Garlands Project Launch: 8 Nov. 2017

Wednesday 8^th November saw the launch of our exciting project surrounding the Garlands Asylum. Along with Cumbria County Council, Cumbria Partnership Trust, and Carlisle Eden Mind, I presented some of my research, which focused on the history of this fascinating institution. The aim of the project is to break down the stigma surrounding mental health by opening up the discussion around the treatment, as it was in the early days of the asylum, and as it stands now, and the help people can access in the event of mental illness. The value of reflection lies within the lessons we can learn from the progression in terminology, treatment and the way we consider mental health. Through this post I will outline the main points I made at the launch, and hope you will join the discussion surrounding mental health.

My focus, of course, is on the history of the Garlands Asylum, and how mental conditions were treated in the period from its opening in 1862, until the outbreak of war in 1914. Placing the patients’ stories and experiences at the heart of my research has caused me to regard the institution with a human aspect. When people ask about my research, and I mention the phrase ‘lunatic asylum’, they have a large misconception about the brutality of treatment received, and regard the institution with a degree of horror. Through my research I aim to breakdown these misconceptions and retell its history through the patients who experienced treatment in the institution.

My talk began with giving a short background of the asylum: when it was constructed, why, what kind of treatments were offered, and the effect this had on the patients. I then set out the regime of care from the inception of the asylum in 1862, and continued throughout the initial decades.

Moral Treatment

Moral treatment, was advocated in all county asylums in the period after 1845. The main facets of this regime were not dissimilar to some of the recommended treatments today: a good diet, regular exercise, recreational activities, religion and useful employment. This treatment was outlined in the 1863 Garlands annual report by the medical superintendent, Dr Clouston:

To treat the patients kindly, to maintain good order and discipline in the house, to provide healthy and suitable employments for all who can employ themselves, to endeavour to get those to work who do not do so, to provide suitable entertainments for their leisure hours, to endeavour to get them all roused into taking an interest in something, thus exercising and strengthening the mental faculties they have left, and to keep up the bodily health and strength in all of them.

He placed great emphasis on the employment of the patients to act as a diversion from the thoughts and circumstances causing their conditions: 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.

Around three quarters of the asylum population were regularly employed. Tasks in the workshops, on the farm, and in the asylum itself were largely carried out by the patients. The result was noted in the 1869 annual report as ‘pleasing and amusing’ the patients to a great extent.

Patients, that were able, were allowed to walk in the asylum grounds, with supervision from the asylum attendants, in order to get regular exercise. This was said to have had a soothing effect on the patient’s behaviour as they got the opportunity to clear their thoughts in the fresh air. Similar to this were the recreational pursuits offered to the patients to keep them usefully occupied whilst in the asylum. A large supply of books and periodicals were available. Knitting, needlework, domestic chores, work on the asylum farm, were all undertaken by the patients to encourage productivity and recovery, as well as contributing to the upkeep of the asylum. Regular events would be held to keep the patients occupied. Weekly dances and balls would be held. Sports events, such as cricket, would occur, with teams being brought in to compete with the patients. Choral groups, ventriloquists, and lecturers would be invited in to the asylum to give performances.

Patients who were otherwise unruly could respond well to these events. For instance, Catherine B, who was admitted in February 1885 suffering with mania and suicidal tendencies, seemed to forget all this and react well to the asylum dances. As described in her case notes in April 1885:

Wanders about the ward moaning and groaning wretchedly. The only occasion in which she appears to forget her troubles is at the weekly dance, when she brightens up wonderfully. Laughs heartily and industriously goes round the hall... Labouring hard often to teach others the steps and educate her fellow patients who require it.

There are many instances of patients responding well to the moral regime of the asylum. This was noted in the 1887 annual report: the disinclination many patients have shown to leave the asylum, shows that the efforts made to treat the inmates justly and kindly, and to render their life here pleasant and enjoyable, have been successful.

