What was life really like in Victorian mental asylums? The story of Hanwell Mental Asylum reveals that they were kinder places than we might think.
The Victorian mental asylum has the reputation of a place of misery where inmates are locked up and left the mercy of their keepers. But when the first large asylums were built in the early 19th century, they were part of a new, more humane attitude towards mental healthcare. The Middlesex County Lunatic Asylum at Hanwell, on the outskirts of London, was one of the first of the new state asylums, and it set many of the standards for mental healthcare in the 19th century.
The origins of the asylum
The mental asylum was the historical equivalent of the modern psychiatric hospital. The term asylum comes from the few (religious) institutions that offered refuge to the destitute and mentally ill. One of the oldest such institutions was Bethlem, which began in 1247 as part of the Priory of the New Order of our Lady of Bethlehem in the city of London.
Before asylums, people with mental illness or learning disabilities were cared for almost entirely by their families. Those who could not be kept at home often ended up destitute, begging for food and shelter. By the 18th century there were a few private institutions where wealthy families could send their ‘mad’ relatives to be cared for with discretion. The poor had to rely on local parishes, which sometimes provided charity-funded asylums, and some ended up in workhouses or prisons.
Social campaigner Harriet Martineau summed up the poor state of public asylums:
In pauper asylums we see chains and strait-waistcoats, three or four half-naked creatures thrust into a chamber filled with straw, to exasperate each other with their clamour and attempts at violence; or else gibbering in idleness or moping in solitude.
The use of physical restraints in asylums
The commonplace use of physical restraints on patients had its roots in the custodial nature of early asylums. The function of mental institutions was simply to keep ‘inmates’ in custody. The keepers were little more than guards and it was not uncommon for patients to be kept in chains or other restraints for most of the time. The extent to which restraints were used varied from one asylum to another, but they were accepted as a necessary part of mental healthcare.
There were several justifications for the use of such restraints:
- Restraints could control anti-social behaviour such as tearing clothes and exhibiting lewd or sexual behaviour.
- Restraints stopped patients harming themselves or attempting to commit suicide. Patients were frequently strapped into their beds at night to stop them hurting themselves.
- Some patients were so worried they would hurt themselves that they asked to be restrained.
Critics said the use of restraints demoralised and brutalised attendants as well as patients. And the violence used by attendants to put uncooperative patients into restraints only increased the level of violence in the asylum.
In 1829 William Scrivinger, a patient at Lincoln Asylum, was found dead from strangulation after being strapped to his bed in a straitjacket and left overnight without supervision. The incident persuaded the authorities at Lincoln to abolish all physical restraints and implement a non-restraint system. Their system was very influential in 19th century asylum reform, and indicative of a wider change in attitude towards mental illness and care of the mentally ill.
Changing attitudes to mental healthcare
Around the beginning of the 19th century reformers such as Harriet Martineau and Samuel Tuke spearheaded a change in attitude towards mental healthcare. For the first time, local authorities had a legal responsibility for the care of the mentally ill in purpose-built accommodation. The shift in emphasis from ‘custody to cure’ of the mentally ill resulted in a flurry of legislation:
- Mental illness was recognised as something that might be cured or at least alleviated.
- It was no longer acceptable to keep the poor mentally ill in workhouses and prisons, so state provision of asylums became mandatory.
- There was unprecedented programme of building asylums based on the latest scientific and medical knowledge about mental illness.
The moral treatment system
The moral treatment system was a new approach to mental healthcare that influenced many of the reforms of the 19th century. The system aimed to treat people with mental illness like rational beings.
Towards the end of the 18th century, Samuel Tuke, director of a mental institution outside York called The Retreat, developed the ‘moral treatment’ system for mental healthcare. Although many of his techniques already existed, he unified them into a system, which he outlined in his book A Description of the Retreat.
Tuke believed that patients benefited from being treated as rational beings. They were expected to dine at the table, make polite conversation over tea, and do regular chores. The role of the alienist (psychiatrist) was to encourage rational behaviour. The system relied on rules and constant supervision, enforced by simple rewards and punishments. Physical restraints could be used to modify behaviour if used sparingly as punishments or deterrents.
In traditional asylums, patients were mixed together in the same ward, but Tuke tried to tailor treatment to each patient and housed patients with similar conditions together.
Therapeutic employment at Hanwell Asylum
Hanwell Asylum was the first of the new wave of County asylums to open its doors in 1832. From the start, it took a progressive approach to patient care.
The first Superintendent, Dr William Charles Ellis, with his wife Mildred as matron, ran the asylum like a grand household, with Ellis as the patriarch.
Ellis had used the moral treatment system in Wakefield Asylum and implemented something similar at Hanwell. In particular, Ellis was known for his ‘great principle of therapeutic employment’. Along with religion, he believed that work was essential to patient recovery and rehabilitation. Within four years of his arrival at Hanwell, 320 of the 560 patients were regularly employed.
