comfort and peacefulness” (SCL, 1903:xxviii). Similar improvements were made to the Perth Asylum, which included replacing worn-out furniture with new and comfortable items, in particular armchairs, which were reportedly “much liked by the patients” (SCL, 1892:xxix) and said to increase their tranquillity and contentment.

The BBC article goes on to explore the importance of greenery and outdoor space to current service users, exclaiming that “it’s not just the inside that’s important”.

Relatedly, the Commissioners widely believed that outdoor recreation and occupation would have a positive affect on the mental condition of a person, stating:

The experience of common life proves that when we are in a state of nervous irritation, fidgety, and out of sorts, comfort and calm are best restored by active exercise in the open air. To be locked up in a remote room would certainly prevent us from proving a nuisance to other people, and distracting their attention from their own occupations; but it would be far better for ourselves that we should work off the cause of irritation in active exercise than in battering the door of the room or destroying the furniture and bedding”. (SCL, 1871:xlvi)

Thus, rather than purely banishing a patient to a “remote room”, the Commissioners continually advocated the use of the asylum estates for treatment, which, through careful planning and management, were believed to hold the ‘power’ to act as a crucial tool in the treatment of the insane. One method of achieving the desired affective atmosphere was through the laying out of the grounds in order to achieve a healthful, cheerful and, if not curative, then at least calming environment. This was done by planting trees and bushes, and laying out walkways and terraces, which had the dual result of providing outdoor employment for a number of patients (to supplement agricultural employment), as well as attaining an aesthetically pleasing appearance. Furthermore, asylums increasingly provided outdoor recreation in their grounds, which it was hoped would act as a deterrent from morbid thoughts, distracting and engaging the patients’ mind through mirroring the entertainment found in ‘ordinary’ life:

Amusement in a pauper establishment may to some appear as an anomaly, but it must be borne in mind that this Institution is a hospital requiring curative agents of every description, among which amusements hold a well-defined position. They act in various ways; they have in many instances a decided curative effect, the apathetic, the melancholic and demented have often dated their awakening into mental vigour from an evening’s fun or some stirring pastime; they break the monotony of routine which must necessarily exist in such an establishment, and they form an incentive to, and a reward for industry and good behaviour. A good proportion of the inmates are young, and to them amusement is very attractive. It will therefore be evident that amusements are necessary for the good and wellbeing of the patients. This year they have received due attention. Dances, concerts, Highland games and pic-nics [sic] continue to take place at proper intervals. I am grateful to those friends who show their interest in the Institution by their occasional presence and assistance at these festivities. (Fife & Kinross D.B., A.R., 1875:17)

As such, a number of institutions were increasingly provided with facilities such as bowling greens, curling ponds, and, in particular, cricket, as it was “regarded as a healthy, orderly game which encouraged self-respect, self-control and respect for rules of behaviour, both written and unwritten” (Cherry and Munting, 2005:48).

This is but a brief exploration of the spatial parallels between the design of the nineteenth century asylums and the “ideal” psychiatric hospital explored in the Madlove project, but perhaps shows that at least some of the ideas are not ‘new’ as such. There is a need, therefore, to keep in mind the lessons and experiences of the past when designing the new ‘asylum’ spaces of the future.

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Lunacy Numbers, 1857-1913

The total number of insane in Scotland resident in an institution recorded in the First Annual Report of the General Board, excluding private single patients, as their number could not be correctly measured is shown in Table 1. As the figures show, the number of pauper lunatics uncovered by the Commissioners during their investigation was 4,737,[1] which was almost 6 per cent of the overall pauper population in Scotland of that year. At this time there were nearly four times more persons registered as pauper rather than as private insane, with the majority of these pauper lunatics situated in either royal asylums, or private dwellings, with smaller numbers housed in private asylums or poorhouses.

 

Institution Male Female Private Pauper Total
Royal Asylums 1226 1154 786 1594 2380
Private Asylums 330 415 219 526 745
Poorhouses 352 487 6 833 839
Private Dwellings 810 974 1784 1784
Total 2718 3030 1011 4737 5748

Table 1 – Distribution of insane in each type of accommodation, 1858 (SCL, 1859).