For more background on Moral Treatment, see my previous post - http://garlandshospital.blogspot.co.uk/2015/09/the-moral-treatment-of-patients.html

Misconceptions

The main focus on my talk was to break down some of the common misconceptions of the Asylum. These are the main three I have come across. First: once patients were admitted, they were incarcerated for life. Overcrowding of the asylum, and the pressure on accommodation in the institution was a constant problem. As early as 1863, one year after opening, the Committee of Visitors stated of Garlands: ‘they are unable to provide sufficient accommodation therein for the number of lunatics who are chargeable to the two counties.’ The asylum underwent several extensions in its initial decades, taking the available capacity from 200 in 1862, to 660 patients in 1902. Taking this into account, the unnecessary incarceration of patients simply was not feasible. Doctors were driven by statistics, and were judged on their rates of recovery. So when a patient came to the asylum, they did their utmost to affect a quick recovery, to maintain a high rate of cure. As we saw in the Garlands recovery rates, they managed to do this. Therefore, it was in the doctor’s interests to keep the patients for as little time as possible in order to free up any available beds, and so that they maintained their professional reputation among the relatively new field of psychiatry. How well this quick-turnaround actually worked is doubtful, as many patients were readmitted to the asylum at a later date, often in a worse condition than when they were first treated.

The second biggest myth is that the patients were subjected to frequent brutality. The common belief is that asylums kept patients constantly in chains or strait jackets. However, as I have shown previous, the regime of moral treatment completely disregarded this practice. Patients were treated with kindness and given the opportunity to adhere to the moral therapy offered. When patients rebelled against this kindness, the doctors only sought to use methods of restraint as a last resort. Violent patients would firstly be placed in a single room on their own and given the opportunity to calm down: Sedatives would also be administered. If the violence continued, and they posed a risk to themselves or others, methods of restraint would be sought. All patients who were placed in mechanical restraints had to be recorded in a specific register, and this would be inspected by the lunacy commissioners on their annual visits.

 

For instance, in 1891, it was recorded that eleven patients had been put in seclusion for a total of 257 hours across the whole year, and that one man had been restrained for 8 hours using sheets, and one woman using the strait jacket for 15 hours, across the whole year. Therefore, although mechanical restraint was used, it was only done so as a last resort, and was not the common mode of treatment.

The last biggest myth is that patients, in particular females, were admitted to the asylum against their will and without suffering from mental illness. I often get people asking me if there are lots of women put in there because they annoyed their husbands and such, but so far I have found no evidence of this. I think that this practice may have occurred in earlier decades and centuries among the wealthier classes who could afford to pay doctors to take their wives into private asylums. But Garlands was a public asylum that provided treatment for pauper patients, and was paid for by local Poor Law Unions. The 1845 Lunacy Act stated that to be admitted to a county asylum, the testimonies of two individuals that had witnessed the person’s insanity had to be recorded on a document called a reception order. These testimonies had to come from an examination from a doctor or medical officer at the local workhouse, and from a relative/neighbour/fellow workhouse inmate who had lived closely with the patient. The form then had to be signed by a local magistrate warranting the person’s removal to an asylum. There are instances of paper work being filled out incorrectly and patients being discharged as a result. Therefore the method of entry to an asylum was much more rigid than many people believe.

Next Steps

From the discussions began at the launch, it is clear that more is required to really address the stigma surrounding mental health. By using the past as a way of reflecting on how much (or how little) treatments have changed, we hope to continue debating what is required in future to treat mental illness.

The exhibition of the some of the Garlands archival materials will be shown at several venues around the county. Full details and dates will be confirmed shortly, and we hope as many of you as possible will be able to view it.

For full information of the launch see

http://www.newsandstar.co.uk/news/WITH-VIDEO-Secrets-of-the-asylum-history-of-Carlisles-Garlands-Hospital-in-spotlight-at-new-exhibition-79aa24c1-7690-4b96-8a23-beb642e8016e-ds

Any feedback of the event, and any comments you may have for suggestions of where we could take the project, please don’t hesitate to get in touch. Caradobbing@gmail.com

Garlands Project Launch, November 2017

As a follow on from my last post, I would like to share some photographs from the Time to Change event in Carlisle on World Mental Health Day 2017. A huge thank you to Caroline Robinson for creating such an amazing display and providing the pictures! Some of the Garlands records were digitised and transcribed for visitors to see how mental illness was regarded and treated in the late nineteenth century. Alongside this was also some detail surrounding the context of the records, most notably the 1890 Lunacy Act.

