Traditional Narratives in Mental Health

What was the situation regarding restraints at Hanwell prior to Conolly's chairmanship?

"In every ward there was a closetful of restraints, and every attendant used them at will. Many patients were always in restraint." Six restraint chairs were added to the stock prior to Conolly's joining - making 41. THAT SHOWS THAT THE PRO-RESTRAINT MOVEMENT CERTAINLY DID NOT LOSE TRACTION WHILE CONOLLY WAS ADVOCATING NON-RESTRAINT MEASURES.

What statement does Browne make which interestingly seems to devalue the opinions and arguments of the patients (and thus imposes a power dynamic whereby their reality is entirely structured by the psychiatrist)?

"Is there any fiction, cunningly devised in the mind of the insane prisoner panting for liberation, at all to be compared with those facts which have been seen and recorded by men who had no motive but mercy, no objects in view but justice?" Browne's comparison between the views of the patient and "facts" presented by those looking in to asylums is extremely provocative. Assumes that the writings of the mad are continually fictionalised (HAS THIS APPROACHED HOW HISTORIANS HAVE ANALYSED THE WRITINGS / OUTPUT OF MADNESS?)

Quote from Browne which demonstrates the difficulty of translating desire for reform into actual reform?

"It may be said that the cause of the lunatic has been eloquently pleaded at the bar of public opinion, but that the court has not yet pronounced judgement." Browne argues that assertions for asylum reform are still generally the preserve of the small class of reformers.

Quote demonstrating Perceval's heavily class-based view of incarceration in Asylum?

"to prove how cruel the situation of a lunatic, and particularly a lunatic gentleman, may be"

What was a key parliamentary debate occurring as Browne was writing his study?

1832-45 (Browne writing 1837) saw an "uneasy alliance" between lay and professional commissioners on parliamentary councils. THERE WAS A DEBATE OVER THE IMPORTANCE OF "RELIGIOUS CONSOLATION" AS THERAPY - which perhaps informs Browne's discussion over the effectiveness of Gheel. ...and shows that Browne is playing into wider debate around clinicalisation as Conolly does.

How did 1845 see another shift in balance of legislative power?

1845 Lunacy bills saw increasing importance of barristers on Commission, and medical professionals were apparently EXCLUDED from contributing to these initiatives.

Give an example of the problems of de-institutionalisation.

1960s California and the release of mental patients. Possibly led to Bay Area homelessness crisis. Is Freedom really liberating? Can it be abandoning?

Browne's statistics demonstrating logistical problems for provision of care at asylums?

3 keepers for 250 patients at one asylum. In French system, however, usually 1 keeper to 10 patients (perhaps interesting display of Francophilia given the times).

Which development in asylum commissions potentially shows Browne's argument for holistic care being taken up?

After 1846 Haycock lodge scandal, commission saw its role increasingly as tied into becoming leading authority on asylum construction. They employed engineers, architects, public health experts to aid them in their studies.

How can one cite that Conolly's non-restraint method may not have been entirely effective / slow to catch on?

Agnew recounts the brutality of restraints in her memoir (I think she was admitted to the asylum by her husband in 1878) - granted she is in America, but Sutzu knew of Conolly's initiatives from Romania... Agnew's case shows restraint still in use c. 20 years following Conolly's letter to Bucknill (and then there is the argument that it continued chemically past this point).

How could one argue that the non-restraint system and moral treatment initiatives did little to improve the conditions of patients?

Arguably physical restraints simply became replaced with chemical restraint later in 20th century. Moral treatment did not seem to equate ethical treatment. E.g. Clark's assertion that students should be sent into asylums to observe patients in isolation, often without the knowledge of the patient (in cases of "acute mania" where the patient was kept in isolation). The patient here seems to have moved simply from an outcast to an object of study.

What did Seymour argue regarding private lodgings?

Argued that though they required regulation, THIS SHOULD BE DONE BY FAMILIES, AND NOT BY INSTITUTIONS SUCH AS THE COMMISSIONS.

How does Clark potentially present the issue of lack of education and spirit of enquiry concerning mental illness as an English problem?

Argues that French have greater system of clinical lectures (started by Esquirol in early 19th century). German commitment to 1817 with clinical lectures started by Horn. Notes Italian chairs of mental pathology (Florence, Bologna, Turin and Naples).

What, for Conolly, does humanisation of asylum practices involve?

Argues that asylum inmates should be viewed in same way as those outside of the asylum - i.e. their treatment should be as individualised and individually focused as those outside of the asylum. "like the persons without the walls of the institution, each individual has a distinct character, his own trains of thought, his own peculiar habits, his own pursuits." This therefore seems to call for a re-evaluation of the mentally ill.

How does Conolly describe dehumanisation within the asylum system?

Argues that asylums transform people from being human individuals into "a stock in trade" - part of a wider asylum goal to simply strive for the highest figures of cure. Argues again that this is due to the inept (or unfeeling) character of unsuitable attendants - argues that patients are often kept in a way specifically designed to keep them in the asylum, so that the asylum governors are able to receive greater amounts of money for their continued upkeep.

Why does Savelli argue that there were barriers to analysis in Yugoslav methodology?

Argues that many reports were conducted using oral interviews with those who identified themselves as "psychoanalytically-orientated psychiatrists" (seems to be a notion of secrecy). Notes the difficulty for a clear interview process in an environment of censorship and repression (interviewees hiding truths / inability of psychiatrists to freely ask questions).

How does Majerus argue that the development of the pill changed the traditional dynamics of control between patients, psychiatrists, and the institution?

Argues that patients began to gain power through their ability to be able to demand chemical medication. Argues that psychiatrists outside of the institution began to gain power through the development of neuroleptics in 1960s - they gained power of control.

How does Browne see the asylum as a platform for reforming moral treatment methods?

Argues that proper mental health reform and treatment should be focused on introducing a holistic method of care, which effects asylum architecture, ward organisation, education of attendants etc as part of the whole package of "moral treatment" which extends beyond the doctor-patient relationship.

Why does Savelli argue that the Freudian psychoanalysis popular in West in early 20th century was incompatible with socialist society?

Argues that the Freudian doctrines of id, ego and superego did not square well with the idea of a socialist society and class consciousness due to the idea of id, ego and superego implying the existence of an individual soul, with individual consciousness.

What main problem does Browne highlight in considering insanity on an institutional level?

Argues that the primary problem is classification - argues that generally the tendency to classify is too reductionist. Argues that the kind of insanity and the severity needs to be taken into account. BROWNE ARGUES THAT WHERE THE PATIENT IS NOT FULLY TAKEN INTO CONSIDERATION (I.E. BLANKET PRACTICE), THE SANE CAN OFTEN BE GROUPED WITH THE INSANE, WHICH CAN LEAD TO SIGNIFICANT PROBLEMS. Does this still appear slightly too clinical and deterministic?

How does class graduation move into asylum life in Browne's view?

Argues that the upper classes should be given cutlery to eat, and as far as possible should eat "in society" with the managers of the asylum, while the lower class patients eat with the attendants.

What does Browne argue regarding the uptake of the non-restraint method of treatment which is also represented in Conolly?

Argues that the uptake is generally extremely slow: "Not many years have elapsed since, in one hall of an asylum... not fewer than eighteen out of twenty-seven male patients were chained, muffled, or strapped to their seats."

What impact has the distance of asylums from social view had on progress of reform according to Conolly?

Argues that this distance has often meant that abuses have gone unchallenged as they simply have not been uncovered. Conolly makes the argument that it is thus important that REFORM COMES FROM THOSE WHO ARE FAMILIAR WITH THE CONDITIONS AND "MALADIES" OF THE INSTITUTION. And this implies - like Browne - that he sees sufficient education and informing of reformers as crucial to effectively ensuring that reform is carried out.

