ABSTRACT

The obituary of the asylum may have been written too soon-and published before its death. More than anything else the asylum towers over the history of Victorian and early twentieth-century psychiatry. Asylums housed, and as the nineteenth century wore on, increasingly warehoused, the mad of western Europe and North America (Jones 1972). More than at any other period in history they exemplified the creed that the mad, however defined, must be separate from the rest of society. The asylums’ Italianate facades and red brick pavilions withstood attack by social reformers until the 1950s. Since then, there has been a progressive reduction in the population of psychiatric in-patients (Thornicroft and Bebbington 1989). A small number of these institutions have closed. Many more continue to exist in attenuated forms, with far fewer individuals actually resident. The emphasis in the rhetoric and the practice of psychiatry, be it concerned with the young and schizophrenic or the elderly demented, is on care in the community (HMSO 1989; Dept of Health 1991). While recent years have seen a genuine increase in the range of settings in which psychiatric practice occurs, there has of late been considerable anxiety about the efficacy of community care. Critics have wondered whether resources are adequate, whether the community, in so far as it can be said to exist, cares at all about anyone with mental health problems. What was heralded as an advance in psychiatric care in the 1950s is seen as a potential social disaster. That this possibility exists must be evident to anyone familiar with Britain’s metropolitan areas where substantial numbers of the homeless population live on the streets. It is increasingly well documented that a high proportion of such individuals are mad (James 1991). This population is particularly vulnerable to criminalization; they are arrested for trivial offences, remanded to prison because they have no permanent address, and are thus warehoused in a more contemporary fashion (James and Hamilton 1991; Joseph 1992). The imprisonment of the mad is a reminder of the pre-asylum era, and to a historian it might seem as if we have come full circle. To those who believe that not only asylums, but also madness, were a nineteenth-century invention this may be more of a surprise. Unsurprisingly, there have been calls from interested parties for a return to the days of the asylum (National Schizophrenia Fellowship 1992). The attempt to provide care in the community is now suspected of being a cynical attempt at cost cutting (Scull 1984); families receive little financial support for looking after relatives who previously might have been accommodated in an asylum. This would not be the first time that the provision of services to the mad was affected by financial considerations; a glance at the archival material relating to the private madhouses of the eighteenth century, the county asylums

of the nineteenth century indicate that thrift was always the order of the day (Crammer 1990; Ripa 1990). Not for nothing is psychiatry known as one of the cinderella services of the current health service.