What is the Eastern State Hospital (Virginia)?

Introduction

Eastern State Hospital is a psychiatric hospital in Williamsburg, Virginia. Built in 1773, it was the first public facility in the present-day United States constructed solely for the care and treatment of the mentally ill. The original building had burned but was reconstructed in 1985.

Francis Fauquier and the Enlightenment

Eastern State Hospital traces its foundation to a speech by Francis Fauquier, Royal Governor of the colony of Virginia, on 06 November 1766. At the House of Burgesses’ first meeting since the Stamp Act and Virginia Resolves, Fauquier primarily discussed the relationship between the Mother Country and these colonists, and expressed optimism for their future. His speech also unexpectedly addressed the mentally ill, as follows:

“It is expedient I should also recommend to your Consideration and Humanity a poor unhappy set of People who are deprived of their senses and wander about the Country, terrifying the Rest of their fellow creatures. A legal Confinement, and proper Provision, ought to be appointed for these miserable Objects, who cannot help themselves. Every civilized Country has an Hospital for these People, where they are confined, maintained and attended by able Physicians, to endeavor to restore to them their lost reason.”

About a year later, on 11 April 1767, Governor Fauquier addressed the same issue before the next House of Burgesses, thus:

“There is a subject which gives me concern, on which I shall particularly address myself to you, as it is your peculiar province to provide means for the subsistence of the poor of any kind. The subject I mean is the case of the poor lunatics. I find on your journals that it was Resolved, That an hospital be erected for the reception of persons who are so unhappy as to be deprived of their reason; And that it was Ordered, that the Committee of Propositions and Grievances do prepare and bring in a bill pursuant to the above resolution. But I do not find that any thing more was done in it. It was a measure which I think could offend no party, and which I was in hopes humanity would have dictated to every man, as soon as he was made acquainted with the call for it. It also concerns me much on another account; for as the case now stands, I am as it were compelled to the daily commission of an illegal act, by confining without my authority, a poor lunatic, who, if set at liberty, would be mischievous to society; and I would choose to be bound by, and observant of, the laws of the country. As I think this is a point of some importance to the ease and comfort of the whole community, as well as a point of charity to the unhappy objects, I shall again recommend it to you at your next meeting; when I hope, after mature reflection, it will be found to be more worth your attention than it has been in this.”

Governor Fauquier’s benevolent and bold expressions did eventually lead to the establishment of the Eastern State Hospital, although he died 03 March 1768, before it was built. His compassion and humanitarian care for those who needed it the most, made it easier for his ideas to be developed and a facility built.

Fauquier’s concern probably rested in Enlightenment principles, which were so widespread throughout the time. The 18th century was a time for rejecting superstitions and religions, and substituting science and logical reasoning. The philosophers David Hume and Voltaire were studying and investigating the worth of human life, which would ultimately alter perceptions of the mentally ill. During this time in London, insane people were viewed and used for as entertainment and comical relief. The Bethlehem Royal Hospital (sometimes called Bedlam) attracted many tourists and even held frequent parades of inmates. Enlightenment attitudes encouraged more sensitivity towards the mentally ill, rather than treating them as outcasts and fools. Some started to believe that being mentally ill was, in fact, an illness of the mind, much like a physical disease or sickness, and that these mental illnesses were also treatable.

Before Governor Fauquier’s speeches, a person who was mentally ill was not diagnosed by a doctor, but rather judged by 12 citizens, much like a jury, to be either a criminal, lunatic or Idiot. Most classified as lunatic were placed in the Public Gaol in Williamsburg. Taxpayers probably appreciated the hospital idea only if they had a family member or close friend who was mentally ill. The only hospital where mentally ill patients were sometimes taken before Eastern State Hospital was built, was the Pennsylvania Hospital, a Quaker institution in Philadelphia. Until a campaign by Benjamin Rush in 1792 to establish a separate treatment wing, mentally ill patients were kept in the basement and out of the way of regular patients who needed medical assistance.

Percival Goodhouse was is thought to be one of the first patients admitted to the Eastern State Hospital after its opening on 12 October 1773.

Civil War and Decline

In 1841, Dr. John Galt was appointed superintendent of the hospital, with roughly 125 patients (then called “inmates”) at the time. Dr. Galt introduced Moral treatment practices, a school of thought which viewed those with mental illness as deserving of respect and dignity rather than punishment for their behaviour. Galt provided his patients with talk therapy and occupational therapy, and argued for in-house research. He decreased the use of physical restraints, even going an entire year without using them, relying instead on calming drugs (including laudanum), and also proposed deinstitutionalizing patients in favour of community-based care, though this proposal was repeatedly rejected. As the head of the hospital, Galt was successful in pressing for admission for enslaved people with mental illness, and taught the enslaved people owned by the hospital to provide talk therapy alongside nurses and aides. Although he claimed to treat patients equally regardless of their race, Galt did not publish racial breakdowns of his patients.

When the Civil War came to Williamsburg, the hospital found itself alternately on one side of the lines and then the other. On 06 May 1862, Union troops captured the asylum. Two weeks later, on 17 or 18 May, Dr. Galt died of an overdose of laudanum, though it is unclear whether this was intentional or accidental. When the hospital was captured, Union soldiers found that the 252 patients had been locked in without food or supplies by the fleeing white employees. Somersett Moore was the only non-African American employee to return following the capture, and he gave the keys to release the patients to the occupying men.

In the following decades, the increasingly crowded hospital saw a regression in methodology as science was increasingly viewed as an ineffective means of dealing with mental illness. During this era of custodial care, the goal became not to cure patients, but to provide a comfortable environment for them, separate from society. On 07 June 1885, the original 1773 hospital burned to the ground due to a fire that had started in the building’s newly added electrical wiring, a consequence of the great expansion of facilities at this time.

Restoration

By 1935 Eastern State Hospital housed some 2,000 patients with no more land for expansion. The restoration of Colonial Williamsburg and development of the Williamsburg Inn resulted in the facility being at the centre of a thriving tourist trade. The hospital’s location and space issues made a move necessary. Between 1937 and 1968, all of Eastern State’s patients were moved to a new facility on the outskirts of Williamsburg, Virginia, where it continues to operate today.

In 1985, the original hospital was reconstructed on its excavated foundations by the Colonial Williamsburg Foundation.

On This Day … 14 August

People (Births)

  • 1840 – Richard von Krafft-Ebing, German-Austrian psychologist and author (d. 1902).

Richard von Krafft-Ebing

Richard Freiherr von Krafft-Ebing (full name Richard Fridolin Joseph Freiherr Krafft von Festenberg auf Frohnberg, genannt von Ebing; 1840-1902) was an Austro-German psychiatrist and author of the foundational work Psychopathia Sexualis (1886).

Life

Krafft-Ebing was born in 1840 in Mannheim, Germany, studied medicine at the University of Heidelberg, where he specialized in psychiatry. He later practiced in psychiatric asylums. After leaving his work in asylums, he pursued a career in psychiatry, forensics, and hypnosis.

