Posts Tagged 'patient letters'

Life in a Victorian Asylum 3: Patient Rights

It’s easy to assume that, once inside in an asylum, Victorian patients had no rights whatsoever. Many were, however, well able to communicate with the outside world. Letters to the Commissioners in Lunacy or the Home Office – or, in the case of many private patients, their solicitors – were by law to be forwarded unopened. Other letters could be checked by the medical officers, but had to be shown subsequently to the Commissioners, to ensure that this had been done to protect the patient or prevent offence to others: a fine of £20 was payable if letters had been wrongly withheld. Although the decision to withhold letters does seem to have been made fairly often (given the numbers of letters addressed to outside parties pasted into patient records), there are also occasions when patients’ letters appear in the case books alongside a complaint from a relative who has returned them, urging the Hospital to be more strict in their censorship. There was, then, no hard and fast rule as to what was considered permissible.

In January 1895, a middle-aged gentleman by the name of Edward Peter King was admitted to Bethlem. King’s case well illustrates the lines of communication open to an asylum patient in the late nineteenth century. Diagnosed with mania, he was regarded as talkative and troublesome. He was constantly writing letters to the Home Office which, rather to his doctors’ annoyance, were often responded to, making him “more fixed in his idea about his importance & the interest taken in him by the State.” Several months after his admission, King ensured that he received a second medical opinion on his case after writing two letters to the eminent George Savage (a previous Bethlem superintendent) asking him to call, which he did, noting that “at all events I consider him insane as far as CONDUCT is concerned & if at large I believe he will always be getting into scrapes.”

King certainly managed to get into a number of “scrapes” even at Bethlem, apparently irritating his fellow patients by constantly passing wind audibly (on one occasion this so aggravated a Mr Rowland that he threw a book at King, and tried to follow this up with a vase before being stopped by an attendant). On March 8 the Commissioners in Lunacy investigated King’s case, after the patient wrote to the Home Office saying he had not been allowed to visit two dying relatives: a request the Hospital claimed neither the patient nor his relatives had ever made.

With the medical officers checking his post, King made full use of his legitimate channels of communication: the Home Office, the Commissioners in Lunacy, and his solicitor. To the latter, he frequently sent bulky packages, containing letters to be passed on elsewhere (much to the despair of his doctors, who regularly lamented his ingenuity in bypassing their regulations), or advertisements to be placed in the press. In late March, for example, one of these appeared in the Morning Post, asking “parents and guardians” to provide “steady well-educated Young Gentlemen as ARTICLED PUPILS for five years” for a “high-class sixpenny illustrated paper” he wished to start up.

King’s frequent letter-writing was sometimes an embarrassment to the Hospital: in particular, when the patient received a letter from the Home Secretary asking him to give evidence in an enquiry into Holloway Sanatorium, but nothing official was sent to the Hospital. From the tone of the case book, it seems that the medical officers may have found some truth in King’s contention that “the Home Secretary looks upon us [i.e. the Hospital staff] with contempt”.

Edward King was discharged well, just four months after admission, although his life immediately following release does not seem to have been an easy one. It was later recorded that he had spent time in several prisons, and he returned to Bethlem at least once, to try and borrow £1 (which was refused). Although the level of correspondence King maintained while at Bethlem was unusual, his case is a particularly strong example of that way in which, even when certified, a late-nineteenth century patient might still interact to a considerable extent with the world beyond the asylum.


Curatorial Conversations XIV

The last essay included in Catherine Coleborne and Dolly MacKinnon’s volume Exhibiting Madness in Museums (our ‘conversation partner’ on this thread over the past year or so) is written by Fiona Parrott and begins: “Studies of psychiatric collecting have tended to focus on the material and visual traces of institutional environments of the past, rather than privileging the traces and presence of patients inside these institutions”.1 On a casual reading, this looks like a criticism, an accusation of bias either on the part of the psychiatric collections or those that have studied them . Yet there is a perfectly innocuous explanation for this tendency. When patients leave hospital – any hospital – they generally take their property with them, and their collections stay private as a consequence. In this regard the exhibition The Lives They Left Behind: Suitcases from a State Hospital Attic is the exception that proves the rule. (Interestingly, Fiona Parrott’s essay describes the reluctance of today’s medium secure unit residents to decorate their rooms with possessions or even put posters on the walls, saying things like “I don’t want to make it look like I’m here for a long-time”.2) As a result, psychiatric collections, artefactual or archival, tend to consist largely of institutional records, which rarely contain unmediated accounts of the attitudes of patients, or of the general public, towards mental healthcare.

At first glance, the collections here at Bethlem are of this institutional nature. Indeed, the Archives & Museum is appointed as a place of deposit for the public records of the NHS Foundation Trust of which it is a part and its antecedents. Yet a little digging shows that the perspectives of patients are never far from the surface, even in the unlikeliest of places. Amongst the building records for the third hospital at St George’s Fields, for example, lie a set of plans and descriptions by the patient James Tilly Matthews, “probably for the first time ever, designs by a lunatic for a lunatic asylum, conceived not from the perspective of the doctors who will manage it but [from that of] the patients who will live in it”, according to Matthews’ biographer.3 There are, of course, more obvious places in our to look in our collections for patient perspectives. This blog’s In the Frame thread is an ongoing reminder of the breadth of our holdings of service user art.

Bethlem’s Victorian medical records open yet another window onto first-hand experiences at the Hospital. Contained in large casebooks, the majority of the record is written at one remove from the patients by Bethlem doctors. However, included in these books from time to time are letters from patients (and sometimes their relatives) to the Hospital, written during or after their stay. A wide range of modes of negotiation is represented here – complaint, threat, entreaty, gratitude. This is a valuable primary source for the patient side of the doctor-patient encounter, one which we hope to utilise in displays planned for our new museum. Though the curatorial conversations that are preparatory to our relocation are continuing, we have decided to close this particular thread of our blog, if only to make way for the discussion of other topics. Research into patients’ letters has already prompted more than one blog post, and we trust that it will prove a rich seam from which we can draw for future posts.

1 F.R. Parrott, The Material and Visual Culture of Patients in a Contemporary Psychiatric Secure Unit’, in Catherine Coleborne and Dolly MacKinnon, Exhibiting Madness in Museums: Remembering Psychiatry through Collections and Display (Routledge, 2011), page 178.

2 ibid., page 181-183.

3 Mike Jay, The Influencing Machine: James Tilly Matthews and the Air Loom (Strange Attractor Press, 2012), p. 186.


A glimpse inside a medium secure unit bedroom