For the insane had medieval origins in Britain, with London's Bethlem Hospital (Bedlam) the most famous. Its shortened name passed into the language as befitted a frame of mind in which madness was equated with brutishness and kept in check with chains and whips. The patients in Bedlam were a spectacle for curious visitors. At the turn of the 18th and 19th cents. reformers began to claim that asylums could be turned into therapeutic environments, in which insanity could be cured by seclusion from external stresses. This line was taken by the Tuke family at their York Retreat. An Act in 1808 empowered counties to set up asylums for pauper lunatics with a view to possible cure as well as custody. In 1845 legislation required the general establishment of pauper asylums, and commissioners in lunacy were established to inspect, remedy abuses, prescribe best practice, and deal with alleged cases of wrongful confinement. Charles Reade's mid‐Victorian novel Hard Cash dealt forcefully with this issue; but the promise of cure made asylums seem less frightening. But as asylums filled up with incurable patients and were unable to attract staff with suitable attitudes, patient–staff ratios increased, and they reverted to custodial control rather than cure. The abuses of the system came to seem to outweigh its therapeutic pretensions, and physical as well as moral restraints were reintroduced. The emergent psychiatric profession had used ‘moral treatment’ to enhance its credibility, but failed to deliver cures in significant numbers. The sheer scale of Victorian investment in the system, and the administrative power of the psychiatrists, kept it in being until the last quarter of the 20th cent., when a fashion for the liberation of inmates led to replacement with so‐called care in the community, whose limitations were quickly apparent.
Subjects: History — Psychology.