Thursday, 1 February 2018
In line with Time to Change’s ‘Time to Talk’ day on 1 February, I would like to reflect on the stigma of mental illness in the nineteenth century, as a way of highlighting how far we have come, and how important it is that we conduct open and honest conversations about the topic, in order to end mental health discrimination.
It is clear from previous posts that the way in which those suffering from mental illness in the nineteenth century were considered, was a far cry from how we consider sufferers now. For a start, incarcerating individuals in an asylum that was built on the outskirts of Carlisle, far from the main population (it was described in an article in the Carlisle Journal in 1898 as a ‘little segregated colony’), is an indication that it was something to be treated in a sealed environment. The terms used to classify those in an asylum seem somewhat insensitive and discriminative to the modern eye - ‘lunatic’, ‘imbecile’, ‘idiot’, ‘feeble-minded’ – and the way in which patients were described in the case notes was in a much less than sensitive manner. In addition, friends and relatives on the outside could also be affected by the stigma of being associated with sufferers of mental illness.
After the 1845 County Asylums Act, every county and borough in England and Wales had to provide an asylum to accommodate pauper patients. Increasingly after this date, families became more willing to admit their relatives to these institutions that offered specialist care, and an increased risk of recovery. Despite this, a stigma remained attached to those suffering from mental illness, and the medical superintendents of Garlands in the later nineteenth century continued to state the need for relatives to admit their loved ones at as early a stage as possible in order for a greater chance of recovery. This was reinforced in the 1885 annual report by Dr Campbell:
A mistaken kindness on the part of their relatives allows them to exhaust all the questionable benefits of home treatment often without recourse to special knowledge of the disease, and only when home treatment is found worse than unavailing is the patient sent to an asylum.
However, not all families could be so ‘kind’. Dr Clouston recalled one case that came to Garlands in 1871:
One young woman was sent here in a deplorable state of filth and neglect, who had been for years allowed to remain in a state of nudity in her father’s house, occupying the same sitting apartment as the rest of the family, scorching herself at the fire, looked after chiefly by a brother, nearly grown up; and all this in the middle of a town of considerable size.
Therefore, despite the availability of specialist care in the Garlands Asylum, families were held back by the stigma attached to admitting that a relative was suffering with a mental condition.
One particular example I have come across in my PhD research of the Garlands nineteenth century patients, highlights this stigma. Isabella Y, aged 33 from Carlisle, was admitted in November 1896 suffering from mania. The event that led to her committal was the death of her husband, William. Her case notes stated: ‘Her husband is said to have locked her up in a room and not to have let her outside for years; he was found dead at his home yesterday, he was an old man about 70 years of age.’ Her physical state on admission indicated that she had been kept indoors for some years, as she was described as pale, emaciated, filthy, and in a generally poor condition.
The fact that Garlands had been open since 1862, less than 5 miles from where they lived, meant that specialist care was readily available within a short distance. This then leads us to believe that the stigma of having a wife suffering from a severe mental illness was so prominent, as he saw it necessary to conceal her from the outside world for such a long period. The additional consideration of the large age gap between the two can also be quite telling. Looking back at census material and marriage certificates, I cannot find much about the pair. The only document I can find is the 1891 census which lists them both living in Botcherby, Carlisle, as man and wife. Isabella is not listed as having any mental condition, so no indication of her illness has given to the outside world (on her Garlands admission she was stated as being mentally unwell since 1886). Consultations with family historians have led me to understand that such large age gaps in this period were not very common. Mostly they would occur when an older man would agree to marry his friend’s daughter, in the event of his death, in order to look after her, and guarantee her financial security. On Isabella’s case notes her next of kin is listed as a second cousin, indicating that she had no nearby close relatives. This may have been because her family was originally from overseas. Her entry on the 1891 census gives her place of birth as Brooklyn, USA. Whether this was true or not, I have not been able to verify through other documents. William’s will listed him as a gentleman, and his effects were left to Isabella’s second cousin in Carlisle. Any records stretching further back I have been unable to trace.
Whatever the explanation for Isabella’s incarceration at home, it is apparent that William was so concerned about the stigma of her mental illness, that he took drastic measures to conceal it.
This case, along with many others I have come across, indicates the stigma attached to the association with those suffering from mental illness that was so dominant in the Victorian period. Although this progressively eased throughout the twentieth century, people still feel unable and uncomfortable with speaking about mental health to the present day. I hope that by looking back at such cases we can see how far we have come, and use this as a platform to encourage the discussion around mental health, to see what still needs to be done. For further information about ‘Time to Talk’ follow the links below, and start the conversation.
