Nicholson’s portrayal of him in the film became iconic representations of the main themes of the anti-psychiatry movement (Cummins, 2017b). The character – serving a prison sentence for statutory rape – is presented as a rebel against the abuses of the regimes but also the wider conformity of post war US consumer society. In his analysis, Goffman excluded the possibility that the asylum could be viewed as an attempt to respond to human suffering. This is clearly not an attempt to defend abusive practices. It is to suggest that Asylums fails to place these institutions in a clear historical context. There is a streak of nihilism that runs through his work that is echoed in Foucault.
The current view of the asylum is largely dominated by its representation as a Gothic institution. Tuan (1979) described them as key markers in ‘landscapes of fear’. Ironically, many of the design features, outlined in the next section, that were seen as therapeutic at the time add to this image. In 1954 there were still 154,000 patients in British mental hospitals. The criticisms of these institutions grew in the 1950s and 1960s. Barton (1959) identified the negative effects that institutionalisation could have on patients, comparing the behaviour of patients on long-stay wards to similar behaviour that he had seen of prisoners in concentration camps. Scott (1973) argued that the hospital itself made individuals passive. This meant that they would be unable to cope with life outside the institution. This followed earlier work by Wing (1962), which had shown how the process of social withdrawal developed among long-stay patients. Overall the picture is one of a physically, socially and culturally isolated institutions cut off from the main stream of health care and the wider society. Martin (1985) described the systemic faults in the institutional provision as the ‘corruption of care’. As discussed in Chapter 3, scandals about the abuse of patients and subsequent public exposure of them became one of the powerful drivers of moves to reform.
Asylum
The term asylum originally meant a place of refuge, safety and protection. This is reflected in its usage in modern international law. Asylum is the protection granted by one state to citizens who have fled another state because of political oppression or fear of persecution. It is the right of a state to grant asylum – it can be refused. In more recent times, asylum seeker has been consistently used in the tabloid press as a term of abuse (Tyler, 2013). Scull (1986) notes that the modern treatment and management of mental illness involved an expansion of state institutions. These institutions were accompanied by the rise of specialists – alienists, the forerunner of the modern psychiatrist – who were able apply their specialist knowledge and skills to the identification, assessment and subsequent treatment of groups or individuals.
The publicly funded asylum did not emerge in England until the 19th century. Prior to this period, there was a system of private madhouses where the wealthy were able to place disturbed relatives. These madhouses were often small and not subject to regulation. Abuse was common and a series of scandals led to a Parliamentary Inquiry and eventually An Act for Regulating Private Madhouses (1774). There were a series of scandals and debates about the treatment of the mentally ill in this period. William Tuke opened the York Retreat in 1796. The funds for the Retreat were raised by the local Quaker community in response to the appalling treatment of Hannah Mills, who died in the York Lunatic Asylum. The system of moral treatment that Tuke helped to develop was based in Quaker informed principles of treating individuals with respect and dignity. The 1828 County Asylums Act saw the establishment of a more formal admissions process but also an inspection regime that provided annual reports to Parliament. In 1845, the Lunatic Asylums Act placed a duty on counties to establish a pauper asylum. This led to a huge expansion in the number of asylums that became such important features of the physical and cultural landscape.
This illustrates that there was a clear humanitarian impulse in the development of the asylum system (Scull, 1986). The later crisis in asylums obscures or marginalises this (Cummins, 2017a). The geographical position and architecture of the asylums were cited by its 20th century critics as evidence of an ideology that sought to banish or exclude the mentally ill and other undesirables from the wider society (Foucault, 2003; Goffman, 2017). This was not the case at the time. Many asylums such as the one in York were called Retreats for the very specific reason that they were just that – a place to escape the pressures of the modern world. One of Scull’s (1986) main criticisms of Goffman (2017) is that he fails to acknowledge that this at any point. As outlined, Goffman (2017) saw the institution as creating the difficulties that the patients face. There is hardly any consideration of the issues that led to their admission. This is, of course, not to deny that abuses took place or that the impact of admission. It is simply to acknowledge the complexity of these processes.
The asylum was planned for a very specific purpose. It is a representation of an ideological response to the problem of madness (Franklin, 2002). The same is equally true of the modern notions of community, which form the basis of community care. The asylums built following the 1845 County Asylum Act were often designed by famous architects such as Sir George Gilbert Scott, a leading figure in the Victorian Revival. In his early career, he designed hundreds of workhouses. His most famous designs include the Albert Memorial and the main building of the University of Glasgow. Charles Fowler, who designed Covent Garden Market, was responsible for an asylum in Devon. The asylums were thus important civic statements. The great architect critic Sir Nikolaus Pevsner praised a number of asylum designs for the scope and ambition of their design. The Victorian Society and other conservation groups have campaigned for the listing of asylums because of their architectural heritage.
The asylums of the Victorian period were located outside of urban settings. This distance from the urban environment and the large grounds that often surrounded them was a key feature of moral treatment. Fresh air and other aspects of the rural idyll were seen as having recuperative properties. The asylums were built on rural slightly elevated sites to avoid the dangers of miasma – foul smelling vapours that were the result of poor sanitation. Until the development of germ theory, it was believed that miasma spread disease (Franklin, 2002). The early asylums were small with a couple of hundred patients. The 1845 Act led to the building of bigger institutions. The other important design features included separate wards for men and women as well as different wards for patients suffering from different conditions. Wards were built facing south with access to a court where patients were able to experience fresh air and sunshine – key elements of the therapy (Franklin, 2002). The corridor plan of these asylums was based on the sanitary principles proposed by Florence Nightingale. The asylum designs often included a house for the medical superintendent, workshops, recreation hall, a ballroom, a farm, a brewery, a chapel and a mortuary. The effect was the creation of a small self-contained community.
In examining a range of perspectives on the development of asylums, it is important not to paint an unrealistic picture or ignore the abuses that occurred or the damage that was done to individuals. Parr et al (2003) in their discussion of the Craig Dunain Hospital near Inverness show that the patients’ narratives of the institution are much more complex and contradictory than is sometimes allowed for. The authors note that the institution had a negative reputation with outside observers. However, the memories of the staff and patients were much more nuanced and complex. The former patients highlighted the lack of personal space and the accompanying indignities. For example, there was no real privacy so patients received injections or had consultations with their doctors in what
