St Clements and the Victorian Asylums A Brief History By Peter Watkins
St Clements and the Victorian Asylums A Brief History This brief history is intended as an ‘open’ account of the rise of the Victorian asylum system in Britain and the place of St Clements Hospital within that system. It is an ‘open’ history in the sense that we encourage readers to submit additional information which we would be happy to publish as an addendum. . Please note that I have used terminology in this paper which in the 21st century context is offensive – for example, insane, lunatic, and mad! It is used intentionally to reflect the terminology and social attitudes of the period being discussed. Canst thou not minister to a mind diseas’d Pluck out the memory of rooted sorrow, Raze the written troubles of the brain, And with some sweet oblivious antidote, Clean the stuff’d bosom of that perilous stuff Which weighs upon the heart? (Macbeth) Introduction Victorian Asylums were built on a wave of confidence in the power of the state to institutionalise social problems away, problems that were becoming ever more manifest in the growing populations of towns and cities. The poor and destitute were sent to workhouses; orphans and children of impoverished families to children’s homes, the old to almshouses, criminals to prisons, and the insane to asylums. Prior to the establishment of county and borough asylums during the mid to late Victorian era, the provision in Britain for the insane was very patchy. People of unsound mind were generally tolerated by their local communities and ‘taken care of’ by their families, if sometimes ‘shut away’ - think of Mrs Rochester in Jane Eyre. Some, if they had the means, were sent to private madhouses, others were committed to one of the few public asylums that existed built by public subscription or benefaction. The first purpose built asylum in Britain was The Bethel Hospital in Norwich which opened in 1713 and continued to provide mental health services right up until the 1990’s. But by 1800 there only eight other public asylums in English towns and it was much more likely for lunatics of limited means who became a problem to their families or the parish to end up in a workhouse or prison. Madhouses and Workhouses Until the Ipswich Borough Asylum (St Clements Hospital) opened in 1870 the town had no facilities for the mentally ill poor, or pauper lunatics - to use the terminology of the time. There were two private asylums in Ipswich, the Belle Vue Retreat sited on high ground between Woodbridge Road and Spring Road and the Grove Retreat situated just off Grove Lane opposite Alexander Park. Kelly’s directory of 1855 records that Belle Vue had places for 40 inmates and was run by Mr James Shaw, a surgeon; whilst the Grove Retreat, run by Dr Barrington Chevallier - who later became the second medical superintendent of St Clements - had 36 places. Both retreats were reported to
be under ‘excellent management and have large gardens and pleasure grounds’. The bell tower of the Grove Retreat remained standing until the 1990’s when the surrounding land was developed for housing. John Clare the Northamptonshire peasant poet was ‘imprisoned’ in one such madhouse, High Beech near Epping Forest, from which he eventually escaped in 1841 to make his now famous ‘long walk home’ to Northborough Northamptonshire. High Beech was reputed to be a well run established but Clare felt alienated from his friends and family and from the much loved landscape of his home. He wrote to Dr Allen, who he called Dr Bottle Imp - I could have stayed on in the forest if friends or family had noticed me or come to see me – but the greatest annoyance in such places as yours are those servant styled keepers who often assumed as much authority over me as if I had been their prisoner and not liking to quarrel I put up with it until I was weary of the place altogether and heard the voice of freedom …. (Bate 2003) By the Victorian period, most Madhouses were run by Doctors, or Alienists as they were sometimes called, in contrast to earlier times when many private asylums were presided over by people who had no medical background or for that matter little in the way of humanitarian motivation and were simply in it for the money. It was clearly a system open to abuse and by the early 19 th century they had became subject to licensing and yearly inspection. Many of the town’s feeble minded or insane poor would have been confined to the workhouse. St Mary’s workhouse in Whip Street, on the site of where Felaw Maltings now stands, opened in 1836 with places for 400 inmates replacing up to 12 small parish workhouses that had previously housed the destitute. St Mary’s was replaced in 1898 by a new