Tag Archives: asylum history

Communicating Mental Health, University of Birmingham, 16-17 September 2013

‘Communicating Mental Health, c.1700–2013′ was a workshop held at the University of Birmingham’s Institute of Advanced Studies, aiming to bring together researchers from a range of backgrounds to consider the communication of mental health and illness, both in the past and in the present. Communication took many forms in the papers presented – verbal, written, and visual.

L0028860 Case notes: Holloway Sanatorium Hospital for the InsaneKicking off the proceedings, Louise Hide from Birkbeck, University of London examined letters written by 19th-century asylum patients. Letter-writing by patients was a significant activity, with around 100 letters a day written at London’s Claybury Asylum in 1895. Such letters are complex both in their contents and the ways in which they might be read by the historian – Hide particularly emphasised patient’s use of metaphor as a way of communicating their experiences within the asylum. This was a trend also evident in the spoken words of patients, as I briefly noted in a paper on the role of the patient in diagnosis. As the asylum admission process in the 19th century didn’t involve the input of an asylum doctor (rather, general practitioners and Poor Law authorities), the information provided on admission documents was often re-assessed in the asylum in light of the patient’s own story. One man, who had told the general practitioner certifying him that the ‘flesh was dropping off his bones’, explained to the asylum doctor that he didn’t really think this, but had employed the phrase to describe his feelings of numbness in the toes.

Letters sent by patients were also examined by Jane Hamlett (Royal Holloway University of London), who described how demands for goods from families may have been a way for the patient to assert authority after being placed in an institution. One patient at Bethlem wrote an astonishingly long list of goods that he ‘required’, asking his father to send him – amongst other things – a harmonium and an alarm clock. That letters were a means of maintaining one’s position as head of the household was evident in the letter written by a man to his wife, who declared that she ‘need not send the cake [she had mentioned], as he did not care for it’, but she might send some rashers of bacon instead. In their provision (or not) of foodstuffs and domestic items, then, we can see families engaging in a form of object-based communication.

Inside the padded cell in the Stephen Beaumont Museum of Mental Health.

Inside the padded cell in the Stephen Beaumont Museum of Mental Health.

That objects might be communicative was a possibility also explored in Rob Ellis’s (University of Huddersfield) talk, which examined the Stephen Beaumont Museum of Mental Health – previously discussed on this blog, here. Ellis argued that museum collections are very much bound up with who ‘owns’ the history of psychiatry (the closure of asylums in the late 20th century, for example, prompted some curators to highlight the ‘progressive’ nature of psychiatry).

This much broader issue of ownership was a concern that ran throughout the two days of the workshop. Towards the end of the first day, we were already asking ourselves if historians were part of ‘myth-making’ about mental illness and, if we were, what we could do about it. But was ‘myth-making’ too simplistic a label to put on the issue? Was there, asked Peter Bartlett (University of Nottingham), any area of life where – as humans – we weren’t constantly constructing myths about history, the present, and ourselves? Many of the papers presented at the workshop had highlighted how there was rarely a single narrative of mental health or illness that enjoyed relative hegemony at any one time. In the stories we were telling about past and present mental health practice, we were also adding other voices to an already varied narrative.

Poster from the Birmingham campaign, ‘Don’t Turn Your Back on the Symptoms of Psychosis’.

Poster from the Birmingham campaign, ‘Don’t Turn Your Back on the Symptoms of Psychosis’.

The languages spoken by these voices seemed diverse – historical, medical, psychoanalytical – but displayed some important similarities. That there was an easily discernible line between ‘normal’ and ‘abnormal’, or ‘health’ and ‘illness’, was complicated by many of the speakers present. Katherine Chisholm and Sarah-Jane Fenton both addressed the importance of identifying mental ill-health in adolescence – the point at which many serious psychiatric disorders began and often manifested themselves in ways that made it difficult to determine the lines between ‘mental illness’ and ‘typical’ teenage behaviour. The language used to talk about mental health issues was also a rapidly changing one, so that – as one current practitioner pointed out – an individual might be diagnosed with something that meant little as a diagnostic label years later. How language and the labels we assign to disorders could profoundly affect an individual’s sense of self, then, was a consideration that came through in papers both by historians and current practitioners.

Methodology also turned out to be an area of common experience: though we might lack a methodology that can properly capture the experience of mental illness at different points in time (as Joseph Melling [University of Exeter] noted), there was a clear similarity across the disciplines in terms of research methods employed. Thematic analysis was central for many speakers, whether analysing the letters of 19th-century asylum patients, or in working with young autistic adults (Susy Ridout, University of Birmingham).