What these figures do not revel, however, was that the Commissioners discovered great discrepancies in the proportions across Scotland, which they argued were dependent:

(1) on differences in the constitution of the inhabitants, (2) on differences in their education and mental culture, (3) on different degrees of social intercourse, and in the amount and nature of their occupations, and (4) on differences in the pecuniary position. (SCL, 1868:xii)

The discrepancies were so great, however, that they found it difficult to conclude which circumstances caused pauper lunacy to be more prevalent: a manufacturing or agricultural population, or in people of a Saxon or Celtic race. They supposed there to be, as a general rule, “a greater degree of mental activity among an urban and manufacturing population, than among one which is chiefly agricultural, and to this fact may possibly be ascribed the more frequent occurrence of insanity among the former” (SCL, 1868:xii). The Commissioners stated that, taking the country as a whole, it must be recognised that it was typically the lower classes of the population where insanity prevailed, drawn from the fact there were more pauper lunatics recorded. They argued that this was due to their low display of mental activities, with the urban and manufacturing environment having an increased impact on the levels of insanity compared to rural agricultural communities as a result of “overcrowding, impure air, exhausting labour, insufficient diet, abuse of stimulants, and contagious diseases” (SCL, 1868:xii). That said, high numbers of pauper patients were later sent to the rurally situated asylums in both Argyllshire and Perthshire, despite the overall population of both districts being in decline. It was generally assumed that such districts, which had a poor and sparse population, would have placed the majority of their patients in private dwellings, but, due to the poor standard of such dwellings and the small allowance available from the parochial boards to substitute home treatment, numbers sent to asylums were nonetheless accumulating.

By the concluding year of the General Board, the insane were distributed as follows:

Institution Male Female Private Pauper Total
Royal Asylums 1774 2006 1964 1816 3789
District Asylums 5553 5253 319 10487 10806
Private Asylums 29 42 71 0 71
Parochial Asylums 126 100 0 226 226
Lunatic Wards of Poorhouses 441 415 0 856 856
Private Dwellings 1289 1654 110 2833 2943
Total 9212 9470 2464 16218 18632

Table 2 – Distribution of insane in each type of accommodation, 1913 (SCL, 1914).

The figures in Table 2 show that, as well as a massive rise in the overall number of pauper lunatics since the first report in 1859, by 1913 the majority of pauper patients were, unsurprisingly, distributed around the district asylums. Although one fifth of the pauper patients were accommodated in royal asylums, which would have included patients from counties such as Orkney and Caithness, who had agreements with the REA and Montrose Royal Asylum, the main energy of the General Board was focused on providing state-run district asylum accommodation for pauper patients, ideally through the expansion of the district asylum network.

As well as the concerted effort to provide each district with its own institution, which ultimately increased the pauper patient numbers as patients were moved out of private dwellings, the accumulation of this class in asylums was also exaggerated due to families taking advantage of the parish contributions towards maintenance costs, and an increasing willingness more generally for the poorer classes to accept pauper relief. The Commissioners recognised the increases as being due to the following:

  1. The erection of new asylums for pauper lunatics – especially affecting localities in which no asylum accommodation for pauper lunatics previously existed.
  2. The readier means of access to asylums due to increased facilities for travelling.
  3. The gradual dying out among the public of feelings of dislike and suspicion towards asylums, a change which has resulted from an increasing recognition on the part of the community of the humane and enlightened methods of modern treatment, and of the protection, comforts, medical treatment, and curative influences generally which modern asylums afford.
  4. The greater readiness among the poorer classes to send relatives to asylums as pauper lunatics, which is due in part to the cause just mentioned, but also in part to a strengthened conviction of the difference which exists between the acceptance of parochial relief in cases of insanity and its acceptance under other conditions.
  5. The growing unwillingness of the poorer classes to submit to all that is involved in keeping an insane relative at home – the discomfort which usually results from the presence of an insane person in a small house, the expense of supporting a member of the family who is unable either to earn wages or to do housework, and the diminution of the earnings of the healthy which the care of an insane relative often involves.
  6. The greater willingness of parochial authorities to recognise claims to parochial relief on the ground of insanity.
  7. The stimulus, both to the readiness to seek relief and to the willingness to afford it, which has resulted from the giving of a State Grant-in-aid towards the cost of maintenance of pauper lunatics [see below].
  8. The widening of medical and public opinion as to the degree of mental unsoundness which may be certified to be lunacy. (SCL, 1892:lvii)