Central to the display were two patient records from the 1890s and 1900s. The first, Tom M, was admitted to Garlands in September 1900 suffering from mania caused by his intemperate habits. What was interesting about Tom's case, is that a newspaper article was attached to his case notes denoting his attempt to take his own life prior to admission:

Clippings from newspapers relating to the patient and their condition were often attached to the case notes during this period. Anything to assist the doctors in creating a picture of their behaviour prior to admission was considered valuable in keeping with their medical records. On admission, Tom seemed to be somewhat confused and could not recall attempting to hang himself: “Patient has a childish vacant expression: Did not know why he was in custody: On being asked why he had attempted to finish himself in that way, he replied ‘What way?’ He has been drinking heavily for a long time and attempted to hang himself. There is no one to take charge of him and in his present condition is not fit to be at large.” It seemed that some time away from his surroundings, and the temptation of alcohol, was enough to fully recover Tom, as one month after admission he was discharged as recovered and never returned for treatment in Garlands.

The second case displayed was that of James G, who was admitted to Garlands in September 1898 also suffering from mania. James was brought to Garlands with little known about him, as he had been found wandering at large: 'Been curious in behaviour and frightening people in district'. He seemed to be very confused at the beginning of treatment as to where he had come from and what had occurred prior to admission. What is most interesting to note from his case notes is that he displayed a desire to remain in the asylum. For instance on 2 October 1898, the doctors noted: "says he is quite content to remain here." Similarly on 2 November 1898: "Says he likes better being up here because there are books here." However, once James began to recover, his desire to return home became clear. Eleven months after admission it was noted: “Rather unsettled and restless. Very anxious to go home or he says he wants a change.” James was discharged recovered in September 1899, and, like Tom above, never returned to Garlands.

These two patient stories are a snippet of the research I have been conducting for my PhD thesis on the history of the Garlands Asylum. The full launch of the Garlands Project will be on 8 November, where I, among many others, shall be giving a talk detailing the history of this fascinating institution. If you would like to attend, please see the below picture. It is also expected for there to be an ongoing exhibition from the event which will be toured around the county, details to follow.

“As Mad as she is Bad”: The Garlands first Criminal Lunatic, 1862

Looking at previous posts, and the title of this current one, it is apparent that the terminology surrounding mental illness, and those that suffered from it, has altered dramatically in the 150 years since Garlands opened. This post shall explore one fascinating case which highlights just how different this was. My current research into the patients of the Garlands lunatic Asylum, Carlisle, part of my wider PhD thesis, has focused on the movement of pauper patients between different institutions in the initial years of its opening. In the Garlands first month of opening (January 1862), 146 patients were transferred directly from nearby asylums and workhouses. The overwhelming majority (121) of these came from Dunston Lodge private asylum near Gateshead, which was the official receptacle for Cumberland and Westmorland’s mentally ill population prior to the opening of their own institution (Garlands in 1862). Whilst studying this transferal of care, I came across the first Criminal lunatic to be admitted to Garlands, and her case notes make for interesting reading.

Elizabeth R was among those first 146 patients admitted in January 1862 to the new Garlands Asylum. She was transferred, along with the majority of the female patients, from Dunston Lodge on 10 January 1862, where she had resided since 14 June 1861. Prior to her committal to Dunston, Elizabeth had been sentenced to three months in Carlisle Gaol for being a ‘disorderly prostitute’, and her occupation was given in her records as prostitute. On admission to Garlands she was aged 27, described as being both suicidal and dangerous, listed as suffering from mania, and was in weak physical health. What is immediately interesting from her admission records is the cause given for her mental illness: ‘remorse of conscience’. The theme of immorality is constant throughout Elizabeth’s case record. On admission she was described as follows: ‘Intelligent face but made impudent by the use of evil deeds’. This is unsurprising given her stated occupation, but I doubt she would have disclosed this as her job, rather, it was imposed on her – further increasing the stigma surrounding her committal – on admission following her arrest. The remorse she was feeling is indicative of the desperation of her situation, as she, more than likely, was forced to resort to prostitution to survive. Further evidence of her depressed mental state is given by the fact that she was suicidal. Prior to being removed from Carlisle gaol to Dunston Lodge, she undertook a period of starvation, and due to her weakened state, her transferal had to be delayed, as the authorities feared that she would not survive the journey.

