Life in a Victorian Asylum 2: Clerks and Governesses

While certainly connected to moral treatment, improvements at Bethlem were presumably also related to the changing patient profile: throughout the nineteenth century the Hospital became increasingly middle class – by the 1860s, the majority of patients tended to come from lower middle and “educated” working class backgrounds. As Hood lamented in 1854, “The records of all Asylums show how liable are clergymen, authors, artists, governesses, professors and similar persons to be attacked by this terrible calamity. None are more subject to this visitation, none are less able in a pecuniary point of view, to struggle through the trial of such an affliction, yet none are less cared for by the many charitable institutions of our country.” This changing patient profile is indicated in the admissions: 10% of male admissions to Bethlem in 1845-55 were clerks (compared to just 0.01% of the population), while 7% of female admissions were governesses or school mistresses (again, just 0.01% of all women were governesses).

In reflection of this changing class of patient, the Hospital’s wards increasingly came to resemble the Victorian domestic ideal: as the Illustrated London News put it, “that which was once a prison-cell has now become a cheery, domestic room,” while Freeman’s Journal later described photographs of the late nineteenth century hospital as “luxurious” and of “hotel-like magnificence.” This was in line with similar changes described at St Luke’s by Charles Dickens, in his article A Curious Dance Round a Curious Tree. Nonetheless, most contemporary observers were aware that these changes might be little consolation for many patients. As the correspondent from the Illustrated London News concluded: “I thought of the luxuries and the comforts, the plants and the pet animals, the books and the periodicals, the billiard and the ball room, the skill and tenderness of the physician; but all these, to my mind, would not fill up the vast abyss of human mental misery yawning beneath the lofty dome in St George’s fields…”

In the Frame for July 2010

The Archivist writes:

My painting of the month is On the Ward, a cartoon vignette of a Maudsley Hospital ward, drawn – we think in the 1940s – by someone known only as ‘Nelson’. The scene depicted is one of pathos and black humour in turns, as the bedridden patients each face private dramas of varying degrees of implausibility.

Above the mantelpiece, where in a 1940s hospital you might expect to find a portrait of the King, hangs a caricature of what appears to be the Maudsley’s medical superintendent. A man is sitting up in bed to the right of the fireplace, reading a book titled Blood and Gore. He is sweating profusely, his face is contorted and his head is pounding. To his right, another man sleeps, but not soundly: in an age of rationing and austerity, he dreams of pork chops. Others dream of ‘Battle of Britain’ dogfights and of saws cutting through wood. Those awake are variously pictured playing a panoply of musical instruments, being prodded by a doctor with a bag of nasty-looking tools and team of inquisitive onlookers beside him, or selling prayer shawls to bickering nurses.

The scene is deliberately far-fetched, and yet it sounds an authentic note of frustration at the want of privacy and purposeful activity on a psychiatric ward. Thomas Hennell, a Maudsley patient of the 1930s and another artist, complained in his autobiography that “we were kept in bed, and to some extent under drugs and suggestion…the most comfortable state was one of half-dozing; in this condition the mind seemed to get physical relief; but the conscious waste of time was very troublesome, and, on the other hand, reading was burdensome, and quickly produced a confused and turbid state” (The Witnesses, p. 167). On the Ward seems to have been ‘Nelson’s’ mock celebration of this enervating state of affairs.

Life in a Victorian Asylum 1

Following investigation and subsequent reform in the early half of the nineteenth century (1815 and 1852), Bethlem Hospital increasingly became a very domestic environment, as pictured in the Illustrated London News in 1860. The accompanying article attributed the changes in the Hospital entirely to Bethlem’s new “skilful and benevolent” resident-physician, W. Charles Hood, appointed in 1853; however, the published annual reports show that a large number of changes had already been made under the previous charge of Sir Alexander Morison and Edward T. Monro, the visiting physicians. In 1845, they reported that “much attention has been paid to the amusements of the patients during the past year. The library, billiard and bagatelle rooms are very generally occupied on the male side by the better classes, and much interest excited by books, cards and games.”

These additions to activities in the Hospital, and improvements in the therapeutic environment, were continued by Hood, who adhered strongly to the twin ideals of moral treatment (cure through re-education, with a clear emphasis on environmental and occupational, rather than strictly medical, therapies) and non-restraint (complete abandonment of any type of mechanical restraint, including straps, straight-waistcoats etc. Seclusion, however, was permitted).

Welcome to the Bethlem Royal Hospital Archives and Museum Blog

This blog has been set up by the Bethlem Royal Hospital Archives and Museum and will provide regular updates on the Museum Relocation Project and other activities of the Archives and Museum, written by the small staff team, as well as interesting historical notes from the archives – 450 years of mental health history, including personal accounts of mental illness before 1900 – written by staff and researchers.