Disclaimer: This article uses offensive and outdated terms, as the language reflects what was considered medically correct and appropriate in the time periods discussed
What went on inside asylums? Which brutal procedures are still used today? Interventional procedures have been used to treat mental illness since the stone age, but mental health treatment has only been standardised across the UK for the last 350 years. By providing a brief timeline of British history, I hope to unveil the outdated and barbaric nature of many procedures still used today.
In 1774 Britain passed the ‘Madhouse Act[i]’ to regulate the legal framework for opening and running insane asylums. This was the first legislation referring to mental illness, making the UK one of the first nations to institutionalise the mentally ill. As patients began to be transferred from workhouses and prisons to the newly opened ‘madhouses’, a whirlwind of often ineffective procedures were developed to treat the perceived ‘spiritual or medical’ causes of mental illness. The common horror stories we associate with asylums begun to circulate as these procedures became widely practiced, some of which are still carried out today.
Perhaps the most popular was trepanation. Although it is the oldest, having roots in the stone age, it was now that it gained widespread popularity. Still used illegally today by a small contingent of modern-day adherents, trepanation involves removing a small portion of the skull to ‘allow evil to escape’ from the mind. The major risks include infection to the exposed dura, strokes, epilepsy, brain abscesses, or damage to the brain by direct contact.
Mesmerism was also birthed in the 1770s, by German doctor Franz Mesmer, to treat several ailments that he believed were caused by the disturbance of magnetic fields within the body, which needed to be ‘realigned’ by passing iron through the patient. Like any other heavy metal, high dosages of iron can be fatal, and so is no longer practiced in the UK. Mesmerism is rightly considered as alternative medicine, as it has no legitimate foundations in medical science.
As we entered the 1800s pressure on local justices to relocate the mentally ill to asylums increased[ii], and two large asylums were built in London[iii]. Each housed up to 2000 patients at any one time. As expected, these were both understaffed and overcrowded, leading to poor conditions and neglect. It was in this era that the first official form of mental health support – as opposed to treatment – was introduced, as discharged mental patients could voluntarily admit themselves to these asylums if they felt they needed to[iv], although it is difficult to believe that anyone would willingly subject themselves to these kinds of facilities.
Towards the end of the 1800s Charles Darwin’s grandfather, Erasmus Darwin, established rotational therapy. Popular throughout most of the 1800s, centrifugal force was believed to cure insanity, and so patients were subjected to high G-forces strapped to and spun in a chair until they slipped out of consciousness. As we approached the 1850s, hysteria therapy was used to treat the ‘wondering of the womb’ throughout female bodies, which was believed to be the cause of psychiatric symptoms exclusive to women. Curing involved exposure to foul-smelling substances, and lasted until the late 1900s. Symptoms previously attributed to hysteria are now recognised as conversion disorder, where psychological stress relating to pregnancy or separation from one’s children manifest in physical symptoms.
The first half of the 1900s brought perhaps the most severe procedures, as interest in scientific technology bloomed. Many treatments were experimental, and trialled for decades before they were proved or accepted. With the 30s came the popularity of a numerous ineffective procedures including hydrotherapy[v], insulin shock therapy[vi], and in 1935 the invention of the lobotomy. Still practiced under the NHS today, the lobotomy involves severing connective tissues in the prefrontal cortex of the brain, leaving patients ‘mentally dull’. The purpose of the operation was to reduce behavioural issues caused by insanity, at the expense of a patient’s personality and ability to function independently. Consequently the lobotomy has become a byword for medical barbarism and is both one of the most controversial and widely used procedures to date. As “an exemplary instance of the trampling of patients’ rights”, it is an outdated and unethical procedure that many believe should not be practiced at all. Improvements in a patient’s symptoms post-operation are uncommon, and the main ‘benefit’ is a reduction in complexity of psychic life. Beneficial only to the facilities caring for these patients, it is inhumane to condone emotionally blunting some the most vulnerable members of society. These patients are in no position to give consent to any form of medical treatment, and often the families are pressured into consent through lack of alternative treatments, and a reduction in care fees for patients to whom NHS care is unavailable.
Thankfully the 1940s saw a reduction in surgical treatments and a rise in psychotherapy[vii]. But by the 1950s, artificial fever therapy[viii] and ECT were introduced, echoing the garish conditions of the 30s. Electric Current Therapy involves running electric currents through the body to cause seizures, which change the brain chemistry of the patient. The hope is to invoke a response in patients with depression or catatonia but is often unsuccessful and highly controversial.
As well as pioneering insane asylums, Britain was one of the first nations to deinstitutionalise the mentally ill, effectively bringing an end to their own invention. The change from institutionalisation to care in the community began in 1961, when Enoch Powell (our Minister of Health[ix] at the time) made a moving speech that inspired parliament to close insane asylums soon after. Although modern medicine is comparatively kind, our stance on treating insanity is only just beginning to change. Mental and physical health services were not integrated until the NHS was established in 1948. Before 2005, the medically insane were deemed responsible for all criminal acts[x], even though they lacked the capacity to comprehend the consequences of their actions. As a society we often demonise psychosis[xi], forgetting that those who suffer from it are disconnected from reality through no fault of their own. Most people have some understanding of what it is like to feel disconnected from life, so why are we so inconsiderate towards those who perceive the world differently? If your reality were altered, wouldn’t your behaviour change accordingly?
[i] “1774 Act for regulating Private Madhouses aimed to better restrict the private trade in lunacy”. 1774 Madhouses Act (warwick.ac.uk)
The first legislation in the UK to address mental health.
[ii] County asylum act 1808 ‘permitted but didn’t compell justices of the peace to provide establishments of for the care of ‘pauper lunatics’so that they could be removed from workhouses and prisions’
[iii] 1867 act built 2 large asylums for London, Leavesden mental hospital & Caterham asylum, each accommodating up to 2000.c patients
[iv] 1862 lunacy act permitted voluntary admission if been a mental patient in the last 5 years.
[v] Hydrotherapy – Extremely hot or cold showers, water wraps or even baths that could last days
[vi] Insulin shock therapy- High dosages of insulin to treat schizophrenia.foten so high patients would fall into a stupor or coma. Mortality rate 1-10%. Fazed out in 1950s
[vii] Psycotherapy – the treatment of mental disorder by psychological rather than medical means
[viii] a method of treatment by raising the body temperature or sustaining an elevated body temperature using a fever. In general, the body temperature was maintained at 41 °C (105 °F). Many diseases were treated by this method in the first half of the 20th century.
[ix] Our current minister of health: Conservative MP Edward Argar
[x] 2005 Mental Capacity Act – legislation includes the power to admit those accused of crimes to be detained as restricted patients.
[xi] Psychosis is where you see or hear things that are not there (hallucinations) or believe things that are not true (delusions). Source: nhs.uk
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