Once in Garlands, shortly after arriving, the following passage was written in Elizabeth’s case notes, describing her and her behaviour:

‘As bad as she is mad – one of the worst cases we have to deal with in lunatic asylums. For the simplest offence as a sharp word from another patient, delay in granting a request, a slight verbal rebuke for bad conduct, she will go off into the most violent passions imaginable – screaming, fighting, breaking windows, attacks upon attendants and patients abuse in the extreme, most threatening in her language and will sometimes last for 3 or 4 days; when at the climax she refuses food – lashing at attendants faces, tears up her clothing and bedding. Doing all the mischief she can conceive of and frequently will keep nothing on herself…makes constant and determined attempts at self-destruction…the very great forbearance and kindness which have been shown her by all parties – everyone has lost all sympathy for her. She is most decidedly (although insane) to a very great extent responsible for her actions. Her conversation is beastly and as profane as that of the commonest Haymarket prostitute. Has haemorrhoids – acne on face – Brown hair, sleepy eyes and has had 2 or 3 children.’

We gain some understanding of the behaviour described when reading the last sentence of this entry. The fact that Elizabeth had children, which were clearly illegitimate, may go some way to explain her suicidal thoughts and tendencies, and her feelings of remorse. We can assume that she was not in contact with these children at the time of her admission, as the doctors did not know for certain how many she had given birth to. It may also have been likely that her family wouldn’t have been in contact with her, as they would have disclosed further personal information to the asylum doctors.

            Throughout her stay, Elizabeth was violent, frequently tore up her clothes and broke items in the wards. On several occasions she was described as feigning illness. For instance, on 24 October 1862, she faked a ‘spasm of the stomach so well that she deceived all the nurses but one who thought she was ill indeed. They were much surprised to see her quickly recover under a shower bath of half a minute’s duration only.’ Also on several occasions she attempted to take her own life. It was noted on 4 November 1862 that she: ‘Has been secluded all yesterday and today owing to her extreme state of maniacal excitement, and intense suicidal propensity – 3 times in my presence attempted to strangle herself – her neck is marked with the ligature.’ In an incident on 25 July 1863, she demonstrated how far she was willing to go to attempt to kill herself. After a particularly violent episode, Elizabeth was removed to a padded room in order to calm her down and prevent injury to herself or others. However, on a previous occasion in the room, she had smuggled a pair of scissors in with her and secreted them in between two of the padded sections of the wall. Luckily, an attendant spotted her recovering them from her hiding place, and could intervene before she was successful.

Elizabeth continued to flit intermittently between behaving well, and behaving in a violent, disruptive, unpleasant manner. During her calmer periods, it was noted that she was able to work well in the asylum laundry, and even assisted with the care of a child who had been a patient in the asylum since 1863, admitted when he was only 4 years old. Having been given this responsible role, it seems that she began to see some purpose in living, as the suicide attempts diminished. However, her illness did still continue, as her violent outbursts were still documented in her notes, but were far fewer than before. Elizabeth remained in Garlands until February 1873, when she was discharged recovered. This would have been relatively rare, as the chance of a patient recovering considerably lowered if they had been resident in an asylum for longer than two years – with the majority of recoveries taking place within one year.

Thank you for taking the time to read this snippet from my research conducted on the Garlands Lunatic Asylum, which forms the basis of the PhD thesis I am currently working on. My aim is to write the history of such a fascinating institution through the experience of its pauper patients. If you have any stories relating to the asylum, or would like help in tracing your ancestors that were in this particular institution, please don’t hesitate to contact me at caradobbing@gmail.com

Rethinking the Institution Conference, July 2017

Recently, I attended the “Rethinking the Institution” conference at Liverpool John Moores University. At the conference, I gave a paper detailing some of the research I have been undertaking for my wider PhD thesis on the Garlands Lunatic Asylum. The focus of the conference was to view the nineteenth century institutions that came to dominate so much of the Victorian landscape in a new light. I hoped to present the county lunatic asylum in a different way to which we seem to consider it in our contemporary mindsets. Through this blog post I will set out some of the main points from my paper in rethinking the way in which the asylum was run, and how the pauper patients responded to it.

Through my research of the pauper patients of the Garlands lunatic asylum, it has become apparent that the common view of the institution – i.e, that it was incarcerating, repressive, and an all round awful place – is one that was not borne out in practice. Following the work of Jane Hamlett,[1] it is clear from asylum records that these institutions attempted to emulate the domestic framework of the family home. This was an attempt to bring order to patients whose mental faculties were particularly disordered at the time of committal.

Asylum construction was particularly accelerated during the latter half of the nineteenth century. Legislation enacted in 1845 made it mandatory for each county and borough in England and Wales to have its own lunatic institution for pauper patients. Prior to this, the main receptacle of care for the mentally unwell was the family home. With the advent of a network of county asylums, a great shift occurred from where was considered “best” to treat a mentally ill relative. Therefore, it is no great surprise that the domestic rituals in the family home were also transferred over to the new county institutions. Creating a familiar, calming environment in which to conduct treatment, was key to the recovery of an individual’s mental affliction.

