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What do you think of when someone says Mental Asylum? Hannibal Lecter? Cages?
Bars? Padded rooms? Screaming? Babbling? A while back I stumbled across an incredibly foolhardy group of people called urban explorers who break into and photograph the rotting abandoned hulks of mental asylums and old hospitals across the UK. As I browsed the fascinating photographs of these places, looked at the remains of the wards, the equipment left behind and the poignant remains of everyday life, I was curious about the people who had been housed here and who had made their lives in these places. So it was off to Amazon (where else?) and this was the first book I ordered.
Presumed Curable is an illustrated casebook of 61 Victorian patients from the very famous Bethlehem Royal Hospital, also known as Bethlem or Bedlam. A mental asylum since 1247, at the time of these patients (1885-1896) it held around 250. The title of this book refers to its policy at the time of only taking patients who they believed had a chance of being cured. Epileptics and people with genetic etc disorders were not admitted as they were considered incurable. At this time it no longer took pauper patients, preferring instead middle and lower middle class patients, governesses, clerks etc. It principally relied on providing a therapeutic environment (hydrotherapy baths, drugs, shock therapy and temporary isolation) and its cure rate was claimed at 50%. Certain restraints were also used as remedial measures e.g. padded jackets that secured the arms at the waist and padded gloves. Patients were allowed relative freedom, day trips and unsupervised walks, a far cry from the medieval and early modern descriptions of the hospital.
The book begins with a preface about the nature of psychiatry and how little we still understand about many of these disorders, but also how some of the latest advances e.g. in schizophrenia could have saved many of these people a whole lifetime of institutionalisation.
There is then a 13 page introduction to Bethlem hospital, the patients, their lives and the doctors who controlled their treatments, illustrated with fascinating pictures of therapeutic groups, the hospital grounds, and contempory cartoons from the time. This overview is a very interesting and accessible introduction to the subject for those to who are new to the subject, and a nice refresher for those who are more familiar.
Then there are the patients. Each patient gets one or two pages with a photograph of themselves. You needed to be certified insane by two doctors under the Lunacy Act, and these certificates have been printed in full next to the photograph. There then follows a concise account of their time, treatment and progress whilst in the hospital, ending when they are discharged uncured to further asylums or are certified sane.
The patient on the front cover for instance, with the roughly chopped hair and padded hospital jacket is Theodora Weston, aged 23. She was admitted in 1894 with a diagnosis of melancholia. She was violent, prone to fantasies and given prolonged baths (up to seven hours a day) in order to try and cure her. She was discharged in 1895, uncured.
The patients stories are in chronological order and according to the authors are supposed to be representative of the 50% cure rate and higher rate of female admissions. The photographs themselves were not regularly taken on admission, but were taken randomly for diagnostic purposes, to train up doctors in identifying mental illness from looking at the persons face.
Some of the pictures and stories are amusing, some are disturbing and some are full of pathos. Above all they depict people, ordinary people who are normally lost in those crowded Victorian photographs displayed in museums and photo albums. We are provided with names, ages, jobs, little fascinating details of their lives which make the period come alive. I spent considerable time just looking at the clothes and hair, it is not often we get such a glimpse into lives and clothes of people of this class as it they do not attract the same attention as the very poor and very rich. This is just a single intriguing snapshot into their lives, once they leave the asylum they fall out of sight again. The authors argue that by naming the patients they have prevented them from being treated impassively and I agree, they bring out the real human side of psychiatry, mental health and the asylum system. These people were amalgamated and institutionalised in life, 100 years later we can see at least some of them as individuals. These stories are completely unique and offer also a real understanding of Victorian attitudes to the mentally ill.
As the authors say:
These voices deserve to be heard
This is a slim little book, only 128 pages and once I received it I devoured it in an evening. I have found myself returning to it regularly, sometimes just to flip through the pictures, to pick up a story here and there and to remind myself of how many similarities and differences there are between us and the Victorians in our treatment of the mentally ill. Sometimes I felt like I was intruding in their lives and certain stories have never left my mind, but this book really does raise sympathy and understanding for those suffering mental illness and encourages us not to lump them all together, but to see them as the human beings they are.
I admire the authors for not trying to diagnose these patients retrospectively, they have not included any of their personal judgements and views in the book, just presented us with the information and allowed us to make up our own minds.
I would imagine that this book would be interesting primarily to psychiatrists, historians and those who have interests in mental health care. It is also accessible enough for general readership as well, the introduction provides an excellent first beginning to the subject and the case studies are clear and well put together.
You can search inside the book on Amazon, using the Search Inside feature, which will give you some additional idea of layout and content.
The ISBN is: 1871816483
Price: £16.50 with a £1.99 sourcing fee = £18.49. Amazon marketplace copies start at £18.48, not much of a saving but you would probably get it faster!
Amazon are quoting a 4-6 week delivery time and I waited about 5 weeks for my copy.
Preface; The study of the history of medicine, and especially that of psychiatry, often induces in the modern reader an understandable sense of relief that he or she is living in today's world, and not at any point in the past. Yet the stories of the patients in this book, representatives of many hundreds admitted to Bethlem Hospital in the late Victorian period, will resonate with all who take an interest in mental health care today. In these early years of our own twenty-first century, the fear and stigma associated with major mental illness remain strong. Psychiatrists and professionals in allied disciplines involved in the care and treatment of people with mental health problems still face disorders of uncertain aetiology that devastate the lives of sufferers and their families and for which there are no 'cures'. The advent of effective treatments for mood disorders and the symptoms of psychosis, some fifty years after the events detailed in this book, did of course result in tremendous improvements in prognosis and the alleviation of suffering. The nineteenth-century casebooks of Bethlem Hospital give relatively little information about the physical and chemical treatments applied to individual patients. Of course, the fact that Bethlem's clinical note-takers did not usually consider drug treatments worthy of mention does not mean that these were never employed. It may, however, suggest that the hospital principally relied upon careful maintenance of a therapeutic environment, as glimpsed from time to time in the records, to assist in patients' recovery. It is instructive, and sometimes movingly impressive, to consider what the environment of an institution like Victorian Bethlem could achieve. While writing this book, we have often wondered how different the lives of its patients might have been, had modern drug treatments been available at the time. Cases that would most clearly attract a contemporary diagnosis of schizophrenia, or in which a strong psychotic element accompanied affective disorder - then among the most intractable - would be obvious candidates for recovery today. Twenty-first century medicine might have spared many of the people featured in this book a lifetime of institutionalization. But, just as we should not be too quick to dismiss a treatment regimen that resulted in a claimed recovery rate of up to 50 percent, we should also not complacently assume that we have all the answers today. Development of more effective and acceptable drug treatments for psychosis is an important milestone on a very long and difficult road. Such advances will need to be accompanied by the kind of wholehearted delivery of care aspired to in Bethlem over a century ago if society is to gain the true benefit of everything that has changed for the better in psychiatry in the intervening years.