In July 1905, a young draper’s assistant from south-east London was admitted to Bexley Asylum. Gertrude L. was 25 and this was her third admission into a lunatic asylum.
Initially, she was described as ‘strange and irrational in manner’. But by January 1906, she was corresponding with her friends on the outside. One letter that was copied and left in her case file provides an intriguing insight into asylum life from the patient’s point of view:
in this so called asylum … you are … treated like the worst form of cattle … We work all the hours God sends without proper nourishment or a proper bed … our hours of work are from 8 in the morn to 20 or 30 minutes past 7 in the evening … and you never see the colour of a copper coin.
From the 1960s to the late ‘80s, Marxist and feminist scholars set out to disabuse Whiggish historians of the notion that the understanding and treatment of mental illness had followed an uninterrupted upward trajectory called ‘progress’ from the late 18th century. As a result of this work, we know a great deal about why and how people were admitted to asylums, but far less about what actually happened to them once the ward door had been shut and the key turned.
What was life like inside these vast ‘monster’ institutions? And how were relationships between doctors, nurses and attendants, and patients constructed by shifting ideas around masculinity and femininity?
My book, Gender and Class in English Asylums, 1890-1914, sets out to answer these questions through a detailed analysis primarily of asylum case notes, committee minutes and annual reports. I have focused on two institutions, Claybury and Bexley. Each was built for 2,000 patients by the newly formed London County Council and opened in 1893 and 1898 respectively.
The turn of the century was an important moment in asylum history. Late Victorian psychiatry was experiencing a ‘clinical turn’ away from the old prison-like asylums towards the new mental hospitals, from the ‘lunatic’ to the mental patient, the attendant to the nurse. That, at least, was the idea even though the reality took some time to catch up.
Location is important, too. London had far higher lunacy rates than any other part of the country. Why?
Migration into the city was one reason. Lack of space and desperate poverty was another; families were simply unable to look after members who could not contribute to the household budget. But there was another reason, too: the abhorrent notion of degeneracy, which claimed that physical, mental and moral ‘defects’ (criminality, prostitution etc.) were passed on from one generation to another, creating an increasingly ‘unfit’ population. And this hereditary ‘taint’ was believed to be particularly prevalent in large, overcrowded urban areas, such as London.
Indeed, degeneracy theory fed directly into eugenics, making the early 20th century one of the darkest periods of psychiatric history.
My book looks at the impact of some of the overarching ideologies that were circulating at the time – degeneracy, feminism, socialism, science and the medicalisation of madness – on people in the asylum.
General hospitals had a powerful influence on the faltering discipline of psychiatry. Gradually, a new generation of well-qualified and scientifically-minded physicians, including a handful of women, started to take up asylum posts. Nurses began to receive formal training and gain recognised qualifications. And, perhaps most controversially, female nurses were moved into male wards shaking up these men-only bastions.
As a result, the highly gendered male doctor/female nurse binary was reinforced, marginalising many male attendants and reducing some to little more than nursing auxiliaries.
To return to Gertrude L., the patient experience is an important part of the book. During a period when virtually every aspect of asylum life was intended to act as ‘treatment’, I endeavour to reveal the effects on patients of the admission process, drugs, seclusion and restraint, the ward environment, work and amusements.
Why, for example, were the ‘rougher’ women put to work in the laundry? How were ward interiors designed in order to distract patients from their dark and troubling thoughts? In what way was food rationed according to a patient’s sex? And what were the consequences of forcing pauper patients to wear communal clothes?
There was, of course, no single patient experience. However, my book does, I hope, provide greater insights into how wider social and medical discourses influenced the lives of men and women living and working inside London’s late Victorian asylums at the most quotidian levels.