The regimes set out in these establishments followed the rhetoric of “moral treatment”, a practice set out earlier in the century by the Quaker run York Retreat, and by pioneering figures such as John Connolly from Hastwell Asylum. Garlands was no different. Built in 1862 to house 200 paupers, it followed the moral treatment regime. Central was advocating a routine of exercise, a good diet, recreational activities, religion and useful employment. Naturally, patients could respond well to this. Dr Clouston, on of the early medical superintendents, reinforced the value of a regime that was free of locks and restraint. It was important the patients did not feel like prisoners, and were regularly encouraged to walk in the open countryside beyond the asylum boundary, albeit with attendant supervision. IN some cases, patients were so comforted by the domestic environment and curative regime in the asylum that they were unwilling to return to their former lives. Dr Campbell noted in the 1887 Garlands annual report; “the disinclination many patients have shown to leave the asylum, shows that the efforts made to treat the inmates justly and kindly, and to render their life here pleasant and enjoyable, have been successful’.

The lunatic asylum was also physically modelled on the family framework. The medical superintendent was the head of the institution, and played a patriarchal role in the regime. Thus, the patients took on the submissive role of the ‘children’. Underpinning this was the fact that the superintendent resided in the asylum grounds full time, often alongside his wife and children. The asylum as a whole functioned as a domestic ‘whole’, as everyone had a vested interest in its upkeep. As mentioned earlier, useful employment of the patients was an element involved in moral treatment. The patients were assigned work-based tasks around the asylum according to their gender. Typically, men carried out manual jobs, cultivating farm land and building items to be used within the institution. Women were employed in the domestic jobs of the asylum, carrying out laundry, cleaning, cooking, sewing and knitting. Occupying the patients in such a way was believed to be beneficial in distracting them from their various conditions. The products ascertained from the work of the patients were vital in easing the ‘financial burden’ they placed on the poor law rates. In several of the Garlands annual reports, the doctors noted how the commodities of the patients were used in the establishment. For instance, in 1863; “all the carpenter work required in the house has been done by ourselves”, and in 1866; “one of the dormitories in the female division was entirely papered by the women themselves”. Thus, everyone was instrumental in the maintenance of the asylum, just as all the members of a family had a vested interest in the survival of the domestic unit.

The furnishing of the asylum was also modelled on the family home. They were keen to emulate the setting of the Victorian middle-class home in an attempt to extol some of the Victorian middle-class values on the patients whilst in recovery. The importance of domestic decoration was frequently referred to in the Garlands annual reports. In 1894 Dr Campbell stated that: “The wards have been kept clean, bright, and well decorated with flowers, and the airing courts while the weather allowed of it, were lovely with well trimmed grass, and beds of tastefully assorted flowers”.

Interestingly, what led patients to be admitted to the asylum in the first place was often a disruption to the family home. Destructive behaviour in the domestic environment can be linked to the indications of insanity provided on a patient’s admission documents. For example, Jacob C’s wife stated on admission that he; “wanders about all day, and comes home generally very dirty and without his shoes and stockings…this morning a man fetched him home having found him in a midden heap…he has torn up his clothes…and has set fire to articles of value.”

Similarly, patients who attacked the homely furnishings of the asylum during bouts of violence, associated with several mental conditions, were seen as attacking the structure of the asylum and resisting its restraints it placed upon them. One example is Sarah F, who throughout her treatment in Garlands during the 1890s was continually described as destructive and violent. She frequently struck out at other patients and destroyed the furnishings of the asylum. In September 1893 it was stated that she was “very destructive to her clothes and plants”; and in June 1894 that she, “often strikes and interferes with other patients, breaks glass and is very unruly”. However, it was noted that on occasion Sarah could respond well to the moral regime, as in April 1894 it was stated that she was more settled and had begun to work in the laundry, where she “does fairly well”. This interchangeable behaviour continued throughout Sarah’s treatment, and she remained in Garlands until her death in May 1911.

