Louise Hide. Gender and Class in English Asylums, 1890-1914. Houndmills: Palgrave Macmillan, 2014. 240 pp. $100.00 (cloth), ISBN 978-1-137-32142-8.
Reviewed by Dee Hoole (University of Aberdeen)
Published on H-Disability (June, 2016)
Commissioned by Iain C. Hutchison (University of Glasgow)
During her childhood, Louise Hide lived on the grounds of a large asylum where her father worked and where her grandmother was an inmate. Indeed, Hide briefly trained as a psychiatric nurse. These associations explain the basis of her interest and understanding of a subject that builds on her doctoral research. It is never easy to illuminate the lives of the institutionalized insane. However, Hide brings together elements of the lives and experiences of asylum inmates and staff at the turn of the twentieth century. Her book is an informative and interesting addition to the expanding body of work concerning asylums in the late Victorian and Edwardian periods, particularly since the time period covered, 1890-1914, was an era of increasing state concern for, and intervention in, the welfare of insane people.
The book is written in such a way as to be easily accessible and enjoyed by readers who may not have previous knowledge of the asylum system. There are eight chapters of roughly the same length, which include not only the patient experience but also that of medical officers, attendants, and nurses. Although the narrative is not strictly chronological, the organization of this work is clearly presented. Most matters concerning the rise in insanity are clearly and concisely explained in the first chapter titled “The Making of the Patient Population.” Each chapter contains a series of subheadings that are easy to navigate and that direct focus on to interrelated topics of discussion. The endnotes are comprehensive and numerous, as is the rich bibliography. Hide’s research builds a composite picture of this time period in huge institutions. She utilizes letters, case notes, and official reports, and she uses what she terms an “ethnographic approach” from which she illuminates the minutiae of daily life, and the regimes that were followed in the asylum, to produce the lived experiences of both patients and staff (p. 3). This begins in the introduction, where contrasting accounts are given of a boy and girl of a similar age who were admitted to Bexley Asylum. Both had chronic mental disorders, but their “outcomes” were very different—one was discharged while the other sank into mental and physical decline and died shortly afterward in the asylum. The questions that arise from these two cases lead into the narrative of life, treatment, regimes, hierarchies, and the interplay between these issues.
This research is predicated on the study of two large London County Council (LCC) mental institutions. Claybury Asylum, in Woodford, Essex, opened in 1893, and Bexley Asylum, in Kent, opened in 1898. The asylums were of similar size, each housing approximately two thousand patients and four hundred staff, and held part of what Hide terms “London’s burgeoning ‘lunatic’ population” (p. 4). As might be expected, there are many similarities, but Hide does not utilize a consistently comparative approach in discussing the two asylums. The explanation is that the surviving case notes are more comprehensive for Bexley than Claybury, yet despite this, the book places greater emphasis on Claybury. There are several photographs and plans of Claybury in the book, while there is just one image of Bexley Asylum. English asylums are discussed briefly, but the reality is that this work is of a narrower focus than the title suggests. The title is misleading, especially if the reader is expecting a wider geographic examination of English asylum life. This is problematic since we need to know much more about the approach of other asylums to the issues discussed by Hide in order to judge if Claybury and Bexley are representative of the care in large asylums nationwide. So we are left questioning the broader patterns and frameworks that underpinned asylum life and work, and the issues of gender and class, nationwide.
The influence of two young and progressive medical superintendents, Robert Jones, later Sir Robert Armstrong-Jones (1857-1943) at Claybury, and T. E. K. Stansfield (1862-1939) at Bexley, is evident in the approach to the professionalization of the staff. It was a time that preceded the metamorphosis of the alienist profession into psychiatrists, but it is clear that these men had ambitions for change through introduction of enlightened policies predicated on the psychological debates of the period. One contentious issue dealt with in detail is the presence of female medical officers at Claybury during the 1890s. The reactions of staff and the asylum committees to their presence make the chapter on medical officers particularly interesting. It is clear that, at Claybury, the professional progress of these female alienists was fraught with difficulties, leading to one female doctor becoming a patient, apparently suffering from delusions and hallucinations and talking of suicide. Hide clearly demonstrates that women doctors were seen by the asylum committee as “the wrong sex in the wrong job”; they concluded that they were “unequal to the heavy duties demanded of them” (pp. 62, 63). Opposition, and indeed contempt, toward these pioneering “lady” doctors was expressed openly by their male colleagues, which makes their marginalization unsurprising.
