The history of the British Lunatic Asylum

Psychological Treatments

In the early years there were little effective treatments for Mental Health problems, the Asylums were built with custodial care in mind and the patients only came to an Asylum as the last resort.  The early ideals were to provide well managed routines, nourishing food (reportedly the calorie intake was up to 3000 a day), clean clothes and plenty of light and exercise.  These were reinforced by the use of sedatives and hypnotics such as bromides and paradehyde; phenobarbital was use at the beginning of the 20th century to control epilepsy.  Restraint was also used on violent patients, this was done through both spatial and physical restrain; confinement and padded rooms were used with strong clothes being employed - strait jackets were occasionally used but where phased out towards the end of the 1920s.  However, the Lunacy Commission were not happy with these restraints.  Modified narcosis was a popular treatment, being widely used until the 70's. 

The first medical breakthrough was to used to against General paresis of the Insane which was caused by the syphilis infection.  In 1917 Julius Wagner-Jauregg found that if patients were to be infected with malaria, the progression if the paresis could be halted.  The infection was administered by placing infected mosquitoes on the skin and allowing them to draw blood.  This treatment was superseded by the use of penicillin after world war two.  However it took a long time before any medicinal treatments were discovered. 

In the 1930s the first major wave of of 'somatic' cures emerged.  It was believed that there was a mutual relationship between epileptics and schizophrenics; it was though that if the convulsions were induced, the schizophrenics could be cured.  There were a number of ways of doing this, the two most popular were the Insulin Coma Therapy and Electroconvulsive Treatment; both involved inducing convulsions.  The Insulin Coma Therapy was viewed as a cruel practice and there was no evidence that proved it to be effective other than offering a placebo effect.  Interestingly a study of its effectiveness was not carried out until twenty years after the treatment was introduced - Baruch & Treacher 1978.

Electroconvulsive Therapy was the most widely used treatment, and still is today.  It is the Italian psychiatrist Ugo Cerletti who can be attributed with inventing the application of electricity to the brain and the first equipment was devised in 1938.  In the beginning ECT was used in conjunction with insulin therapies; in the early days it was also administered without muscle relaxants - patients were physically restrained.  Sedatives were introduced in the 50's and 60' to make the treatment more humane.  ECT proved to be relatively ineffective with schizophrenic patients however it proved very effective with patients suffering from manic depression; hence it occasional use today.  ECT was also worryingly used as a form of punishment is some asylums.  A typical ECT kit is shown to the right, courtesy of Highroydsarchive.co.uk

Possibly the most shocking treatment to be used in the Asylums was the introduction of Leucotomies (Lobotomies)  in 1940 at the Burden Neurological Institute in Bristol; it received wide spread acclaim.  The frontal lobotomy was able to severely alter a patients mood by severing the neural structure at the front of the brain.  One nurse from Severalls Hospital remembers witnessing the recovery of a patient after a leucotomy:

"I can't remember his name - he was very depressed.  He was a well educated man, very depressed, and the gave him a course of ECT and everything, and it didn't help him at all.  So they gave him a leucotomy.  And within six months he was one of the Air Controllers at London Airport."Taken from Madness in its place - Diana Gittins.

One more nurse recounts their thoughts of the leucotomy:

"I must say, I didn't really like the idea of leucotomies.  It was just my personal feelings, but you did see some dramatic changes in the people following them.  They were more tranquil, lets put it this way, and possibly led a better life because they weren't having so much stress and anxiety"  Taken from Madness in its place - Diana Gittins.

Towards the end of the fifties, asylums moved from a physical approach to one of a pharmacological and psychological approach, the first drug being Largactil in 1952.  Psychologists also started to use therapeutic remedies in their approach to patients; art, music and occupational therapies were the favoured choice.

The Decline of the British Mental Hopsital