How does Conolly use the example of Glasgow asylum?

Argues that this is the effect when treatment is concentrated on treating the MIND of the patient - rather than just leaving them to decline / assuming that they are beyond medical help. Conolly argues that the unconventional tactic of reading of scripture manage to reduce the suicidal tendencies of one patient. How far are Browne and Conolly attempting to potentially expand the clinical boundaries of treating mental illness (CONOLLY SEEMS MORE FLEXIBLE THAN BROWNE IN THIS REGARD - THOUGH BROWNE SEEMS TO DERIDE ALTERNATIVE APPROACHES AS SEEN IN GHEEL, CONOLLY SEEMS TO VALUE THEM AS GENUINE WAYS TO APPROACH TREATMENT).

How does Digby oppose / qualify Foucualt's argument regarding the York Retreat?

Argues that this was less of a problem in earlier period when the entire establishment revolved around Quakerism, suggesting that people then probably shared comparable moral beliefs.

How does Browne argue that violence has evolved within asylums, and what has effected this change, according to him?

Argues that violence still exists but has become a covert rather than an overt form of control. Argues that parliamentary commissions (SEE BELOW AND HERVEY) have motivated this change (i.e. public opinion can be important).

How was Vujic an important character in opposition to psychoanalysis?

Attempted to "Stalinise medicine" in Yugoslavia - a focus on material approaches and organic psychiatry. Led to figures such as Matic who held informal group sessions in his home to further develop discipline and continue to influence eventual character of Yugoslav psychiatry.

How did the York Retreat use space to improve the therapeutic quality of the asylum (Porter)?

Attempted to create family environment and one which was restorative to doctors AS WELL AS patients.

How does asylum social reform change throughout the century?

Becomes increasingly related to the state - asylum reform increases by 10 times from start to end of 19th century. (Porter)

How might Warneford Asylum (Oxford) be said to demonstrate that asylums could be places of social reform?

Began as middle class asylum but became asylum for lower classes, and benefitted significantly from philanthropic donations. Asylums part of wider social infrastructure for the poor?

Give three examples of drugs used institutionally, and which often led to drug dependance?

Belladonna, Laudanum, Opiates.

Give an example of a company which specialised in manufacture of asylum beds.

Bouvier Company in Lyon (France).

How does Browne define "cure"?

Browne argues that "curing" an individual through "humane and philosophic" means, means returning them to their place in society. He argues however that for those for which this is not possible, they should instead be "reconciled to their captivity." Cure therefore does not necessarily mean a cure of the ailment, but rather returning the individual back to their social positions.

What term does Browne use to describe the poor provision of staff at asylums, and how is this charged?

Browne argues that attendants are often "of the very worst caste" (he argues that he means here the worst equipped for the task of care). The word "caste" however is heavily charged and aimed towards a class based view of the asylum system - remember Browne is speaking to a middle class audience, and middle class individuals such as Perceval and Agnew felt genuinely that only those of a similar class (and thus world outlook) could take care of them. This therefore is a class issue, despite supposedly being one of logistics and resources.

How does Browne's view of class filter into treatment?

Browne argues that conditions of housing patients should be directed according to the class of the patient. Argues that providing treatment above or below the patient's "natural position" can be dangerous to the mental stability of the patient.

What seems to be Browne's view as to what should drive considerations of courses of action to take regarding insanity?

Browne argues that the driving question of insanity should not be "what is insanity" but rather "what will the SOCIAL CONSEQUENCES BE for the individual if they are declared insane." Browne places general social wellbeing as paramount.

What does Browne highlight as his theory as to what causes madness?

Browne argues that the health of the mind is connected inextricably from the health of the body (which perhaps leads into the notion of the importance of therapeutic space). Browne argues that it is NOT the "mind" or the "understanding" which is at fault for mental illness, but rather it is a defect of the brain and the central nervous system ("destruction or injury of the nervous structure.") This grounds psychiatry in the realm of clinical medicine, but also perhaps gives hope that mental health can, at a baseline level, be cured and overcome. IN SOME WAYS, THIS IS A HOPEFUL MESSAGE.

How does Browne in some ways align with Conolly's sentiments about non-restraint?

Browne argues that, generally, in asylums, "common axioms" need to be re-established and brought to the centre of practice (i.e. love, friendliness etc - "which are felt as strongly in the sane as the insane mind" - need to be brought into the centre of asylum care.

Example of Browne's criticism of asylums drawing from his assertion regarding the "mind-body" connection of madness?

Browne criticises that - in many cases - an ongoing fallacy that the mad cannot feel the cold or experience pain has led to asylums being insufficiently heated. Draws attention to one case in which an inmate was found in 1820 scantily clothed and without sufficient warmth. THERE IS THEREFORE AN IMPLICATION THAT BROWNE SEES ARCHITECTURE OF ASYLUMS AS IMPORTANT FOR TREATMENT (again, see Skavelag).

How does Browne's argument regarding sources from within asylums complicate attempting to look at Browne's view critically?

Browne denounces internal accounts of asylum abuses as untrue and fabrications; results of unsound mind. Terms accounts of abuses as "sheer fabrications" resulting from the patient's "self-inflicted anguish." Demonstrates the discrepancy of views between institutional and patient level. Demonstrates the importance of recognising that the views of Browne and Conolly may not be representative.

How does Browne entertain alternative models to the asylum as a place of incarceration (LINK TO YORK RETREAT HERE)?

Browne interestingly considers examples of asylums that do not operate according to the same systems (or more importantly the same value structures) as modern (contemporaneous) asylums. Gives example of Gheel in Antwerp, where "the patients are boarded with the peasants" who engage the patients in compulsory and useful work - the patients enjoy fresh air, exercise etc and are not subject to stringent routines of asylums. (Defines Gheel as a "retreat") HOWEVER, significant part of this experience in Gheel is that the patients are put into contact with the relics of St Dymph, to whom the responsibility for cure is ultimately delegated. BROWNE HERE INVESTIGATES THE USE OF "SUPERSTITION" AS AN ALTERNATIVE TO THE "SYSTEM OF FORCE" WHICH HE ARGUES IS USUALLY THE MODEL FOR ASYLUMS - so there does seem to be here a willingness to engage with other approaches, even if he sees the Gheel example as something designed for the lower orders and connected to Belgium's Catholic culture.

How might Browne's report not be wholly representative of the global asylum picture?

Browne notes that he excludes from his report those institutions and countries in which there had been improvement in provision of care. I.e. he is consciously striving to convince readers of the NEED for improvement - may produce a coloured image of the general asylum picture.

How is Browne's view of society communicated through his stipulation of the kind of "tests" which should occur within the institution - i.e. to assess cases for admittance and classification?

Browne notes that the definition of madness as being unable to fulfil social roles is not always helpful - some mad people may conceal their madness while living "normal" lives, while some sane people may have a "natural ineptitude" for social tasks. HOWEVER, Browne argues that tests should be "as general as possible" to try and keep those who are socially inept from residing in society - he acknowledges that this will result in some collateral damage, but fundamentally... ...HE ARGUES THAT ASYLUMS SHOULD NOT CONTAIN THOSE WHO ARE SENT THERE ACCORDING TO A DEFINITION OF WHAT "INSANITY" IS, BUT RATHER BECAUSE THEY CANNOT COEXIST IN SOCIETY. So Browne's view of how the asylum should relate to madness is not necessarily clinical - he seems to argue that the walls of the asylum represent the boundaries of social acceptability.

How does Browne's statement about the fate of those within the asylum (related to wider world) echo Perceval's narrative?

Browne notes that there is a 'culture of forgetting' within the families of those who are committed to asylums - LESS SO AMONG THE RICH - as they are financially bound to provide for their family. Browne argues that frequently, for poorer patients, their name and place of origin becomes forgotten entirely.