Monday, 22 January 2018
As stated in previous posts, lunatic asylums in the latter half of the nineteenth century were operated following a regime of moral treatment. One of the main aspects of this was regular exercise. The importance of keeping active and maintaining good mental health is still reinforced today. Mental health charity Mind is running a month long campaign to raise awareness of the benefits of exercise to both body and mind. Details of their RED – run every day – January campaign can be found at http://www.cemind.org/news/2018/1/red-january-over-halfway-there.aspx
Looking into the past, it is apparent that not much has changed. From the outset Dr Clouston, medical superintendent of Garlands 1863-1873, stated that, ‘regular outdoor exercise strengthen[s] the bodily health, and consequently lessen[s] the mental irritability.’ The Garlands Asylum followed a daily routine that revolved around the different aspects of moral treatment. Time was allotted each day for the exercise of the patients. Each ward had its own adjoining airing court, in which patients were encouraged to spend as much of the day as possible. Even those who were physically unwell were brought into the fresh air as much as possible. Spending time in the open air was thought to provide patients with an environment in which to clear their minds of the unwanted thoughts that had caused their mental conditions. Patients were regularly taken out of the asylum boundaries to undertake regular exercise. It was believed that a ‘walk on the country roads thrice a week’ was extremely beneficial.[i]
In 1864, Dr Clouston stressed in more detail the importance of exercise, and how it was administered in Garlands:
Since the new walk round half the circumference of the farm has been completed, all the patients who were formerly confined to the airing courts are sent out to walk at least once every day. It is no uncommon occurrence to have the male wards quite empty during the walking hours in the afternoons, and it is only the sick or those who are otherwise employed who are ever in the house at that hour. This has the most beneficial effect on the worst class of patients who cannot employ themselves, and when in the airing court are apt to sit down and get cold.[ii]
Team games were also encouraged. Male patients formed an asylum cricket team, and in the summer months played three evenings a week. Teams would even be brought in from Carlisle to play the patients. For the females, a croquet set was provided, which they ‘enjoyed very much’.[iii]
Regular employment of the patients in tasks to maintain the day-to-day running of the asylum was also considered a form of exercise. Male patients were expected to help with the work on the asylum farm and in the workshops (e.g. carpentry, tailoring and shoemaking). Whereas for the females, they were expected to contribute to the domestic upkeep of the asylum, completing chores, working in the kitchen and carrying out any needlework repairs. Again, these tasks were thought to distract the patients from their conditions, and give them a sense of purpose through a routine that contributed to the economy of the asylum.
In 1876, the medical superintendent Dr Campbell noted:
The farm has proved a healthful and remunerative source of employment for the male patients, and much useful work has been done by the female patients in the wards, the kitchen, and the laundry. Continuous efforts are being made to improve the condition and habits of the chronic female patients. I believe that the want of some suitable occupation of the simplest nature, and which entails mere physical exertion like wheelbarrow work for the same class of male patients, is the principal cause of the greater excitability and noisiness in the female wards of Asylums.[iv]
Therefore because the males were employed in the outdoors, it was having a more beneficial effect on their health than for the females, who completed their employment tasks indoors. This reinforced the need for patients to be active in the fresh air, as it was having a better effect on their mental conditions.
The medical superintendents of county lunatic asylums were presided over by the Commissioners in Lunacy, who would inspect the institution annually and publish their findings in a report. One of the factors upon which the superintendents would be judged was the number of patients partaking in regular exercise and employment, as well as the number and range of activities for them to partake in. For instance, the Commissioners wrote of Garlands in their 1877 annual report:
…altogether 147 men and 120 women are usefully occupied. Of the former 107 are farm labourers and gardeners, 2 carpenters, 14 mat makers and hair pickers, 2 bakers and 3 tailors. Of the latter 25 work in the laundry, 8 in the kitchen, and 59 at knitting and sewing. Great attention is given to ensuring for the patients good and frequent out-door exercise, and we have no doubt of the beneficial results which ensue. Most of the men who are capable of active exercise are employed in some way, but there are 20 allowed to go on parole about the grounds, whilst about 140 of the women walk daily in the grounds, and nearly 100 sometimes go out beyond them. In fact, the men who do not work, but are capable of the exercise, are walked twice round the grounds daily instead of, as before, three times a week.[v]
The recovery of patients would also be judged, among other things, by their participation in regular exercise and in useful employment. For instance, Ann F, admitted in May 1889 was suffering from melancholia, and was described as considerably depressed. In her initial few weeks of treatment Ann was in weak health and struggled to get out of bed. Her case notes stated that she seemed dazed and confused, and gave little trouble. Two to three months into her stay at Garlands she began to take some exercise in the airing court, despite being very shaky on her legs. Her progression continued, and in August 1889 was described in her notes by doctors: Is brightening up. Takes more interest in things around her. Helps a little in cleaning the ward…answers questions more readily than she did. Finally, on the entry just before her discharge at the end of September 1889, it was stated: She takes a greater interest in what is going on in the ward. Helps to dust up and keep the ward tidy…seems to be in her usual mental state.[vi]
Taking all this information into consideration, it is evident that exercise and useful employment was essential to the treatment utilised at the Garlands Asylum in the latter half of the nineteenth century. This links perfectly to Mind’s RED January campaign, reinforcing the health benefits of exercise. Nineteenth century doctors may not have understood why keeping active had such remedial benefits, but they observed its impact in the county asylums, and in absence of any medical treatments, it offered one of the main facets of their regimes of care.
