Mental physicians and their patients : Psychological medicine in the English pauper lunatic asylums of the later nineteenth century.

The objective of this thesis is to examine the pauper lunatic asylums of later Victorian England and assess the value of the psychological medicine which was carried on there. Broadly, it asks psychiatric, rather than strictly historical, questions in that it considers the benefits accruing to individual patients as being of central importance, whilst also evaluating the advantages gained by the medical profession and by outside society. After an introductory chapter there follows an analysis of medical theory on insanity. This considers the function of theory and assesses its usefulness in handling the problems posed by those labelled "insane". The third chapter analyses theories of treatment. It looks first at somatic therapies - electricity, showers and drugs - then considers what "moral treatment" had by then become, concluding with an overall interpretation of therapy in this period. In the section examining psychological medicine in practice, the first chapter is a reconstruction of asylum function using asylum admission registers. It shows mortality, lengths-of-stay, proportions of cures and so on according to various factors. Some analysis of patients' problems is also attempted. The following chapter pursues this theme with a study of asylum life as it affected the patient and, by implication, his or her course of treatment. The last section sets psychological medicine in its social contexts, first of professionalisation, with the advantages accruing to doctors and attendants and the conditions under which this branch of medicine operated, then of social provision. Asylums were supported by county rates and their patients by the Poor Law authorities and their influence on the enterprise is considered. It concludes that psychological medicine was self-defeating in its own terms because of the dominative nature of the relationship between the asylum and the patients. The perception of the patient as individual sufferer was occluded by a perception of him or her as social deviant. Thus the essential ingredient of the restoration of " normal" self-control - that the "self" be known and its needs recognised - was absent. The alternative to restoration, continued incarceration, was nevertheless socially acceptable and so persisted.