300px-Speech_bubble.svgFittingly, the workshop ended with participants reflecting on how we had communicated with each other. Fostering interdisciplinary study was a laudable aim, but something that involved more than simply delivering papers together at the same event. How could the discussion continue beyond that context, and how far were historians, practitioners, and service users really integrated? Whilst we’d been using the same languages and methodologies, there was still a sense of a divide within the room at times – almost that historians were distanced, detached observers with little direct experience of mental health issues. How could we bridge that divide?

This was a big question that I had the chance to explore a little further a few days later, at the Wellcome Trust’s Engaging Science Day, a workshop for grantholders about public engagement. In our session, ‘Are historians human? Communicating medical history’, we talked about the mental health issue directly. Should we, as historians, communicate our own experiences of mental health and illness to make our field of study more accessible to others? The general consensus was no, unless you felt strongly about doing so. There was, though, a case to be made for engaging with medical and psychiatric history on a more personal level as a way of capturing other’s imaginations. Appealing to people’s preconceptions about the history of psychiatry and medicine as a starting point for discussion was one suggestion. Opening up a talk with an appeal to the audience – such as ‘What do you think the first drug treatments used in psychiatry were?’ – was a way in to a subject that the speaker specialised in, but which the audience might also have some knowledge of, going a small way to bridging that gap between speaker and audience, or historian and service user. Maybe the issue wasn’t one of language, of methodology, even of different disciplines, then, but in the very simple way we communicated with others.

‘Communicating Mental Health’ ended with a discussion amongst University of Birmingham participants about taking the dialogue opened up at the workshop further, and we look forward to hearing more about this in due course. You can view the full timetable of speakers and papers here, and Vanessa Heggie (@HPS_Vanessa) has kindly Storified (or Storify-ed?) live tweets from the two days here.

Surgery in the asylum II: The craniectomy controversy

In January 1895, The Strand Magazine published another instalment in its ‘Stories from the Diary of a Doctor’ series. The tales were written in a semi-fictional tone, ‘in collaboration with a medical man of large experience’ – ‘[m]any [were] founded on fact’. They presented a romantic vision of the doctor as saviour, accompanied by illustrations that echoed other Strand series such as Sherlock Holmes. January’s ‘Diary of a Doctor: Creating a Mind’, relates the situation of a titled family whose male head has been taken ill after an injury. The attending doctor, frequently present in the family’s castle, is there when the young male heir, Cyril, is brought to visit his grandfather on his sickbed.

Strand_Magazine_1891Two and a half years old, the boy is described as beautiful – almost angelic – yet the doctor relates that ‘one glance was enough to tell me that … the mind in that poor little casket was a sealed book. The beautiful boy was looking at no one: he was gazing straight out of the window…’ The grandfather is less poetic: “That boy’s an idiot,” said the Squire – “he’s a beautiful idiot – he’s no heir for me – don’t mention him again.” ‘Idiocy’ was a common term at this time used to refer to a condition present from an early age that made a person incapable of managing their own affairs; it was typically deemed incurable, and covered a range of conditions that are now generally referred to as learning difficulties.

The doctor, his curiosity aroused, examines the child and draws the family’s attention to

“how small his head is in proportion to the rest of his frame. That smallness is at the root of the mischief. The little fellow is suffering from premature ossification of the cranial bones. In short, his brain is imprisoned behind those hard bones and cannot grow. The bones I refer to should at his tender age, be open, to allow proper expansion of the growing brain.”

A little while later, he notes: “An idea has occurred to me – it is a daring one … I propose to open the casket where the child’s mind is now tightly bound up, and so to give the brain a chance of expansion.”

V0030048 Brain of someone described as an "idiot". Process print.

Brain of someone described as an ‘idiot’. © Wellcome Images

The parents of the child consent, and the operation is carried out. Lasting one and a half hours, the procedure is deemed a success. The tale ends triumphantly, with young Cyril like any ‘normal child’ by his third birthday, and presented to his grandfather (now recovered from his illness) with a dramatic flourish, eventually living in the castle and – presumably – a potential heir once more.

Whilst ‘Creating a Mind’ relied on fictional tropes for its effect, it raised very real concerns. T. Telford-Smith, Superintendent of the Royal Albert Asylum, described it as ‘a tale which I fear has given rise to exaggerated hopes in the minds of the parents of many idiot children’, suggesting that several had pursued the possibility of surgery after reading the piece. The procedure in question – craniectomy – involved removing bone from the skull to increase the space available for the brain. Telford-Smith estimated that over 200 such operations had been performed in Britain, America, and France since 1890. It was not something to be taken lightly, he emphasised, and was certainly not the miraculous cure that The Strand made it out to be. Similar concerns were voiced by G.E. Shuttleworth, who thought that craniectomy had ‘almost passed from the domain of science to the region of romance’ as a consequence of ‘Creating a Mind’.

