In this guest post Mary Chapman examines public interest in asylums in the nineteenth century. Mary will soon be commencing a PhD at the University of Leeds, where she’ll be focusing on the impact of gendered psychological medicine on urban women, 1845-1900.
The Victorian asylum looms large in our cultural imagination as a place of fear, abuse and malpractice. The very word conjures up images of vast institutions, where hundreds of patients were kept under lock and key in a warren of rooms and corridors- lost to the outside world forever, with no hope of a cure. Such conceptions proliferate in popular culture, with haunted house tours of old hospitals and horror films that cash in on our dread of a medical discipline that remains taboo even today. As titillating as such things may be, they have served to solidify an anachronistic idea of the mental health professions, and ignore the value of nineteenth-century psychiatry as the foundation for the modern study of the mind.
However, such voyeurism is no twenty-first century phenomenon. Asylum tourism was a popular practice throughout the height of these institutions’ use, and the regulation of public visitation rights was part and parcel of the management of mental hospitals throughout the eighteenth and nineteenth centuries. The oldest psychiatric asylum in Britain, Bethlem, began opening its doors from the early modern period as a way of courting donations from an entertained public, and access to the asylum and its patients continued- in one form or another- until the Victorian era. The story of these prying eyes, and what exactly it was that they looked for, tells us much about changing popular attitudes to mental illness. These visits also reveal the intensity of citizen interest in medicine during the nineteenth century, and the ways in which this interest was encouraged or curtailed by physicians is evidence for the fluctuating attitudes towards public involvement in professional science during this time.
Prior to 1770, the general public could come and visit Bethlem in large numbers. As The History of Bethlem argues, ‘sightseers- of an approved kind- were positively courted by the Governors. The ideal visitor was the “person of quality”’, who would be likely to benefit the hospital with the offer of pecuniary gifts. Bethlem operated as a charitable institution, and the display of the insane was a tactic. ‘”Spectacle” was built into the dynamics of charity at large’ during this period, and thus visitation rights were seen as an important method of securing financial support for the asylum. However, the concept of viewing the mad for entertainment became increasingly frowned upon during the Georgian period. A mounting ‘aware[ness] of abuses’ and ‘the disenchantment of the educated public’ led to a ‘growing curtailment of visiting in the 1760s’. In 1770, a ticket system was introduced and the hospital became largely financially self-sufficient. This system guaranteed funding for the asylum- admitting only those spectators able to afford the entry fee.
The Bethlem Governors continued to address the issue of visitation practices during the following decades. By 1815, entry was further restricted to 4 persons per ticket, on Mondays alone. In 1825, they decreed that, to be permitted to view the hospital and patients, members of the public must have written permission from a governor or an MP. Any visitors were also required to be accompanied on their tour. The necessity of the signature and presence of a governor, MP, or physician meant that in order to visit the asylum at this period one had to ask favour of this rank of men. The new rules therefore acted as an effective social filter, and visiting became heavily class dependent. A visit to Bethlem during the early Victorian period fitted well within an upper-middle class vogue for institutional tourism at this time; the asylum was one stop on the rota of interesting sites to see in the city, but one which nevertheless was to be taken with moralising gravitas. Visitors came to Bethlem to inspect the quality of the care it provided, and to witness the innovative treatments in what was now one of London’s most respected institutions.
Psychiatric care became increasingly professionalised as the century wore on, and debates surrounding the management of the insane led to the passing of the Lunacy Act in 1845, which introduced legal regulation for the first time. Bethlem was of course very much a part of these discussions, and public visits were curtailed after the Act. Motivations for visitation had gradually altered from the early 1830s as attitudes to lunacy changed ahead of reform, shifting from a kind of “civic tourism” to a philanthropic interest in patient care. Bethlem’s visitors’ logs tell us something of what people thought of the asylum, and what drove them to visit. Entries from 1830 are largely concerned with the ‘regularity, comfort, and cleanliness’ of the hospital, and the role of Bethlem within the framework of state government as a whole. Visitors frequently mention the role of the asylum as a national institution; Bethlem is a testament to civic pride, ‘an ornament to the country’. By 1835, the nobility of the ‘patriotic and benevolent institution’ arises not as much from the condition of the building, but from the progressive attitude of the staff within it. There is evidence of a greater interest in the treatment of the insane, with frequent approving references to the sight of ‘so few patients under restraint’. This concern with “moral management” increases in the later entries, with visitors from 1840 speaking of the ‘gentle manner of treatment’, and the ‘tranquillity’ of the patients.
These records show that plenty of well-to-do people continued to come and see the asylum during the early 1800s, with regulated public visitation at Bethlem remaining consistently frequent until the passage of the Lunacy Act. The shift in attitude was therefore not as much within the act of visiting itself, which was still considered a legitimate part of hospital management by physicians and governors, but in the way people were thinking about asylums and their patients. Beliefs about the mentally ill had undergone enormous transformation since the introduction of the ticket system in 1770, even if the validity of visiting the insane for leisure prevailed. As historian Jonathan Andrews has suggested, Bethlem doctors ‘seem to have operated their discretion’ in allowing, and controlling, public access to the asylum well into the mid-nineteenth century. This relationship between the medical men and genteel patrons persisted alongside a growing awareness of patient needs.
This rich and varied understanding of the role of the asylum during the Victorian period has been almost entirely ignored in today’s popular depictions of historical hospitals. Many horror films have been produced in the last decade which feature the malevolent haunting of abandoned asylums. These films often embellish on (historically inaccurate) treatments, focusing on their violent nature. One example, Grave Encounters (2011), features a ghost hunting team who become trapped inside Collingwood Psychiatric Hospital, and are gradually picked off by evil paranormal doctors who perform invasive procedures- like lobotomies- on the unwilling cast.
The recent neo-Victorian Stonehearst Asylum (2014) explores the nineteenth-century asylum in a more gothic mode. The film follows a young alienist who becomes employed at Stonehearst in 1899. He discovers that it is hardly the modern hospital which he anticipates; the asylum is a grand old manor house, shrouded in fog and mystery. The doctor realises that the superintendent is really a patient himself, and that the true staff of the asylum have been locked in cages below stairs, after the barbaric treatments they imposed sparked a revolt. Whilst the film shows sensitivity to the clinical methodologies of late-Victorian psychiatry, it still reuses old tropes- with terrifying electroshock therapy scenes and suspense filled escape sequences.
These films fetishize horror in the history of psychiatry, and whilst they are entertaining cinema, they sadly perpetuate conceptions of the discipline- and its hospitals- as both cruel and scary. The prevalence of these ideas in contemporary popular culture unfortunately encourages the persistence of an atmosphere of secrecy and taboo around mental illness. Such an image of the Victorian asylum is markedly different from the vision the Victorians themselves had of these institutions, as the seat of scientific progress, and worthy of civic pride. Public visitation of asylums during the early nineteenth century was just one aspect of a broader trend towards citizen interest and participation in science, as Victorian society sought ways to define and affirm its modernity.
The reality of the nineteenth-century psychiatric hospital lies between these two conceptions. The asylums were indeed a crucial testing ground for treatments at the forefront of a new discipline, often managed by leading physicians of the day- like Henry Maudsley. However, the nascent and often experimental nature of psychiatry at this time meant that these institutions could rarely provide hope of a long-term cure, and many patients did spend their lives languishing within their walls.