Thank you for taking the time to read this snippet from my research conducted on the Garlands Lunatic Asylum, which forms the basis of the PhD thesis I am currently writing up. My aim is to write the history of such a fascinating institution through the experience of its pauper patients. If you have any stories relating to the asylum, or would like help in tracing your ancestors that were in this particular institution, please don’t hesitate to contact me at email@example.com
[i] Cumbria Archive Centre Carlisle – henceforth CACC, Annual Report 1863, THOS 8/1/3/1/1, p. 14, quoted in C. Dobbing, ‘An Undiscovered Victorian Institution of Care: A Short Introduction to the Cumberland and Westmorland Joint Lunatic Asylum’, Family and Community History (2016), Vol. 19, No. 1, p. 9.
[ii] CACC, Annual Report 1865, THOS 8/1/3/1/3, p. 12.
[iii] CACC, Annual Report 1863, THOS 8/1/3/1/1, p. 13.
[iv] CACC, Annual Report 1876, THOS 8/1/3/1/14, p. 16.
[v] CACC, Annual Report 1877, THOS 8/1/3/1/15, pp. 9-10.
[vi] CACC, Female Casebook 1888-1892, THOS 8/4/40/2, p. 48.
Monday, 13 November 2017
Wednesday 8th November saw the launch of our exciting project surrounding the Garlands Asylum. Along with Cumbria County Council, Cumbria Partnership Trust, and Carlisle Eden Mind, I presented some of my research, which focused on the history of this fascinating institution. The aim of the project is to break down the stigma surrounding mental health by opening up the discussion around the treatment, as it was in the early days of the asylum, and as it stands now, and the help people can access in the event of mental illness. The value of reflection lies within the lessons we can learn from the progression in terminology, treatment and the way we consider mental health. Through this post I will outline the main points I made at the launch, and hope you will join the discussion surrounding mental health.
My focus, of course, is on the history of the Garlands Asylum, and how mental conditions were treated in the period from its opening in 1862, until the outbreak of war in 1914. Placing the patients’ stories and experiences at the heart of my research has caused me to regard the institution with a human aspect. When people ask about my research, and I mention the phrase ‘lunatic asylum’, they have a large misconception about the brutality of treatment received, and regard the institution with a degree of horror. Through my research I aim to breakdown these misconceptions and retell its history through the patients who experienced treatment in the institution.
My talk began with giving a short background of the asylum: when it was constructed, why, what kind of treatments were offered, and the effect this had on the patients. I then set out the regime of care from the inception of the asylum in 1862, and continued throughout the initial decades.
Moral treatment, was advocated in all county asylums in the period after 1845. The main facets of this regime were not dissimilar to some of the recommended treatments today: a good diet, regular exercise, recreational activities, religion and useful employment. This treatment was outlined in the 1863 Garlands annual report by the medical superintendent, Dr Clouston:
To treat the patients kindly, to maintain good order and discipline in the house, to provide healthy and suitable employments for all who can employ themselves, to endeavour to get those to work who do not do so, to provide suitable entertainments for their leisure hours, to endeavour to get them all roused into taking an interest in something, thus exercising and strengthening the mental faculties they have left, and to keep up the bodily health and strength in all of them.
He placed great emphasis on the employment of the patients to act as a diversion from the thoughts and circumstances causing their conditions: regular work for both mind and body will do much to counteract the ill effects of the associations of the persons, places, and circumstances that were connected with the original outbreak of the malady.
Around three quarters of the asylum population were regularly employed. Tasks in the workshops, on the farm, and in the asylum itself were largely carried out by the patients. The result was noted in the 1869 annual report as ‘pleasing and amusing’ the patients to a great extent.
Patients, that were able, were allowed to walk in the asylum grounds, with supervision from the asylum attendants, in order to get regular exercise. This was said to have had a soothing effect on the patient’s behaviour as they got the opportunity to clear their thoughts in the fresh air. Similar to this were the recreational pursuits offered to the patients to keep them usefully occupied whilst in the asylum. A large supply of books and periodicals were available. Knitting, needlework, domestic chores, work on the asylum farm, were all undertaken by the patients to encourage productivity and recovery, as well as contributing to the upkeep of the asylum. Regular events would be held to keep the patients occupied. Weekly dances and balls would be held. Sports events, such as cricket, would occur, with teams being brought in to compete with the patients. Choral groups, ventriloquists, and lecturers would be invited in to the asylum to give performances.
Patients who were otherwise unruly could respond well to these events. For instance, Catherine B, who was admitted in February 1885 suffering with mania and suicidal tendencies, seemed to forget all this and react well to the asylum dances. As described in her case notes in April 1885:
Wanders about the ward moaning and groaning wretchedly. The only occasion in which she appears to forget her troubles is at the weekly dance, when she brightens up wonderfully. Laughs heartily and industriously goes round the hall... Labouring hard often to teach others the steps and educate her fellow patients who require it.