workhouse on a green field site at the top of Woodbridge Road. Its infirmary became the Borough Infirmary in 1930, and is now the site of Ipswich District Hospital. A section of it remained an institution for the homeless, becoming Heathfields Public Assistance Institution through until the late1950’s.The old gate house, which functioned as a porter’s lodge and reception ward, and included tramp cells, is now part of West Villa, a homeless family unit, continuing the tradition of housing the homeless and impoverished. For others afflicted by insanity the town entered into contracts with other Boroughs and Counties to provide a certain number of asylum places. People would be sent some distance from Ipswich to asylums built earlier in the Victorian period such as the Cambridgeshire County Asylum at Fulbourn or Norfolk County Asylum at Thorpe; but interestingly not St Audry’s which had opened in 1827 on the site of an earlier workhouse. Building St Clements By the mid 1860’s it had become difficult to renew contracts with other asylums to provide for the pauper lunatics of Ipswich. At the same time the Lunatic Asylums Act (1858) made it a requirement for all counties and boroughs to make ‘fit and sufficient’ provision for those of unsound mind. The town’s authorities took the decision in 1867 to build the Ipswich Borough Asylum, initially for 120 patients - later increased to 200 beds, on 52 acres of
heathland known as Blackheath to the East of the town, which was at that time at least two miles beyond the populated areas of Ipswich which apart from some scattered houses was still mainly confined to the town’s basin. St Clements was always a relatively small asylum: even in its heyday the inpatient population rarely exceeded 400. Many asylums expanded to accommodate 2,000 patients; Colney Hatch Asylum (Friern Barnet), which opened in 1851, was home to 3,500 patients and boasted the longest corridor in Britain. In its early years the accommodation at St Clements was more than enough for the town’s needs and the asylum was able to provide some contract places for people from Kings Lynn, Great Yarmouth, and from the wider county of Suffolk, as well as taking some private patients. Between 1870 when the Ipswich Borough Asylum opened and 1880, there were 936 admissions, of which 427 recovered or were relieved enough to be discharged. There was quite a high death rate in the early years with 262 patients dying during this period suggesting - borne out by early records that many of those admitted were in a frail state of health. During the first decade in-patient numbers increased from 79 in the first year to 260 by 1880; more women than men were resident in hospital, a statistical in-balance that has continued to be reflected in the history of the psychiatric care. The rate charged per week in 1871 was 13 shillings for local paupers (65p in new currency); 16 shillings for paupers from other boroughs and 20 shillings for private patients. This revenue contributed significantly to the repayment of the £18,950 outlay made for construction. The first medical superintendent appointed was a Dr Long who had previously worked in an asylum in Stafford. He was paid £250 a year and occupied the medical superintendent’s house to the right of the main entrance (as you face it) where medical records; the dispensary and outpatients have been accommodated in more recent times. In his first report Dr Long expressed the desire to make … this establishment not only a boon to the insane but a credit to the town at large. The asylum was staffed by a head female attendant who also doubled as housekeeper, a head male attendant, 5 male attendants and 5 female; they all lived in and received between £15 and £30 a year. They were joined by a cook, a porter, maids, a seamstress, a farm bailiff and artisans who in addition to maintaining the upkeep of the hospital were employed to instruct inmates in learning new skills. It is doubtful whether the attendants had anything resembling training, which was not introduced in a systematic and widespread way until the end of the century; although one attendant (Mary Reeve) had previously worked at the Hanwell Asylum where one of the great asylum reformers John Connelly had been medical superintendent. Asylum attendants were generally employed for their good character and temperament. The Handbook for Attendants on the Insane (known as The Red Handbook) first published in 1885 describes certain necessary moral qualifications for prospective and successful asylum attendants : “Endurance and Cheerfulness; Firmness; Self Control; Honesty of Purpose; and Altruism” by which was meant “absolute kindness and forbearance, inexhaustible patience, tolerance and respect”.
