![]() Foucault’s analysis was cotemporaneous and convergent with that of the anti-psychiatry movement, which regarded mental illness as socially fabricated and those afflicted as wrongfully confined and medicated. Scull took a Marxist perspective in his analysis, 18 which fits with his description of asylums as “Warehouses of the Unwanted”, “largely receptacles for the confinement of the impossible, the inconvenient and the inept”, 19 the economically unproductive sector of the population. ![]() Their conclusions linked to the theoretical and ideological standpoints which they held. 16 Despite good intentions of the reformers, as sometimes revealed verbatim in their reports in Hansard, 17Sculland Foucault identified the underlying ethos of the asylums as inherently and inevitably damaging to those within. These notions contributed constructively to new lunacy legislation, asylum building and asylum care in England. 15 Even though, like leprosy, mental disorders were tainted by fear and stigma, in the nineteenth century there was also a public perception that people with disturbed minds required protection, care and compassion. Scull took as his starting point that the asylums, mainly established in the nineteenth century, were associated with defining a problem population and incarcerating them “in a specialised, bureaucratically organised, state-supported asylum system which isolated them geographically and symbolically from the larger society.” 14Foucault also attributed asylums’ rural locations to the public desire to segregate “mad” people from the majority of the population, drawing analogies between asylums and leper houses of the middle ages. Mid- to late twentieth century historical interpretation of the lunatic asylums was contentious and damning, including the persuasive and influential analyses by Andrew Sculland Michel Foucault. To comprehend how the asylums coped with the crisis of the Great War, it is necessary to understand their development, and disentangle fact from fiction. ![]() The asylum story may also contribute to debate and shed light on the mechanisms and processes underlying standards of mental health services in other periods of austerity, including in the first decades of the twenty-first century. The narrative overlaps with the direct effects of war on the mental health of military personnel and civilians living in the community, material which is used here to help contextualise and explain what happened in the asylums. It tells the story of four asylums on the periphery of London to the north of the River Thames at a time of national turmoil, when intense austerity, deprivation and competing priorities affected those within them. 13 No in-depth historical studies have specifically drawn together the various elements of the story to provide a contextualised and detailed analysis, as this book sets out to do. 12 By contrast, the historiography of civilian asylums and their patients at the same time is meagre, featuring in a few academic journal articles and chapters in some general asylum histories. 11Ī substantial historiography exists on “shell shock”, the syndrome of mental disturbances suffered by war-traumatised soldiers during the First World War. The situation was a sad commentary on the low social priorities attached to people identified as suffering from mental disorders. Wartime shortages of staff and material goods, and overcrowdingafter the War Office requisitioned asylums to use as military hospitals, were associated with a calamitous fall in standards of care for mentally unwell civilian patients. By the beginning of the war, in England and Wales, an average asylum had 1000 beds 10 and over 100,000 people were certified as pauper lunatics. ![]() The increasing size of asylums, beyond that which could be accounted for by demographic changes, is likely to have been due to the decades-long mental disability caused by chronic psychotic disorders, such as schizophrenia, 9 accompanied by a changing balance of therapeutic interventions and custodial care. ![]() 8 There is no evidence that the type or severity of mental disorders accounted for the changes. 7 The death rate remained stable, but the discharge rate declined. Total annual admissions rose steeply after 1890, associated with the new Lunacy Act, but then stayed roughly in line with demographic trends (Fig. By 1870, public asylums had an average of 500 beds. ![]()
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