Leonard Smith

A gentleman's mad-doctor in Georgian England: Edward Long Fox and Brislington House

The late eighteenth and early nineteenth centuries were a period of particular innovation in the history of British psychiatry. Enlightenment ideas brought a change in attitudes to insanity, reflected in the growing prevalence of psychologically based treatment techniques being implemented in both public and private institutions. A new group of practitioners, specializing in the treatment and management of insanity, was emerging. One of the most prominent and successful was Dr Edward Long Fox, a Bristol physician. His main venture was the establishment of Brislington House in 1806. Here he created a state-of-the-art asylum, catering mainly for the wealthier members of society. Its unique design, with seven distinct houses, enabled classification of patients according to social class as well as behavioural presentation. Within a context of safety and security, Fox sought to provide a therapeutic regime based on the principles and practices of moral management.

‘God grant it may do good two all’: the madhouse practice of Joseph Mason, 1738–79

Private madhouses made a significant contribution to the development of psychiatric practices in eighteenth-century England. Joseph Mason of Bristol, proprietor of a madhouse at Stapleton and then at nearby Fishponds, was part of a dynasty of successful and respected mad-doctors. A deeply religious man, his Christian ethics constituted the guiding force in his work with patients and interactions with their relatives. He was also an astute man of business, who recognized that comfortable domestic surroundings and the achievement of recoveries would enhance his reputation and attract lucrative middle-class custom. His treatment approaches, illustrated in a 1763 diary, were eclectic and pragmatic, comprising various medicines, dietary regulation, graded social interactions, and the cultivation of individualized therapeutic relationships with his patients.

Welcome release: perspectives on death in the early county lunatic asylums, 1810–50

Deaths in the asylum could be interpreted as a sign of failure, particularly if they were related to the poor condition of those admitted, the spread of disease among patients, or the direct consequences of severe mental disorders. County asylum superintendents lamented the bad physical state in which many were sent to the asylum and the consequences for death rates. Due to limited consideration of environmental and sanitary matters before the 1830s, there was great risk of contracting fatal diseases in the asylum. Combined with the deteriorated physical condition of many patients, and the growing overcrowding, this had a notable influence on mortality. For some individual patients, death came about as a direct consequence of a profound mental disorder. Without effective treatments to confront manifestations of disordered thinking, mental symptoms might precipitate physical deterioration to the point of death, while severe distress led some to kill themselves in the asylum.

‘Details on the Establishment of Doctor Willis, for the Cure of Lunatics’ (1796):

The ‘mad-doctor’ Dr Francis Willis achieved national and international celebrity following his successful treatment of King George III’s first major episode of insanity in 1788–9. At the time of his summons to attend the King, Willis was a well-established provincial practitioner and madhouse proprietor. An anonymous French visitor published a description of Willis’s Lincolnshire madhouse and his therapeutic practices in 1796. The translated text of the full article provides a unique insight into the work of a key figure in the historical development of psychological medicine. The accompanying Introduction summarizes Francis Willis’s career as a mad-doctor and uses salient information from the original text to place him and his madhouse practice within a contemporary context.

The Working Man’s Champion: Reverend Humphrey Price (1775–1853)

Reverend Humphrey Price was the son of a Kidderminster weaver. Ordained in the Church of England in 1797, from 1809 until his death in 1853 he was minister of Christ’s Church in Needwood Forest, Staffordshire. In later life he acquired some celebrity as an unlikely advocate for the industrial and political rights of working people. Price came to prominence during the Kidderminster carpet weavers’ great strike of 1828. He authored forthright publications attacking the actions of the manufacturers, which brought about his prosecution for criminal libel and a 1-year jail sentence. During the 1830s Price became active in the wider campaign for radical reform, severely criticizing the middle classes and the political and clerical establishment, whilst arguing eloquently for universal suffrage and working class representation in parliament. He embraced the emergent Chartist movement and remained involved for several years. Price’s writings and activities were always informed by his deep abiding Christian principles.

Insanity and Ethnicity: Jews in the Mid-Victorian Lunatic Asylum

There is currently much interest in how members of ethnic minorities experience the psychiatric system. In mid-Victorian provincial England, the presence of Jews as a small but significant minority was reflected in the population of lunatic asylums that served cities such as Liverpool, Manchester, and Birmingham. Case evidence suggests certain patterns of symptom presentation and behaviour among Jewish asylum patients. In some instances, delusional ideas and other symptoms of disturbance show a clear religious or cultural content. The response of the asylum authorities to Jewish patients varied from the sympathetic and accepting to the unthinking and prejudiced. Culturally determined behaviour could easily be interpreted as part of the manifestation of mental disorder.

Lunatic Asylum in the Workhouse: St Peter’s Hospital, Bristol, 1698–1861

In recent years there has been growing acknowledgement of the place of workhouses within the range of institutional provision for mentally disordered people in nineteenth-century England. This article explores the situation in Bristol, where an entrenched workhouse-based model was retained for an extended period in the face of mounting external ideological and political pressures to provide a proper lunatic asylum. It signified a contest between the modernising, reformist inclinations of central state agencies and local bodies seeking to retain their freedom of action. The conflict exposed contrasting conceptions regarding the nature of services to which the insane poor were entitled. Bristol pioneered establishment of a central workhouse under the old Poor Law; ‘St Peter’s Hospital’ was opened in 1698. As a multi-purpose welfare institution its clientele included ‘lunatics’ and ‘idiots’, for whom there was specific accommodation from before the 1760s. Despite an unhealthy city centre location and crowded, dilapidated buildings, the enterprising Bristol authorities secured St Peter’s Hospital’s designation as a county lunatic asylum in 1823. Its many deficiencies brought condemnation in the national survey of provision for the insane in 1844. In the period following the key lunacy legislation of 1845, the Home Office and Commissioners in Lunacy demanded the replacement of the putative lunatic asylum within Bristol’s workhouse by a new borough asylum outside the city. The Bristol authorities resisted stoutly for several years, but were eventually forced to succumb and adopt the prescribed model of institutional care for the pauper insane.