He died in Graz in 1902. He was recognized as an authority on deviant sexual behaviour and its medicolegal aspects.

Principal Work

Krafft-Ebing’s principal work is Psychopathia Sexualis: eine Klinisch-Forensische Studie (Sexual Psychopathy: A Clinical-Forensic Study), which was first published in 1886 and expanded in subsequent editions. The last edition from the hand of the author (the twelfth) contained a total of 238 case histories of human sexual behaviour.

Translations of various editions of this book introduced to English such terms as “sadist” (derived from the brutal sexual practices depicted in the novels of the Marquis de Sade), “masochist”, (derived from the name of Leopold von Sacher-Masoch), “homosexuality”, “bisexuality”, “necrophilia”, and “anilingus”.

Psychopathia Sexualis is a forensic reference book for psychiatrists, physicians, and judges. Written in an academic style, its introduction noted that, to discourage lay readers, the author had deliberately chosen a scientific term for the title of the book and that he had written parts of it in Latin for the same purpose.

Psychopathia Sexualis was one of the first books about sexual practices that studied homosexuality/bisexuality. It proposed consideration of the mental state of sex criminals in legal judgements of their crimes. During its time, it became the leading medico-legal textual authority on sexual pathology.

The twelfth and final edition of Psychopathia Sexualis presented four categories of what Krafft-Ebing called “cerebral neuroses”:

  • Paradoxia, sexual excitement occurring independently of the period of the physiological processes in the generative organs.
  • Anaesthesia, absence of sexual instinct.
  • Hyperaesthesia, increased desire, satyriasis.
  • Paraesthesia, perversion of the sexual instinct, i.e., excitability of the sexual functions to inadequate stimuli.

The term “hetero-sexual” is used, but not in chapter or section headings. The term “bi-sexuality” appears twice in the 7th edition, and more frequently in the 12th.

There is no mention of sexual activity with children in Chapter III, General Pathology, where the “cerebral neuroses” (including sexuality the paraesthesias) are covered. Various sexual acts with children are mentioned in Chapter IV, Special Pathology, but always in the context of specific mental disorders, such as dementia, epilepsy, and paranoia, never as resulting from its own disorder. However, Chapter V on sexual crimes has a section on sexual crimes with children. This section is brief in the 7th edition, but is expanded in the 12th to cover Non-Psychopathological Cases and Psychopathological Cases, in which latter subsection the term paedophilia erotica is used.

Krafft-Ebing considered procreation the purpose of sexual desire and that any form of recreational sex was a perversion of the sex drive. “With opportunity for the natural satisfaction of the sexual instinct, every expression of it that does not correspond with the purpose of nature—i.e., propagation,—must be regarded as perverse.” Hence, he concluded that homosexuals suffered a degree of sexual perversion because homosexual practices could not result in procreation. In some cases, homosexual libido was classified as a moral vice induced by the early practice of masturbation. Krafft-Ebing proposed a theory of homosexuality as biologically anomalous and originating in the embryonic and fetal stages of gestation, which evolved into a “sexual inversion” of the brain. In 1901, in an article in the Jahrbuch für sexuelle Zwischenstufen (Yearbook for Intermediate Sexual Types), he changed the biological term from anomaly to differentiation.

Although the primary focus is on sexual behaviour in men, there are sections on Sadism in Woman, Masochism in Woman, and Lesbian Love. Several of the cases of sexual activity with children were committed by women.

Krafft-Ebing’s conclusions about homosexuality are now largely forgotten, partly because Sigmund Freud’s theories were more interesting to physicians (who considered homosexuality to be a psychological problem) and partly because he incurred the enmity of the Austrian Catholic Church when he psychologically associated martyrdom (a desire for sanctity) with hysteria and masochism.

Works

A bibliography of von Krafft-Ebing’s writings can be found in A. Kreuter, Deutschsprachige Neurologen und Psychiater, München 1996, Band 2, pp.767-774.

  • Die Melancholie: Eine klinische Studie (1874) OCLC 180728044.
  • Grundzüge der Kriminalpsychologie für Juristen (second edition, 1882) OCLC 27460358.
  • Psychopathia Sexualis: eine Klinisch-Forensische Studie (first edition, 1886).
  • Die progressive allgemeine Paralyse (1894) OCLC 65980497.
  • Nervosität und neurasthenische Zustände (1895) OCLC 9633149.

Translations

  • Domino Falls translated and edited Psychopathia Sexualis:The Case Histories (1997) ISBN 978-0-9820464-7-0.
  • Charles Gilbert Chaddock translated four of Krafft-Ebing’s books into English:
    • An Experimental Study in the Domain of Hypnotism (New York and London, 1889).
    • Psychosis Menstrualis (1902).
    • Psychopathia Sexualis (twelfth edition, 1903).
    • Text Book of Insanity (1905).

What was the Erwadi Fire Incident (2001)?

Introduction

Erwadi fire incident is an accident that occurred on 06 August 2001, when 28 inmates of a faith-based mental asylum died in the fire. All these inmates were bound by chains at Moideen Badusha Mental Home in Erwadi Village in Tamil Nadu.

Large number of mental homes existed in Erwadi which was famous for the dargah of Quthbus Sultan Syed Ibrahim Shaheed Valiyullah, from Medina, Saudi Arabia who came to India to propagate Islam. Various people believe that holy water from the dargah and oil from the lamp burning there have the power to cure all illnesses, especially mental problems. The treatment also included frequent caning, beatings supposedly to “drive away the evil”. During the day, patients were tied to trees with thick ropes. At night, they were tied to their beds with iron chains. The patients awaited a divine command in their dreams to go back home. For the command to come, it was expected to take anything from two months to several years.

As the number of people seeking cure at dargah increased, homes were set up by individuals to reportedly take care of the patients. Most of these homes were set up by people who themselves had come to Erwadi seeking cure for their relatives.

The origins of the fire are unknown, but once it spread, there was little hope of saving most of the 45 inmates, who were chained to their beds in the ramshackle shelter in which they slept, though such shackling was against Indian law. Some inmates whose shackles were not as tight escaped, and five people were hospitalised for severe burns. The bodies of the dead were not identifiable.

Aftermath and Legacy

All mental homes of this type were closed on 13 August 2001, and more than 500 inmates were placed under government’s care. As per Supreme Court directions, a commission headed by N. Ramdas was set up to enquire into these deaths. The commission recommended that care of mentally ill people is to be improved, that anybody wishing to set up a mental home to acquire a license, and that all inmates be unchained.

In 2007, the owner of the Badsha Home for the Mentally Challenged, his wife and two relatives were sentenced to seven years imprisonment by a magistrate Court.

What was the Alleged Lunatics’ Friend Society?

Introduction

The Alleged Lunatics’ Friend Society was an advocacy group started by former asylum patients and their supporters in 19th-century Britain.

The Society campaigned for greater protection against wrongful confinement or cruel and improper treatment, and for reform of the lunacy laws. The Society is recognised today as a pioneer of the psychiatric survivors movement.

