Mental health treatment has thankfully come a long way over the millennia. Historically, people with mental health conditions were thought to be possessed by a demon or the devil, while ancient medical knowledge defined mental health conditions as a sign that something in the body was out of balance. Treatment could range from drilling holes into a patient’s skull to exorcisms and bloodletting.
The modern history of mental health care starts with the widespread establishment of hospitals and asylums in the early 16th century (though there were some earlier ones). These institutions were often used more as a place of confinement for people with mental health conditions, as well as for criminals, the poor and the homeless. In large parts of early modern Europe, people who were deemed ‘insane’ were considered closer to animals than humans, often suffering horrendous treatment as a result of this archaic view.
By the Victorian era, new attitudes towards mental health started emerging, with barbaric restraint devices falling out of favour and a more sympathetic, scientific approach to treatment gaining ground in Britain and Western Europe. But Victorian asylums weren’t without their problems.
Asylums before the 19th century
By the 18th century, the dire situation in European mental asylums was well known and protests started emerging, demanding better care and living conditions for those housed in these institutions. The 19th century, then, in general saw a growth of a more humanitarian view of mental illness which encouraged psychiatry and saw a move away from strict confinement.
Harriet Martineau, often described as the first female social scientist, and philanthropist Samuel Tuke were two of the biggest advocates for improved conditions in asylums in the 19th century. Independently, they helped to encourage a more sympathetic and respectful attitude towards mental health treatment.
Martineau, as a writer and reformer, wrote of the barbaric conditions that were rife in asylums at the time and abhorred the use of straitjackets (then known as strait-waistcoats) and chains on patients. Tuke, meanwhile, encouraged the ‘moral treatment’ of mental health conditions in institutions in northern England, a healthcare model which revolved around humane psychosocial care rather than confinement.
As parts of Victorian society began to adopt new attitudes towards mental health treatment in the 19th century, new asylums and institutions were being created across the country.
William Tuke (1732–1822), father of the aforementioned Samuel Tuke, called for the creation of the York Retreat in 1796. The idea was to treat patients with dignity and courtesy; they would be guests, not prisoners. There were no chains or manacles, and physical punishment was banned. Treatment focused on personal attention and benevolence, restoring the self-esteem and self-control of residents. The complex was designed to take in around 30 patients.
One of the earliest large-scale new mental care institutions was the Lincoln Asylum, founded in 1817 and operational until 1985. It was noteworthy for implementing a non-restraint system on their premises, something that was incredibly uncommon at that time. Patients were not locked-up or chained together, and they could roam around the grounds freely. The catalyst for this change was the death of a patient who was left unsupervised overnight in a straightjacket.
Hanwell Asylum, founded in 1832, would follow in the footsteps of Lincoln Asylum, allowing patients to walk around freely in 1839. The first superintendent, Dr William Charles Ellis, believed that work and religion together could heal his patients. The whole complex was run like a grand household with patients being used as the primary workforce. It’s important to note, though, that residents were unpaid for their work, since their labour was seen as part of the cure.
By 1845, physical restraint methods were phased out of most asylums in the United Kingdom.
Bethlem Royal Hospital – better known as Bedlam – is often remembered as one of Britain’s most infamous mental asylums. Founded in 1247, it was the very first mental health institution in England. During the 17th century it looked like a grandiose palace, but inside one could find inhuman living conditions. The general public could embark on guided tours of the facility, forcing its patients to be observed like animals in a zoo.
But the Victorian age saw winds of change arrive to Bethlem too. In 1815 the groundworks for a new building were laid. By the mid-19th century, William Hood became the new physician in residence at Bethlem. He championed change at the site, creating programs that were designed to actually nurture and help its residents. He separated criminals – some of whom were housed in Bethlem simply as a way of ejecting them from society – from those who needed treatment for mental health conditions. His achievements were widely recognized, with him eventually being awarded a knighthood.
Remaining problems and decline
The Victorian era saw tremendous improvements to mental health care compared to the previous centuries, but the system was a long way from perfect. Asylums were still used to shut ‘unwanted’ individuals out from society, keeping them hidden away from public view. Women, especially, were confined to institutions en masse, often simply for failing to adhere to society’s strict expectations of women at the time.
An increase in numbers of patients coupled with poor funding meant that the new and improved mental asylums found it more and more difficult to keep up the personalised treatment methods originally envisioned by the first reformers. Fresh air therapy and patient supervision became increasingly difficult to manage. Superintendents once again resorted to mass confinement, using restraint devices, padded cells and sedatives in growing numbers.
The end of the 19th century saw the general optimism of the years prior disappear. Hanwell Asylum, which contributed in the early to mid-19th century much to the development and improvement of these institutions, was described in 1893 to have “gloomy corridors and wards” as well as an “absence of decoration, brightness and general smartness”. Once again, overcrowding and decay were the defining characteristics of mental health institutions in Britain.