The Architecture of Asylums Victorian asylums were constructed in grand architectural manner in keeping with many public buildings of the time which incorporated many architectural styles such as Gothic, Romanesque, and Georgian, as can be seen by the pillared porch, the beautifully proportioned arched windows and the entrance hall staircase at St Clements. The ornate water towers and chimneys of asylums, a landmark feature in the countryside and towns of Britain, were referred to in Enoch Powell’s now famous ‘water tower’ speech in 1961 which launched the mental hospital closure programme: ‘There they stand, isolated, majestic, imperious, brooded over by the gigantic water-tower and chimney combined, rising unmistakable and daunting out of the countryside - the asylums which our forefathers built with such immense solidity to express the notions of their day….’ Modern mental health facilities are built with therapeutic use of space in mind but through the 19th century ideas about the nature of insanity and it’s ‘cure’ were limited and no one really had much idea how these buildings would function, except that they should provide safe (and custodial) care. They were advisably called asylums because they were intended to offer a place of safety and protection from accident, ill-treatment and plunder. There were strictly segregated wings for male and female inmates, and no male attendant was allowed to enter, let alone work on female wards. However as early as the 1860’s the newly formed Medico Psychological Association were talking about the value of female attendants on male wards to encourage better self care and less violent behaviour, something that was not to happen for another 100 years . There seems to have been some graduation of wards in most asylums – ranging from those where custodial care and stricter regimes predominated, to wards where greater freedom prevailed and a more benevolent approached to care was practiced. Underlying this was the idea that inmates would be encouraged to control their irrational impulses and moderate their behaviour in order to enjoy the privileges of the freer wards. Refractory wards, which accommodated those who were most disturbed and whose mental disorder expressed itself in ways difficult to manage were a part of most mental hospitals well into the 20th century. Most asylums were built with ‘cellar rooms’ and a dark mythology has built up around their use. We know from the documented history of the reform movement that started in York in the early 1800’s that the incarceration of some inmates at night, in ‘cells’ situated in cellars at the York County Asylum in vile conditions, was one of the abuses that led to the reform of asylums in the Victorian period. Opportunities for work, recreation and exercise were considered important and this was reflected in the planning of asylums. Dr Kirkman, the medical superintendent at St Audry’s Hospital, Melton, from 1832 – 1876, established an enlightened regime at that hospital, placing great importance on
watchfulness, gentleness and tact as the cornerstone of asylum care and valuing activity and useful employment as agents of improvement for all inmates. All asylums incorporated large high walled “airing courts” where inmates who were not able to be gainfully employed were allowed to take exercise under the watchful eye of attendants. At the rear of St Clements the separate airing courts for males and females can still be clearly seen, with the initials of many who must have tediously circumnavigated those ‘thinking paths’ day in day out, carved into the brick work. Most asylums were built with large recreation halls - as at St Clements, where regular ‘entertainments’ were held. Dr Barrington Chevallier appointed to run the Borough Asylum in 1877, seemed quite keen on entertainments which he ‘reviewed’ in the medical superintendents journal: ‘A very successful musical and dramatic entertainment given by Suffolk House Company’. Scene from Pickwick well acted; ‘Dancing to instrumental music much enjoyed by a large party’; ‘Entertainment by Mr Packer instrumental music good, singing bad’. Because of the large numbers of people living in close proximity to each other, asylum populations were susceptible to outbreaks of infectious diseases – typhoid, dysentery, typhus, smallpox and tuberculosis were all endemic in society at that time. The outer wings of St Clements, which until the closure housed Levington and Priory wards, were built as sick wards where patients could be barrier nursed. Both wards had large solariums attached which allowed those with TB access to rest, fresh air and sunshine -the only treatment for that disease at the time. The Ipswich Fever Hospital (later known as St Helens) opened in 1878, across the road from St Clements where staff accommodation and the St Elizabeth Hospice now stand but it is unlikely that they would have taken the infectious sick from the Borough Asylum which remained a largely segregated community. All asylums, even Borough Asylums, were built with farms or extensive gardens and grounds where much of the food for the institution was grown. From the outset St Clements had its farm which until the1960’s continued to keep pigs, grow crops and provide ‘employment’ for many male patients - the old farm buildings are still in evidence next to the Staff Social Club. A cricket pitch and croquet lawn – that perennial pastime of the labouring classes, were laid in 1878! Every asylum had its own laundry, sewing room, cobblers, butchery and bakery, carpenters shop, stores, fire service, chapel, mortuary, and grave yard. Asylums were in effect ‘island’ communities, railed off and isolated from the local town and surrounding countryside, meeting most of their own needs. Training of Attendants and the Emergence of Psychiatry In 1841 the Medico Psychological Association (later to become the Royal Medico Psychological Association and eventually the Royal College of Psychiatrists) was formed by a group of asylum medical superintendents interested in sharing ideas and improving the status of their profession. The British Journal of Psychiatry was first published by this group in 1854. The term psychiatry – literally soul or mind treatment, had been coined by a German Doctor Johann Christian Reis in1808 at a time when the idea that insanity was in some unknown way, a disease of the nervous system was