How does Browne's outlook perhaps create a barrier for the application of other kinds of reforms?

Browne's attitude towards the attendants' class perhaps removes the possibility for educating them as a form of reform - educating the attendants would not change their class; Browne seems to be advocating replacement rather than education. BROWNE ARGUES THAT FOR ATTENDANTS TO BE BETTER EDUCATED, THEIR CLASS WOULD NEED TO BE "RAISED."

How might Browne's method of selecting case studies demonstrate that asylums could be a source for reforming the health system?

Browne's use of other successful asylum systems / examples (e.g. France, York Retreat) perhaps demonstrates that successful asylums could provide as the inspiration for reformers. Also consider Skavelag and Norwegian use of Danish / German models of asylum architecture.

How might the microcosmic nature of the asylum hinder its potential for reform?

Can an asylum be a source of reform if it is a product of the views and prejudices of the society around it? Does the anti-psychiatry movement demonstrate that psychiatric reform occurs AFTER other social reforms and changes, not the other way around?

How might one glean from Perceval's account that he was actually treated favourably?

Care for him was attempted at home. He was given aid by doctors (one "Doctor Piel") His brother supported him, at least during his period of care at home.

How is masculinity important in wider 19th century literature?

Character of Rochester in Jane Eyre - regains sanity when he fulfils his male duty and fathers a son. Masculinity = power.

What does Browne himself chart as an extremely important shift in the history of asylums?

Cites Pinel's practice (from 1792) as being extremely important in changing the character of asylums - HE ARGUES THAT PINEL'S METHOD HAS SEEN THE TRANSITION OF THE ASYLUM FROM BEING A PLACE OF "SAFE CUSTODY" TO ONE IN WHICH THE INSANE ARE REHABILITED INTO SOCIALLY ACCEPTABLE ROLES. See below for a discussion of this point regarding Browne's view of "cure."

How could one use Clark's memoir of Conolly to argue that asylums could be places of social reform?

Clark makes the point that Conolly saw asylums as a key battleground for growth of psychiatric profession and education of those within the profession. Perhaps simply the concentration of mentally ill within the asylum places them naturally on the front lines of attempts to reform - they provide locations which can constantly be platforms for the practical application of hypotheses of care. "The almost total neglect of insanity as a branch of medical education by our Universities and Medical Schools had long been a subject of complaint by Doctor Conolly."

What reference is there in Clark's memoir of Conolly which suggests that his non-restraint method was not entirely successful?

Clark references "Dr. Gull"'s letter regarding his experiences attending Conolly's Hanwell lectures. HOWEVER, Gull notes that lectures like Conolly's have largely faded into obscurity following his death - "year by year these large fields of knowledge have been lying waste and barren... The prejudice was too strong for even Dr Conolly."

How does closing of Connelly's letter to Dr Bucknill suggest that asylums could be a place for social reform?

Connelly notes that "I have generously been repaid by public opinion" in his non-restraint measures.

How does Conolly's own account potentially anticipate the rise of chemical treatments in psychiatric medicine and the supremacy of the psychiatrist?

Conolly argues (when referencing the point about stimulating the mind) that stimulation through the use of medication can also prove useful in some cases. However he argues that the use of chemical medication to treat mental illness needs to be done under the supervision of "the medical practitioner", not those "unacquainted with the principles of medicine." THIS PERHAPS ADDS TO THE ARGUMENT THAT CONNOLY IS FUNDAMENTALLY ATTEMPTING TO INCREASE THE POWER OF THE CLINICIAN AND THE INFLUENCE OF THE "MEDICAL" IN THE ASYLUM SPACE. IS THIS REALLY REFORM? OR IS THIS JUST A TRANSFER OF POWER WITHIN THE PSYCHIATRIC PROFESSION?

How might one argue that Conolly is cast in the same mould as Browne when it comes to his interpretation of madness' social impact?

Conolly argues that a significant travesty of the perception of asylums is that the mad are left to continually co-exist within their society (when they shouldn't be, as Connelly particularly highlights in the case of those who "on certain points, [are] so indubitably of unsound mind, as to cause great and constant uneasiness in their families." Connelly argues that such people - who are occasionally unstable though not so mad to be deemed in immediate need of incarceration - will continue to exist in society while the reputation of asylums (and the large costs which incarceration bring) continue to abound. DEFINES THE INSANE AS THOSE WHO ARE UNABLE TO CO-EXIST IN SOCIETY.

What does Conolly's reinterpretation of the individuality of the patient imply regarding their treatment?

Conolly argues that because the insane can have just the same degree of individual goals etc as the sane, their treatment should be just as specialised and individualised.

What is the problem which Conolly highlights as being at the heart of attempts to reform asylums?

Conolly firstly highlights the difficulty of "penetrate[ing] into private institutions" stating that many are reluctant to give their assertions on the lives of those who live with mad people daily (and not just as a one off visit). SO THE DISTANCE OF THE ASYLUM IN SOME WAYS MAKES REFORM DIFFICULT, AND THIS AGAIN MIGHT IMPLY THAT WIDER SOCIAL ATTITUDES - as to how asylums are viewed by public - MAY BE REQUIRED.

How does Conolly present a similarly class-based view to that of Browne (and potentially advocate for a change in how the environment of the asylum relates to wider society)?

Conolly makes the point that the vast majority of patients in the asylum are self aware, and realise what it is that it being done to them. Conolly argues that - ESPECIALLY FOR PATIENTS ACCUSTOMED TO A "REFINED" WAY OF LIFE - often being wrenched out of familiar surroundings and confined to the asylum damages their mental state irreparably; they are forced to return home to their families even when they are not ready to do so, as the asylum is affecting more harm than good.

How does Conolly highlight similar abuses in asylums as Browne?

Conolly notes that patients are frequently confined to asylums for a significant period (if not all) of their lives - they are often left to descend into "imbecility." Implies for Conolly that the re-humanisation of the patient involves putting them to work in engaging with "useful" practices.

How might one argue that Conolly's initiatives to humanise the patients are limited (or at least should be periodised)?

Conolly seems to be partly advocating a re-evaluation of asylums in order to investigate and better equip asylums as a place of medical and clinical practice. WHEN THINKING ABOUT THE EXAMPLES OF PHOTOGRAPHY AND HOW THIS CONTRIBUTED TO ASYLUM PRACTICE, these things did not necessarily contribute unilaterally to more "moral" treatment - often the inverse was true. Clinical advancement versus morality is a divide and a struggle which needs to be grappled with.

How does Conolly's approach to classification differ from that of Browne?

Conolly seems to oppose classification (almost) outright - THIS IS EXTREMELY RADICAL CONSIDERING THE NATURE OF ASYLUMS AT THE TIME. Conolly argues that in most larger lunatic asylums, practices of classification are not sufficiently practiced to aid in any way to the recovery of patients. Conolly argues, for example, that those recovering from mental illness should not be kept with those who are also recovering - CONOLLY ADVOCATES FOR SEPARATE TREATMENT UNDER THE SUPERVISION OF A MEDICAL PROFESSIONAL. SO THE EMPHASIS IS STILL ON REMOVAL FROM SOCIETY, BUT GREATER REGULATION IN THEIR REMOVAL (so it is not necessarily classification, but rather clinicalisation - i.e. being placed increasingly under the control of the psychiatrists). Again, this is a push towards increasing power of psychiatric profession.

How does Conolly's view of the patient "post-asylum" differ from Browne?

Conolly seems to value and take seriously the accounts of patients who have left asylums - references the "most painful recollections" of former patients, which Conolly takes as genuine indications of their former mistreatment, rather than an additional symptom of madness.

What aspect of treating the mentally ill does Conolly appear to introduce (and therefore distinguishes him in some ways from Browne)?