Unlike private patients, who were often removed from institutions after a much shorter period of time to save the family money (either once the hope of recovery was passed or the patient had become more manageable), the pauper patient was more likely to be left in the asylum. As such, the total number of private lunatics enumerated in 1858 and 1913 less than tripled, whereas the pauper lunatic population rose from 4,737 to 16,218; a near four-fold increase.[2] Through their institutionalisation, the pauper family and the inspector of poor were “relieved of all trouble and responsibility in connection with the case” (SCL, 1870:v). Revealingly, only thirteen years after the passing of the 1857 Act, the General Board warned that the consequences of these factors “were every day assuming an aspect of greater gravity” (SCL, 1870:v), as the growth of pauper patient numbers fast outgrew the provision of accommodation.

[1] The number of pauper lunatics returned by the Royal Commissioners during the 1855 inquiry was only 3,904, but it appears they omitted a large number of pauper lunatics.

[2] This could, of course, also be due to pauper patients moving from private houses to district asylums.

The locational history of Scotland’s district lunatic asylums, 1857-1913

I have been off the radar for a while, squirrelled away up in Aberdeen completing my thesis. The final title is ‘The locational history of Scotland’s district lunatic asylums, 1857-1913’, and I managed to submit it to Glasgow Uni in mid-February. The abstract is as follows:

This thesis looks into the later ‘Asylum Age’ in Scotland, concentrating on the legislation and construction of Scotland’s district lunatic asylums from the passing of the Lunacy (Scotland) Act, 1857 to the Mental Deficiency and Lunacy (Scotland) Act, 1913. Concentrating on the specific geographies of the asylums, what Foucault refers to as “the space reserved by society for insanity” (Foucault, 1965:251), the thesis weaves a new route between previous radical/critical and progressive/simplistic interpretations of the ‘Asylum Age’, by integrating a Foucauldian interpretation with non-representational theories around the engineering of affective atmospheres. This more nuanced approach, which concentrates on the ‘affective power’ of the institutions across different geographical scales (site and situation, grounds and buildings), recognises the ways in which Scotland’s district asylums, constructed predominantly for pauper patients, were moulded and reshaped as the discourses around the treatment of insanity were developed. The moral, medical and hygienic dimensions to the discourses ultimately outlined the institutional geography, by having a profound influence on asylum location and layout. The ideal district ‘blueprint’ for asylum siting and design, as put forward by the Scottish Lunacy Commissioners, is uncovered and reconstructed by ‘picking out’ the macro and micro-geographies discussed in the annual reports of the General Board. The research then moves to uncover the system ‘on the ground’ as it was constructed in bricks-and-mortar by the various district boards. As asylum location and architecture was a relatively novel concern, questions of siting and design became more pertinent, and indeed central, in institutional planning during the decades after the mid-century lunacy reforms. Thus, despite periods of waning enthusiasm for the institution as a mechanism for ‘curing’ insanity, fitting the building to its purposes continually involved a variety of structural innovations, stylistic refinements and new ways of organising the external and internal spaces of the asylums.

My viva isn’t for a few months, and in the mean time, I am hoping to work on some journal papers and continue the job search. If anyone has any questions regarding the research I conducted for my thesis, please contact me by email: k.ross.3@research.gla.ac.uk or twitter: @kimro_s.

 

 

 

The “open door” policy

The open door policy was first introduced in 1869 by Dr Tuke at the Fife and Kinross Asylum, as, the District Board stated, “there is nothing people dislike so much as being locked up; to some it is positive agony. If such be true of the sane, it is equally true of the insane” (Fife and Kinross D.B., Annual Report, 1875:15). The policy meant that attendants and patients could freely move around and even beyond the institution with minimal need for a key, increasing the liberty of the patients, and removing the prison-like atmosphere of the buildings. It appeared to result in increased tranquillity, improvements in the patients’ habits, “and in the general satisfactory condition of the establishment” (Scottish Commissioners in Lunacy (SCL), 1875:xxix). In the Fife and Kinross Asylum, the policy was extended throughout the nineteenth and into the twentieth century, with the Commissioners reporting in 1902 that:

It was possible to pass from end to end of the female division of the asylum without the use of a key, and that, with one exception, the doors of all the female wards were unlocked, so that the great majority of the female patients can pass at will into the open air. Practically the same freedom prevails on the male side. (SCL, 1902:xxx)” 

Many “distinguished physicians and others” visited this institution to see the system in process, arriving, it was said, “incredulous, as most physicians in the speciality are, but after a day’s thorough insight went away convinced of the truthfulness and reality of the movement” (Fife and Kinross D.B., A.R., 1875:15). Due to its obvious success, it was extended year on year in this institution and others. 

The system transferred a greater level of personal responsibility to the inmates, and empowered them to take more of their own decisions, for instance by allowing free access to the grounds unaccompanied by an attendant. As an example, it was reported that seventy per cent of the female patients at the Midlothian and Peebles Asylum were free to move between their day-room and the grounds, and that, despite this liberty, the number of escapes were markedly small. Remarkably, four of the patients at the Inverness District Asylum were trusted enough to be given their own set of keys so they could enter and leave the asylum at their own will.

Although initially not going as far as a complete open-door policy, in some asylums, for example at Ayr and Perth, the locks and handles on the doors were changed to ones found in ordinary dwellings, in an attempt to increase the effect of the asylum mirroring ordinary life. It was reported that, through all of these changes in management, the relationship between the patients and the staff was strengthened, becoming kindlier, although it was admitted that proof of this shift was difficult to observe. It did, however, definitely force the attendants to practice more continuous and intelligent supervision: as they could no longer rely on locked doors for the confinement of troublesome and disgruntled patients, they inevitably had to become more aware at all times of where these patients were and what they were doing. The Commissioners commented, “the relations of an attendant to his patients thus assumed less of the character of a gaoler, and more the character of a companion or nurse” (SCL, 1881:xxxiii), and it was acknowledged that this change in the control of patients could be more widely used, with the recognition that the disuse of locked doors reduced the desire of escape in a number of patients:

Under the system of locked doors, a patient with that desire was apt to allow his mind to be engrossed by the idea of watching for the opportunity of an open door, and it was by no means infrequent to find such a patient watching with cat-like eagerness for this chance. The effect of the constantly open door upon such a patient, when the novelty of the thing had worn off, was to deprive him of special chances of escape on which to exercise his vigilance, since, so far as doors were to be considered, it was as easy to escape at one time as another; and it was found that the desire often become dormant and inoperative if not called into action by the stimulus of special opportunity. It is indeed a thing of common experience, that the mere feeling of being locked in is sufficient to awaken a desire to get out.

Hence, by the 1880s most of the asylums in Scotland had embraced the principles of the open door policy, although in varying degrees. It was reported that the removal of the restrictions of liberty positively influenced the behaviour of the patients, producing a calming affect, bringing increased order to the institution. Conversely, when institutions were found to have unusually high levels of restraint and seclusion, such as was reported in the Ayr Asylum in 1884, it was suggested that the cause was either inefficient management by, or insufficient numbers of, attendants.

 

Lunatics in a Fort – Defying the “Japanese”

I am currently spending time going back through all the notes I took in the archives last year, sorting material for the empirical chapters of my thesis. I will post a few bits and pieces that may be of interest to people as I come across them.

The following article is taken from a book of newspaper clippings located in the Northern Health Board Archives, Aberdeen. Although it is not about Scottish district asylums, it does give an interesting and somewhat humorous insight into negotiations between patients and staff at these institutions.