This is not to say that medical practitioners deplored the operation completely. Telford-Smith had known it performed on several children who had been admitted to the Royal Albert. Relating the case of a six-year-old boy who had never spoken and often knocked his head violently against the wall – a practice that the parents found ‘most distressing’ – he said that the parents could see only limited difference after three procedures were performed in 1895. The child remained speechless, yet his parents said they would submit him to the operation again knowing the results, as his restlessness had decreased markedly and the head-knocking had ceased. The case was presented by Telford-Smith in direct response to ‘Creating a Mind’ – despite the slight improvements in the child, he said, ‘A mind has not been created’. His account, though, emphasised the need to look at each case individually, weighing up the risks and possible outcome. He also noted the need for dedicated education and training after surgery, reminding readers that a physical procedure was no substitute for love and attention.

Surgery on the brain (or that aims to affect the brain) is a highly emotive issue, especially when performed on children as in these cases. The Strand episode is an interesting example in which a popular representation of psychosurgery was positive – so much so that several doctors were moved to respond to it. ‘Creating a Mind’ sits in contrast to tales like Heart and Science (mentioned in this post) that portrayed surgery on the brain as a Gothic nightmare. It’s a reminder, then, that discussions about psychosurgery often extended beyond the asylum walls and that opinions on the matter were rarely straightforward: for some parents of the 1890s, a novel medical procedure such as craniectomy may have been perceived as a means of ‘cure’ for their children.

Further reading

L.T. Meade and Clifford Halifax, ‘Stories from the Diary of a Doctor: Creating a Mind’, The Strand Magazine (Jan. 1895).

G.E. Shuttleworth, ‘The Surgical Treatment of Idiocy‘, Journal of Mental Science (Jan. 1896).

T. Telford-Smith, ‘Craniectomy for Idiocy, with Notes of a Case‘, Journal of Mental Science (Jul. 1897).

T. Telford-Smith, ‘Craniectomy, with the After-History of Two Cases‘, Journal of Mental Science (Jan. 1896).

David Wright and Anne Digby (eds.), From Idiocy to Mental Deficiency: Historical Perspectives on People with Learning Disabilities (London: Routledge, 1996).

Medical technology in the asylum – and plans for the blog

With the Science in the Asylum conference completed, we’re excited to begin a more regular blog schedule, with posts each Monday from myself, Mike, and guest contributors. Submissions are strongly encouraged – the conference brought us into contact with several people working on the history of science and medicine in relation to the asylum, and we’d love to find more of you! Please get in touch here.

This is the first of our Monday blogs, and takes up a theme we plan to revisit in some future posts: the use of medical technologies within the asylum.

By the 19th century, as doctors increasingly focused on bodily lesions as the site of disease, there was hope that disturbances of the mind might also have somatic origins. It was commonsensical, for example, that the activity of the brain depended upon its blood supply; thus, blood vessels were often identified as the starting point of disease. Daniel Hack Tuke’s Dictionary of Psychological Medicine noted that ‘capillary disorder could lead to a wide variety of dysfunctions’, and suggested that circulatory issues were the cause of many mental diseases. Indeed, during microscopical and post-mortem investigations, the poor state of patient’s blood vessels was often noted.

How could such bodily change be examined in the living patient though? In Medicine and the Reign of Technology, Stanley Reiser lists the new pulse-recording instruments that appeared in the 19thcentury. Among these, Étienne-Jules Marey’s sphygmograph of 1860 was crucial. By resting one end of a piece of metal on a pulsating artery, and attaching a pen to the other, the pulse could be made visible as each movement was traced onto a strip of paper.

Marey’s sphygmograph. © Wellcome Images

By the 1880s, Marey’s device had been eclipsed by Robert Ellis Dudgeon’s ‘pocket sphygmograph’, a smaller device that was especially useful for the asylum physician who dealt with restless or excitable patients.

Dudgeon’s less cumbersome ‘pocket’ sphygmograph. © Wellcome Images

Sphygmographs had their problems: each model might produce a slightly different result, or be further affected by the technique of the person using it. Nevertheless, George Thompson at Bristol Asylum said that he ‘implicitly trusted [the] instrument as a means of discovering at least one form of brain-disease’. He applied the sphygmograph to almost every form of mental disease found in the asylum, but found the most striking results in general paralysis (now understood to refer to neurosyphilis).