Conolly separates the "medical" treatment of the patient from the "moral" treatment of the patient - though Conolly does subscribe to the idea of the 'mind-body' connection as Browne does (refers to mental illness as treating paralysed limb - see below) he does not necessarily seem to view that the medical and moral treatment of the patient is necessarily the same thing. Whereas Browne sees re-establishing social function (appropriate to class) - the "cure" - as fundamentally containing an aspect of what is morally 'right' for a certain kind of patient.

Why is the 1827 Commission important for analysing Conolly?

Conolly's claim that medical expertise is required in governing asylums strikes at heart of debate in asylum reform in this commission. There was discrepancy between evangelical reformers and magistrates on the one hand, and medical professionals on the other who opposed many of the initiatives proposed by 1827 commission.

What example specifically illustrates Conolly's transition towards seeing the patient as primarily an object of study (so potentially dehumanising in another sense)?

Conolly's lecture series and programmes of observation which began in 1842 - students were taken through the hospital to observe different cases of "stages" of insanity, selected personally by Conolly - WHAT DOES THIS SAY ABOUT PATIENT AGENCY, AND COULD THIS PLAY INTO PHOTOGRAPHY AND CONTINUATION OF "CULTURE OF OBSERVATION"?

How could one argue that Conolly's work would not lead to a reformation of how effective treatment is, or how mental illness itself is actually approached?

Conolly's work seems to mainly effect how the mentally ill are viewed, not how mental illness is actually treated. I.e. he argues and directly compares treating mental illness with treating a paralysed limb. The same rules of physical illness are seen to apply.

Why is Conolly's letter to Dr Bucknill important?

Demonstrates Conolly's attempt to push for non-restraint in asylum practice, but also the resistance from academic community, and the problems of applying reforms. E.g. at Hanwell, where Conolly was eventually elected as chairman of the asylum - he took over from the regimes of William Ellis and "Dr Millingen" who were both staunch pro-restraint advocates - he apparently managed to transition the asylum away completely from the use of restraint. HOWEVER CONOLLY'S LETTER EXPLAINS THAT HE WAS CONTINUALLY OPPOSED IN THESE INITIATIVES - "many friends of the old system were my enemies to the last."

Why should one be careful about stressing the "success" of the York Retreat as asylum?

Digby argues that successfulness decreased over time as uniqueness of the Quaker model lessened. Digby also argues that some patients could not fit into the system (one patient was so violent he was constantly restrained, another religious "melancholic" refused to ever leave his room and was not forced to. Occupational treatment was far more difficult for some patients (depressives, melancholics) than for others.

Give three examples of Perceval's state of mind before entering the asylum?

Discussed the Row miracles at length, and provides supposed "proof" for his "own divine authority." (he is apparently directed by a spirit in 1830 to stare at a clock - following discussing Row miracles - and then throw himself to the floor). Perceval notes hearing "articulate voices", yet argues he was not mad, as he deliberated carefully around what they commanded of him. Questions the religious standpoint of his doctors, and attempts to reverse the direction of his head without breaking his neck. ("Dr. Piel was, I believe, an unitarian; therefore, as I conceived, an infidel concerning the Holy Ghost.")

Give three examples of abuses Perceval suffered in the asylum (first asylum in Bristol)?

Due to "delusion" he apparently sang Psalm 100 aloud, and was beaten over the ear for doing so - apparently so fiercely and often that he suffered an "internal haemorrhage." Apparently continually 'tied down' / restrained when in bed. Writes that he "made water of a morning" because of this (i.e. wet his bed). Plunged into cold baths continually for treatment (also beaten, strangled).

What practices does Conolly associate with an asylum that is being run by corrupt practices / for the wrong reasons?

Employing a system of "uniform restraint." Having a "prescription book as a substitute for an apothecary" (i.e. standardising treatments according to a set procedure rather than what the patient actually needs). THIS COULD POTENTIALLY BE LINKED TO SOME OF THE ARGUMENTS THAT BEGIN TO RAISE THEIR HEADS IN THE ANTI-PSYCHIATRY MOVEMENT.

Quote demonstrating Browne's belief in the need for a holistic treatment method?

Every arrangement... from the situation, the architecture and furniture of the buildings intended for the insane to the direct appeals made to the affections... ought to be embraced by an effective system of moral treatment"

What were the early attempts for state control over asylum reform, and how did these reflect the biases seen in Browne and Conolly?

First commission in 1774 was plagued by vested interest - the commissioners were appointed by College of physicians who had previously rejected calls for 1754 commission. The 1774 commission was concerned with PREVENTING ADMISSION OF THE MENTALLY FIT rather than improving conditions. 1774 stipulation that admission needed medical certificate DID NOT APPLY TO THE POOR - reform seems to benefit the middle and upper classes.

What does Perceval's stated purpose suggest about how we should view the memoir?

Firstly the notion that he has supposedly been ignored is quite an interesting one - again raises the question as to how closely accounts of mental illness can ever totally be separated from sensationalism. And this memoir in itself is an interesting one for the historian, as it shows Perceval attempting to self-construct an idea of self (through rearranging memory and establishing a different perception of selfhood to that which society ascribed him).

How does Foucault argue that the York Retreat's practices did not - in reality - lead to a less stringent system?

Foucault argues that physical restraint was replaced by "gigantic moral imprisonment" - the patients were forced to adhere to a Quaker-ist system, in which adherence and disobedience to a socio-moral system was joined with bodily punishment and reward (bad patients were secluded from the rest).

How did the advent of county asylums in 1845 effect the commissions?

GOOD = In 1850s, commissioners were appointed from ex-county asylums - and so did not have personal biases to private asylum owners as 1845 commissioners had done. BAD = Proliferation of magistrates on commission who had dual interests between asylums but also their own communities (e.g. Colonel Clifford magistrate in Hereford who inserted last-minute clause into 1863 lunacy bill to widen catchment of Workhouse care). THIS SUITED CLIFFORD, BUT WENT AGAINST THE STATED PURPOSE OF THE COMMISSIONS.

What does Browne highlight as significant problems (and failures) of the asylum system in Britain?

Generally, "negligence" is a significant evil which he highlights - patients are not engaged in any kind of useful or stimulating activity, and he cites that - for many of them - their muscles can be seen to be subject to contraction and wastage. SO HE CONTRASTS THIS TO THE EARLIER EXAMPLES HE CITES (e.g. Gheel and Pinel) IN WHICH THE PATIENT IS EFFECTIVELY GIVEN STIMULATING AND WORTHWHILE PRACTICES TO ENGAGE IN.

What does Perceval's case potentially demonstrate about the perception of asylums?

Given Perceval's regime of care at home, perhaps his admittance to an asylum was a genuine attempt at cure by his family, which demonstrates that asylums were indeed seen by the wider public as places of cure. Again, we must remember that Perceval is heavily invested in the narrative he describes.

Which two examples does Browne give to attempt to demonstrate the potential success of the asylum system?

Gives the example of Perth Australia, in which less severely ill patients are recruited to help manage the care of those who are more severely effected. Also gives the example of French institutions in which convalescent wards are employed - the recovering are separated from the still mentally ill.

How does Conolly understand mental illness?

He agrees with the consensus of the time that it is fundamentally a "corporeal" disease (i.e. of the body) - YET HE ARGUES THAT IT IS POORLY UNDERSTOOD BECAUSE CLINCIALLY IT IS NOT TREATED AS OTHER CORPOREAL DISEASES ARE; e.g. far fewer attempts are made to "cure" the disease than is the case in other instances. Conolly argues that following the failure of standardised 'usual' practice of curing the mentally ill, they are essentially treated as a lost cause within the institution, and essentially beaten into submission through a variety of abuses ("starvation, imprisonment, lonliness, and threats") until "excitement" is succeeded by the "low state" in which patient enters into the kind of imbecility Conolly references above.