taking root, and since the mind was considered a product of the brain it followed that its treatment fell within the province of specialist physicians. In the 19th century many people suffering from what we now know to be diseases of the nervous system – epilepsy and general paralysis of the insane, frequently ended up in asylums. Throughout most of the 1800’s there was no agreed classification for illnesses of the mind, no great insights into aetiology and no pharmacological treatment apart from sedatives, mainly opiate drugs. William Tuke at York, John Connelly at Hanwell, and Gardiner Hill at Lincoln had by the 1840’s ushered in more humane regimes and the abolition of restraint and the moral treatments they introduced created places of safety and healing in which inmates recovered. Towards the end of the 18th century a simple classification of mental disorders was adopted by the medico psychological association. States of Insanity Depression: melancholia – simple acute, chronic Excitement and exaltation: Mania simple, acute chronic, sometimes recurrent and alternating with melancholia (circular insanity) Delirium Stupor Confusion Chronic Delusion: fixed or progressive Mental enfeeblement Kinds of Insanity General paralysis Insanity from brain lesions Insanity associated with epilepsy Insanity associated with alcohol Insanity connected with childbirth Insanity during adolescence Insanity of old age Idiocy and other congenital defects Medico Psychological Society 1908 In 1887 Emile Kraepelin a German psychiatrist, regarded as the founding father of science based psychiatry, began to describe a condition he called dementia praecox - literally early dementia, which in the above classification appears as insanity during adolescence. He studied the history, symptoms and the progress of this disorder and was the first to postulate a hereditary basis. Dementia praecox was further defined and renamed as schizophrenia in 1911 by Eugen Blueler a Swiss Psychiatrist as it become clear that it did not lead to dementia and was more a condition in which there was fragmentation or a ‘split’ in an individual’s mental functioning. Blueler was the first to describe the ‘positive’ and ‘negative’ symptoms of schizophrenia, observations that are still regarded as having implications for outcome today. This period marks the beginning of scientific research into the types and causes of mental illness but it was not until 1951 that the Diagnostic and Statistical Manual of Mental Disorder was published, listing 106 mental
disorders which became the definitive diagnostic guide for most Western countries. Today there are a 390 listed in DSM 1V. Does this mean that the world is getting steadily madder or is it that psychiatric diagnosis in being used to define and pathologise an ever broader spectrum of human experiences, that are just that – human experiences? The only training deemed necessary and required of asylum attendants was a thorough familiarisation with the Asylum Rules, which each hospital was required by law to produce and which had to be approved by the Lunacy Commission. The 24 asylum rules for the Ipswich Borough Asylum agreed in 1903 can be seen as an addendum to Michael O’Donovan’s A History of St Clements Hospital available on this web site. They give a fascinating glimpse into asylum life for inmates and staff at the turn of the century. These were essentially drawn up by medical superintendents and reflected his views on the conduct of staff and the care and management of the inmates. In 1860 the Medico Psychological Association began instituting training for attendants which it was thought would have an ‘elevating influence’ on the care of inmates. A series of lectures and exams were instituted in some hospitals with these initiatives resulting in the publication of the Handbook for Attendants on the Insane in 1885. Known as the Red Handbook it was regularly revised and reissued until 1970 and for more than 60 years was the ‘bible’ for mental nurses. The MPA recommended that attendants should be given a 2 year training (which became 3 years in 1896) followed by an exam set by the MPA who also issued certificates and kept a register. By the end of the century 500 certificates a year were being issued and over 100 hospitals were participating in a form of systematic training. We have no way of knowing if St Clements was one of those participating hospitals but there is reference in some early hospital documents to training being delivered by senior attendants. The recommended syllabus of training in the early 1900’s was very physically orientated with only a small section concerned with the mind and its disorders and with nursing and care of the insane. This extract from the syllabus suggests predominantly a custodial role or one of safe keeping. Management of the mental condition: observance of the rules of the asylum; routine; dealing with delusions; insane habits; occupation and amusement; liberty and escapes; precautions against suicide and homicide; violent patients assaults and struggles; use of force; epileptics; reporting mental changes; bearing of attendants towards patients. The Royal Medico Psychological Association continued to regulate the training of mental nurses as attendants until the 1950’s when the General Nursing Council finally took over all responsibility for nurse training registration and regulation. Life in Victorian Asylums It is difficult to say from the prism of time what life might have been like for inmates of Victorian asylums like the Ipswich Borough Asylum in the 1870’s. Often it is the darker aspects of asylum life that are documented and the benevolent care and humanitarian attitudes that had been ushered in by the proponents of moral treatment are sometimes forgotten.
