The Household and the Care of Lunatics in Eighteenth-Century London 1

The pattern of care and provision for lunatics in England went through a gradual but fundamental transformation between c. 1650 and c. 1850. The most remarkable aspect of the shift was the rise of the asylum, or specialist institution for the insane. ² The increasing segregation of lunatics into asylums has been studied fairly extensively. Major works have concentrated on the twofold processes of the institutionalization of the insane and the creation of asylum-based specialized medicine, drawing a picture of more or less linear evolution from mixed institutions to mental hospitals. Michel Foucault's Histoire de la Folie is centred on the creation of the ‘general hospital’ which incarcerated the insane indiscriminately with the social outcast, emphasizing the role of the institution in the transformation of madness as an object of social policy and medical discourse. ³ Stimulated by Foucault, but largely critical of his conclusions, there is a body of increasingly sophisticated historical monographs dedicated to the study of individual institutions. ⁴ The role of the asylum in the making of the psychiatric profession and discipline has been studied in depth. Andrew Scull has examined the process through which English ‘mad-doctors’ transformed themselves into ‘psychiatrists’ to consolidate their position in the newly created asylum system and Jan Goldstein has charted the similar strategy of French alienists in a wider political and cultural setting. ⁵