How does Perceval relate to his memoir in a similar way to Perkins Gilman?

He also uses the memoir as a form of "escape" - in this case not fictionalised. He pens his memoir as an attempt to preserve his sense of identity which he argues is being eroded as part of the asylum environment. "Fearing that these causes, in process of time, may break my spirits and render me foolish, or tempt me to acts of retaliation, and expressions of resentment which may be distorted, and looked upon as additional reasons for persisting in the line of conduct that produces them" THERE IS A SENSE HERE THAT ACTS FROM THE INSANE WITHIN THE ASYLUM CARRY A DIFFERENT SENSE OF MEANING - could one argue that in that way Foucault could be right to assert that the asylum is a "heterotopia."

What does Browne (similar to Conolly here) highlight as the primary obstacle to a more wide-reaching reformation of asylums?

He argues that "natural prejudices" are the primary obstacle for totally embracing the reform movement that he argues was begun by Pinel. He argues that "nothing but a more extended acquaintance with the moral constitution of man" will successfully allow for these prejudices to be transcended.

What is Conolly's view of those patients who are defined as "less feeling" (i.e. less aware of surroundings) and what does that demonstrate about his perception of madness?

He argues that for these patients, they begin to gradually retreat into themselves, often wanting to add to the chaos around them as their minds become more "childish." = THIS IS A FAR CRY FROM AN ANTI-PSYCHIATRIC VIEW OF INSANITY - for Conolly, insanity does not constitute an alternative way of seeing, rather it is held by him to represent a lower plane of existence. THIS SEEMS TO BE THE APPROACH WHICH IS TAKEN INTO COLONIAL SETTINGS.

What is Perceval's purpose for writing this account (/ memoir)?

He argues that he has already published a previous volume that was either not circulated widely enough or was not taken seriously by those who read it. Perceval here intersperses his 'recovered' sections of text with LETTERS HE WROTE AT THE TIME, IN THE ASYLUM. He intends specifically to show the reader "the FACT, that I was then of sound mind; which was DENIED, and no reason given me for the denial." (his use of capitalisation here - seems to convey significant degree of emotion).

What is Browne's stated aim for the "lunatic" and why is his presentation of them important?

He argues that he hopes that his suggestions will lead to "an attempt to ameliorate the condition of the lunatic" Yet, to slightly offset this, he argues that the case of the mad person is equivalent to that of "the slave, the oppressed, the destitute." DOESN'T SEEM TO BE QUITE VERGING ON WHAT REES ARGUES - and obviously note the additional caveat that Browne's view of the mad is highly class-based.

How does Perceval argue that the views of those in his domestic community worsened his madness?

He argues that part of his "lunacy" was caused by being afraid to speak freely for fear of being disciplined / restrained etc. THERE IS A SENSE HERE - REPEATED OFTEN - THAT THE ASYLUM SYSTEM CAN AGGREVATE AILMENTS (not however that Perceval is writing in 1840, and asylums continued in full swing until c. 1990s - people don't really seem to take notice!)

What - concerning asylums - does Browne most want to change?

He argues that there has been a prevailing "spirit of indifference" which has reigned supreme in minds of those who run asylums - he seeks to change this fundamentally - AT NO POINT DOES HE SEEM TO COUNTENANCE THE COMPLETE ABOLITION OF THE ASYLUM.

How could one argue that Browne is not (as Rees argues) attempting to fundamentally challenge the psychiatric discipline?

He cites a variety of other studies by doctors to corroborate his view of mental illness being an inherently physical phenomenon (AND AGAIN THE NOTION OF DISSECTION REVEALING MENTAL ILLNESSES IS AN INTERESTING NOTION TO CONSIDER - madness at this stage is definitely seen as a clinical problem, which lends more weight to Browne's concerns surrounding the classification of the mentally ill).

What kind of social consequences does Browne consider regarding insanity, and how does he frame this debate?

He considers questions of self-sufficiency and being able to survive in the modern social world - "Is a man able to manage his own affairs, is he violent, virulent, extravagant and troublesome?" THIS IS CAST AS PART OF BROWNE'S DEBATE AS TO WHETHER THE INDIVIDUAL SHOULD BE KEPT IN ISOLATION OR NOT - Browne argues that often the patient is not held in consideration when considering this question. Yet Browne does make the argument that "Property and the public peace of society must be protected. And where either the one or the other is threatened, or disturbed, no difficulty can be experienced as to the propriety of coercing the violator. I.E. BROWNE ARGUES INDIVIDUAL CIRCUMSTANCES MUST BE CONSIDERED MORE READILY, BUT HE DOES NOT RULE OUT ISOLATION ENTIRELY - does the definition of 'moral treatment' change over time?

Why is Browne's statement on classification interesting?

He considers that sending a criminal to isolation - when they are mistaken for being severely insane (i.e. violently so, disorderly) - is only a "minor evil." BROWNE DOES ATTEMPT TO IMPROVE THE CONDITION OF SOME PATIENTS, BUT HE FOCUSES ON A CERTAIN KIND OF PATIENT - THIS SENTIMENT SEEMS TO DEMONSTRATE THAT THERE ARE THOSE (IN BROWNE'S VIEW) WHO ARE UNTREATABLE. ...see point below about being "reconciled to their incarceration."

Where does Browne see education as a viable option?

He gives the example of the Saltpetriere asylum in France, in which a tutelage system was successfully employed. I.e. he sees greater education of medical professionals / recruiting attendants from pools of medical professionals (e.g. York Retreat) as the way forward.

What is Browne's understanding of mental illness most influenced by?

He is convinced (as he says in preface) that "Insanity can neither be understood, nor described, nor treated by the aid of any other philosophy [PHRENOLOGY]." Browne's emphasis on Phrenology ramps up the focus on his "mind-body" connection idea. IF MADNESS IS CAUSED BY A PHYSICAL DEFECT - AS BROWNE ARGUES - THEN INITIATIVES SUCH AS ASYLUM INFRASTRUCTURE ARE GOING TO BE EXTREMELY CRUCIAL IN VIEWS ON MADNESS (as regulation of the physical space becomes a form of regulation of the mind - see Skavelag and the idea behind the pavillion system).

What does Browne note about his own view which may suggest that it is reformatory?

He notes that the view he holds is still generally confined to the minority.

How is Browne's interpretation of madness potentially inflexible, and what does this suggest?

He spends time discussing the notion that the insane body will display signs of "morbid action" in post mortem examinations (as instabilities in the brain manifest themselves to different parts of the body according to symptoms). However, Browne argues that in those cases where no "lesion" or other physical defect is observable, THIS IS THE FAULT OF THE PHYSICIAN, OR IS A CASE WHERE THE PHYSICAL DEFECT WAS ONLY VISIBLE WHEN THE PATIENT WAS ALIVE. This might suggest why Browne cannot abandon the idea of the physical asylum space (he cannot even entertain that madness can be non-physical) - AND IT MIGHT IMPLY THAT HE IS - IN SOME SENSES - ATTEMPTING TO ASSERT HIS NOTION OF PHRENOLOGY ON THE READER (even though he states he is not attempting to do this).

How does Conolly relate treating the mentally ill with treating a paralysed limb?

He states that just as attempting to stimulate the limb and making the patient try and move it can sometimes prove useful, so "certain well-timed impressions, sensations, or emotions" can contribute to patient being able to potentially recover from mental "convalescence."

What could an asylum be described as?

Heterotopia rather than a microcosm - siphoned off section of society rather than being a reflection of the society at large.

What is Browne's view on restraint?

Highlights those "completely stripped of the attributes of intelligence and moral feeling" for whom restraint is acceptable, though argues that PHYSICAL RESTRAINT IS ONLY JUSTIFIABLE IN RARE CASES. Though he does advocate other, less obvious, forms of "bodily coercion" - e.g. classification, having a private room etc.