Introduction: historical contexts to communicating mental health

Contemporary discussions around language, stigma and care in mental health, the messages these elements transmit, and the means through which they have been conveyed, have a long and deep lineage. Recognition and exploration of this lineage can inform how we communicate about mental health going forward, as reflected by the 9 papers which make up this special issue. Our introduction provides some framework for the history of communicating mental health over the past 300 years. We will show that there have been diverse ways and means of describing, disseminating and discussing mental health, in relation both to therapeutic practices and between practitioners, patients and the public. Communicating about mental health, we argue, has been informed by the desire for positive change, as much as by developments in reporting, legislation and technology. However, while the modes of communication have developed, the issues involved remain essentially the same. Most practitioners have sought to understand and to innovate, though not always with positive results. Some lost sight of patients as people; patients have felt and have been ignored or silenced by doctors and carers. Money has always talked, for without adequate investment services and care have suffered, contributing to the stigma surrounding mental illness. While it is certainly ‘time to talk’ to improve experiences, it is also time to change the language that underpins cultural attitudes towards mental illness, time to listen to people with mental health issues and, crucially, time to hear.

Book Review: Emmanuel Akyeampong, Allan G. Hill and Arthur Kleinman (eds), The Culture of Mental Illness and Psychiatric Practice in Africa (Leonard Smith)

of alcohol abuse and in shaping wider cultural ideas about alcohol consumption and drunkenness. As one of the symptoms of alcoholic insanity, mania-a-potu, or delirium tremens, not only attracted interest among America’s emerging medical profession, but it also captured the public’s imagination because it came to symbolize the fragility of the ‘American Dream’. Osborn locates the study in Philadelphia, where the foundations of the medical profession emerged amid a backdrop of profound social, political and economic upheaval and change. The book charts the development of medical ideas on intemperance over the first half of the nineteenth century. It begins with Benjamin Rush’s views on intemperance as a disease of the will – a theory derived in part from Rush’s own moral and political beliefs and from the transatlantic exchange of medical texts and ideas. Although Rush’s theories sparked medical interest in the issues surrounding intemperance, the moralistic elements of his analysis were largely dismissed by younger physicians eager to identify pathological reasons for heavy drinking. In the 1810s, delirium tremens emerged as a disease that could fill this role. By this time, Philadelphia had a burgeoning urban population, with widening class differences and deepening levels of urban poverty. Drunkenness was a pressing social issue and one that was exacerbated by an economic depression. By the 1820s Philadelphia doctors were treating increasing numbers of alcoholic insanity cases among the richest and poorest in society. This in turn aroused medical interest in delirium tremens as a distinct disease and sparked the moral and political debates that contributed to the rise of the medical temperance movement. In aligning themselves with temperance ideology, doctors carved out a ‘respectable’ niche within a competitive market. By mid-century it was therefore vital that the medical profession championed the cause of social responsibility, and this involved educating the public on the dangers of heavy drinking and its pathological consequences. While most of the book does a skilful job of weaving the medical history of delirium tremens into the social, political and economic fabric of the early Republic and the emergence of the American medical profession, the best chapter by far is the last. In this chapter Osborn explores the nineteenthcentury fascination with delirium tremens, and it is a dark journey into the fears, hopes and desires of a meritocratic culture. The book’s title Rum Maniacs comes from a poem by Joseph Allison in which a man, in the hallucinogenic throes of alcohol withdrawal, begs a doctor to give him rum to stop ‘the horrors’. The poem, with its demonic and lurid imagery, was widely circulated in temperance propaganda. By the mid-nineteenth century, delirium tremens had captured the public’s imagination and representations of the disease appeared in literature and popular entertainment. This has parallels with the Victorian fascination with madness, drunkenness and social ruin, which were recurrent themes within gothic horror novels and popular fiction. Yet the Old World preoccupations with maintaining the status quo were lost in American culture, which was grounded in the meritocratic dream. The struggle for social success in many ways mirrored the drunkard’s battle to overcome his ‘demons’. Therefore within the American context, delirium tremens had a unique place. Rum Maniacs offers a rich and detailed account of the history of delirium tremens. While the focus on the book remains largely fixed on the medical angle, the importance of the broader social and cultural context is never ignored. In this respect it makes a valuable contribution to the growing number of social and cultural histories of alcohol and drugs.

Book Review: Barbara Taylor, The Last Asylum: A Memoir of Madness in Our Times

Penguin Books Ltd. Paperback. Book Condition: new. BRAND NEW, The Last Asylum: A Memoir of Madness in Our Times, Barbara Taylor, The Last Asylum is Barbara Taylors haunting memoir of her journey through the UK mental health system. A Radio 4 Book of The Week Shortlisted For The RBC Taylor Prize. In July 1988, Barbara Taylor, then an acclaimed young historian, was admitted to what had once been Englands largest psychiatric institution: Colney Hatch Lunatic Asylum, later known as Friern...