The Royal Bethlehem Hospital (now the Imperial War Museum) designed by James Lewis in 1815 with important additions by Sydney Smirke, 1835-1846. Click on image to enlarge it.

By 1815, when the Royal Bethlem Hospital for the Insane (The Hospital of St. Mary of Bethlehem, London) was removed from Moorgate, north of the River Thames, to Lambeth-Southwark, south of the river, the asylum had long developed an odious reputation and common name — of ‘Bedlam’, whose many discharged but uncured inmates, often previously licensed to beg, were the “Tm o’ Bedlam” and “Jack o’ Bedlam” of the sprawling unhygienic metropolis and its disorderly masses.

The dreadful reputation of the place and its mad-doctors [doctors-in-charge of the mad] drew fierce condemnation from Parliament, which voted on Bills of the Select Committee on Madhouses, and Bills to amend the laws for Regulation of Pauper Lunatics. Foremost among campaigners for improvements — to the physical, hygienic and socio-economic conditions of hapless inmates, though scarcely yet their medical and psychological care — was Anthony Ashley Cooper, 1801-1885, Seventh Earl of Shaftesbury:1 Shaftesbury thus became the leading governmental Commissioner in Lunacy, and Chairman of The Board, 1829- 1885, op. cit., p. 132. His experiences were vivid and real — of “fearful evils” being perpetrated upon “unhappy persons”, “outcasts”, full of “pain” and neglect, whom he witnessed would “writhe under supposed contempt”, ibid, 130. Lord Ashley’s name rightly stood “at the head” of those Lunacy Commissioners whose struggles eventually provided for the “mighty change in the treatment” of lunacy, via the County Asylums system, whether for genuine cases of dissociation [from reality]-insanity, or spurious incarcerations of ‘inconvenient’ people.2

Specialist psychiatric historians, such as R. H. Rollin and Z. Kotowicz, have indicated how formal care models and associated treatment regimes at that period were still far from efficacious, humane or logical-impartial, and often continued a tradition of critical blame — both secular and religious — heaped upon the inmates, together with a deleterious marked separation of interest from and by the general medical profession.3 Thus,

(a) James Prichard, MD, 1786-1848, offered the diagnosis of ‘moral insanity’, which was rapidly and enthusiastically taken up.4

(b) Sir Alexander Morison, 1779-1866, routinely described child-patients through the above system, finding them “violent”, “mischievous” and “incoherent of speech”. Six year-old Eliza, admitted in 1842 with convulsions, was given into the care [sic] of an older patient [sic], and discharged ‘cured’ after two years (cited in Kotowicz).

( c) the saintly Dr. Isaac Watts, DD, 1674-1748, though long dead and departed, maintained a continued ‘moral’ standpoint via his published books, aimed against …The Sins and Follies of Childhood and Youth. His eventually pernicious framework was given a not too subtle drubbing by Lewis Carroll’s Alice,5 as Carroll-Dodgson had himself, meanwhile, discovered the non-moral psychological borderline between dreams and wakefulness, reality testing and the truer definition of madness.6 The moral-diagnostic route continued to be followed by authorities, including J. Crichton-Browne, for some time thereafter. 7

By c. 1855-60 the ‘moral treatment regime’, of enforced occupational therapy, food austerity and exercise-yards, was beginning to wane. More progressive alienists in the new County Asylums were now distinguishing the stubbornly incurable and the chronically insane [dissociated, hallucinatory] from the wrongfully confined [social misfits, feebleminded youth, senile aged; inebriates, and the merely ‘pauper lunatics’ with no social-economic recourse]. The County of York provided one region of new and especially improved practice, with the York Out-Patient Clinic, the Leeds Medical School and the Wakefield ‘West Yorkshire Pauper Asylum’. Here there came to some competence, if not wider medical prominence, such men as the later great J. Hughlings Jackson, 1835-1911; Daniel Hack Tuke, 1827-1895, and James Crichton-Browne, 1840-1938, the latter being Medical Superintendent at Wakefield, 1866-76, before moving to London. Innovations included visiting alienists, ward rounds, and exchanges of ideas via conversaziones as the order of the day. The alienists were nevertheless largely ignored, with their speciality suffering from the isolation from General Medicine (6). Children were especially still prone to lack of understanding, with critical attitudes maintained against their [developmentally normal] “flights of imagination” as a “pernicious practice.”8

By 1867 in England, broader diagnostic schemes, then including childhood epilepsy and melancholy, were becoming recommended, as by Henry Maudsley, 1835-1918, physician, Manchester Asylum, before becoming Professor of Medical Jurisprudence at University College London, 1869-79.9

Any formal emergence of psychopathological, psychiatric and especially child psychiatric disciplines however, even on crudely diagnostic criteria rather than on psychodynamic and developmental-pedagogic lines, was nevertheless slow and faltering — if not non-existent — in Victorian England (14), with roots continuing to incite controversy to the present day. Students of these fields, recently more pertinent to Lewis Carroll Studies, must therefore look elsewhere for the centre and lingua franca of scientific-based mental health studies in the period c. 1865-1898.

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Last modified 31 July 2016