Hanwell’s extensive grounds were used for farming as well as recreation. And a bakery, brewery and many other ‘cottage industries’ aimed to make the asylum as self-sufficient as possible. When Harriet Martineau visited Hanwell in 1834, she found an industrious environment:
In the bakehouse… are a company of patients, kneading their dough; and in the wash-house and laundry, many more, equally busy, who would be tearing their clothes to pieces if there was not the mangle to be turned.
Patients were not only earning their keep, they were gaining the therapeutic benefits of hard work.
The non-restraint system at Hanwell Asylum
If hard work was central to Ellis’s therapeutic regime at Hanwell, then the removal of physical restraints was at the heart of the system established by John Conolly, the third superintendent at Hanwell. He took his inspiration from the non-restraint system he observed at Lincoln Asylum. Conolly’s great achievement was to introduce the method successfully into the largest of the metropolitan asylums, paving the way for it to be adopted in public asylums throughout the country.
The traditional asylum keeper had a lowly status, often little more than a jailor. With non-restraint and moral treatment, much more was required of attendants and nurses. The system required attendants to provide constant surveillance, so they could intervene before harmful or destructive behaviour escalated. This meant not only more staff, but staff trained to provide manual restraint without injury.
The greatest challenge for non-restraint was how to manage uncooperative and violent patients. For the most unruly patients, the last resort was isolation so that they could not harm others or themselves. The therapeutic rationale of seclusion was to remove the patient from the cause of his or her agitation and to limit external stimulation until they calmed down.
The Metropolitan Commissioners who inspected Hanwell supported Conolly’s use of seclusion in the form of padded cells, finding it:
to have a very powerful effect in tranquillising and subduing those who are under temporary excitement or paroxysms of violent insanity.
By 1845 physical restraints were on their way out of public asylums. The new regime relied on strict operational systems and monitoring, of both staff and patients, to maintain order. Conolly observed with some satisfaction that ‘residence in a well-ordered asylum’ was ‘among the most efficacious parts of direct treatment’.
The decline of asylums
To some extent the Victorian asylums were victims of their own success. With an ever-growing asylum population, it became increasingly difficult to maintain the sort of personalised moral treatment envisioned by the early reformers.
Medical superintendents and reformers started the century with the best of intentions, believing that a scientific approach to improved surroundings, and a humane approach could lead to rehabilitation and recovery. And the new public asylums did make life easier for most pauper patients. Working in the asylum community gave them purpose and kept them reasonably well fed. In return for their good behaviour and hard work, they were rewarded with social activities such as plays, concerts and parties.
But with growing asylum populations, superintendents found that the only way to maintain control in the increasingly overcrowded and poorly staffed county asylums was to resort to restraints, padded cells and bromides. Conolly complained that:
the magistrates go on adding wing after wing and story after story [sic], contrary to the opinion of the profession and common sense, rendering the institution most unfavourable for the treatment of patients. [quoted in an article in the Edinburgh Review, 1871]
By the end of the century the optimism around county asylums had virtually disappeared. An inspector who visited Hanwell in 1893 described ‘gloomy corridors and wards’, an ‘absence of decoration, brightness and general smartness’ and ‘a want of sufficient ventilation’, conditions that were in stark contrast to the moral treatment days of Ellis and Connelly. His conclusion was damning:
it would be astonishing to find that any cures are ever made there.
What happened to Hanwell Asylum?
By the early 20th century the term asylum had fallen out of favour and in 1929 Hanwell was renamed Hanwell Mental Hospital. In 1937 all associations with the old Hanwell asylum were removed as it was renamed St Bernard’s Hospital.
To try to reduce the stigma of psychiatric hospitals, a new district general hospital was built in the grounds of the former asylum. The whole site was then named Ealing Hospital.
Some of the original asylum buildings such as the chapel and the two gatehouses remain, and the St Bernard’s Wing still provides mental healthcare. The Age of the Asylum may be long gone, but the site of the once innovative Hanwell Asylum continues to meet the changing mental healthcare needs of each generation.
Suggestions for further research
More about asylums:
- Website: From Bethlehem to Bedlam—England’s First Mental Institution, Historic England
- Book: ‘The Most Solitary of Afflictions : madness and society in Britain, 1700–1900’ by Andrew Scull, 1993
More about Hanwell Asylum:
- Website: St Bernard’s Hospital, Hanwell, Wikipedia
- Digital collections: Mental healthcare archives at Wellcome Collection
- Ebook: ‘Description of the Retreat’ by Samuel Tuke, 1813
- Ebook: ‘A treatise on the nature, symptoms, causes, and treatment of insanity: with practical observations on lunatic asylums and a description of the Pauper Lunatic Asylum for the county of Middlesex, at Hanwell’ by William Ellis, 1838
- Ebook: ‘The Treatment of the Insane Without Mechanical Restraints’ by John Conolly, 1856