There are many instances of patients responding well to the moral regime of the asylum. This was noted in the 1887 annual report: the disinclination many patients have shown to leave the asylum, shows that the efforts made to treat the inmates justly and kindly, and to render their life here pleasant and enjoyable, have been successful.
For more background on Moral Treatment, see my previous post - http://garlandshospital.blogspot.co.uk/2015/09/the-moral-treatment-of-patients.html
The main focus on my talk was to break down some of the common misconceptions of the Asylum. These are the main three I have come across. First: once patients were admitted, they were incarcerated for life. Overcrowding of the asylum, and the pressure on accommodation in the institution was a constant problem. As early as 1863, one year after opening, the Committee of Visitors stated of Garlands: ‘they are unable to provide sufficient accommodation therein for the number of lunatics who are chargeable to the two counties.’ The asylum underwent several extensions in its initial decades, taking the available capacity from 200 in 1862, to 660 patients in 1902. Taking this into account, the unnecessary incarceration of patients simply was not feasible. Doctors were driven by statistics, and were judged on their rates of recovery. So when a patient came to the asylum, they did their utmost to affect a quick recovery, to maintain a high rate of cure. As we saw in the Garlands recovery rates, they managed to do this. Therefore, it was in the doctor’s interests to keep the patients for as little time as possible in order to free up any available beds, and so that they maintained their professional reputation among the relatively new field of psychiatry. How well this quick-turnaround actually worked is doubtful, as many patients were readmitted to the asylum at a later date, often in a worse condition than when they were first treated.
The second biggest myth is that the patients were subjected to frequent brutality. The common belief is that asylums kept patients constantly in chains or strait jackets. However, as I have shown previous, the regime of moral treatment completely disregarded this practice. Patients were treated with kindness and given the opportunity to adhere to the moral therapy offered. When patients rebelled against this kindness, the doctors only sought to use methods of restraint as a last resort. Violent patients would firstly be placed in a single room on their own and given the opportunity to calm down: Sedatives would also be administered. If the violence continued, and they posed a risk to themselves or others, methods of restraint would be sought. All patients who were placed in mechanical restraints had to be recorded in a specific register, and this would be inspected by the lunacy commissioners on their annual visits.
For instance, in 1891, it was recorded that eleven patients had been put in seclusion for a total of 257 hours across the whole year, and that one man had been restrained for 8 hours using sheets, and one woman using the strait jacket for 15 hours, across the whole year. Therefore, although mechanical restraint was used, it was only done so as a last resort, and was not the common mode of treatment.
The last biggest myth is that patients, in particular females, were admitted to the asylum against their will and without suffering from mental illness. I often get people asking me if there are lots of women put in there because they annoyed their husbands and such, but so far I have found no evidence of this. I think that this practice may have occurred in earlier decades and centuries among the wealthier classes who could afford to pay doctors to take their wives into private asylums. But Garlands was a public asylum that provided treatment for pauper patients, and was paid for by local Poor Law Unions. The 1845 Lunacy Act stated that to be admitted to a county asylum, the testimonies of two individuals that had witnessed the person’s insanity had to be recorded on a document called a reception order. These testimonies had to come from an examination from a doctor or medical officer at the local workhouse, and from a relative/neighbour/fellow workhouse inmate who had lived closely with the patient. The form then had to be signed by a local magistrate warranting the person’s removal to an asylum. There are instances of paper work being filled out incorrectly and patients being discharged as a result. Therefore the method of entry to an asylum was much more rigid than many people believe.
From the discussions began at the launch, it is clear that more is required to really address the stigma surrounding mental health. By using the past as a way of reflecting on how much (or how little) treatments have changed, we hope to continue debating what is required in future to treat mental illness.
The exhibition of the some of the Garlands archival materials will be shown at several venues around the county. Full details and dates will be confirmed shortly, and we hope as many of you as possible will be able to view it.
For full information of the launch see
Any feedback of the event, and any comments you may have for suggestions of where we could take the project, please don’t hesitate to get in touch. Caradobbing@gmail.com
Wednesday, 18 October 2017
As a follow on from my last post, I would like to share some photographs from the Time to Change event in Carlisle on World Mental Health Day 2017. A huge thank you to Caroline Robinson for creating such an amazing display and providing the pictures! Some of the Garlands records were digitised and transcribed for visitors to see how mental illness was regarded and treated in the late nineteenth century. Alongside this was also some detail surrounding the context of the records, most notably the 1890 Lunacy Act.
