Rise of Asylums in Nineteenth Century England: Capitalism, Mental Illness, and Social
Asylums occupy a distinct place in the history of psychiatry and mental illness. The purpose of the present work is to analyse why asylums became the primary mode of treating mental illness in the nineteenth century. The paper traces the evolution of asylums in response to the growing prevalence of mental illness and the factors behind those shifts. Capitalism, industrialisation, and the economic boom are claimed to have greatly contributed to the changing epidemiology of mental sickness in the 19th century. Other factors such as changes in family routines, the rise of mad-doctors and private asylums, and the tightening social control of the state over its subjects are considered. The complexity of the socioeconomic, historical and cultural contexts which facilitated and favoured the rapid popularisation of asylums as the foundational feature of the mental healthcare system in England is analysed.
Madness as both a disease and a feature of the human character enjoyed diverse conceptualisations in medicine, mental health, and social sciences. However, by the beginning of the nineteenth century, it had become one of the driving forces behind the profound restructuring of the medical, mental health, and social systems in the country and elsewhere. The end of the 18th – the beginning of the 19th centuries was the period of sweeping transformations, which had far-reaching implications for all areas of human performance. However, nowhere else were those transformations as radical and lasting as the in the asylum system. In fact, before the nineteenth century, England could hardly boast having a well-developed network of mental health facilities. Just a century later, the country would make a revolution in its approaches to mental health, turning asylums into the foundational component of most, if not all, treatment strategies. Numerous factors contributed to that change. Moreover, the rise of asylums as the mainstay of England's mental health system was a logical extension of the economic, social, and cognitive shifts facing the country. It would be fair to say that the asylum became the most popular way to treat mental illness in the nineteenth century, due to the growing incidence of mental illness, changes in family routines, the promising profitability and subsequent professionalisation of mental health facilities, as well as the growing power of the state as an instrument of social control over its subjects.
The history of psychiatry in England and the rest of the world is inextricably linked to the stories surrounding the emergence and gradual popularisation of asylums as the primary place for confining mentally sick. In fact, one can never develop a holistic understanding of psychiatry and its evolution over centuries without considering the factors, which stood behind the rise of asylums as a distinct treatment ideology. "No period of history can be considered in isolation: history is a continuum, and any period must be seen in relation to what came before. In other words, what follows later must be seen in the context of the events of at least the previous half-century" (Rollin, 2003, p. 292). Asylums exemplify a perfect illustration of such historical continuities. Their spreading throughout 19th century England was a compound product of multiple historical, social, economic, and cultural influences.
The asylum became the most popular way to treat mental illness in the nineteenth century mostly due to the unprecedented increase in the number of mentally sick individuals. Of course, this assumption was questioned more than once. Some researchers like Hill and Laugharne argue that asylums mushroomed not because the number of the mentally sick increased but because the overall tolerance to mental illness in the British society rapidly decreased. Others like Rollin refer to unparalleled population growth between the eighteenth and nineteenth centuries: for example, between 1760 and 1820 the number of people living in England and Wales showed a steep increase, from 7 to nearly 12 million. By 1890, more than 30 million people lived there. In any case, that the absolute number of citizens requiring high-quality medical assistance and confinement due to their mental health issues increased was apparent. Those demographic changes necessitated the development of urgent and massive measures to curb the endemic. Asylums became a weapon of choice for the medical professionals and authorities in England. They launched a whole sequence of transformations, which increased the number of public and private asylums across the country, turning them into an acceptable measure of treating mentally sick.
In fact, the current assumptions of the madness epidemic in the nineteenth century sound quite plausible, given the complex relationship between economic difficulties and mental health troubles. Porter confirms that the rise of capitalism, demographic shifts, dislocation and disruptions in the historically accepted socioeconomic routines created optimal conditions for the development of mental illness. Industrialization separated people from nature. Economic austerity left little room for restoring traditional community links. Face-to-face interactions suddenly gave place to commercial relationships, which left little room for human feelings. Individualism and competition created an unbeatable sense of anxiety, which created a fertile ground for the development of multiple cognitive and emotional disorders. It is quite possible that the nineteenth century saw an upsurge in the number of mentally disturbed individuals, which further reinforced the need for building more asylums across the country. However, the abovementioned social and economic changes also changed the public attitudes to mental illness, which predetermined the rising power of asylums in treating mental illness.