The asylum could also offer a familial context to those who otherwise lacked a supportive network of relatives on which to depend for care. Mentally ill patients often fell into the asylum system, not due to a lack of family support, but due to a lack of relatives with the finance to support them outside of the institution. One example is Mary M, who came to rely on Garlands due to an absence of family members willing and able to care for her. Mary was first admitted to Garlands in April 1883, aged 20, suffering with congenital imbecility. She was transferred from Fusehill workhouse in Carlisle, where she had been resident for the previous seven years, since the age of thirteen, due to the death of both of her parents. Her case notes described her as having an imperfect education, and that whilst in the workhouse she was allowed to grow up as a “street waif”. Mary was stated as being “weak-minded and silly” since birth, but her condition had been manageable in the workhouse until the three months preceding her admission. Interestingly, an aunt is named on her reception order as her next of kin, but as Mary was institutionalised for such a long period, we can assume that she was either unwilling or financially unable to care for Mary. She remained in Garlands for the rest of her life, until her death in April 1922. The presence of a familial framework in the asylum was important in stabilising Mary’s condition, even if a recovery was not possible, the convalescence of such patients was valuable to the curative environment of such institutions.

Viewing the asylum as providing a domestic, ritualised regime of care which, in some cases, sought to act as a surrogate family environment, is important in dispelling the myths of contemporary opinion of the Victorian lunatic asylum. Looking back through the patient records, it is apparent that they adapted to life in the asylum, helped in part through its domestic routine.

This blog post is part of a wider PhD thesis based on the patient records of the Garlands lunatic asylum Carlisle, which will seek to recount history from the perspective of those who experienced it first hand. Any stories, memories or any questions you may have relating to the Cumbrian institution, please do not hesitate to get in touch caradobbing@gmail.com

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[1] J. Hamlett, At Home in the Institution (2014)

Call for Participation

Hello, many of you know that I am working on my PhD which is looking at the patients of the Garlands Lunatic Asylum (pre-1914). Many of you have contacted me with stories and I have also assisted several people with finding their relatives in the Garlands records. 

Cumbria County Council, in collaboration with myself and a few others, are working on a project surrounding mental health, of which the records of the Garlands will play an important part. It is hoped an exhibition/series of talks will come out of the project later in the year. I am writing to ask for your stories/photographs/memories of the asylum. We are looking for people happy to share their stories and are happy for them to be (possibly) published in an exhibition. Stories/pictures/newspaper articles can be about patients or staff, we are keen to include both facets of the institution. 

I am very excited to be working as part of the project, which it is hoped will draw parallels with the past in terms of how mental health was treated, and pinpoint some of the key advances in the field over the last 150 years. The project will aim to be a community oriented one, and will highlight the importance of such a key institution in Cumbria that affected so many people's lives over the years. I have always found all your stories of Garlands fascinating, so it is very important for me to get these to the forefront of the project. 

Email me at caradobbing@gmail.com with any items of interest you may have. I am sorry if I cannot get round to replying to every email, but all emails will be passed on to the project manager for consideration for inclusion. Thank you all in advance for your help.

Forced-feeding, Food refusal, and the attitude to Food in the Garlands Asylum

A couple of weeks ago I gave a seminar as part of the University of Leicester’s History of Medicine series. The seminar detailed a small part of the research I have undertaken during my PhD studies. The focus was on the how food was viewed and utilised in the asylum, as both a way of treating mental illness, and how, in certain patients, an aversion to eating could exacerbate their condition. This blog post will provide some of the points which I discussed, with the key focus being on providing the patients with sufficient nourishment, and resorting to forcible methods of feeding in those that refused it.

Moral Treatment

To begin with, it is necessary to give a bit of background as to the treatment given at this time in the nineteenth century lunatic asylums. A growing era of philanthropy, an increased concern among society about humanity, and delivering humane treatments, led to the adoption of ‘moral treatment’ in the county asylums built after the 1845 Lunacy Act. Pioneered at the Quaker run York Retreat at the end of the eighteenth century, the asylum regime centred on providing patients with a good diet, regular exercise, useful employment, recreational entertainments, and regular religious services. Self-restraint was encouraged among the patients so that asylum doctors no longer had to mechanically restrain them using locks and chains. Discipline and enforcing a rigid regime was adopted widely to promote the notion of self-restraint. No longer were harsh punishments, violence, and an environment of brutality accepted in lunatic asylums. Psychiatry in this era was in its infancy, and little was known about the conditions which caused a mental breakdown. Therefore, there were few medical treatments to cure the patients who found themselves with mental illness in a lunatic asylum. Doctors instead focussed on curing the physical ailments of an individual, as it was believed this would promote a cure in their mental faculties. Central to this were the aspects of moral treatment outlined above, of which a nourishing diet was key.