It is important too to view asylum life against a backdrop of the social conditions of the poor at the time of industrial expansion in Britain. Many of the early inmates of St Clements would have come from the St Clements parish of Ipswich which covers an area from the Waterfront to where Suffolk New College now stands. Here there was a concentration of two up two down terraced cottages, mouldering former merchant’s houses and airless tenement courts, where the labouring classes lived in overcrowded squalid housing, often in extreme poverty, with the spectre of the workhouse an ever present fear (Grace 2006). Although insanity was a less likely eventuality than destitution, the stigma of being certified insane and committed to the local asylum may have been a greater anxiety, even though asylum life would have offered some respite from the relentless and oppressive hardship of life in a Victorian slum. Stigma associated with being mentally afflicted was already ingrained in social attitudes of the time which is reflected in the derogatory terms embedded in the language of the 19 th century: deranged, batty, cracked, crazy, cuckoo, raving, touched, barmy, imbecile, and lunatic! Frank Grace tells the affecting story of a man who in 1881 had been laid off from his job as a foundry worker because of serious ill-health, a double loss that undermined his spirit, dignity and morale. His perilous state of mind was compounded further by discovering his wife in a sexually compromising position with a young lodger they had taken in to tide them over this period of social hardship. Overwhelmed by humiliation he committed suicide by drowning himself in Ipswich Docks; but before taking his life he went to great trouble to explain in letters to local medical practitioner Dr Adams and to others who knew him, his reasons for ending his life, so that he was not thought insane. Even today in these more enlightened times such is the fear of being thought ‘mentally unwell’ that people, particularly men, will suppress, mask and deny the emotional storms that rage in the psyche until they are faced with the unavoidable storm damage. It is generally recognised that there was a ‘golden period’ in the history of Victorian asylums from about 1850 until the1880’s. Moral treatment was now a widely accepted practice and the use of mechanical restraint had been abolished in many asylums and along with seclusion had become better regulated. Dr Kirkman at St Audry’s, Melton, surely one of the unsung asylum reformers, maintained the view that no restraint can be employed that is as powerful as tenderness. Moral treatment was a concept that had a wider and deeper significance than simply treating people with kindness, dignity and compassion. It had elements of what in modern times have been termed behaviour therapy and milieu therapy - that is the creation of a social and physical environment in which recovery can take place. The routine and discipline of day to day asylum life were considered important to encourage a disciplined mind and moderate behaviour, and to prevent a descent into total derangement and degradation. For all but the most disturbed there was the dignity of meaningful work (albeit unpaid labour for the benefit of the asylum) and an opportunity for sport and regular entertainment. During the early years of the Ipswich Borough Asylum, outings
were organised to Felixstowe; a lending library was set up; and one of the male wards had a snooker table and a handsome aviary stocked with canaries. By today’s nutritional standards the diet was limited but compared to what the poor might have been accustomed to at that time, it was good. A typical dinner for inmates at the Ipswich Borough Asylum in 1871 would have been 4ozs meat, 12ozs vegetables, 2ozs bread, ½ pint beer. Wards were light, clean and comfortable with good quality beds and bed linen and modern facilities for personal hygiene and sanitation. Some inmates would have had freedom to roam in the grounds and beyond with the permission of the medical superintendent. Visiting was allowed, if only once a fortnight; but no male was allowed alone in a room with a female without the supervision of an attendant; and letters to and from inmates were ‘examined’ by the medical superintendent before being sent or received. Even in those early days of psychiatry, there was for many an expectation of recovery and still today therapeutic optimism remains a mainspring of hope in a person’s journey through mental turmoil and despair. In the first 20 years of the Ipswich Borough Asylum 1,793 people were admitted and although the mortality rate was quite high because of the enfeebled state of many patients, 1,019 were discharged either recovered or relieved. These figures are impressive even by today’s standards and given that there was very little in the way of medication, apart from a few sedative drugs, this recovery must have been assisted by the psychological and social conditions of care. Of course by no means all remaining recovered or relieved; at the turn of the century19% of patients in asylums were reported to have had previous attacks (Medico Psychological Association 1908). Moral treatment was the bedrock of psychiatry in the mid to late 19 th century. As in general medicine, where strict hospital hygiene and skilled care enabled physical healing and recovery to take place, so in asylums ‘mental hygiene’ was considered a requirement for restoring the mind. Newly emerging in the language of psychiatry alongside this notion of moral treatment were the concepts of ‘illness’ rather than ‘insanity’; ‘hospital’ rather than ‘asylum’, ‘patient’ rather than ‘inmate’ and ‘nurse’ rather than ‘attendant’. These terms were gradually adopted as the century closed and heralded the beginnings of shift in social attitudes towards disorders of the mind. The early admission ledgers detailing the circumstances of individual’s confinement describe many states of mind which would be recognised on admission wards today: melancholia and disorders of emotion; delusional states; states of confusion; states of enfeeblement; manic excitement; alcohol related states; mental disorder associated with epilepsy; mental disorder associated with childbirth and general paralysis of the insane. This latter affliction was a common cause of admission to asylums in the Victorian era and into the 20th century. About 11% of all admissions to asylums in Britain were suffering from this disease which at the time was thought to be caused by ‘toxins’ but is now known to be the result of a syphilitic infection. More men than women were affected by the condition which manifested in mid-life and commonly presented in its early stages, as a state of manic excitement with delusions of grandeur.