An understanding of contemporary issues that influenced the care and treatment of the chronic mentally disordered is evident throughout this work. Consideration is made of the widely held eugenic attitudes of the period, the predisposition to mental disorder, the degeneration theory of faulty inheritance, the disorder general paralysis of the insane, and the influence of alcohol as a predisposing cause of insanity. Ever present within society was the stigma associated with admission to an asylum, and this was particularly prevalent among the working classes and, arguably, remained the case throughout the twentieth century. It was also a period of wider socioeconomic change. The social backgrounds of many asylum patients reflect this. It was working-class inmates of the asylum who made up the vast majority of pauper lunatic admissions and, at Claybury, most patients came from the poor parishes of the East End of London. Yet there were some private patients in both asylums, the differences in their living conditions and the differences in their treatment and care by the staff is revealed for this more privileged class of patient. For example, at Claybury, male private patients were housed in a separate mansion away from the main blocks containing pauper lunatics. Private patients were provided with a better diet and were permitted to eat apart rather than in a communal dining hall. Additionally, in many instances attendants for such patients were deployed in a very different capacity than occurred in the general asylum wards, fulfilling a role more as servants than attendants. Private patients were also allowed certain other privileges not available to pauper lunatics, such as being able to wear their own clothes and having access to the asylum grounds for their recreation rather than the airing courts frequented by the ordinary asylum population. Between the two asylums, differences in the care of patients generally are also apparent. For example, at Bexley, in 1907, it was standard practice to confine newly admitted patients to bed for a week, although it is unclear if this was practiced on private as well as pauper patients.
Gender is a central focus throughout this book and gendered space within the asylum extended even to the degree of designated male and female mortuaries—at Claybury there was segregation even in death. There were also embargoes on workmen and male attendants being allowed within female wards, and male doctors were chaperoned by female nurses on evening visits to female wards. The sexes mixed briefly at times during church attendance or when allowed to attend dances but it is clear that there was strong supervision during all such meetings. Gender was also a consideration when staffing wards with female nurses; at first they were only allowed to work on female wards. Despite the fact that female nurses were paid less than male attendants, it appears that female doctors received the same salary as their male counterparts, which perhaps reflects their different class status. Work within, and to the benefit of, the asylum inevitably played a large part in enabling those of both sexes who were able to benefit from this form of moral therapy. It was a significant part of the rehabilitation for the mentally disordered, potentially re-equipping many for life outside the asylum. Quite a lot of the chapter concerning the asylum regime is given over to the different aspects of work undertaken by patients, ranging from skilled workshops to household chores.
The questions surrounding how life was lived within these closed institutions are multifaceted and interwoven with contemporary concerns. The complexities of custodial care and the management of such institutions were driven by Victorian and Edwardian ideas that affected patients’ experiences. Additionally, this was in conjunction with, on the one hand, the evolving nature of poor law care, and on the other hand, the drive by the Medico-Psychological Association (MPA) to raise standards within the profession. Theory, medical policy, and clinical practice had to operate successfully in conjunction with each other in order to deliver a more modern approach to patient care and treatment. The transition from an asylum to the modern mental hospital is an important element of this research and a chapter is devoted to this topic. While it was apparent that 1890 to 1914 was indeed a period of transition for these two asylums, more generally it was a picture of slow improvement. Change within other institutions was far from universal and more limited than Hide intimates. The transition continued well beyond 1914, and in many provincial asylums it continued for more than a decade after the end of Hide’s research period. Therefore, even though she acknowledges that it was “ideologically ... the beginning of the end of the asylum era,” it seems unconvincing to suggest that this period resulted in progressive institutions becoming transformed entirely, or quickly, not least because of the disruption caused to asylums during World War One, which delayed change significantly (p. 4).
Clearly, this is a book that should be read alongside other asylum histories to gain wider understanding of asylum practices. Regimes of care varied between institutions and this point is not fully apparent in this study of two London asylums. The unprecedented growth of London’s population and the pressures that this growth put upon ordinary lives were perhaps greater than in other English cities. Hide refers to London’s “crisis in lunacy,” highlighting that, between 1898 and 1909, 96-98 percent of London’s insane were incarcerated in county asylums. It is unsurprising, therefore, that the Commissioners in Lunacy conceded circa 1911 that “patients were more likely to leave the asylum in a coffin than to be discharged recovered” (p. 21). No statistical tables concerning gender or class, recoveries, rates of discharge, lengths of stay, or deaths for Bexley or Claybury are provided. Therefore, it is not possible to assess these particular asylums’ success or failure in terms of care and treatment. The tables that are included are all general tables concerning figures and percentages for England and Wales and all appear in a single chapter. The figures that do appear in the narrative detailing lengths of stay, deaths, etc., are largely collective figures for a total of ten London county asylums. Individual asylum tables might have allowed some useful comparisons between Claybury and Bexley and indeed other LCC asylums.
Although much of what took place in the asylum wards was not recorded by staff, Hide has managed to amass a wealth of detail for Claybury and Bexley, such as the statistic that up to one thousand visitors came to Claybury Asylum each Sunday. She has captured the chaos, the misery, and the routine, as well as the communalities and contradictions that constituted the lived experiences of patients. She has examined the complex relationships between arguably disparate groups—patients, attendants, nurses, medical officers, and leading alienists of the time. Despite the limitations discussed, this study is well researched, and the author shows a depth of understanding that makes this book an enjoyable read. This book certainly achieves Hide’s aim by providing a fascinating insight into “real lives experiences by real people” (p. xi). Consequently, it will be useful to many scholars of asylum, medical, and social history.
If there is additional discussion of this review, you may access it through the network, at: https://networks.h-net.org/h-disability.
Dee Hoole. Review of Hide, Louise, Gender and Class in English Asylums, 1890-1914.
H-Disability, H-Net Reviews.
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