Background

There was concern in the United Kingdom in the 19th century about wrongful confinement in private madhouses, or asylums, and the mistreatment of patients, with tales of such abuses appearing in newspapers and magazines. The Madhouses Act 1774 had introduced a process of certification and a system for licensing and inspecting private madhouses, but had been ineffectual in reducing abuses or allaying public anxiety. Doctors in the 19th century were establishing themselves as arbiters of sanity but were reliant on subjective diagnoses and tended to equate insanity with eccentric or immoral behaviour. Public suspicion of their motives was also aroused by the profits that were made from private madhouses.

In 1838, Richard Paternoster, a former civil servant in the East India Company, was discharged after 41 days in a London madhouse (William Finch’s madhouse at Kensington House) having been detained following a disagreement with his father over money. Once free, he published, via his solicitors, a letter in The Times announcing his release. The letter was read by John Perceval, a son of prime minister Spencer Perceval. Perceval had spent three years in two of the most expensive private asylums in England, Brislington House in Bristol, run by Quaker Edward Long Fox, and Ticehurst Asylum in Sussex. His treatment had been brutal in the Brislington House; at Ticehurst the regime was more humane but his release had been delayed. Perceval contacted Paternoster and they were soon joined by several former patients and others:

  • William Bailey (an inventor and business man who had spent several years in madhouses);
  • Lewis Phillips (a glassware manufacturer who had been incarcerated in Thomas Warburton’s asylum);
  • John Parkin (a surgeon and former asylum patient);
  • Captain Richard Saumarez (whose father was the surgeon Richard Saumarez and whose two brothers were Chancery lunatics); and
  • Luke James Hansard (a philanthropist from the family of parliamentary printers).

This group was to form the core of the Alleged Lunatics’ Friend Society, although the Society would not be formally founded until 1845.

The group began their campaign by sending letters to the press, lobbying Members of Parliament (MPs) and government officials, and publishing pamphlets. John Perceval was elected to the Board of Poor Law Guardians in the parish of Kensington (although he was opposed to the New Poor Law) and was able to join magistrates on their visits of inspection to asylums. Richard Paternoster and Lewis Phillips brought court cases against the people who had incarcerated them. John Perceval published two books about his experience. Richard Paternoster wrote a series of articles for The Satirist magazine; these were published in 1841 as a book called The Madhouse System.

Formation

On 07 July 1845, Richard Paternoster, John Perceval and a number of others formed the Alleged Lunatics’ Friend Society. A pamphlet published in March the following year set out the aims with which the Society was founded:

At a meeting of several Gentlemen feeling deeply interested in behalf of their fellow-creatures, subjected to confinement as lunatic patients.

It was unanimously resolved:… That this Society is formed for the protection of the British subject from unjust confinement, on the grounds of mental derangement, and for the redress of persons so confined; also for the protection of all persons confined as lunatic patients from cruel and improper treatment. That this Society will receive applications from persons complaining of being unjustly treated, or from their friends, aid them in obtaining legal advice, and otherwise assist and afford them all proper protection.

That the Society will endeavour to procure a reform in the laws and treatment affecting the arrest, detention, and release of persons treated as of unsound mind…

John Perceval was listed as the honorary secretary, Luke James Hansard as treasurer, and Henry F. Richardson as honorary solicitor (Gilbert Bolden would later become the Society’s lawyer). Sixteen vice-presidents included both Tory and Liberal MPs; notable amongst them was the radical MP for Finsbury, Thomas Duncombe. New legislation, championed by Lord Ashley, was being introduced in parliament (the Lunacy Act 1845 and County Asylums Act 1845) and the creation of a formal society put the group in a better position to influence legislators. Four days after the Society was founded Thomas Duncombe spoke in the House of Commons, arguing for the postponement of new legislation pending a select committee of inquiry, and detailing a number of cases of wrongful confinement that had come to the Society’s attention. The legislation however went ahead, and the Society would have to wait until 1859 for an inquiry, although the Society’s supporters in parliament managed to secure a number of clauses to safeguard patients in the 1845 Act.

Although the Society had influential supporters such as Thomas Duncombe and Thomas Wakley (surgeon, radical MP for Finsbury and coroner), they did not gain widespread public support, probably never having more than sixty members and relying upon their own money for funding. A critical article in The Times of 1846 revealed the views and prejudices that the Society would have to counter:

“We can scarcely understand what such a society can propose to accomplish… There have been, no doubt, many cases of grievous oppression in which actual lunatics have been treated with cruelty, and those who are only alleged to be insane have been most unlawfully imprisoned… These, however, are evils to be checked by the law and not tampered with… by a body of private individuals… Some of the names we have seen announced suggest to us the possibility that the promoters of this scheme are not altogether free from motives of self-preservation. There is no objection to a set of gentlemen joining together in this manner for their own protection… but we think they should be satisfied to take care of themselves, without tendering their services to all who happen to be in the same position.”

John Perceval replied that the law afforded patients insufficient protection, and that the Society existed to give legal advice to individuals and draw the government’s attention to abuses as well as to encourage a more general discussion about the nature of insanity. In response to the article’s reference to the fact that several members of the Society had been patients in asylums, Perceval had this to say:

“I would remind the writer of that article, that men are worthy of confidence in the province of their own experience, and as the wisest and best of mankind hold the tenure of their health and reasoning faculties on the will of an Inscrutable Providence, and great wits to madness are allied, he will do well to consider that their fate may be his own, and to assist them in saving others in future from like injustice and cruelties, which the ignorance of the fondest relations may expose patients to, as well as the malice of their enemies.”

Social worker Nicholas Hervey, who has written the most extensive history of the Alleged Lunatics’ Friend Society, suggested that a number of factors may have contributed to the lack of wider public support, namely: alignment with radical political circles; endorsement of localist views, rather than support of the Lunacy Commission’s centralism; fearless exposure of upper-class sensibilities regarding privacy on matters concerning insanity, thus alienating wealthy potential supporters; attacks on the new forms of moral treatment in asylums (what John Perceval referred to as “repression by mildness and coaxing”).

Achievements

As well as lobbying parliament and campaigning through the media and public meetings, during the next twenty years or so the Society took up the cases of at least seventy patients, including he following examples:

  • Dr Edward Peithman was a German tutor who had been falsely imprisoned in Bethlem Hospital for fourteen years after he had tried to gain access to Prince Albert.
    • John Perceval took up his case and, after the Commissioners in Lunacy released him in February 1854, took him home with him to Herne Bay.
    • Dr Peithman promptly tried to speak to Prince Albert again, and was committed to Hanwell Asylum.
    • Again Perceval obtained his release, this time escorting him back to Germany.
  • Jane Bright was a member of a wealthy Leicestershire family, the Brights of Skeffington Hall.
    • She was seduced by a doctor who took most of her money and left her pregnant. Soon after the birth of her child, her brothers had her committed to Northampton Hospital.
    • On her release she enlisted Gilbert Bolden, the Society’s solicitor, to help her recover the remains of her fortune from her family.
  • Anne Tottenham was a Chancery lunatic who was removed from the garden of Effra Hall Asylum in Brixton by Admiral Saumarez.
    • This course of action was a rare exception to the Society’s more usual rule of following legal routes to secure the release of patients who had been wrongly confined.
  • Charles Verity was serving a two-year prison sentence when he was transferred to Northampton Hospital. He contacted John Perceval in 1857 about abuses in the refractory ward and the Society secured an inquiry.
    • The Commissioners in Lunacy reported in 1858 that charges of cruelty and ill-usage had been established against attendants and the culprits had been dismissed.