With psychiatry in its infancy, there was no generally agreed classification of mental affliction or understanding of its cause, although then as now most psychiatrists considered all mental disorder to be a disease of the brain, as of course many disorders seen in asylums in those days were. It was a period of expanding knowledge about the nature of disorders of the mind, knowledge gleaned from observation. Observations of a patient’s behaviour, the content of speech and thought, the fluctuations of mood and the progress of their disorders, was paramount and paved the way towards a universal symptom based classification in the early 20th century. There was very little dialogue with patients about the nature and meaning of their experiences; generally inmates were thought to be unreliable witnesses of their own predicaments – insanity was irrationality manifest and an irrational mind could not reliably comment on itself. This meant that relationships between doctors, attendants and their patients were often characterised by benevolent authority and directive care. In one of the early published accounts written by a patient of their treatment, John Perceval in 1840 complained bitterly about being dealt with in a way contrary to reason and nature because of his apparent derangement. Because Perceval was ‘well connected’ his experiences helped to popularize the more radical view that the best way of treating a person of irrational mind was with reason and rationality. The admission ledgers also point to the social hardship experienced by many poor families. Resourceful endurance was a sustaining virtue in Victorian Britain but it is difficult not to believe that it was this remorseless struggle for survival that tipped the balance of the mind in many cases. The lives of women are a particular case in point who, in their struggle to feed and care for the family, felt the full force of poverty. They often took on charring and washing to earn a few extra pennies to keep the family safe from the ignominy of poor relief. They faced frequent pregnancies; a lack of antenatal care; poor confinement conditions; and high infant mortality and it is little wonder that mental disorders connected with childbirth were common. There was no possibility of living independently for women of the labouring classes, no escape from violent or abusive marriages and if deserted or widowed, the workhouse and the break up of the family became a real possibility. Despite the use of the term ‘golden period’ it is important not to idealise the treatment people received in the late Victorian asylums. It was another 40 years before the concept of voluntary treatment became possible; certification involving two medical recommendations and a magistrate’s order was required for all admissions and, while there was some right of appeal, any admission was for an indeterminate length of time, with discharge being at the discretion of the medical superintendent. This legal confinement created a sense of unjust imprisonment for many patients and as with today’s system of sectioning under the mental health act, the loss of freedom and independence for reasons not accepted or fully understood caused great fear and resentment. Long periods of confinement caused people to lose touch with their family and friends, lose their place in the community, lose hope and
volition, and lose their sense of identity - a state of mind that later became recognized as the disabling psychiatric syndrome institutionalization. John Clare was certified and confined to Northamptonshire general asylum in 1841 where he spent the last 23 years of his life. He was described as suffering from insanity brought on by excessive proselytizing and was at times delusional, deeply melancholic, occasionally volatile and violent. Today he would almost certainly have been diagnosed as suffering from bi-polar affective disorder and treated with Lithium but at that time he was subject to a moral treatment regime. He had his own room on a ward of mainly private patients. In the early years of his confinement he was allowed to roam the surrounding countryside and go into Northampton. Often he worked in the hospital kitchen gardens and was known amongst his fellow inmates for his witticisms, for his impersonations and his lusty singing of ballads. William Knight the asylum steward encouraged him to continue writing and transcribed and collected over 800 of his asylum poems. But in his periods of lucidity Clare was not happy - he did not know why he had been ‘put away amongst the Babylonians’ and he likened himself to the caged skylark kept on the ward, ‘we are both of us bound birds you see’ (Bate 2003). His letters home reflect his longing, his loneliness and the sense of bitterness and persecution he felt at his confinement. One of his most famous and haunting asylum poems ‘I Am’ begins: I am yet what I am no one knows or cares/ My friends forsake me like a memory lost/ I am the self consumer of my