Scull started by describing the feelings surrounding psychiatric hospitals in the 1950s: they had become places of ‘degradation’, physically decrepit and socially unacceptable. At a time when the population of these hospitals had begun to decline, there was concern about what would become of the decaying buildings. This view was in stark contrast to the early nineteenth century when the Royal Edinburgh Hospital (REH) was founded. Jonathan Connolly, a contemporary English psychiatrist saw asylums (as they were then known) as places to “restore tranquillity”. His Scottish counterpart, W.A.F. Browne believed in ‘moral treatment’, a move away from the eighteenth century ‘madhouses’ which, established in a period of little regulation, were essentially private enterprises, making money from the ‘trade in lunacy’. There was a great variation in the quality of care and some became notorious, such as Bethlem Asylum, rebuilt in 1676. The use of space was a key feature of the reformed asylums and the layout of the REH was no accident of design. In contrast to the converted mansions from which the old ‘madhouses’ were usually made, the new asylums were designed to a plan: science and humanity were to be employed to counteract barbarity in a utopian experiment.
Despite the public scandal whipped up by a series of investigations, change was slow to arrive: public asylums were expensive to build, and doctors at private asylums had a powerful voice to lobby against change. It was not until the Lunacy Acts (1845 in England, 1857 in Scotland) that it became compulsory for parishes to use public money to provide care for the mentally ill, and a Commissioner in Lunacy appointed to oversee them. W.A.F. Browne became the first Scottish Commissioner. His belief in ‘moral treatment’ included the idea of classification: separating the most disturbed patients from the calmest, and rewarding ‘good behaviour’. This proved to be less successful in big asylums, only working in small enterprises, and the numbers of long-term patients grew. Asylums became strange places, isolated from the communities they served. In 1845, there had been 12,000 asylum patients in the UK but by 1900, this had risen to 100,000, hence the vast institutions that had become so discredited by the 1950s.
This talk provided the context for the setting up of the REH, and some of the therapeutic ideas prevalent at the time. It set the scene for the seven lectures to come and we look forward to John Burnett’s talk on sport and health at the REH on 14 November. Please visit our website to find out more about the lecture series, and there will be more to follow about our Archive Appeal.
The City Chambers just before the lecture started