ABSTRACT
The beginnings of mental disorder are usually noticed first in the family. Irritability, sleeplessness, violence, self-neglect, obsessions, irrational fears and hallucinations, are all likely to become evident in the first instance to the relatives and friends who spend most time with a person. It is they who are likely to face the decision of whether, when and where to refer someone for care and treatment. In the eighteenth century, the increasingly high evaluation of gentility, and close family relationships, helped to create a market for private asylum care. If this represented a change, which rapidly accelerated development of the trade in lunacy, this study has also revealed striking continuities in families' subsequent responses to mental disorder. When relationships were close, insanity in the family made the relatives of sufferers feel helpless and distressed. On the one hand, they wanted to seek help; on the other, they were wary of poor standards, corrupt motives and alleged cruelty in private madhouses. It was these fears which many Georgian asylum proprietors were able to overcome, by emphasizing their kindness and skill in managing the insane. The provision of genteel and comfortable accommodation and facilities for private patients helped to ease families' guilt and fears about confinement.