Central to the display were two patient records from the 1890s and 1900s. The first, Tom M, was admitted to Garlands in September 1900 suffering from mania caused by his intemperate habits. What was interesting about Tom's case, is that a newspaper article was attached to his case notes denoting his attempt to take his own life prior to admission:
Clippings from newspapers relating to the patient and their condition were often attached to the case notes during this period. Anything to assist the doctors in creating a picture of their behaviour prior to admission was considered valuable in keeping with their medical records. On admission, Tom seemed to be somewhat confused and could not recall attempting to hang himself: “Patient has a childish vacant expression: Did not know why he was in custody: On being asked why he had attempted to finish himself in that way, he replied ‘What way?’ He has been drinking heavily for a long time and attempted to hang himself. There is no one to take charge of him and in his present condition is not fit to be at large.” It seemed that some time away from his surroundings, and the temptation of alcohol, was enough to fully recover Tom, as one month after admission he was discharged as recovered and never returned for treatment in Garlands.
The second case displayed was that of James G, who was admitted to Garlands in September 1898 also suffering from mania. James was brought to Garlands with little known about him, as he had been found wandering at large: 'Been curious in behaviour and frightening people in district'. He seemed to be very confused at the beginning of treatment as to where he had come from and what had occurred prior to admission. What is most interesting to note from his case notes is that he displayed a desire to remain in the asylum. For instance on 2 October 1898, the doctors noted: "says he is quite content to remain here." Similarly on 2 November 1898: "Says he likes better being up here because there are books here." However, once James began to recover, his desire to return home became clear. Eleven months after admission it was noted: “Rather unsettled and restless. Very anxious to go home or he says he wants a change.” James was discharged recovered in September 1899, and, like Tom above, never returned to Garlands.
These two patient stories are a snippet of the research I have been conducting for my PhD thesis on the history of the Garlands Asylum. The full launch of the Garlands Project will be on 8 November, where I, among many others, shall be giving a talk detailing the history of this fascinating institution. If you would like to attend, please see the below picture. It is also expected for there to be an ongoing exhibition from the event which will be toured around the county, details to follow.
Monday, 9 October 2017
In line with world mental health day (10th October), I wish to share with you a fascinating case from the Garlands records which highlights the change in attitude (and vocabulary) surrounding those suffering from mental health issues, and in particular how suicide was dealt with. Time to Change are holding an event in the centre of Carlisle to help take the stigma away from mental illness. Part of the event will include two examples of patients that were in Garlands in the late nineteenth century, to highlight how attitudes, and terminology, have changed with regard to the treatment of mental illness. Incorporated into this will be a discussion around suicide, and how it was regarded in the 1890s. To fit in with this, I have discovered a patient who took her own life whilst resident in Garlands.
Mary W was admitted in May 1885 suffering from melancholia. She had previously suffered with mental illness, and had had a short stay in Garlands in 1880 for five months. Mary was from Whitehaven, a widow who was in her 50s. On admission she was described as industrious and active, but had been feeling anxious due to her thoughts around harming herself and her children. Prior to her previous admission she had attempted to hang herself, and these thoughts had begun to resurface. Looking at her family background on the census, it would suggest that the death of her husband in 1880 led to her first committal in Garlands. Learning from her previous attack of mental illness, it was noted on admission in 1885 that she: ‘Expressed a desire to come here herself’. This was often the case for patients fearing that they were unwell in some way, and certainly for those aware of the irrational feelings they were experiencing towards harming themselves or their loved ones. Quite often in the Garlands records patients are noted as wanting to be admitted for their own safety.
Throughout her stay in Garlands (four years in total), Mary was described as behaving perfectly well, but continually complaining of a feeling of a great weight bearing down upon her head. She was described as quite withdrawn, listless, dazed and feeling slightly lost. Five days after admission, the following was written in her case notes after an examination by the medical superintendent: “She labours under melancholia. She is dull and nervous. Told me today that she had a bad pain in her head, that she could not sleep at night, that she had such awful feelings and such a dread of something fearful impending, that she wished she was put out of her way and that she feared she might try to kill herself. She is in average bodily health. No marks.”
A month later, her depressed feelings and thoughts of suicide led to an incident observed by an asylum attendant: “Has been keeping well up to this date, but yesterday she was noticed to be unusually dull and…instructions were given that she was to be well looked after. This afternoon while the attendant’s back was turned she disappeared down the cellar stairs and, with a piece [of] tape, attempted to strangle herself. She was seen shortly after and no serious injury was observed, but she was noisy, listless, acutely depressed and struggled a great deal. Is sleeping close to attendant in observation dormitory.” Unfortunately her suicidal thoughts and attempts continued, as described in this entry for August 1885: “She has had several transient outbursts of excitement recently lasting only for a few hours each time during which however she is to be most carefully looked after as she is actively suicidal and is continually saying she is dead and asking to be killed. Sleeping badly. Takes food.”
As her treatment continued into 1886, the doctors began to see an improvement in her, noting that she had become much more cheerful, and even herself admitting she felt better. This led to the proposal of Mary being discharged, and the result was noted in July 1886: “Last month she looked so well that it was proposed to discharge her, but when she was told she said she did not feel well enough and had not sufficient confidence in herself and asked to be allowed to remain here a little longer. She is quiet, nervous and very industrious in habits.” Her nervousness and anxiety became a common factor in her condition as her stay in Garlands progressed. It seems that Mary lacked the confidence in her ability to remain well when discharged back home. The anxious feelings remained, and on more than one occasion prevented her being discharged. For instance, one entry in her case notes stated: “Says she still feels nervous and has not sufficient confidence in her own ability to face the world.”