In the West Riding Medical Reports in 1871,Thompson described his experiments on the pulse of general paralytic patients at the West Riding asylum. He presented two tracings, one from his own research and one from W.B. Carpenter’s Principles of Human Physiology. They bore a remarkable resemblance. Whilst Thompson’s example represented the pulse of a general paralytic, Carpenter’s showed the pulse of a healthy person in a state of chill.

Thompson’s pulse tracing of a general paralytic patient.

…And Carpenter’s tracing of a healthy individual suffering from ‘chill’.

To Thompson, it was evident that in both cases a contraction of the vessels was being recorded. He concluded that general paralysis was ‘a disease … owing to a considerable extent to persistent spasm of the vessels’.

Could halting this spasm also halt the degenerative process that was characteristic of general paralysis? James Crichton-Browne was one of several alienists who used Calabar bean for this purpose. Calabar is a poisonous seed from an African plant, lethal if ingested in anything more than minute quantities. It was put to a number of uses in the 19th century due to its ability to paralyse muscle, and proved to be the first effective drug treatment for glaucoma. It was suggested that Calabar could lead to an improvement in general paralytic patients such as ‘S.M.’:

‘When admitted to the West Riding Asylum he had exalted ideas; there [was] inequality of the pupils, tremor of the lips, and awkwardness of gait. … [After three months of treatment with Calabar bean] there was such marked improvement in his condition that the use of the extract was discontinued.’

Calabar beans. © Wellcome Images

Calabar’s relative scarcity in the historical record suggests it was seen as an occasional palliative measure rather than cure, however. Writers on the subject were at pains to point out that they knew of no authenticated cases of cure; those patients who recovered enough to be discharged were often re-admitted later, any improvement proving only temporary.

These experiments with the sphygmograph in the Victorian asylum are interesting for a number of reasons. Many historians have emphasised how new medical technologies in the 19th century served to remove the patient’s subjective experiences from the picture, with doctors relying on supposedly ‘objective’ mechanical data. In the case of the sphygmograph, data didn’t necessarily eclipse the patient, with the tool employed alongside established methods of clinical examination including consideration of the patient’s own testimony.

Looking at the use of such technology in an asylum context can also expand our understanding of the asylum’s place within contemporary medical landscapes. Christopher Lawrence describes the sphygmograph as a tool with limited usage, partly because experimental physiology only developed as a specialty in the 1870s. The use of it in the asylum suggests that researchers there were drawing inspiration from a wide variety of medical disciplines – a spirit of innovation also evident in the invention of instruments and post-mortem tools by members of the alienist community.

Examining such research can also problematise wider assumptions about the development of the medical profession and the resulting impact on patients. As described above, post-mortem findings could raise questions that were investigated further in the laboratory, the findings of which then informed clinical intervention. The notion of an easy split between the laboratory and clinical contexts, then, is perhaps less applicable to the asylum at this time.

Forgotten episodes within the history of asylum research are often forgotten because they don’t involve a breakthrough discovery, a success story, or a bizarre intervention that raises our anxieties about patient care. Yet they can also be places where we might find alternative viewpoints to the pictures presented in broader histories of medicine. Perhaps then, unusual endeavours such as Thompson’s should grab our attention not as side projects in the historiography, but as narratives with wider historical significance.

Further reading

William Bevan Lewis, ‘Teachings of the Sphygmograph in General Paralysis of the Insane’, Journal of Mental Science 27 (1881).

T. Duncan Greenlees, ‘Observations with the Sphygmograph on Asylum Patients’, Journal of Mental Science 32 (1887).

Christopher Lawrence, ‘Physiological Apparatus in the Wellcome Museum. 1. The Marey Sphygmograph’, Medical History 22 (1978).

Christopher Lawrence, ‘Physiological Apparatus in the Wellcome Museum. 2. The Dudgeon Sphygmograph and its Descendants’, Medical History 23 (1979).

Alex Proudfoot, ‘The Early Toxicology of Physostigmine: A Tale of Beans, Great Men and Egos’, Toxicological Reviews 25 (2006).

Stanley Joel Reiser, Medicine and the Reign of Technology (Cambridge: CUP, 1978).

George Thompson, ‘On the Physiology of General Paralysis of the Insane and of Epilepsy’, Journal of Mental Science 20 (1875).

George Thompson, ‘The Sphygmograph in Lunatic Asylum Practice’, West Riding Lunatic Asylum Medical Reports 1 (London: J & A Churchill, 1871).

Keith Wailoo, Drawing Blood: Technology and Disease Identity in Twentieth-Century America (Baltimore: Johns Hopkins University Press, 1997).

– Jennifer Wallis