What does Browne's use of the Gheel example illustrate about his view of asylums more generally?

His points about Gheel being good for Catholic Belgian society - and useful for the "lower orders" (even if physicians approach it with scepticism) - seems to suggest that his view is fundamentally grounded in a notion that THE ASYLUM WORKS BEST AS A PLACE TO ACCOMMODATE THOSE WHO EXIST WITHIN THE SOCIAL SYSTEM AND VALUE STRUCTURES OF THE WIDER SOCIETY. He doesn't seem to necessarily advocate a single, global ideal, but rather the asylum always has to fit in with the society which surrounds it.

How do the changing circumstances of asylums effect the thrust of reform?

Increase in middle class clientele leads to changing thrust of reform. Perhaps explains why Browne seems to be focused on the wellbeing of middle class patients mainly.

How can one argue that institutions could play into colonial settings?

Institutionalisation and separation of black patients potentially plays into ideas of paternalism consistent with colonial mindset.

1827 stipulations opposed by Physicians?

Keeping of medical registers to be inspected. Daily observation of patients and night watches. Introduction of surgeons on visitational duties. PHYSICIANS WANTED TO SAFEGUARD THE EXCLUSIVITY (AND SECRECY) OF THEIR PROFESSION AND METHODS.

How could the York Retreat's value be criticised?

Lack of recognised medical doctrine there. HOWEVER, REGULARITY OF USE OF CHEMICAL TREATMENT DID INCREASE INTO EARLY 19TH CENTURY - and Digby argues that by 1840s, regularity of drugging was comparable with other institutions.

Secondary Sources on this topic?

Majerus - Material culture and the asylum. Savelli - Psychoanalysis in Yugoslavia. (Locatelli - Emotions and Religion). Digby - York Retreat Hervey - Lunatic Commissions Porter - Madness and its institutions.

How could one argue that the development of the asylum bed reflected the key way in which asylums were integrated into the society around them?

Majerus argues that as beds moved from being wooden to metal, they were no longer manufactured in the asylums themselves. Specialist companies were set up which specialised in creating beds which removed excrement themselves (for example). The medical press played a key role in advertising for these companies, and the commercialisation of asylum materialism reflects the asylum as part of a whole social wide network which extends beyond the walls of the institution.

How could one use Majerus to argue that the 19th century was not a massive new step in favour of moral treatment (and therefore not necessarily an age of optimism)?

Majerus argues that the straitjacket was first introduced in late 18th century as a new moral form of treatment. Argues that straitjacket only began to be seen as dehumanising in mid 20th century with development of anti-psychiatry.

How could one use Majerus to argue that reports / figures surrounding asylums can obscure the truth?

Majerus makes the point that statistics of the use of the straitjacket, and stories of its use does not cover the violence of the ACT OF APPLICATION of the straitjacket. Argues that this often involved several attendants and would often result in the patients sustaining injuries such as broken bones.

Who agrees that the pill became a chemical form of restraint to replace the straitjacket?

Majerus.

How was the asylum a gendered environment?

Male dominated field of psychiatry - generally female nurses versus male doctors. Female nurses treating male patients potentially damaged notions of masculinity (combined with shaving of patients - e.g. Perceval - upon arrival). Female nurses were seen as naturally more empathetic than male doctors.

Give two additional examples which may suggest an age of optimism within the asylum system (not in Browne).

Military hospitals during reign of Louis XIV - able to give place to society for those who were rejected in 1670s (late 17th century). Ergotism hospitals (for Ergot poisoning) in 16th century.

How does the narrative of non-restraint movement demonstrate difficulties with reform?

Non-restraint abandoned due to logistical difficulties - reform is not always practically possible. In 1847, most asylums had not desisted restraining patients.

How did pills becoming recreational effect the status of the patient and thinking on madness (anti=psychiatry)?

Note in anti-psychiatry topic thinking which emerged surrounding hallucinogenic drugs and these making conditions such as schizophrenia more normalised. Drugs increasingly began to be a symbol of wealth and class ("pills increasingly found themselves in the mouths of Hollywood superstars").

How does Clark argue that Conolly's recommendations for education of medical classes have been taken up?

Notes Conolly's influence on educational curriculum at Edinburgh, Glasgow, Aberdeen, University of London. Though does argue that the required areas of the medical profession have not been influenced fully enough. Argues that - for example - very few of the students at Edinburgh, Glasgow and Abderdeen take up the opportunity to clinically observe the insane as part of their degree.

How else (besides metaphor of limb) does Conolly subscribe to a "Browneian" approach to mental illness?

Notes example of those who succumb to imbecility - (i.e. they become paralysed or lose power of expression) - which Conolly again argues is caused by a defect in the part of the nervous system which he argues intelligent thought is produced by. Again, this seems to play into approaches to colonial mental health later in period.

Give three examples in Perceval's account which demonstrates that his experience was heavily regulated by class?

Notes that Perceval's family continued to fund his upkeep (e.g. washing at eight pounds or guineas per annum) - even if he complained that what they contributed was not enough. Also complains that he is kept in same space as those "below him" in social ladder. "I was also degraded to keep company with the lunatic, the blasphemous, the indolent, the idle, and the profane! With vulgar persons below me in society" YET, THERE IS AN INDICATION THAT HE HAD A SEPARATE "BEDROOM" WHILE BEING KEPT IN BRISTOL ASYLUM, WHICH AGAIN SEEMS TO SUGGEST THAT HE WAS AFFORDED SOME DEGREE OF PRIVILEDGE - his family wealth ensured that he was sent to some of the most expensive institutions in the country. A lower class experience of the asylum may have been considerably different (one should note that Perceval is later moved to a private institution for the middle classes in Bristol later on).

How does Clark argue that the provision of education for students investigating the insane has not been rigorous enough?

Notes that some universities (London, Edinburgh) have seen the creation of lecture courses, though these remain voluntary in nature and are not sufficiently promoted by universities. HE DOES HOWEVER NOTE THAT CONOLLY ATTEMPTED TO RECTIFY THIS PROBLEM HIMSELF BY SETTING UP HIS OWN SERIES OF CLINICAL LECTURES AT HANWELL. This does seem to be in the Charcot model (which Browne I think alludes to).

How does Conolly's work potentially suggest the notion that confinement within an asylum is seen as a form of social abandonment?

Notes that those who are "eccentric" rather than "insane" (i.e. those in the asylum that should not be there) will be able to comprehend and realise their "abandonment" by their friends and family by virtue of being conferred to the asylum. Conolly argues that for such "eccentric" people, living normally within society would allow them to usually put right their eccentricities personally, though Conolly argues that residence within the asylum "ripens eccentricity" and "renders permanent what might have passed away." Suggests that the asylum does have a potentially ontological bad reputation, which may be difficult to reform.

How could one argue that Browne is only writing for middle class patients?

Notions of rationality between classes and social roles means that "cure" can only effect certain patients. What the asylum "should be" for Browne = massive microcosm and separation.

How did character of Superintendents at York Retreat add to a notion of occasionally departing from medical care?

Often the superintendents were selected for Quakerist expertise rather than medical knowledge. Though Jepson (superintendent from 1797) did possess medical experience and pioneered many of Retreat practices, his successor Allis (1823) and his successor Candler (1841) were not doctors. Candler was a former missionary.

How did the development of asylums reflect previous methods of care?

One might argue that asylums were simply new manifestations of previous domestic secrecy (in the words of colleague - what's the difference between the asylum and the attic?) Compartmentalisation of social responsibility.

What does Perceval's statement about his own experiences seem to suggest in relation to standards of wellness?