Not all the Society’s cases were successful:

  • James Hill (father of Octavia Hill) was a Wisbech corn merchant, banker, proprietor of the newspaper the Star of the East and founder of the United Advancement Society.
    • He had been declared bankrupt and had been committed to Kensington House Asylum.
    • After his release in 1851 the Society helped him sue the proprietor of Kensington House, Dr Francis Philps, for wrongful confinement but the case was unsuccessful.
  • Captain Arthur Childe, son of William Lacon Childe, MP, of Kinlet Hall in Shropshire, was a Chancery lunatic who had been found to be of unsound mind by a lunacy inquisition in 1854.
    • The Society applied on his behalf for another lunacy inquisition in 1855, claiming he was now of sound mind.
    • The Society was unsuccessful; the jury found Captain Childe to be of unsound mind and there was a quarrel about costs.

The Society was successful in drawing attention to abuses in a number of asylums. Notable amongst these was Bethlem Hospital, which, as a charitable institution, had been exempt from inspection under the 1845 Lunacy Act. The help of the Society was enlisted by patients and they persuaded the home secretary to allow the Commissioners in Lunacy to inspect the asylum. The Commissioner’s critical report in 1852 led to reforms. Together with magistrate Purnell Bransby Purnell, the Society ran a campaign to expose abuses in asylums in Gloucestershire.

One of the aims of the Society had always been to persuade parliament to conduct a committee of inquiry into the lunacy laws. This, after numerous petitions, they finally achieved in 1859. John Perceval, Admiral Saumarez, Gilbert Bolden and Anne Tottenham (a patient they had rescued from Effra House Asylum) gave evidence to the committee. The results were disappointing; the committee made a number of recommendations in their 1860 report but these were not put into place.

Legacy

The Society’s activities appear to have come to an end in 1860s. Admiral Saumarez died in 1866, and Gilbert Bolden had a young family and moved to Birmingham. In 1862 John Perceval wrote a letter to the magazine John Bull:

“I am sorry to say that this Society is so little supported, in spite of the great good it has done, and is in consequence so entirely disorganised, that I have repeatedly proposed to the committee that we should agree to a dissolution of it, and I have only consented to continue acting with them, and to lend my name to what is rather a myth than a reality, from their representation that however insignificant we were, we had still been able to effect a great deal of good, and might still be further successful…”

Nicholas Hervey concluded:

“The Society’s importance lies in the wide panorama of ideas it laid before Shaftesbury’s Board. Unrestrained by the traditions of bureaucratic office, it was free to explore a variety of alternatives for care of the insane, many of which were too visionary or impolitic to stand a chance of implementation. The difficulty it faced was the blinkered perspective of the Commission and of Shaftesbury in particular… it would not be an exaggeration of the Society’s worth to say that patients’ rights, asylum care, and medical accountability all suffered with its demise in the 1860s.”

The cause for lunacy law reform was taken up by Louisa Lowe’s Lunacy Law Reform Association, whose aims were very similar to those of the Alleged Lunatics’ Friend Society. In more recent years the Society has been recognised as a pioneer of advocacy and the psychiatric survivors movement.

What was the Kirkbride Plan?

Introduction

The Kirkbride Plan was a system of mental asylum design advocated by Philadelphia psychiatrist Thomas Story Kirkbride (1809-1883) in the mid-19th century.

The asylums built in the Kirkbride design, often referred to as Kirkbride Buildings (or simply Kirkbrides), were constructed during the mid-to-late-19th century in the United States. The structural features of the hospitals as designated by Dr. Kirkbride were contingent on his theories regarding the healing of the mentally ill, in which environment and exposure to natural light and air circulation were crucial. The hospitals built according to the Kirkbride Plan would adopt various architectural styles, but had in common the “bat wing” style floor plan, housing numerous wings that sprawl outward from the centre.

1848 lithograph of the Kirkbride design of the Trenton State Hospital.

The first hospital designed under the Kirkbride Plan was the Trenton State Hospital in Trenton, New Jersey, constructed in 1848. Throughout the remainder of the nineteenth century, numerous psychiatric hospitals were designed under the Kirkbride Plan across the United States. By the twentieth century, popularity of the design had waned, largely due to the economic pressures of maintaining the immense facilities, as well as contestation of Dr. Kirkbride’s theories amongst the medical community.

Numerous Kirkbride structures still exist today, though many have been demolished or partially-demolished and repurposed. At least 30 of the original Kirkbride buildings have been registered with the National Register of Historic Places in the United States, either directly or through their location on hospital campuses or in historic districts.

Background

Basis and Philosophy

The establishment of state mental hospitals in the US is partly due to reformer Dorothea Dix, who testified to the New Jersey legislature in 1844, vividly describing the state’s treatment of lunatics; they were being housed in county jails, private homes, and the basements of public buildings. Dix’s effort led to the construction of the New Jersey State Lunatic Asylum, the first complete asylum built on the Kirkbride Plan.

Thomas Story Kirkbride (1809-1883), a psychiatrist from Philadelphia, Pennsylvania, developed his requirements of asylum design based on a philosophy of Moral Treatment and environmental determinism. The typical floor plan, with long rambling wings arranged en echelon (staggered, so each connected wing received sunlight and fresh air), was meant to promote privacy and comfort for patients. The building form itself was meant to have a curative effect, “a special apparatus for the care of lunacy, [whose grounds should be] highly improved and tastefully ornamented.” The idea of institutionalisation was thus central to Kirkbride’s plan for effectively treating the insane.

Design and Architectural Features

The Kirkbride Plan asylums tended to be large, imposing institutional buildings, with the defining feature being their “narrow, stepped, linear building footprint” featuring staggered wings extending outward from the centre, resembling the wingspan of a bat. The standard number of wings for a Kirkbride Plan hospital was eight, with an accommodation of 250 patients. Kirkbride’s philosophy behind the staggered wings was to allow individual corridors open to sunlight and air ventilation through both ends, which he believed aided in healing the mentally ill. Each wing, according to Kirkbride’s original guidelines, would house a separate ward, which would contain its own “comfortably furnished” parlour, bathroom, clothes room, and infirmary, as well as a speaking tube and dumbwaiter to allow open communication and movement of materials between floors. The furthest wings from the centre complex of the building were reserved for the “most excitable,” or most physically dangerous and volatile patients. Patient rooms were suggested to be spacious, with ceilings “at least 12 feet (3.7 m) high,” but only large enough to room a single person. The centre complexes of the Kirkbride Plan buildings were designed to house administration, kitchens, public and reception areas, and apartments for the superintendent’s family. Architectural styles of Kirkbride Plan buildings varied depending on the appointed architect, and ranged from Richardsonian Romanesque to Neo-Gothic.