The 19th century was the time of remarkable shifts in how the British society perceived mental illness. As mentioned earlier, the overall tolerance to the presence of mentally sick individuals in public rapidly declined. Simultaneously, healthy people had to spend more time at work. They also wanted to enjoy simple and small pleasures by the time they returned home, instead of spending it all on their significant others. Thus, mental instability became the primary justification for confining unhealthy individuals. According to Porter, in the 19th century, most mentally sick individuals were taken to asylums on the initiative of their families and friends rather than authorities. The priority of familial support was replaced by the priority of personal leisure and pastime, and asylums were expected to undertake the new responsibility for managing mentally disturbed individuals on behalf of the state or family members, who were willing to pay for the timely provision of high-quality services. In that controversial context, the growing number of families who wanted to get rid of their mentally sick members or relatives led to the monetisation and simultaneous professionalisation of mental health care, which also favoured the rise of asylums as the primary means for treating mentally ill.
The 19th century was the time when public asylums in England enjoyed the growing popularity, but it is private madhouses that took the lead in transforming the system of mental healthcare, turning asylums into the most popular way to treat mental illness. In economic terms, the logic was simple and straightforward: asylums became popular in response to the growing demand for their services. As Porter puts it, the remarkable popularisation of asylums accompanied the birth of a consumer society, which commodified insanity turning it into a profitable object of trade. Mad-doctors in the 19th century emerged as a new caste of professionals, who enjoyed a privileged position and used their power to earn tangible revenues and profits. Many of those doctors captured the emerging career opportunities. Many others used the new social and healthcare contexts to test their psychiatric theories and institutional practices in treating mentally ill. In any case, the profession of mad-doctors was thriving at that time. Asylums grew in response to the growing demand for quality mental health services, and mad doctors of the nineteenth century were immediately there to attend to changing healthcare needs of the English society. They became the so-called mental entrepreneurs who reshaped the vision of mental health care and carved out a distinct sector of healthcare services. Those changes were particularly successful and lasting, given the growing power of the state in controlling the lives of citizens.
The growing power of the state as an instrument of control over its subjects was another essential factor behind the growth of asylums in the nineteenth century. Stories of the subjects who were confined as a result of misbalanced actions of the state abound. For example, in 1840, the state confined infamous Professor Edward Peithman on the basis that he had entered the Buckingham Palace without invitation and appointment. In reality, Peithman was not aware of the protocol and the entire case was a matter of sheer misunderstanding. However, Professor had to spend months in Bethlehem, before his sanity was confirmed. The case was a reflection of the tightening control over mentally ill persons that came to action during the Enlightenment, at the end of the 18th century. The Lunacy Act of 1845 was a reflection of that control, which systematised and governed the evolution of mental health care at that time. Although many of then mental health practices later became obsolete or were outlawed, the nineteenth century set the stage for the gradual transformation of mental healthcare as a separate component of the healthcare system in England and the rest of the world.
In conclusion, asylums became the primary way to treat mental illness in the nineteenth century. The rapid popularisation of asylums was a product of multiple historical, socioeconomic, and cultural influences. Industrialisation, capitalist production, and the economic boom altered most societal routines, leading to the growing prevalence of mental illness, coupled with a stronger desire of family caregivers to keep their mentally instable in institutional confinement. With the growing demand for institutional services, private asylums and mad-doctor practices mushroomed, turning mental sickness into a convenient commodity and an object of trade. Ultimately, asylums became a measure of the tightening social control of the state over its subjects. The historical context favoured the evolution of asylums into an acceptable measure for managing mentally sick individuals.