PERCEVAL'S ACCOUNT IS USEFUL FOR THE HISTORIAN, AS IT REVEALS DEGREES OF DEFINITIONS OF WELLNESS OUTSIDE OF CLINICAL CATEGORIES. Perceval counts his experiences as lucid because - for him - they are "real." Perceval writes that "men who do not think of, or believe in the word of life, call the expressions of a believer, in a world and body of sin and death, delusions or madness." This shows the difficulty defining madness as "other" creates. PERCEVAL WOULD HAVE BEEN DEFINED BY CONOLLY AS ONE OF THOSE MEN WHO COULD BE CONSIDERED AS "ECCENTRIC."

How does Perceval's consideration of his treatment perhaps reflect Agnew's in some way?

Perceval again (perhaps related to class) highlights the indignity of his treatment as a key reason for his disaffection. He details - for example - those caring for him at home attempting to administer a clyster (enema) without his consent (on account of the fact that he was deluded). And argues that often sufficient materials were not provided for patients to adequately use the toilet (writes that he saw one patient "defile his trousers."

How does Perceval's case illustrate that the problem asylums are involved in extend beyond the walls of the institutions?

Perceval also focuses on corruption from magistrates, the neglect of his family, and the misguided nature of his doctors as equally pressing matters to his actual treatment within the asylum. The account is an account of Perceval's social experience, not only his treatment. "I was to be found in that madhouse, contesting the right of others to treat me as they did - and appealing in vain to the Magistrates... against my mother, and my physician."

How does Perceval's memoir potentially illustrate that asylums could be a place of institutional reform (and how - like Browne's work - does it show that this reform is shackled and limited in some way)?

Perceval argues that an extremely grievous fault he has had to overcome is that of ignorance - specifically ignorance of the magistrates. Perceval notes that the magistrates "know the condition of a gentleman" and review asylums in person annually, though he argues that despite this they never succeed in "put[ting] themselves in the patient's place" - argues that generally such reviews flatter the views of the physician. THIS IS INTERESTING BOTH BECAUSE IT REFERS SPECIFICALLY TO REFORMING THE INCARCERATION OF "GENTLEMEN" (like Browne, Perceval is writing for his own class), BUT ALSO BECAUSE ITS CRITICISM OF THE PSYCHIATRIC CLASS IS UNIQUE IN THE PRIMARY SOURCES FROM THIS TOPIC - almost seems to verge on the anti-psychiatric. Note that Browne and Conolly both criticise asylum practices, but unlike Perceval they never criticise the psychiatric profession itself (quite an important element).

What is interesting about Perceval's relation of his own divine "experiences" (which one could certainly class retrospectively as a kind of religious delusion)?

Perceval cuts short writing about his experiences (this is when he is in the asylum) noting that "I dare not, in a lunatic asylum, express my feelings as my nature requires, for fear of misconstruction or calumny, from dread of being called lunatic." HE MAINTAINS THAT WHAT HE HAS JUST RELATED IS NOT AN ACCOUNT OF INSANITY - any reader reading this would arguably see the paradox behind it (he is unable to express supposed symptoms of his delusions in an asylum) and so this in itself could lead to a belief that repressive environment of asylum is not fit for purpose.

How does Perceval's memoir perhaps allow one to re-evaluate the "morality" behind Bale and Conolly's notion of treating the mad when bearing in mind the mind-body connection which was seen to exit in madness?

Perceval notes that he was subject to two operations to attempt to cure his madness - one of which was severing of his temporal artery, and the other was an operation on his ear to "let out extravasated blood." SHOWS THAT THE NOTION OF "MORAL" TREATMENT NEEDS TO BE PERIODISED; BUT NONETHELESS SHOWS THAT THE SUPPOSED PHYSICALITY OF MADNESS COULD LEND ITSELF TO SIGNIFICANT VIOLENCE (see Majerus and the violence of straitjacketing as another example).

Why is Perceval's text difficult to deal with?

Perceval's description of his state of mind and actions before entering the asylum do seem to suggest that he was experiencing mental instability - how do we then interpret his own claims that he did not deserve to be in the asylum? Should this be viewed in the wider context of the conflict he endured with his family? Is he deliberately seeking the reader's pity to sell copies?

What might make Browne's statements regarding the innate untruthfulness of inmate's accounts cast into doubt?

Perhaps the later development of photography could create a view of the patient experience which was more truthful than the one Browne extolls? Or perhaps photographs simply channel the powers of professionals in new ways.

How were the commissions' reach limited?

Private lodges were significant institutions not overseen by the commission. Doctors such as Morison were able to exist outside of commission's influence by unofficially overseeing several "lodgings" for the mentally ill. The rich frequently used lodgings for the anonymity they provided - lack of medical records. However that meant that admissions were not reported by lodgings to commission, and patients' liberties were essentially sacrificed.

Give an example of a way in which public opinion may have been important to the operation of asylums.

Rate payers often funded the operation of asylums and therefore demanded high rates of cures. However this could be a problem as well as a motivator, as asylums would often doctor their statistics to supposedly "illustrate" the high rate of cures. Perhaps photography and photographic record made such an undertaking more difficult?

How does Perceval condemn his experiences in the asylum in his introduction?

Refers to those who were responsible for his care as "swindlers." Also states that the first establishment in Bristol he was committed to (under one Dr. Fox) prior to being moved to Sussex (for middle class inmates) was "one of those places called in mockery an asylum."

What was Haycock Lodge Scandal?

Revelation of appalling conditions at Haycock lodge in 1846 (e.g. 5 patients left dead in their beds for several nights) led to calls for ways in which patients were housed in asylums.

What do Browne's aims he sketches out suggest about his intended audience?

Seems to place a change in perceptions of potential benefactors as the primary focus of his work. Actual structural changes in the running of asylums does not appear to be the main concern of his work. I.e. this is a work for the upper classes.

What was the most common type of psychoanalysis in Yugoslavia?

Semi-psychiatry - shorter periods of psychoanalysis were combined with a greater use of group therapy to fit the ideological precepts of the state.

Why did the 1828 Madhouses Act change the playing field of asylum reform?

Setting up of Metropolitan Lunacy commission attempted to mediate between disputes highlighted by 1827 commission (between medics and government). Included a (majority lay - 75%) board that would oversee the commission, and its powers were substantial.

Who is Clark's memoir dedicated to, and why is this important?

Shaftesbury - he was a key figure in dictating the character of asylums. While Shaftesbury understood importance of non-restraint, moral care, and scientific advancement, Hervey argues that he retained personal prejudices about the causes of insanity (that madness was linked to intemperance - he argued that society was becoming more temperate and that lunacy was decreasing: THE OPPOSITE WAS TRUE). Dedicating this memoir to Shaftesbury shows that non-restraint movement played into the prejudices of the commissions (e.g. 1845 commission only investigated the care of "privately held" patients = STILL ONLY UPPER CLASSES).

How do gendered issues show themselves in Perceval's narrative?

Shaving = removal of manhood and a measure of control? (he writes that his whiskers are cut off, and his hair was cut in a "ridiculous fashion." Perceval claims at the beginning of his narrative (first account written in the asylum) that he is greatly aggrieved at "ABOVE ALL... CONTINUED EXCLUSION FROM THE SOCIETY OF MY EQUALS, PARTICULARLY FROM THAT OF FEMALES" (his capitalisation); this also supports the notion that his restriction in the asylum is perceived by him to be an attack on his manhood and his ability to assert himself in his required social role.

What must be considered when evaluating "practical" and "rational" practices Browne discusses in 19th century?

Should be considered on their own terms - any consideration of "optimism" or "benevolence" should be considered in the context of 19th century practice. What seems benevolent and practical to Browne may not apply to us, and vise versa. Browne terms the contemporaneous approach to caring for the mentally ill as "benevolent" and "rational."

How might one argue that the character of Yugoslav psychiatry was influenced by social situation?

