of the various forms of so-called medical men (Jones, 1972) meant that commonplace treatments aimed to work on the bodies of sufferers. It has been argued that some of the treatments for insanity that looked particularly barbaric – involving the use of restraint or even beatings – were not wilfully cruel, but rather reflected the widespread belief that those who were without reason were in fact like animals and so had to be trained to behave (Scull, 1979b).
By the beginning of the nineteenth century some of the physical treatments were becoming quite elaborate. Benjamin Rush, who ran the Pennsylvania Asylum, designed the ‘tranquilliser chair’ which held the body still while allowing cold water to be applied to the head and warm water to the feet – acting ‘as a sedative to the tongue and temper as well as the blood vessels’ (Rush, cited in Scull, 1981, p. 34).
Figure 1.1 Benjamin Rush and his tranquilliser chair
Despite the continuing interest in physical treatment, in the decades leading up to the establishment of the profession of psychiatry there was a significant move towards a more psychological orientation. A very important innovation was that of moral treatment – the idea that a cure would follow from the provision of a calm environment away from the stresses of modern urban living, where staff treat the afflicted with dignity, kindness and respect. Significant innovations occurred at the York Retreat in England, led by the Tukes (a wealthy Quaker family who were not medics), and by the noted medic Philipe Pinel in France. Samuel Tuke (1813) emphasised the psychological nature of insanity and its treatment: ‘If we adopt the opinion, that the disease originates in the mind, applications made immediately to it are obviously the most natural; and the most likely to be attended with success’ (Tuke, 1813, p. 84). Tuke gave credit to the work of Pinel, who had claimed that patients undergoing moral treatment were ‘treated with affability, soothed by consolation and sympathy’ and thus put on a road to ‘rapid convalescence’ (Pinel, 1806, p. 67).
Moral treatment A form of treatment for insanity that supposed that a cure could be achieved through placing a patient in calm, restful and attractive surroundings, treating them with respect and encouraging good behaviour. It was a key argument for the construction of asylums in the nineteenth century.
The rationale of this psychological form of treatment helped provide the new profession with a respectable identity. It construed insanity as identifiable and curable, which justified the construction of asylums. Eventually, this led to the Lunacy Act 1845 and County Asylums Act 1845, which required all local authorities to provide an asylum.
Figure 1.2 shows what an early asylum would have looked like. This asylum was opened in 1851, designed in the Gothic style by the renowned architect William Fulljames who also designed churches, commercial buildings and a country house in Gloucestershire. It was originally built to accommodate 210 patients as a joint county asylum (Herefordshire, Monmouthshire, Brecon and Radnor), but at its peak had well over 1000 inmates.
Figure 1.2 A contemporary drawing of Joint Counties Lunatic Asylum, which was built following the Lunacy Act 1845 and County Asylums Act 1845. It is quite typical in style: the country-house appearance was considered as important as the confinement that it provided.
These asylums were built under architectural assumptions that were very different from those of prisons and workhouses. They were designed to mimic grand houses and were placed within often large and pleasant grounds in order to create an atmosphere of calm and peace, thought crucial for cure (Edginton, 1997). In some important respects, their rapid success was their undoing. Scull (1979a) traces the increase in the numbers of so-called pauper lunatics (as a reasonable measure of the population of the asylums) and finds the numbers leapt from 16,821 in 1844 (representing a rate of 10.21 for every 10,000 of population) to 77,257 in 1890 (26.27 for every 10,000). This trend continued into the twentieth century. At their peak, in 1954, there were over 140,000 patients (in England) in psychiatric hospitals.
The substantial increase in the numbers of asylum inmates undoubtedly helped establish the idea that the psychiatric institutions were a necessary component of a modern society, but it also undermined the possibilities of moral treatment, as the new asylums quickly became overcrowded, underfunded and understaffed. They began to fully deserve the condemnation aimed at them through a new series of scandals about the poor conditions, even in the new asylums (Scull, 1996). Thus, eventually there was a turning away from the asylums through the second half of the twentieth century. Nevertheless, the asylums provided an institutional base for the emerging profession of psychiatry, while the claims for expertise in the criminal justice system were to raise its public profile.
Methodology: The connection between research and understanding history
Critics of psychiatry (such as Foucault) have often focused on the history of the profession. This might be for a number of reasons, including an interest in making links to past practices that can often appear barbaric. It might also be because an understanding of where our ideas and practices have come from can help us question our current assumptions.
The disciplines of psychology and psychiatry have been accused of being ahistorical – they do not take account of their own history and the circumstances that have created their own assumptions.
As this chapter suggests, however, there can be important differences between ways of understanding past events. Studies of history cannot use experiments as they are used in natural sciences, medicine and psychology. One might therefore pose the question: How do we decide which version of the past is the most accurate? Indeed, why might history (and one’s understanding of it) be important to understanding psychiatry and psychology?
2.2 Moral insanity and criminological expertise
The earliest signs of the formal recognition of categories of ‘insanity’ come from processes of legal justice. For as long as we have written records, we know that systems of justice have recognised that those who were deemed to be suffering from insanity ought to be treated with some leniency (Walker, 1968). While the principle was recognised across time, there has been a long debate about how insanity might be reliably detected. The claim of expertise in this territory became an important facet of the case for recognition of the profession of psychiatry. Some of these developments are described in Chapter 18. For the purposes of this chapter we observe a series of initiatives in Germany, France, Britain and the US that aimed to define disorders of the mind that might be associated with criminality (Jones, 2016). Particular claims were made about ‘monomanias’, ‘partial insanity’ and moral insanity. These all emerged from the idea that the mind could be understood as an object of exploration, and that it was possible to identify particular aspects of the mind that might be disordered in a way that could lead to criminality and violence.
Moral insanity A term used in the nineteenth century to refer to a supposed psychological disorder that was associated with antisocial and criminal behaviour.
Despite some success in the courts, these ideas were considered too radical when debated in the public arena, fuelled by the relatively new phenomenon of a widespread and popular press. The newly formed profession of psychiatry moved away from these more nuanced psychological ideas and back towards their medical and physiological roots (Jones, 2017b). By the 1860s an unfortunate alliance was made between the new profession’s need to profess expertise in the field of criminality and ideas about the significance of hereditary. The