Food as Medicine

Increasingly during this period, physicians reinforced the link between poor food intake, and patients suffering from conditions of the nerves. This was due to the contemporary understanding that the stomach as an organ was heavily related to the nerves. Thus, well cooked and varied meals, of a higher standard than pauper patients would receive at home, were provided in the asylum. In the 1863 Garlands annual report, Dr Thomas Clouston, medical superintendent of Garlands from 1863 until 1873, stressed that ‘a good dinner…generally [has] a far more soothing effect than any sedative’. Below is a picture of the ordinary patient’s diet that was administered to the male and female patients in 1863.

As can be seen from the picture, the asylum dietary was varied, albeit in a rigid, weekly format. Male patients received slightly more than the females, and some meals were also different for each sex. Meals were adapted depending on the time of the year, with meat pies being substituted for rhubarb and gooseberry ones in the summer months. The Commissioners in Lunacy, a body created to regularly inspect all the county institutions of England and Wales, judged the efficacy of each asylum on the standard of food it offered to its patients. For instance, in 1877 they said on their visit to Garlands, that: ‘There were today 91 men and 82 women dining together in the hall, and the dinner of soup, with fresh meat and potatoes, which was well served and in good taste, seemed to meet with general approbation’.

            Common in the treatment of certain mental conditions was tailoring the diet to each individual. For example, Dr John Campbell, medical superintendent in Garlands from 1873 until 1898, administered a milk diet for patients that were particularly violent and irritable, whereby animal food would be avoided for some weeks in an attempt to soothe them. For those suffering from an increased appetite, in particular patients with general paralysis, a restricted diet was advised; mincemeat and potatoes would be given on two days of the week, for the rest, the patient would receive only broth and milk. Whiskey and beef tea were especially prescribed for patients who were sick and bedridden, in an attempt to stimulate them back to health.

Food refusal and Forced-feeding

Great importance was placed upon the value of asylum patients receiving a good diet, therefore cases which refused all nourishment posed significant problems for the asylum doctors, as they had to resort to feeding via forcible means. When we think of force-feeding we conjure up images of the hunger-striking suffragette, and we seem to forget that this practice was made commonplace in the county lunatic asylums of the nineteenth century. The adoption of this calls into question the efficacy of moral treatment, as patients had to be held down and restrained whilst liquid mixtures were forced into their stomachs via a feeding tube administered through the mouth or nose. Due to this, the practice was, unsurprisingly, surrounded by debate and controversy. Garland’s own Dr Campbell was equally incensed by the issue, and in 1878 wrote an article (‘Feeding versus fasting’) in the British Medical Journal. He outlined that at Garlands forced-feeding would only be resorted to if patients had refused food for two consecutive days. However, for those already weak and in an emaciated condition, force-feeding may be utilised sooner. From 1873 until 1878, thirty-five patients had had to be force-fed, in one case continuously for two years. In the article, Campbell described the features that were common in food refusing patients;

silly emotional excitement, alternating with trance-like or cataleptic-like state, in which the patient would lie for hours, taking no notice of what went on around, and apparently unconscious of pain or discomfort, and refusal of food for considerable periods.

He also explained, that in some circumstances, simply by explaining the method of force-feeding via the tube was enough to bring patients to eat. Liquid mixtures, usually containing beef tea or milk and brandy, were administered down the tube to provide nourishment to self-starving patients. Forcible feeding was therefore employed to prevent as many deaths as possible through food refusal. However, the brutality it inflicted upon patients called into question the ability of asylums to use moral treatment to effectively bring about recovery.

Thank you for taking the time to read this snippet from my research conducted on the Garlands Lunatic Asylum, which forms the basis of the PhD thesis I am currently working on. My aim is to write the history of such a fascinating institution through the experience of its pauper patients. If you have any stories relating to the asylum, or would like help in tracing your ancestors that were in this particular institution, please don’t hesitate to contact me at caradobbing@gmail.com

Murder at Longtown Workhouse

Throughout my PhD research of the Garlands Lunatic Asylum, Carlisle, I have come across many extraordinary stories of the patients that came through its doors from its inception in 1862, until the end of the nineteenth century. The story I am going to recount through this post is one of a patient that committed a most brutal and terrible crime ten years after his release from the asylum. This calls into question the ability of the authorities of the time to judge a patient fit for release, and whether discharged patients were properly monitored in the years after their confinement in an institution.

