The Moral Treatment of Patients

In the latest episode of the BBC'c Who Do You Think You Are? Frank Gardner was shocked to discover his great-grandmother, Grace Rolleston, was incarcerated in Victorian lunatic asylums after the death of her husband in the latter half of the nineteenth century. He was even more surprised to learn that in this era, moral treatment was advocated in these instituitons. This blog is based on a recently submitted a paper for the William Bynum Essay prize detailing the moral methods of treatment employed at the Garlands Asylum.

Modern images conjured up by the phrase 'lunatic asylum' are of shackled madmen in dark damp cells subjected to ridicule from their keepers. Contrary to popular perception, lunatic asylums in the latter half of the nineteenth century advocated moral methods of treating their patients. This was in response to the brutalisation of the insane which had taken place for centuries before. The emerging profession of psychiatry and growing knowledge of diseases of the brain brought with it new and humane ideas for treating madness.

In England the pioneer of moral treatment was the York Retreat, a private Quaker house specialising in the care of the mentally ill. Following ideas adopted on the continent, the Retreat - run by successive generations of the Tuke family - was opened in 1792 and its moral regime was based upon the structure of the family. Patients were treated as children and the Retreat operated as a 'surrogate home'. Staff dined with the patients; patients helped with the chores, and they organised social events together. (See A. Digby Madness, Morality and Medicine) Due to its small patient intake, and the fact that the Retreat only cared for wealthy Quakers, its methods were not widely adopted in county asylums. This did not occur until the 1840s and 1850s after Dr John Conolly of the Hanwell Asylum had successfully proved that the abandonment of mehcanical restraint could work in a large institution. 

Along with the use of non-restraint, the new institutions built after the 1845 County Asylums Act were opened with the moral management of patients in mind. Central to the new moral regimes of care were: a nourishing diet - often a departure in the lives of most pauper lunatics living in destitution; exercise - absent from those living in cramped conditions; useful employment in tasks which benefit the running of the asylum in order to divert the minds of the insane from unwanted thoughts; religion, and recreational pursuits.

The Garlands Asylum was opened in 1862, in the period when moral treatment dominated asylum care. In the first rules and regulations of the Garlands it was clearly set out that the 'medical and moral treatment of the individual cases...be the first duty of the medical officers'. In line with the staples of moral treatment as stated above, in the 1863 annual report, medical superintendent Dr Clouston stated that 'a good dinner has generally a far more soothing effect than any sedative'. He highly regarded the effects of patients taking regular exercise, advocating 'a walk on the country roads thrice a week'. With regards to useful employment, Clouston believed that 'regular work for both mind and body will do much to counteract the ill effects of the associations of the persons, places, and circumstances that were connected with the original outbreak of the malady'. Daily prayers and frequent church services in the asylum chapel were seen as an important way of promoting a patient's recovery through self-confidence and self-belief. Also integral to upholding a moral regime of care was ensuring suitable amusements and recreational pursuits were provided for the patients. Annual trips to the seaside and nearby places of interest were routinely organised. Dr Clouston believed that, 'amusement and recreation rouse whatever mental power still remains, and may even call up the long unfelt sense of conscious happiness and enjoyment of life'. For those too unwell to leave the asylum other distractions were provided. A generous supply of books and periodicals were on offer, as well as an abundance of craft material for hobbies such as knitting and sewing. Visitors would often be invited to perform a series of different entertainments to keep the patients happy. Choirs, dancers, drama groups, guest speakers and even ventriloquists would appear at the Garlands, and on special holidays - such as Christmas and Easter - dances would be held for the patients.

One method which was adopted at the Garlands, which was not widely done elsewhere at this time, was the absence of alcohol in the dietry of the patients. The opening rules and regulations of the asylum stated that: 'No beer, wine, or intoxicating liquor...will be allowed'. Dr Clouston acknowledged in 1869 the rarity of the absence of alcohol in the daily diet of the patients; '[this is] one of the few English asylums in which no beer is given as part of the ordinary dietary'. Even the moral pioneer the York Retreat advocated the consumption of alcohol among its patients. This unique abstinence stance is unsurprising given the context of Cumbria in this period. The temperance movement was extremely prevalent in Northern England, and one of its leading figures became the Countess of Carlisle, Rosalind Howard, in the 1890s. Clouston personally held teetotal beliefs as he stipulated in one of his many articles; 'alcohol I believe to be an enemy to the fruitful working of the mind by diminishing the power of attention'. However, alcohol was employed for medicinal purposes in the Garlands Asylum to severe cases of feeble-mindedness, hysteria, and neuralgia. Alcohol was also advocated in times of national celebration. In 1897, to celebrate Queen Victoria's golden jubilee, patients were alloted a pint of beer with their evening meal to mark the occassion. In this respect, Garlands was a pioneer in its stance on abstinence, as other asylums failed to realise the benefit of teetotalism in the daily regime of asylums until the 1880s.

These examples of moral treatment in the Victorian lunatic asylum are a far cry from the images we are presented with in our minds eye. We must be educated in the growing humanity which was adopted in this era, as it was this which the modern basis of psychiatry was formed. I am aiming to retell the story of the Garlands so that people understand that it was a caring, humane institution in which to receive care, rather than one to be terrified of. 

This blog is a small part of my ongoing PhD research into the Garlands Hospital. I am attempting to write the asylum's history as it is one currently unwritten. Any stories you may have about the history of the Garlands Hospital, Carlisle, please use the comment box to share them. I would love to learn as much as possible about this undiscovered institution.