Sarah Wise begins her epic exploration of 19th century mental health ‘care’ with the story of Edward Davies, an eccentric, nervy young man whose loving mother had him declared insane and locked up in an asylum so she could gain control of his business interests. Davies was exonerated and declared of ‘perfectly sound mind’ in a jury trial at the end of 1829, only a year after the passing of the Act to Regulate the Care and Treatment of Insane Persons in England, which specified that:
- Two certificates of lunacy were required for each private patient (those who could afford to pay for their care);
- Each certificate must be signed by a different doctor, following two separate interviews no more than fourteen days apart;
- No physician could sign a certificate if he was an owner, co-owner or regular attendant at a madhouse;
- A lunacy order was to be completed by the person who had first alerted doctors to the lunatic.
Wise’s far-reaching, comprehensively researched book utilises twelve shocking case studies to indicate how this Act (known colloquially as the Madhouse Act) was manipulated by relatives and friends to dispose of their inconvenient people. It’s a brilliant achievement, and deserves reading by anyone with an interest in the history of mental health care.
Starting with poor Edward Davies we move through the decades, focusing on such characters as John Perceval, whose own incarceration led him to start the Alleged Lunatics’ Friend Society; elderly, wealthy Mrs Cumming, declared insane by her own estranged children; Louisa Nottidge, who joined the Agapemone ‘Abode of Love’ cult; spiritualist and eventual campaigner Louisa Lowe; and William Windham, whose wild behaviour resulted in one of the century’s most expensive lunacy trials and his natural death at the age of 25.
Wise tells these sad stories with panache and great humour – there is plenty of ridiculousness here, not least the idea, held by early ‘alienist’ (mad doctor) Dr George Man Burrows, that insane persons could be diagnosed by the way they smelled. Her language is beautiful and her sketches read like Victorian novels; the plots are equally intricate and far-fetched. She is sympathetic to an extent to the medical professionals, recognising that they were operating at a time when understanding of mental health conditions was in its infancy and largely experimental, saving her harshest words for the often venal, corrupt asylum proprietors.
As well as detailing the progress made in legislation (her style is sufficiently entertaining that the legal bits, while dense, are not boring or dry. We also meet some weird and wonderful characters, including the famously social reforming Lord Shaftesbury) and in public sympathy for victims of the system, Wise provides a cracking literary analysis.
Perhaps the most shocking stories in the book are those that deal with single-patient care – where a lunatic boards in someone else’s home, or stays with their own family. There are cases here of a girl who would now be diagnosed with learning difficulties being murdered by her relatives and of men left to rot in windowless rooms in their own excrement because their families have no idea how to deal with them. Wise looks at Bertha Mason‘s character in Jane Eyre in this context, defending Mr Rochester for actually looking after his wife significantly better than he was really obliged to do – keeping her from the asylum, where she might have been subject to all sorts of inhumane punishment, was in a sense a mark of his nobility.
Wise also, understandably, references Wilkie Collins’ The Woman in White, and devotes a chapter to the ‘mad’ wife of Edward Bulwer-Lytton, whose most enduring contribution to literature was giving us ‘It was a dark and stormy night’. The incarceration of his estranged wife Rosina, herself a writer, who believed Dickens and her husband grew facial hair to hide their evil features, caused a huge scandal in the 1850s and drew public attention to the issue of women’s rights in marriage for perhaps the first time.
In her epilogue, Wise points out ‘the stubborn unchangeability of many aspects of the lunacy issue’, and draws our attention to the horrific treatment of people declared mentally ill up until the mid-20th century and beyond. In some ways we’re actually going backwards. While we might think how ridiculous it is that Victorians could declare people insane and have them locked away forever because of their religious views, or (in the case of actress Elsa Lanchester‘s mother Edith in the 1890s) because they didn’t want to get married, it’s worth remembering that in the latest version of the Diagnostic and Statistical Manual, disagreeing with authority is considered to be a diagnosable mental health issue.