In addition to the intricate building design, Dr. Kirkbride also advocated the importance of “fertile” and spacious landscapes on which the hospitals would be built, with views that “if possible, should exhibit life in its active forms.” Kirkbride also suggested the hospital grounds be a minimum of 100 acres (40 ha) in size. The foliage and farmlands on the hospital grounds were sometimes maintained by patients as part of physical exercise and/or therapy. Over the course of the nineteenth and twentieth centuries, the campuses of these hospitals often evolved into sprawling, expansive grounds with numerous buildings.

Operations and Staffing

In his proposal, Dr. Kirkbride outlined specific guidelines as to how a Kirkbride Plan hospital should be staffed and operate on a daily basis. Dr. Kirkbride suggested a total of 71, all of whom were required to live within, or in the immediate vicinity of, the hospital. The superintending physician, or physician-in-chief, was required to live in the main hospital or in a building contiguous to it, while his family had the option of residing at the hospital or seeking private lodging. The staff was also to have a balanced gender distribution, with approximately 36 female and 35 male staff members.

Among the staff of a Kirkbride Plan hospital were the superintending physician, an assisting physician and nurses, supervisors and teachers of each sex, a chaplain, matron, and a nightwatchman. Kirkbride urged that at least two attendants be working in each ward at any given time, and stressed the importance of the superintendent’s “proper selection” of attendants, given the extent of their management responsibilities: “The duties of attendants, when faithfully performed, are often harassing, and in many wards, among excited patients, are peculiarly so. On this account pains should always be taken to give them a reasonable amount of relaxation and their position should, in every respect, be made as comfortable as possible.” For general labour at the hospital, he suggested that the able-minded patients help maintain the hospital grounds and assist in duties in their respective wards.

Dr. Kirkbride’s estimation of the number of staff as well as their respective compensations was outlined in an 1854 publication on the Kirkbride Plan design. He proposed a living wage for all employees of the hospital, noting that “although in a few institutions a liberal compensation is given, in many, the salaries are quite too low, and entirely inadequate to be depended on, to secure and retain the best kind of talent for the different positions. The services required about the insane, when faithfully performed, are peculiarly trying to the mental and physical powers of any individual, and ought to be liberally paid for.” Salary for the superintending physician according to the 1854 guideline was to be USD$1,500 (equivalent to $43,206 in 2020) if the physician’s family resided at the hospital, and $2,500 (equivalent to $72,009 in 2020) if they found lodging at a private residence. In addition to the medical staff and attendants, the Kirkbride Plan hospitals also employed labourers of various trades, including resident engineers, carpenters, cooks and dairymaids, gardeners, seamstresses, ironworkers, clothing launderers, and a carriage driver.

Decline and Phasing Out

By the late-nineteenth century, the Kirkbride design had begun to wane in popularity, largely because the hospitals (which were state-funded), had received significant budget cuts that rendered them difficult to maintain. General psychiatric and medical opinion of Kirkbride’s theories regarding the “curability” of mental illness were also questioned by the medical community.

Future

Status

A total of 73 known Kirkbride Plan hospitals were constructed throughout the United States between 1845 and 1910. As of 2016, approximately 33 of these identified Kirkbride Plan hospital buildings still exist in their original form to some degree: 24 have been preserved indicating that the building is still standing and still in use, at least, in part. 11 of the 24 preserved properties received secondary condition codes of deteriorating, vacant, partial demolition or a combination, while the remaining nine have been adaptively reused. Of the 40 hospital buildings that no longer exist (either via demolition or destruction from natural occurrences, such as earthquakes), 26 were demolished to be replaced with new facilities.

The highest concentrations of Kirkbride Plan hospitals were in the Northeast and Midwestern states. Fewer Kirkbride Plan hospitals were constructed on the West Coast: In California, the Napa State Hospital was a notable Kirkbride Plan hospital, though the original structure was severely damaged during the 1906 San Francisco earthquake, and was ultimately demolished. The two surviving Kirkbride structures on the West Coast are both located in the state of Oregon, at the Oregon State Hospital, and the Eastern Oregon State Hospital, the latter of which now houses the Eastern Oregon Correctional Institution. While the vast majority of Kirkbride hospitals were located in the United States, similar facilities were built in Canada, and the Callan Park Hospital for the Insane in Sydney, Australia (constructed in 1885) was also influenced by Kirkbride’s design.

Preservation Efforts

Due to their intricate architectural features and historical significance, Kirkbride Plan hospitals have attracted conservation efforts from local and national groups, and (as of 2016) approximately 30 of the buildings have been registered with National Register of Historic Places. Local conservation groups and historical societies have made attempts to save numerous Kirkbrides from demolition: The Danvers State Hospital in Danvers, Massachusetts is one example, in which a local historical society filed a lawsuit in 2005 to stall demolition of the building. The majority of the Danvers State Hospital was demolished in 2007 in spite of the lawsuit, with only the centre portion of the building receiving restoration and conversion into apartments. The Northampton State Hospital in Northampton, Massachusetts, was demolished in 2006.

Many of the surviving Kirkbride Plan buildings in the United States have undergone at least partial demolition and have been repurposed, often with the centre portions of the buildings being most commonly preserved. The centre complexes of the Hudson River State Hospital in Poughkeepsie, New York, and the Oregon State Hospital in Salem, Oregon, for example, have been retained in spite of the majority of the outermost wings being demolished. One such Kirkbride Plan facility that has survived in its entirety is the Trans-Allegheny Lunatic Asylum, though does not contemporarily function as an active hospital. As of 2017, Trans-Allegheny Lunatic Asylum has not undergone demolition.

Several facilities originally established as Kirkbride Plan hospitals are still active in the 21st century, though not all have retained the original Kirkbride buildings on their campuses. The Oregon State Hospital, the longest continuously-operated psychiatric hospital on the West Coast, retained the majority of its original Kirkbride building during a 2008 demolition, seismically retrofitting and repurposing it as a mental health museum in 2013.

In Popular Culture

Numerous Kirkbride Plan hospitals and buildings have been featured in the arts: the Danvers State Hospital in Danvers, Massachusetts was both the setting and primary filming location for the 2001 psychological horror film Session 9. It has also been suggested by historians as an inspiration on H.P. Lovecraft, and in turn an inspiration for the fictional setting Arkham Asylum in the various Batman series. The Oregon State Hospital was also featured as the primary filming location for the film One Flew Over the Cuckoo’s Nest (1975), and was also the setting of “Ward 81,” a 1976 series of photographs by photographer Mary Ellen Mark.

The Trans-Allegheny Lunatic Asylum in West Virginia was featured on the Travel Channel reality series Ghost Adventures.

What is a Psychiatric Hospital?