It was this anxiety at being released from the confines of the asylum, and specialist care, which led to her taking her own life in Garlands. The entry dated 17 December 1889 described the incident:
“This patient has seemed so well in mind for a long time that last week Dr Campbell discussed with her the subject of her being discharged. She said she did not yet feel sufficiently well and was anxious to be allowed to remain in the asylum a little longer. On Saturday and Sunday (14th and 15th December) she complained of headache and stayed in bed. Yesterday and this forenoon she went about her work as usual and was quite cheerful. She was seen and spoken to by Miss Fraser about 4 o’clock this afternoon and nothing peculiar in her manner was then noticed. A little before 6 pm this evening the medical officers were summoned to the coal cellar of the female infirmary where the dead body of this patient had just been discovered by an attendant. The body lay on its back on the coals, the arms laid across the body. A cut across the throat and liquid and clotted blood on the clothing and on the coals beside the body clearly indicated the cause of death. There was an ordinary attendant’s table knife lying on the coals at the side of the body. The body was not cold, the muscles were flaccid. The cut is across the upper part of the throat, severing wind pipe and important vessels and death must have necessarily been rapid.”
This sad case was unfortunately only one of many that took place in Garlands. Precautionary measures were taken to prevent such events occurring, but sometimes they were not enough.
In line with world mental health day, it is important to highlight that mental illness can occur to any of us, at any time. Reflecting on stories such as this one reasserts the importance of talking about our feelings, and helping each other when we may be particularly struggling.
Thank you for taking the time to read this snippet from my research conducted on the Garlands Lunatic Asylum, which forms the basis of the PhD thesis I am currently working on. My aim is to write the history of such a fascinating institution through the experience of its pauper patients. If you have any stories relating to the asylum, or would like help in tracing your ancestors that were in this particular institution, please don’t hesitate to contact me at firstname.lastname@example.org
Monday, 25 September 2017
Looking at previous posts, and the title of this current one, it is apparent that the terminology surrounding mental illness, and those that suffered from it, has altered dramatically in the 150 years since Garlands opened. This post shall explore one fascinating case which highlights just how different this was. My current research into the patients of the Garlands lunatic Asylum, Carlisle, part of my wider PhD thesis, has focused on the movement of pauper patients between different institutions in the initial years of its opening. In the Garlands first month of opening (January 1862), 146 patients were transferred directly from nearby asylums and workhouses. The overwhelming majority (121) of these came from Dunston Lodge private asylum near Gateshead, which was the official receptacle for Cumberland and Westmorland’s mentally ill population prior to the opening of their own institution (Garlands in 1862). Whilst studying this transferal of care, I came across the first Criminal lunatic to be admitted to Garlands, and her case notes make for interesting reading.
Elizabeth R was among those first 146 patients admitted in January 1862 to the new Garlands Asylum. She was transferred, along with the majority of the female patients, from Dunston Lodge on 10 January 1862, where she had resided since 14 June 1861. Prior to her committal to Dunston, Elizabeth had been sentenced to three months in Carlisle Gaol for being a ‘disorderly prostitute’, and her occupation was given in her records as prostitute. On admission to Garlands she was aged 27, described as being both suicidal and dangerous, listed as suffering from mania, and was in weak physical health. What is immediately interesting from her admission records is the cause given for her mental illness: ‘remorse of conscience’. The theme of immorality is constant throughout Elizabeth’s case record. On admission she was described as follows: ‘Intelligent face but made impudent by the use of evil deeds’. This is unsurprising given her stated occupation, but I doubt she would have disclosed this as her job, rather, it was imposed on her – further increasing the stigma surrounding her committal – on admission following her arrest. The remorse she was feeling is indicative of the desperation of her situation, as she, more than likely, was forced to resort to prostitution to survive. Further evidence of her depressed mental state is given by the fact that she was suicidal. Prior to being removed from Carlisle gaol to Dunston Lodge, she undertook a period of starvation, and due to her weakened state, her transferal had to be delayed, as the authorities feared that she would not survive the journey.
Once in Garlands, shortly after arriving, the following passage was written in Elizabeth’s case notes, describing her and her behaviour:
‘As bad as she is mad – one of the worst cases we have to deal with in lunatic asylums. For the simplest offence as a sharp word from another patient, delay in granting a request, a slight verbal rebuke for bad conduct, she will go off into the most violent passions imaginable – screaming, fighting, breaking windows, attacks upon attendants and patients abuse in the extreme, most threatening in her language and will sometimes last for 3 or 4 days; when at the climax she refuses food – lashing at attendants faces, tears up her clothing and bedding. Doing all the mischief she can conceive of and frequently will keep nothing on herself…makes constant and determined attempts at self-destruction…the very great forbearance and kindness which have been shown her by all parties – everyone has lost all sympathy for her. She is most decidedly (although insane) to a very great extent responsible for her actions. Her conversation is beastly and as profane as that of the commonest Haymarket prostitute. Has haemorrhoids – acne on face – Brown hair, sleepy eyes and has had 2 or 3 children.’