Lunatics in a Fort – Defying the “Japanese”

Half a dozen lunatics escaped from the Morris Plains Asylum at New Jersey on Tuesday. They crossed the river and built a fort with logs and boulders. They then declared themselves to be Russians determined to fight the Japanese, as they called the asylum attendants. The latter, who were thirty strong, advanced, but retreated under a heavy fire of rocks and stones. The attendants then divided their force, and while one section tried to hold the enemy’s front, another section tried a flanking movement. The lunatics succeeded in outwitting this strategy, and held their fort successfully for three hours. Then Mr Clarke, the secretary of the asylum, conceived the idea of taking the defenders seriously. He ran up a white flag, shouting, “We have 200 guns on the hills at the back of us, and we demand your surrender.” This compliance with the etiquette of war pleased the lunatics immensely. One of the crazy men, acting as general advanced to a rock in the middle of the river, where peace terms were discussed with Mr Clarke. The lunatics agreed to capitulate if easy conditions were offered, and they finally returned to the asylum as “prisoners of war”.

Article originally from the Daily Telegraph, but re-printed in the Aberdeen Daily Journal, 22/10/1904.

Gartloch Hospital – Mindreel film

A couple of months ago, I came across this Mindreel film about the history of Gartloch Hospital from its opening in 1896 as Glasgow District Asylum (find out more here), to its closure in 1996 due to policies of deinstitutionalisation. The film tracks the (very different) experiences of both patients and staff at Gartloch, and includes great historical photographs, interviews, and footage of the hospital when it was closed in 1996. In particular, the opening sequence of photographs shows the vast scale of the institution during its early years, with the contrasting “present day” photographs showing the deterioration and dismantling of the building after its closure (more of which has happened since the photos were taken).

The difference in testimonies from the patients and staff is immense. The patients talk of their trauma and hatred of being housed in the Victorian institution, of the stigma of being admitted to “Gartloch”, and being labeled a “mental patient”. One ex-patient felt that it was like being in a “concentration camp”, and although others did praise the beautiful grounds and main building, all agreed that they felt imprisoned and wanted to be at home with their families. On the other hand, the staff praise the community spirit, lament the closure of the Hospital and enjoy their visit back. One ex-nurse says “it was a big thing lost when they locked the doors… moved us off to pastures new”.

If you have a spare half an hour, I’d strongly recommend watching it, particularly if you’re interested in Scottish asylum history, the after-lives of asylums, patient/nurse testimonies, etc.

The film was winner of the “Best Factual” category at the Scottish Mental Health Arts and Film Festival in 2007.

To watch, follow this link: Gartloch Hospital | Mindreel.

© Fast Forward Play Productions and Jane McInally

A request for stories about the after-lives of Scotland’s district asylums.

In the next few weeks I am turning my attention to what have been called the ‘after-lives’ and, in many cases, ‘ruination’ of Scotland’s district asylums, looking in detail at these Victorian institutions, which are loaded with historical baggage and in many cases still highly visible on the landscape.

The policy dilemmas around what to do with these ‘difficult’ buildings are many and varied: indeed, the huge Victorian and Edwardian ‘psychiatric estate’ (buildings and grounds), which now seems largely unfit for purpose as well as often being regarded as ‘stigmatised’ territory, comprises a considerable burden on the UK National Health Service (NHS). There are telling differences in how individual institutions have fared with closure, and in tackling the problems of adaptation, transition to other land uses and, in particular, their collapsing in to ruins.

If anyone has any information, annecdotes or experiences about the, closure, after-lives and ruination of Scotland’s asylums post-deinstitutionalisation, then I would be very interested to hear more. Please either leave a comment, or email me at k.ross.3@research.gla.ac.uk.

Many thanks.

List of Scotland’s district asylums and their other names:

Elgin D.A. – Bilbohall Hospital
Argyll and Bute D.A. – Lochgilphead Hospital
Inverness D.A. – Craig Dunain Hospital
Perth D.A. – Murthly Hospital
Stirling D.A. – Bellsdyke Hospital
Banff D.A. – Ladysbridge Hospital
Fife and Kinross D.A. – Stratheden Hospital
Haddington D.A. – Herdmanflat Hospital
Ayr D.A. – Glengall/Ailsa Hospital
Roxburgh D.A. – Dingleton Hospital
Midlothian and Peebles D.A. – Rosslynlee Hospital
Glasgow D.A. – Gartloch Hospital
Lanark D.A. – Hartwood Hospital
Govan D.A. – Hawkhead/Leverndale Hospital
Edinburgh D.A. – Bangour Village Hospital
Aberdeen D.A. – Kingseat Hospital
Renfrew D.A. – Dykebar Hospital