Pennsylvania Express

Our Archivist has been awarded short-term travel grants from the Francis
Clark Wood Institute for the History of Medicine at The College of
Physicians of Philadelphia and the
Committee for Professional and International Affairs of the Archives and
Records Association (UK and
Ireland) to enable research into the photographic representation of
psychiatric patients using the archival resources of the College’s
Library.

There should be ample scope for this research in the city of Benjamin
Rush, Thomas Kirkbride and Silas Weir Mitchell; and if only the Dorothea
Dix Library and Museum (opened as a reading room for the female
patients of Pennsylvania’s Harrisburg State Hospital, which Dix and
Kirkbride co-founded in 1851) had not closed in 2006, it would have been
the next stop on our Archivist’s itinerary. As matters stand, hopefully
there will be enough time for a ‘Letter from America’ to be written for
publication on this blog in due course.

Photo courtesy of The College of Physicians of Philadelphia.

Getting into Georgian Bethlem 3

In previous posts we described the restrictions placed on admissions to Bethlem Hospital, and to its ‘incurable’ ward, in the eighteenth century, and told the first of two stories of attempts made to gain admission for a patient. The second concerns Sarah Lufkin of Little Bentley near Manningtree, Essex, who came into the Hospital on 16 February 1782, and was discharged uncured on 15 February of the following year, in strict accordance with the previously-described rules governing admission and discharge. Mrs Lufkin was considered a ‘fit Object’ for transfer to Bethlem’s ‘incurable’ ward, but had to go on the waiting list for a vacancy. It took seven years for her to be offered a place, and a letter written to the Hospital by Sarah’s son John Lufkin is preserved in the archives.

‘My Brothers, Sisters and myself have Deliberated on the matter,’ John wrote, ‘and although her who has been one of the tenderest Mothers still continue in a state of Insanity, I leve [sic] you to judge from your own feelings if it would not be a heard, very heard work for us to part from her and perhaps never to see her more.’ This was no exaggeration on John’s part. Little Bentley was at least two days’ coach journey away from London in the eighteenth century, and the fare was not cheap.

By 1790 Sarah Lufkin’s children had been seven years without Bethlem’s assistance in caring for her. ‘Ever since she left London she has been in a very Creditable Famaly [sic] where she is treated with the greatest kindness and has every Indulgence a person in her Situation can have, and where we can see her as often as we please as the Distance is only half a mile from our own Famaly.’ What would they do, then, with Bethlem’s renewed offer of help?

‘Although it is a very heavy Expence’, John Lufkin continued, ‘we hope with the Blessing of God to be able to support her till it shall please the Lord to release her from her heavy affliction, for can we do two [sic] much for a good Parent’? That John Lufkin’s filial devotion was shot through with practicality is evidenced by the next (and effectively last) line of his letter: ‘Sir, if we omit this opportunity and if at a futer [sic] time any thing unforeseen should happen so that we find the Expence more than we are able to support, could she then at a Vacancy be admitted’? No record survives of the answer given by the Hospital, but we may surmise that, if that it stuck by its rules, the answer would probably have been ‘No’.

The History of the World in 100 Objects

As the British Museum gears up to reveal their 100th object today, we have added several items from our collection to the History of the World site, incorporating elements of the history of madness and mental health treatment from the Hospital’s founding in 1247 up to the present day.

The life-size statues of “Raving and Melancholy Madness,” were displayed at the entrance to Bethlem Hospital from 1676, have already been mentioned on this blog (here and here). As significant London landmarks of their time, these statues became symbolic of “human mental misery” (as a nineteenth century news reporter described it) for visitors from around the globe. As one German travel writer wrote in the late eighteenth century, “These two figures show so much truth and expressiveness that they equal the best sculptures in Westminster Abbey.”

More difficult to present, perhaps, are the eighteenth century restraint devices pictured below: nonetheless, these form a significant aspect of the history of mental health treatment in many areas of the world. Until the Victorian era, hospital patients that threatened violence against themselves or others were physically restrained from acting on their threats by a panoply of devices and garments engineered for the purpose, usually applied temporarily but sometimes for prolonged periods. These gradually fell into disuse upon the advent of the non-restraint movement, which swept the public asylums of England in the 1840s, and were banned altogether from Bethlem in 1853. Interestingly, Bethlem retained what it had come to regard as the “revolting instruments of mechanical coercion” as material evidence both of its history and of its progress. Today, these objects remind of the ongoing debate concerning involuntary detention, seclusion and chemical restraint.

Find us on The History of the World website.