woes…… The golden era of asylum care faded under the ever increasing hospital populations. Between 1870 and 1900 the average resident population of St Clements increased from 79 to 305, in a hospital built for 200. More and more people were being admitted to mental institutions because they were increasingly being thought of not only as places sanctuary but also as places of treatment. As Porter (2002) puts it the asylum became a victim of its own success. As overcrowding increased, so care became more and more routine bound and authoritarian. Meaningful activity for everyone was no longer possible and a lot of time was spent in boredom and idleness. It was more difficult for medical superintendents to preside over the functioning of expanding hospitals and assure compliance with the asylum rules and also impossible for them to see patients regularly. In most hospitals the balance shifted towards being mainly custodial institutions rather than places where the mind could heal. In these increasingly ‘total institutions’ many people slipped further into madness and began careers as mental hospital patients that sadly lasted for their lifetime. Ervin Goffman the eminent sociologist talked famously about the stripping process (Goffman1961) that occurred in the dehumanising, authoritarian, institutional regimes of mental hospitals, where people were stripped of their power, their identity, their freedom, their voice, their hope – think of McMurphy in One Flew over the Cuckoos Nest. At its height the resident mental hospital population in Britain was 150,000. Things did not really begin change until the mental treatment act of 1930 which made it possible for people to be treated as voluntary patients and was the stimulus for the beginnings of day hospitals and outpatients. The next
wave of reforms came with the 1959 Mental Health Act, which made the majority of admissions to mental hospitals as ‘informal’ and free of legal restraint as admission to a general hospital. This meant that institutions became less closed and isolated from the local community and more open to public and official scrutiny. A new therapeutic era began to emerge. Anti psychotic and antidepressant drugs became available in the 1950’s; social psychiatry began to radically transform and de-institutionalise mental hospitals creating dynamic living learning environments; and in the 1970’s community psychiatry began to develop making possible Enoch Powell’s vision of sweeping away the Victorian Asylums. Conclusions Asylums were for much of their history places that were out of sight and out of mind. Perhaps as a society we have always felt the need to distance ourselves from those considered mentally ill and to emphasize the differentness of those afflicted as a way of denying our own latent madness and the flaws and failings in our society. Mental hospitals have always been the ‘psychological casualty centres’ of society and as such may have something fundamental to teach us about what is wrong with our way of being and living. Maybe Krishnamurti was right in saying that ‘it is no measure of health to be well adjusted to a sick society’? What of Dr Long’s hope and aspiration that St Clements would be a boon to the insane and a credit to the town? As I wander the empty corridors and wards of the hospital I get a no sense of a chorus of approval echoing from those who have past that way; how could there be, those walls have witnessed to much suffering. But my final thought is this - what else has been there to gather people up at times of extremis and I know that for many the hospital has provided a haven, for a time, from the troubled waters of life. An anchor, the St Clements motif, is something we all need at times if we are not to be swept away on turbulent currents that flow through any life. Sources and References O’Donovan M. A History of St Clements Hospital. Suffolk Records Office St Clements Rendezvous – Centenary Souvenir Issue (1970) Suffolk Records Office St Audry’s Exhibition. Felixstowe Museum www.felixstowe-museum.co.uk Porter R. (2002) Madness – A Brief History Oxford University Press, Oxford Bate J. (2003) John Clare – A Biography. Picador, London Medico Psychological Association (1908) Handbook for Attendants on the Insane. Bailliere Tindall & Cox, London A Middlesex University Resource by Andrew Roberts. Mental Health History Timeline. www.studymore.org.uk You Tube. History of Psychiatry Timeline. www.youtube.com. Grace F. 2006 Rags and Bone - A social history of a working-class community in nineteenth century Ipswich. Unicorn Press, London.
Pete Watkins has a connection with St Clements Hospital that spans 50 years. He trained at St Clements was a charge nurse at the hospital in the 1970â€™s before becoming a lecturer in mental health at Suffolk College. He returned to work for SMHP NHS Trust with the outreach team in the late 90â€™s and retired in 2009. He now runs the arts in mental health charity Inside Out. Copyright P.N. Watkins 2011