How times change: the “local hospitals and asylums” pamphlet box

Any reader with even the most basic knowledge of the history of asylums and mental institutions – whether from academic reading or from popular fiction – knows that such places could, until shamefully recently, often be terrible places for people with mental health issues or learning disabilities to live. One of our interesting but at times less enjoyable-to-read pamphlet boxes that contains various reports into institutions in Calderdale is Box 362: “Local Hospitals and Asylums”. Many different ways of treating and viewing asylum patients and attitudes towards people with disabilities are reflected in some of its contents, which we will discuss in this post.

WARNING: some parts of the following post, direct quotations mainly, may be distressing to read but are included as they are reflective of the attitudes of those in charge of these places at the time.

In the 1800s hospitals for not just the physically unwell, but also the mentally unwell and what were then termed “imbeciles”, were being built across the UK to try and accomplish two aims: either the restoration of moral and physical health, or protection of the wider population from those who were sent there. Hospitals to treat specific ailments in isolation such as smallpox or typhoid were built; “preventative homes for girls” were established to remove girls and women from risky environments that were thought to be leading or had led them into prostitution or immoral practices, and quietly and (hopefully) healthily give birth, while being trained in various skills so that on release they could find honest work for themselves; and while existing workhouses tried to cater to the needs of those who were out of work because of injury or because of non-physical disabilities, they were increasingly unable to cope with the very different demands of both groups. Hence asylums and mental institutions becoming new, specialised places for the treatment of the latter. The County Asylums Act 1808 and the Lunacy Act 1845/County Asylums Act 1845 were behind this increase in asylum provision, and the latter two particularly were Acts designed to reframe those sent there as patients rather than inmates. 

Local health boards were keen to avoid reproducing the outrages and failures of infamous institutions like Bethlehem Hospital, aka “Bedlam”, while still catering to both the needs of families to have unwell relatives looked after and the desire of communities to have people deemed to be inconveniently or dangerously unwell kept away from everyone else. In the Halifax and wider pre-Calderdale area, most people who needed that sort of care would have previously been sent to small private institutions. If they couldn’t afford this or were paupers they would be sent to the West Riding Pauper Lunatic Asylum in Wakefield. As a result of the 1845 Acts provision of residential care extended to Menston Asylum, and then Storthes Hall in Kirkburton. Stansfield View in Todmorden, initially a workhouse, later morphed into an institution providing both residential care and training for eventual readmission to society.

Wakefield Asylum’s reports from 1842, 1849, and 1879 are in the box and all show what was for the time a relatively compassionate and progressive view of treatment. It castigates Overseers in various areas for not referring patients at an earlier point in their illness, instead waiting for them to be committing criminal acts or harming themselves, and describes this as “a criminal neglect of duty towards the patient” – strong words! It also discusses hereditary inclination towards mental health issues like anxiety and depression, and how trying to support family members in distress can make other family members equally unwell, with a case study of a family where five members were in and out of the asylum at various points because of the difficulties one or two institutionalisations presented to the others. The 1879 report shows a thoughtful and detailed approach to the care of patients and attempts to prevent further injury happening to themselves – the Medical Superintendent and Director, Dr. Herbert C. Major, gives some case histories and makes two interesting points clear: that needless referrals are often made for people who would be better served by workhouses or community support and who are not in need of intensive care or removal from society, and should be refused; and that options such as narcotic or physical restraint should only be used in the rarest of circumstances. It also includes a report by two Lunacy Commissioners giving a very favourable report of the place, noting that “the use of mechanical restraint or seclusion has in no instance been found necessary” and praising the opportunities for learning trades and occupying their time as positively influencing patients’ behaviour. There is no sense of disdain for or hopelessness about the long-term prospects for the vast majority of patients.

For all its sensitivity, however, you can see from the admissions table that it was still 1879…13 women were admitted for “change of life”, in other words menopause-related symptoms, 6 women for “love affairs (including seduction)”, and 8 men for “self abuse (sexual)”. What was considered “insanity” owed as much to the culture of the time as it did to any medical or psychological knowledge.

In stark contrast, a report into the building and administration of Menston Asylum and Storthes Hall which was published in 1901, and updated in 1904, makes for grim and sometimes angering reading to the modern reader in its attitude towards those who were sent to either location. Only about a third of the report is about the places themselves, and most of it (written by Alderman John F. Coe, not a doctor!) veers between grudging admiration for the “geniuses” who are admitted only because they are too sensitive for modern life and disgust for those with moral failings such as addiction issues. The worst is saved for those with congenital birth defects or hereditary genetic conditions, who he refers to as “human lumber” and “broken human crockery” and for whom his musings on possible future solutions are too distressing to be included in this blog post. While he feels that forced sterilisation of what another writer called “the unfit of all classes” is an extreme opinion, he later opines that laws preventing alcoholics, the insane, and the physically unwell (anything from consumption to cancer) from marrying should be brought into force, and that at the very least these people should almost all be permanently segregated from society as a quarter of discharges are readmitted fairly quickly and “it would be dangerous … to send our among the public, persons cured of small pox or plague without first having disinfected their clothes”. Maybe the difference in tone from Dr. Major reflects Coe’s lack of medical training, but his opinions and quotations came from many leading physicians of the day as well as early psychologists such as Cesare Lombroso (responsible for now-discredited but then popular theories about phrenology and the biological origins of criminality).

The passage above, a quotation from a talk given at a meeting of the BMA, starts off with the usual biological essentialism about the brains of “primitive people” but then moves to one of the few moments in these reports that hits on something we now know to be true about the causes of many mental illnesses. Namely,

When people are barely surviving and not thriving, mental health suffers. Sadly Coe still manages to miss the point by then returning to quoting and endorsing reductive and eugenics-based theories of insanity. Education and intelligence are not always found together.

Leaping several decades forward in time, the Percy Commission of 1954, aka the Royal Commission on the Law Relating to Mental Illness and Mental Deficiency, brought about many changes to how places like these were run – primarily around voluntary admission and encouraging treatment within the community. A small booklet in this box, undated but more modern guidance for family members of patients at Stansfield View, ends with the following quotation:

Time did indeed bring out a view of treatment closer to what Dr. Major preferred back in 1879, with treatment and restoration of health being the purpose of an institution. Unfortunately negative stereotypes closer to Lombroso’s theories still persist within society – one reason why it’s useful, even if it makes for difficult reading, to be able to see where those ideas came from and to consider how the over-medicalisation of psychiatric illnesses, exaggerated and romanticised notions of the “unstable genius”, and neglect of making adjustments for learning disabilities have their roots in those outdated and often brutal stereotypes of the “mentally deficient”.

Other items in this box include reports from the 1950s and 1960s from the Halifax Area Hospital Management Committee, booklets about Northowram Hall Isolation Hospital, and “A Full Report of the Ceremony of Laying the First Stone of the Huddersfield Infirmary” from 1829. If you want to learn more about the asylum building boom in the 1800s, the County Asylums webpage has plenty of information – and this pamphlet box is kept in the Horsfall Turner Room, available on request.