Getting into Georgian Bethlem 2

Correspondence between two eighteenth century solicitors, currently being edited for publication by the Sussex Record Society, provides an unexpected insight into how the rules of admission to Bethlem Hospital (described in an earlier post) functioned in practice at that time. We are grateful to the editor of these letters for drawing our attention to this example, and for permission to cite it here.

On 12 November 1745, James Collier of Hastings wrote to John Collier ‘in relation to the unhappy affair of Mary Cousens, whom my uncle and I though a proper person’ for admission to Bethlem.

‘I shall be able I beleive [sic] to have some respite in regard to her removal, and when the committee are known, shall endeavour to get her minuted down for the ward of the incurables which depends principally upon the report of Dr Monro; and I am glad to find that our case, viz. a raving madness, is a circumstance that particularly induces the committee to send such poor people there.’

In seeking a place for Mary Cousens at Bethlem, Mr Collier was acting as a professional agent of the Hastings authorities legally and financially responsible for the care of all ‘pauper lunatics’ resident within their parish boundaries. His communications with Bethlem’s Physician, Dr Monro, seem to have been conducted via a third party. At any rate, he had been poorly advised. As noted in the previous post in this series, in the ordinary course of events patients were not admitted directly to the ‘incurable’ department, and people judged ‘incurable’ would not be admitted to the Hospital in the first place.

While he hoped for a Bethlem admission for Mary, James Collier did not put all his eggs in one basket. ‘By next post, I shall be able to acquaint you with certainty what will be done as to Guy’s hospital,’ his letter to John continues. ‘They never suffer anybody to enter there, who has once been in bedlam, and I am afraid private madhouses will be attended with great expence.’

How did matters turn out? From a second letter, written by James Collier to John nine days later, it appears that Mary lived under Bethlem’s roof while being assessed for admission, but was not in the event admitted. ‘Mary Cousens is not as yet removed out of Bethlem hospitall [sic], but it is impossible to get her continued there’, he writes. ‘Mr Alnright of Lambeth marsh will take her for one month upon trial for 8sh per week, but if her distemper is such as to require a more than ordinary attendance, he will have more.’ With an eye to parish finances, Mr Collier would have preferred Bethlem to relent, an outcome for which he continued to hope against hope. ‘I don’t despair at present of getting her minuted down in the list of persons who are to supply the vacancys in the ward of incurables.’ In the event, however, Mary Cousens’ name does not appear in any of the Hospital’s admission registers, incurable or otherwise. Where she went, we cannot say.

Nineteenth Century Society: Women, Madness and Marriage 1

This short series looks at the very different experiences of several of Victorian Bethlem’s female patients regarding marriage. The diversity of these reminds us of how problematic it can be to make general assumptions about social expectations in the nineteenth century, despite the fact that some cases do indicate elements of the stereotypes commonly indicated by many feminist histories.

What might be of particular interest in an era in which online dating has received regular attention – both positive and negative – is those references found in the Bethlem casebooks to matrimonial agencies. For single women well past the usual marrying age, such as Mary Ann Swann, who was admitted to Bethlem in July 1895 as a voluntary boarder, social expectations could be difficult to deal with. Young people were expected to suffer from insanity following “love disappointments,” yet in fifty-year-old Swann’s case, her attitudes to marriage were seen as evidence of her mental illness. Mary Ann held the delusion “that she is persecuted by her sisters in order that they may keep her money … She is also erotic & desires to marry some man who will protect her from her sisters & brothers.” While her desire to marry in order to escape her perceived persecution could be regarded as quite a rational response to something she felt was very real, Mary Ann’s persistent desire to marry was instead regarded in Bethlem as a further delusion, related to her “erotic” nature: inappropriate behaviour in someone regarded as a confirmed spinster.

What was most problematic was Swann’s use of matrimonial agencies to effect her object: the Commissioners in Lunacy clearly regarded this as a dubious means of finding a suitor. After she was discharged well, in September 1895, Commissioner Mr Frene paid a visit to the Hospital, presumably instigated by the patient’s relatives, “to enquire how it was that this patient was at large as she was doing most extraordinary things & was shortly to be married to a man whom she had got to know through the Matrimonial News.” The Bethlem medical officers promptly arranged for Swann’s re-certification: presumably suspicion of such dating agencies was widespread. Mary Ann herself regarded her re-admission as a conspiracy on the part of her relatives, claiming that there was nothing extraordinary in her conduct. Yet, as Bethlem superintendent George Savage pointed out in his published writings, in the frequent absence of visible physical signs and symptoms the presence or absence of insanity had often to be determined by behaviour, regardless of the patient’s protestations. In the event, Mary Swann was discharged well after three months as a Bethlem patient.