Introduction

Psychiatric hospitals, also known as mental health units or behavioural health units, are hospitals or wards specialising in the treatment of serious mental disorders, such as major depressive disorder, schizophrenia and bipolar disorder.

Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients. Others may specialise in the temporary or permanent containment of patients who need routine assistance, treatment, or a specialised and controlled environment due to a psychological disorder. Patients often choose voluntary commitment, but those whom psychiatrists believe to pose significant danger to themselves or others may be subject to involuntary commitment and involuntary treatment.

Psychiatric hospitals may also be called psychiatric wards/units (or “psych” wards/units) when they are a subunit of a regular hospital.

The modern psychiatric hospital evolved from and eventually replaced the older lunatic asylum. The treatment of inmates in early lunatic asylums was sometimes brutal and focused on containment and restraint. With successive waves of reform, and the introduction of effective evidence-based treatments, most modern psychiatric hospitals emphasize treatment, and attempt where possible to help patients control their lives in the outside world, with the use of a combination of psychiatric drugs and psychotherapy. Exceptions include Japan, where many psychiatric hospitals still use physical restraints on patients, tying them to their beds for days or even months at a time, and India, where the use of restraint and seclusion is endemic.

Brief History

Modern psychiatric hospitals evolved from, and eventually replaced, the older lunatic asylum. Their development also entails the rise of organised institutional psychiatry.

Hospitals known as bimaristans were built in Persia (old name of Iran) beginning around the early 9th century, with the first in Baghdad under the leadership of the Abbasid Caliph Harun al-Rashid. While not devoted solely to patients with psychiatric disorders, they often contained wards for patients exhibiting mania or other psychological distress. Because of cultural taboos against refusing to care for one’s family members, mentally ill patients would be surrendered to a bimaristan only if the patient demonstrated violence, incurable chronic illness, or some other extremely debilitating ailment. Psychological wards were typically enclosed by iron bars owing to the aggression of some of the patients.

Western Europe would later adopt these views with the advances of physicians like Philippe Pinel at the Bicêtre Hospital in France and William Tuke at the York Retreat in England. They advocated the viewing of mental illness as a disorder that required compassionate treatment that would aid in the rehabilitation of the victim. In the Western world, the arrival of institutionalisation as a solution to the problem of madness was very much an advent of the nineteenth century. The first public mental asylums were established in Britain; the passing of the County Asylums Act 1808 empowered magistrates to build rate-supported asylums in every county to house the many ‘pauper lunatics’. Nine counties first applied, the first public asylum opening in 1812 in Nottinghamshire. In 1828, the newly appointed Commissioners in Lunacy were empowered to license and supervise private asylums. The Lunacy Act 1845 made the construction of asylums in every county compulsory with regular inspections on behalf of the Home Secretary, and required asylums to have written regulations and a resident physician.

At the beginning of the nineteenth century there were a few thousand “sick people” housed in a variety of disparate institutions throughout England, but by 1900 that figure had grown to about 100,000. This growth coincided with the growth of alienism, later known as psychiatry, as a medical specialism. The treatment of inmates in early lunatic asylums was sometimes very brutal and focused on containment and restraint.

In the late 19th and early 20th centuries, terms such as “madness”, “lunacy” or “insanity” – all of which assumed a unitary psychosis – were split into numerous “mental diseases”, of which catatonia, melancholia and dementia praecox (modern day schizophrenia) were the most common in psychiatric institutions.

In 1961 sociologist Erving Goffman described a theory of the “total institution” and the process by which it takes efforts to maintain predictable and regular behaviour on the part of both “guard” and “captor”, suggesting that many of the features of such institutions serve the ritual function of ensuring that both classes of people know their function and social role, in other words of “institutionalising” them. Asylums was a key text in the development of deinstitutionalisation.

With successive waves of reform and the introduction of effective evidence-based treatments, modern psychiatric hospitals provide a primary emphasis on treatment; and further, they attempt – where possible – to help patients control their own lives in the outside world with the use of a combination of psychiatric drugs and psychotherapy. These treatments can be involuntary. Involuntary treatments are among the many psychiatric practices which are questioned by the mental patient liberation movement. Most psychiatric hospitals now restrict internet access and any device that can take photos. In the US state of Connecticut, involuntary patients must be examined annually by a court-appointed psychiatrist. Patients may also apply for release at any time and receive a full hearing on the application.

Types

There are a number of different types of modern psychiatric hospitals, but all of them house people with mental illnesses of widely variable severity. In the United Kingdom, both crisis admissions and medium-term care are usually provided on acute admissions wards. Juvenile or youth wards in psychiatric hospitals or psychiatric wards are set aside for children or youth with mental illness. Long-term care facilities have the goal of treatment and rehabilitation within a short time-frame (two or three years). Another institution for the mentally ill is a community-based halfway house.

Crisis Stabilisation

The crisis stabilisation unit is effectively an emergency department for psychiatry, often treating suicidal, violent, or otherwise critical individuals.

Open Units

Open psychiatric units are not as secure as crisis stabilisation units. They are not used for acutely suicidal persons; instead, the focus in these units is to make life as normal as possible for patients while continuing treatment to the point where they can be discharged. However, patients are usually still not allowed to hold their own medications in their rooms because of the risk of an impulsive overdose. While some open units are physically unlocked, other open units still use locked entrances and exits, depending on the type of patients admitted.

Medium Term

Another type of psychiatric hospital is medium term, which provides care lasting several weeks. Most drugs used for psychiatric purposes take several weeks to take effect, and the main purpose of these hospitals is to monitor the patient for the first few weeks of therapy to ensure the treatment is effective.

Juvenile Wards

Juvenile wards are sections of psychiatric hospitals or psychiatric wards set aside for children or adolescents with mental illness. However, there are a number of institutions specialising only in the treatment of juveniles, particularly when dealing with drug abuse, self-harm, eating disorders, anxiety, depression or other mental illness.

Long-Term Care Facilities

In the UK, long-term care facilities are now being replaced with smaller secure units (some within the hospitals listed above). Modern buildings, modern security, and being locally situated to help with reintegration into society once medication has stabilised the condition are often features of such units. Examples of this include the Three Bridges Unit, in the grounds of St Bernard’s Hospital in West London and the John Munroe Hospital in Staffordshire. However, these modern units have the goal of treatment and rehabilitation to allow for transition back into society within a short time-frame (two or three years). However, not all patients’ treatment can meet this criterion, so the large hospitals mentioned above often retain this role.

These hospitals provide stabilisation and rehabilitation for those who are actively experiencing uncontrolled symptoms of mental disorders such as depression, bipolar disorders, eating disorders, and so on.

Halfway Houses

One type of institution for the mentally ill is a community-based halfway house. These facilities provide assisted living for an extended period of time for patients with mental illnesses, and they often aid in the transition to self-sufficiency. These institutions are considered to be one of the most important parts of a mental health system by many psychiatrists, although some localities lack sufficient funding.

Political Imprisonment

In some countries, the mental institution may be used for the incarceration of political prisoners as a form of punishment. A notable historical example was the use of punitive psychiatry in the Soviet Union and China.