We gain some understanding of the behaviour described when reading the last sentence of this entry. The fact that Elizabeth had children, which were clearly illegitimate, may go some way to explain her suicidal thoughts and tendencies, and her feelings of remorse. We can assume that she was not in contact with these children at the time of her admission, as the doctors did not know for certain how many she had given birth to. It may also have been likely that her family wouldn’t have been in contact with her, as they would have disclosed further personal information to the asylum doctors.
Throughout her stay, Elizabeth was violent, frequently tore up her clothes and broke items in the wards. On several occasions she was described as feigning illness. For instance, on 24 October 1862, she faked a ‘spasm of the stomach so well that she deceived all the nurses but one who thought she was ill indeed. They were much surprised to see her quickly recover under a shower bath of half a minute’s duration only.’ Also on several occasions she attempted to take her own life. It was noted on 4 November 1862 that she: ‘Has been secluded all yesterday and today owing to her extreme state of maniacal excitement, and intense suicidal propensity – 3 times in my presence attempted to strangle herself – her neck is marked with the ligature.’ In an incident on 25 July 1863, she demonstrated how far she was willing to go to attempt to kill herself. After a particularly violent episode, Elizabeth was removed to a padded room in order to calm her down and prevent injury to herself or others. However, on a previous occasion in the room, she had smuggled a pair of scissors in with her and secreted them in between two of the padded sections of the wall. Luckily, an attendant spotted her recovering them from her hiding place, and could intervene before she was successful.
Elizabeth continued to flit intermittently between behaving well, and behaving in a violent, disruptive, unpleasant manner. During her calmer periods, it was noted that she was able to work well in the asylum laundry, and even assisted with the care of a child who had been a patient in the asylum since 1863, admitted when he was only 4 years old. Having been given this responsible role, it seems that she began to see some purpose in living, as the suicide attempts diminished. However, her illness did still continue, as her violent outbursts were still documented in her notes, but were far fewer than before. Elizabeth remained in Garlands until February 1873, when she was discharged recovered. This would have been relatively rare, as the chance of a patient recovering considerably lowered if they had been resident in an asylum for longer than two years – with the majority of recoveries taking place within one year.
Thank you for taking the time to read this snippet from my research conducted on the Garlands Lunatic Asylum, which forms the basis of the PhD thesis I am currently working on. My aim is to write the history of such a fascinating institution through the experience of its pauper patients. If you have any stories relating to the asylum, or would like help in tracing your ancestors that were in this particular institution, please don’t hesitate to contact me at email@example.com
Sunday, 23 July 2017
Recently, I attended the “Rethinking the Institution” conference at Liverpool John Moores University. At the conference, I gave a paper detailing some of the research I have been undertaking for my wider PhD thesis on the Garlands Lunatic Asylum. The focus of the conference was to view the nineteenth century institutions that came to dominate so much of the Victorian landscape in a new light. I hoped to present the county lunatic asylum in a different way to which we seem to consider it in our contemporary mindsets. Through this blog post I will set out some of the main points from my paper in rethinking the way in which the asylum was run, and how the pauper patients responded to it.
Through my research of the pauper patients of the Garlands lunatic asylum, it has become apparent that the common view of the institution – i.e, that it was incarcerating, repressive, and an all round awful place – is one that was not borne out in practice. Following the work of Jane Hamlett, it is clear from asylum records that these institutions attempted to emulate the domestic framework of the family home. This was an attempt to bring order to patients whose mental faculties were particularly disordered at the time of committal.
Asylum construction was particularly accelerated during the latter half of the nineteenth century. Legislation enacted in 1845 made it mandatory for each county and borough in England and Wales to have its own lunatic institution for pauper patients. Prior to this, the main receptacle of care for the mentally unwell was the family home. With the advent of a network of county asylums, a great shift occurred from where was considered “best” to treat a mentally ill relative. Therefore, it is no great surprise that the domestic rituals in the family home were also transferred over to the new county institutions. Creating a familiar, calming environment in which to conduct treatment, was key to the recovery of an individual’s mental affliction.
The regimes set out in these establishments followed the rhetoric of “moral treatment”, a practice set out earlier in the century by the Quaker run York Retreat, and by pioneering figures such as John Connolly from Hastwell Asylum. Garlands was no different. Built in 1862 to house 200 paupers, it followed the moral treatment regime. Central was advocating a routine of exercise, a good diet, recreational activities, religion and useful employment. Naturally, patients could respond well to this. Dr Clouston, on of the early medical superintendents, reinforced the value of a regime that was free of locks and restraint. It was important the patients did not feel like prisoners, and were regularly encouraged to walk in the open countryside beyond the asylum boundary, albeit with attendant supervision. IN some cases, patients were so comforted by the domestic environment and curative regime in the asylum that they were unwilling to return to their former lives. Dr Campbell noted in the 1887 Garlands annual report; “the disinclination many patients have shown to leave the asylum, shows that the efforts made to treat the inmates justly and kindly, and to render their life here pleasant and enjoyable, have been successful’.