            This blog post centres on Michael Edward Carr, who was a patient of the Garlands Asylum on five separate occasions between 1870 and 1888. His visits to the asylum for treatment varied in length; the first being one year two months; the second three months; the third was six months; the fourth was for five months, and his final stay lasted only four months, with his final date of discharge on 12 July 1888 – almost ten years before the dreadful event briefly outlined in the West Cumberland Pacquet[1] below.

 

On the evening of 31 May 1898, in the hospital ward of Hallburn workhouse in Longtown, Carr and six other inmates were asleep, and had been since 8 o’clock, when he suddenly became somewhat excited and accusatory of James Nichol, at around midnight. Carr was adamant that Nichol was in his bed, when in fact it was the correct bed and Carr’s laid empty next to him, therefore he was in a delusional and confused state. Nichol was aged 79, had completely lost the use of his legs, and was partially blind. Carr himself had deformity of both his legs, and had to walk with the aid of two walking sticks. Inmates of the hospital ward who witnessed the incident said that Carr set about Nichol with both his walking sticks and beat him to death, all because he believed he was in his bed. One of the witnesses, a fellow inmate, recalled how: ‘blood spattered on to me, I was terrified that he would strike another old man’. This same witness stated that for two days prior to the incident Carr had been somewhat depressed and refused to speak to anyone. However, the master of the workhouse stated that they did not have any inclination as to Carr’s mental state, and the incident came completely out of the blue. Carr had only been an inmate of Hallburn workhouse for seven days, thus possibly not enough time for the master to fully assess his condition. Carr had instantly killed Nichol with the first blow to the head with his stick, but had kept on beating him. The result, as reported by the Doctor who arrived about an hour after the incident, was that ‘his face was a mass of pulp, his right arm was broken and there were bruises on his body…his head was practically beaten in’. He also stated that he had treated Carr a couple of days previous for bronchitis, and that he noticed nothing wrong with him mentally.

            It seems strange that in light of this brutal murder the people that had come into contact with Carr had not noticed any strangeness in his character or suspected anything wrong with his mental state. It also seems strange that none of the people interviewed in Carr’s trial new of his history in the Garlands Asylum. Each time he had been admitted to the asylum he was chargeable to Longtown Union, thus they paid for his maintenance. Also, being incarcerated in a county lunatic asylum at this time carried with it a great stigma, therefore I find it hard to believe no one in this area knew of his previous treatment for mental illness. In suspecting that he was insane at the time of the murder, due to his strange belief that Nichol was in his bed, Dr Campbell, medical superintendent of Garlands was called to examine the prisoner at Carlisle Gaol. On 24 June, Campbell remarked of his examination of Carr:

 

‘He complained to me that he had been assaulted and nearly murdered by 8 men in the Longtown workhouse. He denied that he had ever killed a man or even attacked anyone…I found his memory as to long past occurances excellent, but as to matters which took place within the last month his memory was very defective, almost a blank…I do not believe the man to be feigning insanity. In my opinion the man is insane, holds and expresses delusions of persecution and is not in the full possession of his senses so as to be pleading to the indictment’.

 

Michael Carr was charged with, ‘having on the 31^st day of May last at the parish of Arthuret in the said County feloniously and of his malice aforethought killed and murdered one James Nichol’. After being examined by Dr Campbell Carr was found guilty but insane at the time of the murder, and was sent to be detained in Broadmoor Criminal Lunatic Asylum, where he remained until his death in 1924.

What is apparent from the murder committed by Michael C, is that the monitoring of discharged asylum patients was none existent. The fact that Michael had been in Garlands several times should have resulted in him remaining longer in Garlands each successive time he was admitted, however the inverse occurred. Of particular concern was the fact that Michael was continually referred to as dangerous and violent in his case notes, which seem to have also been failed to have taken in account.

 

Thank you for taking the time to read this somewhat brutal story from my research conducted on the Garlands Lunatic Asylum, which forms the basis of my PhD thesis I am currently writing. I am working towards writing the history of such a fascinating institution through the experience of its pauper patients. If you have any stories relating to the asylum, or would like help in tracing your ancestors that were in this particular institution, please don’t hesitate to contact me at caradobbing@gmail.com

 

All material for this blog post relating to the trial of Michael Edward Carr comes from the national archives, ASSI 52/38.

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[1] Dated 8 July 1898.