Secure Units

In the UK, criminal courts or the Home Secretary can, under various sections of the Mental Health Act, order the admission of offenders for detainment in a psychiatric hospital, but the term “criminally insane” is no longer legally or medically recognised. Secure psychiatric units exist in all regions of the UK for this purpose; in addition, there are a few specialist hospitals which offer treatment with high levels of security. These facilities are divided into three main categories: High, Medium and Low Secure. Although the phrase “Maximum Secure” is often used in the media, there is no such classification. “Local Secure” is a common misnomer for Low Secure units, as patients are often detained there by local criminal courts for psychiatric assessment before sentencing.

Run by the National Health Service, these facilities which provide psychiatric assessments can also provide treatment and accommodation in a safe hospital environment which prevents absconding. Thus there is far less risk of patients harming themselves or others. The Central Mental Hospital in Dublin performs a similar function

Community Hospital Utilisation

Community hospitals across the United States regularly see mental health discharges. A study of community hospital discharge data from 2003-2011 showed that mental health hospitalisations were increasing for both children (patients aged 0-17 years) and adults (patients aged 18-64). Compared to other hospital utilisation, mental health discharges for children were the lowest while the most rapidly increasing hospitalisations were for adults under 64. Some units have been opened to provide “Therapeutically Enhanced Treatment” and so form a subcategory to the three main unit types.

The general public in the UK are familiar with the names of the High Secure Hospitals due to the frequency that they are mentioned in the news reports about the people who are sent there. Those in the UK include Ashworth Hospital in Merseyside, Broadmoor Hospital in Crowthorne, Berkshire, Rampton Secure Hospital in Retford, Nottinghamshire, and Scotland’s The State Hospital in Carstairs. Northern Ireland and the Isle of Man have their own Medium and Low Secure units but use the mainland facilities for High Secure, to which smaller Channel Islands also transfer their patients as Out of Area (Off-Island Placements) Referrals under the Mental Health Act 1983. Of the three unit types, Medium Secure is most prevalent throughout the UK. As of 2009, there were 27 women-only units in England alone. Irish units include those at prisons in Portlaise, Castelrea and Cork.

Criticism

Hungarian-born psychiatrist Thomas Szasz argued that psychiatric hospitals are like prisons unlike other kinds of hospitals, and that psychiatrists who coerce people (into treatment or involuntary commitment) function as judges and jailers, not physicians. Historian Michel Foucault is widely known for his comprehensive critique of the use and abuse of the mental hospital system in Madness and Civilisation. He argued that Tuke and Pinel’s asylum was a symbolic recreation of the condition of a child under a bourgeois family. It was a microcosm symbolizing the massive structures of bourgeois society and its values: relations of Family-Children (paternal authority), Fault–Punishment (immediate justice), Madness-Disorder (social and moral order).

Erving Goffman coined the term “Total Institution” for mental hospitals and similar places which took over and confined a person’s whole life. Goffman placed psychiatric hospitals in the same category as concentration camps, prisons, military organisations, orphanages, and monasteries. In his book Asylums Goffman describes how the institutionalisation process socialises people into the role of a good patient, someone “dull, harmless and inconspicuous”; in turn, it reinforces notions of chronicity in severe mental illness. The Rosenhan experiment of 1973 demonstrated the difficulty of distinguishing sane patients from insane patients.

Franco Basaglia, a leading psychiatrist who inspired and planned the psychiatric reform in Italy, also defined the mental hospital as an oppressive, locked and total institution in which prison-like, punitive rules are applied, in order to gradually eliminate its own contents. Patients, doctors and nurses are all subjected (at different levels) to the same process of institutionalism. American psychiatrist Loren Mosher noticed that the psychiatric institution itself gave him master classes in the art of the “total institution”: labelling, unnecessary dependency, the induction and perpetuation of powerlessness, the degradation ceremony, authoritarianism, and the primacy of institutional needs over those of the persons whom it was ostensibly there to serve: the patients.

The anti-psychiatry movement coming to the fore in the 1960s has opposed many of the practices, conditions, or existence of mental hospitals; due to the extreme conditions in them. The psychiatric consumer/survivor movement has often objected to or campaigned against conditions in mental hospitals or their use, voluntarily or involuntarily. The mental patient liberation movement emphatically opposes involuntary treatment but it generally does not object to any psychiatric treatments that are consensual, provided that both parties can withdraw consent at any time.

What was the Board of Control for Lunacy and Mental Deficiency?

Introduction

The Board of Control for Lunacy and Mental Deficiency was a body overseeing the treatment of the mentally ill in England and Wales.

Background

It was created by the Mental Deficiency Act 1913 to replace the Commissioners in Lunacy, under the Home Office however it was independent in that it reported to the Lord Chancellor who had responsibility for investigating breaches of care and integrity. The Board was transferred to the Ministry of Health by the Ministry of Health Act 1919, and reorganised in 1930.

The Board consisted of a Chairman, two Senior Medical Commissioners, one Senior Legal Commissioner, six Commissioners including lawyers and doctors, six Inspectors and administrative staff. By law, at least one of these had to be a woman. The Commissioners of the Board travelled around England and Wales ensuring that those detained under mental health legislation were legally in custody, their care was appropriate, and moneys and other properties owned by patients were not being misused or stolen.

The Board was based in Northumberland Avenue, London, until 1939 when it was moved to Hobart House, Grosvenor Place.

Its functions were transferred to the Minister of Health by the National Health Service Act 1946.

Refer to Chronology of UK Mental Health Legislation, Commissioners in Lunacy, Commissioners in Lunacy for Scotland, and Commissioners in Lunacy for Ireland.

Members

Announcements of members were carried in the major national newspapers, including The Times.

  • On inception of the Board in 1913, the chairman was Sir William Byrne with Arthur Rotherham and Mary Dendy joining the ex officio members of the previous Lunacy Commissioners; C.H. Bond, Marriott Cooke, S. Coupland, B.T. Hodgson, S.J.F. MacLeod, F. Needham L.L. Shadwell, and A.H. Trevor.
  • In 1916, due to Sir William Byrne moving on, Marriott Cooke became acting chairman, and Robert Welsh Braithwaite was appointed to the board.
  • In 1921, Dr Ruth Darwin was appointed to the Board
  • In 1926 due to Robert Welsh Braithwaite’s retirement, Robert Cunyngham Brown was appointed a commissioner.
  • In 1928, due to the retirement of the chairman, Sir Frederick Willis, Laurence George Brock was appointed chairman.
  • In 1929, Dr Bedford Pierce was appointed a commissioner.
  • From the start of 1931, the Board was reconstituted, with a chairman and four other members.
    • L.G. Brock continued as chairman, with S.J. Fraser MacLeod, C. Hubert Bond, Arthur Rotherham, Ellen Pinsent.
  • William Rees-Thomas was appointed to the Board in 1931.
  • In 1931, Dr Isabel Wilson was appointed as a Commissioner, holding the position until 1948.
    • From 1949 to 1960 she was a Senior Commissioner, after which the Board was abolished and her position was changed to the Principal Medical Officer, Ministry of Health.

