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 the time that London's Bethlem Royal Hospital for the Insane, better known as Bedlam, was removed from Moorgate to Lambeth-Southwark, south of the Thames, in 1815, it had earned an odious reputation. Its many discharged but uncured inmates, often previously licensed to beg, became the scourge of the sprawling metropolis.

The dreadful reputation of the place and its doctors drew fierce condemnation from Parliament, which voted on legislation to regulate the asylum, for instance, 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 became the leading governmental Commissioner in Lunacy and served as Chairman of the asylum's Board from 1829 to 1885. His experiences were vivid and real; he reported "fearful evils" being perpetrated upon "unhappy persons," "outcasts" suffering from "pain" and neglect, who "writhe[d] under supposed contempt" (ibid., 130). Lord Ashley was premier among those administrators 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 or spurious incarcerations of "inconvenient people," to use historian Sarah Wise's term.2

Historians of psychiatry such as R. H. Rollin and Z. Kotowicz have indicated how formal care models and associated treatment regimes of the period were still far from efficacious and humane, and often continued a tradition of heaping blame upon inmates, together with a deleterious marked separation of interest from and by the general medical profession.3 Thus, James Prichard, MD (1786-1848) offered the diagnosis of "moral insanity" which was rapidly and enthusiastically taken up.4 Sir Alexander Morison (1779-1866) routinely described child patients using this system, finding them "violent," "mischievous," and "incoherent of speech." In a case cited by Kotowicz, a six-year-old child named Eliza, admitted in 1842 with convulsions, was given into the "care" of an older "patient" and discharged "cured" after two years. The influence of Isaac Watts, DD (1674-1748) and his "moral" standpoint continued via his published books, aimed against "the sins and follies of childhood and youth." His 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 true madness.6 The moral-diagnostic route continued to be followed by authorities, including J. Crichton-Browne, for some time thereafter.7

The influence of the so-called moral treatment regime, involving enforced occupational therapy, food austerity and exercise yards, began to wane between 1855 and 1860. More progressive clinicians in the new County Asylums were now making finer distinctions between patients in their care: the stubbornly incurable, the chronically insane, those suffering from dissociation and hallucinations, the wrongfully confined, those with alcohol dependencies, and the merely "pauper lunatics" who had no social-economic recourse. In York, new and especially improved practices were developed at the York Out-Patient Clinic, the Leeds Medical School and the West Yorkshire Pauper Asylum of Wakefield. It was here that the following alienists came to prominence: J. Hughlings Jackson (1835-1911), Daniel Hack Tuke (1827-1895), and James Crichton-Browne (1840-1938), who was Medical Superintendent at Wakefield between 1866 and 1876 before moving to London. Innovations included clinician visits, ward rounds, and regular exchanges of ideas. The alienists were nevertheless largely ignored, and their speciality suffered from isolation from general medicine. Children remained especially vulnerable to misunderstanding, as their developmentally normal "flights of imagination" were met with pernicious criticism.8

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

The formal emergence of psychopathological, psychiatric and especially child psychiatric disciplines was nevertheless slow and faltering, if not non-existent, in Victorian England (Kotowicz 14). 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 between 1865 and 1898.

Related Material

Created 31 July 2016

Last modified 15 February 2022