The lunatic asylum was also physically modelled on the family framework. The medical superintendent was the head of the institution, and played a patriarchal role in the regime. Thus, the patients took on the submissive role of the ‘children’. Underpinning this was the fact that the superintendent resided in the asylum grounds full time, often alongside his wife and children. The asylum as a whole functioned as a domestic ‘whole’, as everyone had a vested interest in its upkeep. As mentioned earlier, useful employment of the patients was an element involved in moral treatment. The patients were assigned work-based tasks around the asylum according to their gender. Typically, men carried out manual jobs, cultivating farm land and building items to be used within the institution. Women were employed in the domestic jobs of the asylum, carrying out laundry, cleaning, cooking, sewing and knitting. Occupying the patients in such a way was believed to be beneficial in distracting them from their various conditions. The products ascertained from the work of the patients were vital in easing the ‘financial burden’ they placed on the poor law rates. In several of the Garlands annual reports, the doctors noted how the commodities of the patients were used in the establishment. For instance, in 1863; “all the carpenter work required in the house has been done by ourselves”, and in 1866; “one of the dormitories in the female division was entirely papered by the women themselves”. Thus, everyone was instrumental in the maintenance of the asylum, just as all the members of a family had a vested interest in the survival of the domestic unit.
The furnishing of the asylum was also modelled on the family home. They were keen to emulate the setting of the Victorian middle-class home in an attempt to extol some of the Victorian middle-class values on the patients whilst in recovery. The importance of domestic decoration was frequently referred to in the Garlands annual reports. In 1894 Dr Campbell stated that: “The wards have been kept clean, bright, and well decorated with flowers, and the airing courts while the weather allowed of it, were lovely with well trimmed grass, and beds of tastefully assorted flowers”.
Interestingly, what led patients to be admitted to the asylum in the first place was often a disruption to the family home. Destructive behaviour in the domestic environment can be linked to the indications of insanity provided on a patient’s admission documents. For example, Jacob C’s wife stated on admission that he; “wanders about all day, and comes home generally very dirty and without his shoes and stockings…this morning a man fetched him home having found him in a midden heap…he has torn up his clothes…and has set fire to articles of value.”
Similarly, patients who attacked the homely furnishings of the asylum during bouts of violence, associated with several mental conditions, were seen as attacking the structure of the asylum and resisting its restraints it placed upon them. One example is Sarah F, who throughout her treatment in Garlands during the 1890s was continually described as destructive and violent. She frequently struck out at other patients and destroyed the furnishings of the asylum. In September 1893 it was stated that she was “very destructive to her clothes and plants”; and in June 1894 that she, “often strikes and interferes with other patients, breaks glass and is very unruly”. However, it was noted that on occasion Sarah could respond well to the moral regime, as in April 1894 it was stated that she was more settled and had begun to work in the laundry, where she “does fairly well”. This interchangeable behaviour continued throughout Sarah’s treatment, and she remained in Garlands until her death in May 1911.
The asylum could also offer a familial context to those who otherwise lacked a supportive network of relatives on which to depend for care. Mentally ill patients often fell into the asylum system, not due to a lack of family support, but due to a lack of relatives with the finance to support them outside of the institution. One example is Mary M, who came to rely on Garlands due to an absence of family members willing and able to care for her. Mary was first admitted to Garlands in April 1883, aged 20, suffering with congenital imbecility. She was transferred from Fusehill workhouse in Carlisle, where she had been resident for the previous seven years, since the age of thirteen, due to the death of both of her parents. Her case notes described her as having an imperfect education, and that whilst in the workhouse she was allowed to grow up as a “street waif”. Mary was stated as being “weak-minded and silly” since birth, but her condition had been manageable in the workhouse until the three months preceding her admission. Interestingly, an aunt is named on her reception order as her next of kin, but as Mary was institutionalised for such a long period, we can assume that she was either unwilling or financially unable to care for Mary. She remained in Garlands for the rest of her life, until her death in April 1922. The presence of a familial framework in the asylum was important in stabilising Mary’s condition, even if a recovery was not possible, the convalescence of such patients was valuable to the curative environment of such institutions.
Viewing the asylum as providing a domestic, ritualised regime of care which, in some cases, sought to act as a surrogate family environment, is important in dispelling the myths of contemporary opinion of the Victorian lunatic asylum. Looking back through the patient records, it is apparent that they adapted to life in the asylum, helped in part through its domestic routine.
This blog post is part of a wider PhD thesis based on the patient records of the Garlands lunatic asylum Carlisle, which will seek to recount history from the perspective of those who experienced it first hand. Any stories, memories or any questions you may have relating to the Cumbrian institution, please do not hesitate to get in touch firstname.lastname@example.org