What was the Madhouses Act 1774?

Introduction

The Madhouses Act 1774 (14 Geo. 3 c.49) was an Act of the Parliament of Great Britain, which set out a legal framework for regulating “madhouses” (insane asylums).

Refer to Chronology of UK Mental Health Legislation.

Background

By the mid-eighteenth century, the common methods in the United Kingdom for dealing with the insane were either to keep them in the family home, or to put them in a “madhouse”, which was simply a private house whose proprietor was paid to detain their residents, and ran it as a commercial concern with little or no medical involvement. This led to two forms of abuse: the first was the keeping of “legitimately” insane people in atrocious conditions, and the second the detention of those who were falsely claimed to be insane – in effect, private imprisonment.

At this stage, there was no legislation to regulate the incarceration of anyone other than a Chancery lunatic or a pauper; there was only a vaguely defined common law power to “confine a person disordered in mind, who seems disposed to do mischief to himself, or another person”.

In a case in the mid-1750s, a woman came to suspect that her son-in-law had committed his wife to a madhouse in Hoxton; with the aid of a Justice of the Peace, she secured the release of her daughter after obtaining a confession from the husband. A similar case in 1762 saw a man trying to obtain the release of an acquaintance, one Mrs Hawley, who he suspected had been confined in a madhouse. His initial application to Lord Mansfield for a writ of habeas corpus was rejected because he was not a relative and so had no standing, but the judge arranged for a doctor to visit the house and speak to the woman. On his report, a writ was granted; she was brought before the court, and discharged.

A Select Committee of the House of Commons, chaired by Thomas Townshend, was set up in 1763 to study the problem of unlawful detention in private madhouses and focused on the Hawley case. It found that she had been committed to the house solely on the word of her husband, who paid two guineas (two pounds and two shillings) a month for her board, and that she was unable to leave the house or communicate with anybody outside it. The inmates were treated as insane, but the agent who arranged their entry freely admitted that he had not committed a single insane person to the house in the past six years. No-one who would pay was turned away, no physicians attended the inmates, and no register was kept of their names. This was, the Committee stated, a common situation; they noted that a number of similar cases could have been studied, and they recommended that some form of legislative intervention was needed. The Commons ordered the committee to prepare a bill, but it appears this was never brought in.

The issue was next addressed in 1773 when Townshend’s son, also named Thomas Townshend, sponsored a bill to regulate private madhouses; within seven miles of London, this would be the responsibility of the Royal College of Physicians; and outside that, magistrates in county towns. The bill passed the Commons but was rejected by the Lords.

Legislative History

In 1774, Thomas Townshend again reintroduced the Madhouses Bill. The Bill was presented to the Commons for its first reading on 02 March, and was amended in committee on 23 March. The Lords voted on it on 21 April, and made two amendments (the addition of s.19 and s.31) on 06 May, before the bill returned to the Commons on 10 May. The bill received Royal Assent on 20 May.

Provisions

The Act required that all madhouses be licensed by a committee of the Royal College of Physicians. This license would permit the holder to maintain a single house for accommodating lunatics, and would have to be renewed each year. All houses were to be inspected at least once per year by the committee, who would also keep a central register of all the confined lunatics in order that people could locate them; outside London, the task of inspecting them would fall to the local quarter sessions.

The penalty for “concealing or confining” more than one insane person without a license was set at £500, and every keeper of such a house who took in a patient without an order from a doctor was liable to a fine of £100.

Implementation

The Act took effect on 20 November 1774, six months after receiving Royal Assent, and was originally stated to remain in force for five years and then until the end of the next Parliamentary session.

  • It was continued for a further seven years by the Madhouse Continuation Act 1779 (19 Geo. 3 c.15);
  • Then continued indefinitely by the Madhouse Law Perpetuation Act 1786 (26 Geo. 3 c.91); and
  • It remained in force until repealed by the Madhouses Act 1828.

What were the Commissioners in Lunacy for Scotland?

Introduction

The Commissioners in Lunacy for Scotland or Lunacy Commission for Scotland were a public body established by the Lunacy (Scotland) Act 1857 to oversee asylums and the welfare of mentally ill people in Scotland.

Refer to Chronology of UK Mental Health Legislation, Commissioners in Lunacy for Ireland, and Commissioners in Lunacy.

Previous Bodies

The Madhouses (Scotland) Act 1815 established the right of Scottish Sheriffs to order the inspection of madhouses.

Establishment

The Board of Commissioners in Lunacy for Scotland was established in 1857 by the Lunacy (Scotland) Act 1857. There were two Commissioners of Lunacy each paid £1,200 a year and two Deputy Commissioners each paid £600 a year.

Asylums Commissioned

The legislation created a General Board of Commissioners in Lunacy for Scotland. It also created district boards with the power to establish and operate publicly funded “district asylums” for patients who could not afford the fees charged by existing private and charitable “Royal Asylums”. These existing “Royal Asylums” (with Royal Charters) were the Aberdeen Royal Lunatic Asylum, the Crichton Royal Institution, the Dundee Royal Lunatic Asylum, the Royal Edinburgh Lunatic Asylum, the Glasgow Royal Lunatic Asylum, the Montrose Royal Lunatic Asylum and James Murray’s Royal Lunatic Asylum. The aim of the legislation was to establish a network of “district asylums” with coverage throughout Scotland.

The following asylums were commissioned under the auspices of the Commissioners in Lunacy for Scotland:

  • Aberdeen District Asylum, 1904.
  • Argyll and Bute District Asylum, 1863.
  • Ayrshire District Asylum, 1869.
  • Banff District Asylum, 1865.
  • East Lothian District Asylum, 1866.
  • Edinburgh District Asylum, 1906.
  • Elgin District Asylum, 1835.
  • Fife and Kinross District Asylum, 1866.
  • City of Glasgow District Asylum, 1896.
  • Glasgow Woodilee District Asylum, 1875.
  • Govan District Asylum, 1895.
  • Inverness District Asylum, 1864.
  • Kirklands District Asylum, 1881.
  • Lanark District Asylum, 1895.
  • Midlothian District Asylum, 1874.
  • Paisley District Asylum, 1876.
  • Perth District Asylum, 1864.
  • Renfrew District Asylum, 1909.
  • Roxburgh District Asylum, 1872.
  • Stirling District Asylum, 1869.

In addition the Southern Counties Asylum, which was intended to provide facilities for paupers, was erected on the site of the Crichton Royal Institution (which focused on fee paying patients) in 1849 but subsequently amalgamated with the Crichton Royal Institution. Likewise the Dundee District Asylum, which was intended to provide facilities for paupers, was established alongside the Dundee Royal Lunatic Asylum (which focused on fee paying patients) in 1903 but subsequently amalgamated with the Dundee Royal Lunatic Asylum.

Successor Body

The Mental Deficiency and Lunacy (Scotland) Act 1913 replaced the Commission with the General Board of Control for Scotland.