Significant emphasis on group therapy which perhaps grew out of a collective mentality of underground psychiatric communities and development of discipline. Savelli argues that psychoanalysis did not thrive in Yugoslavia under Tito, but similarly argues that it was not totally dormant either.

How does Browne argue that the "mind" is constructed?

Splits consciousness into four separate faculties: Impulses and instincts (can direct feeling and when combined with reason can achieve "noble ends") Second part = "sentiments where there is a vivid emotion superadded to a propensity to act" - things like pride, vanity, hope etc. Intellectual powers = allow a process of reasoning. Observing powers (comprehending external objects).

What is important to note about the "morality" of York Retreat's practices?

THE YORK RETREAT EMPLOYED RESTRAINT IN INCREASINGLY NUMEROUS CASES AS ASYLUM GREW. Moral treatment did not automatically echo non-restraint. The administration of York Retreat continued to argue that some limited restraint being employed was better for the patient.

Who does Browne attempt to target - in terms of changing perceptions - outside of the asylum?

Takes aim specifically at juries who rule on cases of madness - Browne argues that everyone who rules on madness should be sufficiently educated regarding its properties to decide on the best course of action (AND THIS IS NOT RESTRICTED TO CLINICAL PERSONNEL).

Which example supported Conolly's belief on recovery and covalescent patients?

The York retreat - Digby argues that the retreat had a spirit of "controlled openness" whereby the covalescent were often taken to engage with wider society - especially in Quaker Friends' Society meetings (services).

How does Conolly's use of the example of Glasgow university demonstrate the need for balance when considering asylums?

The example of a successful use of treatment (reading of scripture) at Glasgow asylum demonstrates that one should not automatically assume asylums were a doomed project - report's like Browne's and Conolly's were designed to strive for a particular goal (as memoirs such as Perceval's were) and this demonstrates that they may obscure other aspects of asylum life and culture which also need to be considered.

How was the York Retreat similar / different to existing modes of care?

The model of "Gentle re-education" was seen in other approaches, so its use of these methods was not new. HOWEVER, the York Retreat (until 1820) was ONLY FOR QUAKERS, AND HAD ONLY QUAKER ATTENDANTS. The adherence to the family atmosphere was heavily dependant on the notion that the patients, attendants, and superintendents all believed in Quaker ideals. Digby argues that as asylum became increasingly non-Quaker (especially attendants), the model became less effective.

Why might Browne's view of the mind be said to be open to class-based discrepancy / potential discrimination?

The notion that certain "higher" faculties are only accessible relating to certain tiers of the mind - COULD IT BE SAID IN THIS MODEL THAT THE "EDUCATED" ARE MORE SANE, AS THEY SUPPOSEDLY CAN UTILISE THE 'TIERS' OF THEIR MINDS MORE EFFECTIVELY?

What does Conolly conclude is the most serious defect of the asylum system?

The notion that though some administrators and governors of mental institutions are themselves intelligent and good-intentioned people (and despite the "spacious grounds... good food" and varied pursuits the asylum offers to its patients), THE ENTIRE ENTERPRISE IS MARRED BY THE PATIENTS BEING KEPT IN COMMON WITH EACH OTHER, WITHOUT ACCESS TO "SANE" PERSONS FOR CONVERSATION. = Conolly again advocating personalised, specialised psychiatric treatment (though the push remains to keep mental illness as something which is clinical and needs "curing.")

What does Conolly's attempt to rehumanise the patient suggest about how asylums can potentially be a place for social reform?

The practices of the asylum (in this case the treatments) should be dependant on a social view of the mentally ill according to Conolly - changing asylum practices requires changing the prevailing interpretation of what it means to be insane (and vice versa).

What - besides the treatment of the patient - does Conolly highlight as an equally important problem in approaching the care of the insane?

The problem of recovery times for those in mental health - Conolly argues that often certain symptoms reappear, or are manifested in different ways, making the detection of "recovery" harder in mentally ill than physically ill - argues that this leads to a situation whereby the patient is retained in the asylum environment (mentally unhealthy so Conolly argues) for long after they should be. BROWNE ARGUES A SIMILAR POINT REGARDING FRENCH ASYLUMS, HIGHLIGHTING THAT THERE, COVALESCENT WARDS ARE FREQUENTLY EMPLOYED (I think he's referencing Equirol when stating this).

How is Conolly's assessment of eccentricity perhaps another example of how his view of the insane should be periodised?

There is again a sense that Conolly - perhaps unwittingly - sees social conformity as equivalent to wellness - GROUPING TOGETHER THE "ECCENTRIC" WITH THE "INSANE" IN THE FIRST PLACE SEEMS TO SAY SOMETHING IN ITSELF ABOUT CONOLLY'S APPROACH TO MADNESS. Like Browne, it seems to suggest that it is tied into an inability to socially conform / fulfill social roles properly.

How did the materialism of asylums reflect the highly class-based organisational structure of the asylum?

Through doctrines surrounding manufacture and organisation of patient beds. 1831 - Roller argues that beds should be constructed from different kinds of wood for the different classes. 1885 - Stephansfeld asylum (Strasbourg) gave 6 bed sheets to those from 1st, 2nd, and 3rd classes, only 4 sheets to those from 5th and 6th classes.

How was the 1828 act initially successful?

Two private asylums had licenses revoked for malpractice, and powers to alter asylum management structures were implemented.

How did the hospital bed confer the power relationship between patient and doctor?

Upon arrival at the asylum, patients were often "put to bed", which confirmed their status as part of the "ill", to be cared for and controlled by the doctors.

How should powers / effectiveness of 1828 Act be qualified?

Vested interest still a problem - Home Secretary (Peel) allowed head of College of Physicians to decide on physicians who would sit on council. By 1833, many of lay commissioners were also parliamentarians (esp Shaftesbury) and so were unwilling / unable to dedicate time to commission - it became a "de facto" clinical enterprise. 1832 Act for Care and Treatment of the Insane increased the numbers of clinicians on the Commission.

Who / what does Savelli argue was important for the survival and development of Yugoslav psychoanalysis?

Vladislav Klajn - advocate of Freudian psychoanalysis who became involved in Communist state (became Communist agitator in POWs and then joined the partisans in 1943). Argues that Klajn was an important connector between "old" and "new" Yugoslavia - pre and post war - which maintained the character of Yugoslav psychoanalysis.

Primary sources for this topic?

William A.F. Browne - What Asylums were, are and ought to be Clark - Memoir of John Conolly Conolly - Present Condition of Asylums Perceval - A Narrative of the Treatments Experienced by a Gentleman, During a Period of Mental Derangement.

How did psychoanalysis in Yugoslavia be connected to wider international struggles?

With majority of practitioners being Jewish (and Freud being Jewish), psychoanalysis was seen as a way to oppose German antisemitism, and Freud was now presented as a Communist partisan, fighting for his beliefs against would-be oppressors.

How does Browne illustrate who his "target audience" is?

Writes that he was commission to write the account by the "Directors of the establishment under my charge, to whom my observations were in the first instance addressed." In his preface, he writes that his main aims are to influence these directors, and also to sway the opinion of "those who administer either by their opinion or by their power to the necessities of the 'poor in spirit.'"

How were logistical problems of asylum care elsewhere?

York Retreat 1 attendant to 8, Hanwell, 1 attendant to 22. Private asylums were generally better - Ticehurst (where Perceval is sent secondly) has ratio of almost one to one.

How did demographic factors effect the development of Yugoslav psychoanalysis?

Yugoslavia was only beginning urbanisation, and many rural communities viewed psychoanalysis with suspicion. Psychoanalysis was expensive and only available to the privileged few. Yugoslavia was a society with far more pressing health issues, which led to a far more "diluted" form of psychoanalysis.