The publicly funded asylum did not emerge in England until the 19th century. Prior to this period, there was a system of private madhouses where the wealthy were able to place disturbed relatives. These madhouses were often small and not subject to regulation. Abuse was common and a series of scandals led to a Parliamentary Inquiry and eventually An Act for Regulating Private Madhouses (1774). There were a series of scandals and debates about the treatment of the mentally ill in this period. William Tuke opened the York Retreat in 1796. The funds for the Retreat were raised by the local Quaker community in response to the appalling treatment of Hannah Mills, who died in the York Lunatic Asylum. The system of moral treatment that Tuke helped to develop was based in Quaker informed principles of treating individuals with respect and dignity. The 1828 County Asylums Act saw the establishment of a more formal admissions process but also an inspection regime that provided annual reports to Parliament. In 1845, the Lunatic Asylums Act placed a duty on counties to establish a pauper asylum. This led to a huge expansion in the number of asylums that became such important features of the physical and cultural landscape.
This illustrates that there was a clear humanitarian impulse in the development of the asylum system (Scull, 1986). The later crisis in asylums obscures or marginalises this (Cummins, 2017a). The geographical position and architecture of the asylums were cited by its 20th century critics as evidence of an ideology that sought to banish or exclude the mentally ill and other undesirables from the wider society (Foucault, 2003; Goffman, 2017). This was not the case at the time. Many asylums such as the one in York were called Retreats for the very specific reason that they were just that – a place to escape the pressures of the modern world. One of Scull’s (1986) main criticisms of Goffman (2017) is that he fails to acknowledge that this at any point. As outlined, Goffman (2017) saw the institution as creating the difficulties that the patients face. There is hardly any consideration of the issues that led to their admission. This is, of course, not to deny that abuses took place or that the impact of admission. It is simply to acknowledge the complexity of these processes.
The asylum was planned for a very specific purpose. It is a representation of an ideological response to the problem of madness (Franklin, 2002). The same is equally true of the modern notions of community, which form the basis of community care. The asylums built following the 1845 County Asylum Act were often designed by famous architects such as Sir George Gilbert Scott, a leading figure in the Victorian Revival. In his early career, he designed hundreds of workhouses. His most famous designs include the Albert Memorial and the main building of the University of Glasgow. Charles Fowler, who designed Covent Garden Market, was responsible for an asylum in Devon. The asylums were thus important civic statements. The great architect critic Sir Nikolaus Pevsner praised a number of asylum designs for the scope and ambition of their design. The Victorian Society and other conservation groups have campaigned for the listing of asylums because of their architectural heritage.
The asylums of the Victorian period were located outside of urban settings. This distance from the urban environment and the large grounds that often surrounded them was a key feature of moral treatment. Fresh air and other aspects of the rural idyll were seen as having recuperative properties. The asylums were built on rural slightly elevated sites to avoid the dangers of miasma – foul smelling vapours that were the result of poor sanitation. Until the development of germ theory, it was believed that miasma spread disease (Franklin, 2002). The early asylums were small with a couple of hundred patients. The 1845 Act led to the building of bigger institutions. The other important design features included separate wards for men and women as well as different wards for patients suffering from different conditions. Wards were built facing south with access to a court where patients were able to experience fresh air and sunshine – key elements of the therapy (Franklin, 2002). The corridor plan of these asylums was based on the sanitary principles proposed by Florence Nightingale. The asylum designs often included a house for the medical superintendent, workshops, recreation hall, a ballroom, a farm, a brewery, a chapel and a mortuary. The effect was the creation of a small self-contained community.
In examining a range of perspectives on the development of asylums, it is important not to paint an unrealistic picture or ignore the abuses that occurred or the damage that was done to individuals. Parr et al (2003) in their discussion of the Craig Dunain Hospital near Inverness show that the patients’ narratives of the institution are much more complex and contradictory than is sometimes allowed for. The authors note that the institution had a negative reputation with outside observers. However, the memories of the staff and patients were much more nuanced and complex. The former patients highlighted the lack of personal space and the accompanying indignities. For example, there was no real privacy so patients received injections or had consultations with their doctors in what amounted to public spaces on the ward. At the same time, the former patients spoke about the friendships that they had developed. The grounds of the asylum were particularly fondly remembered as a place where patients were able to enjoy a measure of personal freedom – smoke cigarettes, have intimate relationships and so on. The asylum in this approach is viewed as a much more complex and ambiguous set of social and physical relationships than is allowed for Goffman’s total institution narrative. As one former resident put it ‘That awful place was home’ (Parr, 2003). In Parr et al’s (2003) study the former patients of Craig Dunain are very critical of the new functionalist mental health facility that replaced it – describing it as soulless.
The asylum may have physically disappeared from the landscape, but it remains a potent cultural reference point. There are any number of computer games and apps such as ‘Adventure Escape: Asylum’ which are based on the Gothic image of the asylum. In this game, for example, the marketing plays to a number of tropes that occur across the horror genre:
Anna wakes up one day in an asylum with hazy memories of her past. Soon, it’s clear that something has gone very, very wrong at the Byers Institute. In fact, there is a killer on the loose. (Google Play, no date)
In addition, there are several modern novels that explore the experience of asylums. These include Lehane’s (2003) tribute to B movies and pulp fiction Shutter Island, where a detective is called to a hospital for the criminally insane to investigate the disappearance of a patient. In Maggie O’Farrell’s (2006) Costa award winning novel The Vanishing Act of Esme Lennox, the title character has spent her adult life in an Edinburgh asylum. The novel explores the reasons why her family sought to have her institutionalised.
The process of deinstitutionalisation created the question: what should be done with the sites of the asylums? One of the ironies was that the geographical position of the asylum meant that they were now prime sites for development. Cummins (2018) notes that the site of the former asylum in Gorizia that was closed as part of Basaglia’s reforms of the Italian system became a public park. In the UK of the 1980s and 1990s, the focus was much more on private provision – housing and shopping developments. The