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Madhouses and Mental Hospitals

Mary Shaw, 'Simple mania' patient at West Riding Lunatic Asylum. Credit: Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

What was an asylum?

From The Victorian Asylum, by Sarah Rutherford:

"Defined as 'an institution for the shelter and support of afflicted or destitute persons, in particular, for the insane', the asylum was one of many institutions developed as essential parts of Victorian society [...] Each had its own community, based on a great building, park and gardens, and was intended to be therapeutic and to help cure the patients. 

Asylums had spread through much of the world by 1914, but most have become redundant. Many survived into the late 20th century as working psychiatric hospitals treating patients, many of whom lived in them for years, and for whom they were home." 


The History of Asylums

The first purpose-built building devoted to insane patients was the Bethlem Hospital in 1676. Commonly known as Bedlam, this is where the (usually derogative) terms surrounding that name come from. It had a bad and notorious reputation, and made money from letting wealthy sightseers visit and ogle patients in distress.

In the 18th century, a 'trade in lunacy' grew rapidly, and sprouted many madhouses which took in private patients who were paid for by relations or parish authorities. These madhouses ranged from normal houses which just locked the insane person in a spare room, up to bigger establishments such as the charitable asylum in York called The Retreat which used more humane methods of treatment like 'moral therapy'.

The 1845 Lunatics Act made counties provide for pauper lunatics, which led to a great boom in asylum building from the middle of the 19th century. Visits and inspections of asylums became normal practice. Admissions were more thorough and safer (theoretically).

On admission, patients' conditions were recorded in casebooks. Few patients were released as 'cured'. Admissions increased until the county pauper asylums became so-called warehouses for the mad. There could be thousands of patients in one asylum.

Reasons for admission varied. Child-bearing (post-natal depression), physical trauma, eccentricity, epilepsy, imbecility (learning difficulties) were just a few. For many poor people, life inside could be better than at home. There were modern facilities like running water and gas lighting, and a reliable supply of wholesome and varied food and drink. Dances and concerts were regularly held. There were fetes in summer, board games, sports facilities, reading material, and knitting.

However, privacy was scarce. Days were strictly regimented. Visits from friends and family were rare. Treatments varied from archaic blood-letting, to mechanical restraints, to drugs like morphia, to working in the asylum itself.

In the 20th century, the post-war world entertained more liberal ideas. New drugs brought more effective relief and enabled greater control of patients' conditions. The 'open door' policy led to the unlocking of ward doors, and patients were no longer put to work. As Rutherford states, "There was a perceived need in the mid-20th century for 'therapeutic community systems' rather than large impersonal institutions: 'care in the community' was the new theory."


Find out more...

Some fabulous fiction containing asylums include:

For non-fiction, I can recommend:

To see what life was like in a psychiatric ward in the 1950s, and to see the inspiration for my own Ward 13, check out this video on YouTube. 


To see all of this information in action, check out my book, Woman on Ward 13.

About the author

Delphine Woods

Delphine Woods

Delphine Woods is an author who loves to write historical mysteries and thrillers. 

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