that they had developed. The grounds of the asylum were particularly fondly remembered as a place where patients were able to enjoy a measure of personal freedom – smoke cigarettes, have intimate relationships and so on. The asylum in this approach is viewed as a much more complex and ambiguous set of social and physical relationships than is allowed for Goffman’s total institution narrative. As one former resident put it ‘That awful place was home’ (Parr, 2003). In Parr et al’s (2003) study the former patients of Craig Dunain are very critical of the new functionalist mental health facility that replaced it – describing it as soulless.
The asylum may have physically disappeared from the landscape, but it remains a potent cultural reference point. There are any number of computer games and apps such as ‘Adventure Escape: Asylum’ which are based on the Gothic image of the asylum. In this game, for example, the marketing plays to a number of tropes that occur across the horror genre:
Anna wakes up one day in an asylum with hazy memories of her past. Soon, it’s clear that something has gone very, very wrong at the Byers Institute. In fact, there is a killer on the loose. (Google Play, no date)
In addition, there are several modern novels that explore the experience of asylums. These include Lehane’s (2003) tribute to B movies and pulp fiction Shutter Island, where a detective is called to a hospital for the criminally insane to investigate the disappearance of a patient. In Maggie O’Farrell’s (2006) Costa award winning novel The Vanishing Act of Esme Lennox, the title character has spent her adult life in an Edinburgh asylum. The novel explores the reasons why her family sought to have her institutionalised.
The process of deinstitutionalisation created the question: what should be done with the sites of the asylums? One of the ironies was that the geographical position of the asylum meant that they were now prime sites for development. Cummins (2018) notes that the site of the former asylum in Gorizia that was closed as part of Basaglia’s reforms of the Italian system became a public park. In the UK of the 1980s and 1990s, the focus was much more on private provision – housing and shopping developments. The heritage status of some sites led to the retention of the buildings as part of prestige developments (Chaplin and Peters, 2003), with the substantial grounds being a bonus. These luxury housing developments use a language of sanctuary that has echoes of the asylum narrative. The development is a private space that offers an escape from the pressures of the city but convenient access to it. This is, of course, required as the buyers will need to work in lucratively paid jobs to afford such an exclusive property. Chaplin and Peters (2003) note that the advertising for such developments uses terms such as ‘seclusion’ that had generally negative overtones when the space was an asylum. The authors found that there were few explicit references to the fact that these developments were on the sites of former asylums. The stigma attached to the asylum lingers on, even after the institution itself has physically disappeared. However, as Chaplin and Peters conclude, ‘paradoxically, asylum can now be bought in an ideal self-contained community, with security to keep society out’ (Chaplin and Peters, 2003: 228).
Leary (2011) outlines what he calls ‘ruin pornography’, by this he means the stylish and artistic photographs and media representations of once great industrial cities. He terms this trend Detroitism, as the city has gone from being a metonym for post war growth to one for deindustrialisation. As he points out, it is possible to buy art house coffee table books of ruined and neglected buildings that were once the heartbeat of US post war industrial economic boom. What these photographs cannot capture is the dynamism of a booming economy or what that meant for working class people. The stylised photographs and images obviously cannot capture the reality of these areas as working environments – the heat, the noise and the physical effort required to keep up with industrial processes are all missing. In a rather similar vein, there is a thriving interest in neglected and abandoned asylums. These photographs are used, in a similar way, to capture the essence of the former institutions. These haunting photographs of abandoned wards, strange equipment used in treatments and images of neglected patients all add to the Gothic reputation of the asylum. ‘Asylumism’ thus acts as a metonym for the management and treatment of mental illness before the advent of community care. In doing so, it collapses the end of the asylum as an institution into its whole history.
Van der Velde (2016) published Abandoned Asylums – a series of photographs that promises readers ‘an unrestricted visual journey inside America’s abandoned state hospitals, asylums and psychiatric facilities, the institutions where countless stories and personal dramas played out behind locked doors and out of public sight’. It also promises images of hospitals that treated the famous and infamous, including Marilyn Monroe and Charles Manson. The abandoned and decaying institutions act as magnets for so-called ‘urban explorers’, such as Keïtaï, who enter abandoned sites and post photographs of what they find. Alongside a series of photographs, the following is an entry from Keïtaï’s blog about a visit to the former West Park Asylum in Epsom Surrey.
We were able to see more of the place; the padded cell, the main hall, the post office and the children’s creche. The padded cell was our main goal like many others who venture there. It was smaller then [sic] I expected and harder too. (Keïtaï, 2011)
This is not the only approach to the complex history of the asylum. For example, ‘The lives they left behind: Suitcases from a state hospital attic’ (Community Consortium, 2015) is an exhibition based on a suitcases found in an abandoned building when the Willard Psychiatric Center in New York’s Finger Lakes closed in 1995. The exhibition paints a complex portrait of the individual lives of the patients before they entered the asylum. This approach forces the reader to ask fundamental questions such as ‘why were these individuals admitted to the institution, how were they treated and why were patients for such long periods?’ Raymond Depardon produced a series of superb photographs of the Gorizia asylum where Basaglia (Foot, 2015) enacted his reforms. These photographs document the need for the reform, as Depardon in discussing how he came to take the photographs states:
I often went back to the old hospital in Trieste, the place called the ‘manicomio’, the ‘lunatic asylum’. One day, I followed this group coming out of the canteen. What was it about the patients that struck me: the way they looked, the clothes they wore, the way they walked? I was drawn to them. I found myself in a very old ‘reparto;’ the door of the ward closed behind me, there wasn’t a nurse in sight. With the noise and the decrepitude of the place, I confess that for a moment I took fright. I started taking photographs, very quietly. (Raymond Depardon, quoted in Howard, 2018)
The development of mental health policy is a history of space and place, seclusion and exclusion. In examining this history, it is vital to consider the symbolic value that is placed on particular spaces and places. Bedlam comes to be representative of institutionalised care. In the US, conscientious objectors in the Second World War were sent to work as hospital orderlies in asylums. Parsons (2018) highlights that these individuals were appalled by what they saw and became committed to reform. This initially involved fighting racial segregation. Conscientious objectors working at the Philadelphia State Hospital at Byberry took their concerns to two journalists Alfred Deutsch and Albert Maisel. This resulted, in 1946, in the publication of an expose in Life magazine, which reached millions of US citizens – the modern equivalent of a prime time documentary or
