Records dating back as far as 1670 show that private mental health facilities or “madhouses” were in existence but it was not until a century later that there was any attempt to inspect and regulate them.
At this time mental health treatment had not been developed and so conditions which we recognise and treat today were considered signs of madness. Those displaying symptoms were locked away from society and very often left to die in squalid and inhumane conditions. Over time society would use these institutions as places to lock away those who they felt weren’t “like them”, including those with what we would now consider to be low level learning difficulties.
Melancholy, wilfulness and “possession by evil spirits” could be reasons for committal to the madhouse. Husbands who could afford to pay a sympathetic doctor could have their wives imprisoned at the madhouse with no just cause other than they would not obey their spouse. Whilst inside an inmate had no legal redress and no means to fight for their release as they were refused contact with any visitors.
It wasn’t until the 18th century that the science of psychiatry really began to develop, and with it came changes in the way that society treated the mentally ill. The 18th century was a time of great reflection and “enlightenment” resulting in the questioning of society, and changes in science which saw the belief in evil spirits regarded as superstition. Doctors and scientist began to understand about the workings of the brain and the nervous system, and so began the slow progress of mental health treatment.
The 1774 Lunacy Act saw the beginning of regulation with medical certificates from two separate doctors being required before a person could be committed, madhouses had to be registered and annually inspected, and a register of all inmates had to be held by a central authority. The Act was a huge step forward although it did not stop sane people from being detained. Neither did it give Magistrates powers to release people, although having regular inspections made it easier for them to petition for release. Following an assassination attempt on George III in 1800, the Criminal Lunacy Act was passed, followed eight years later by the County Asylum Act which saw the building of new institutions specifically for the criminally insane. This began a process that saw patients with mental health issues being assessed and sent to different institutions depending on the nature of their condition.
At the turn of the 19th century insanity came to the fore with the monarch’s illness widely reported as George III suffered bouts of insanity from 1788 until his death in 1820. Shortly after this Alexander Morison, a physician and inspector of the Surrey madhouses, started lecturing on mental diseases, the first formal lectures on psychiatry. However, despite this new found interest in the causes and treatment of mental illness, it was not the 1833 Madhouse Amendment Act that was responsible for the way patients were treated during the Victorian era, but the 1834 Poor Law. This Act was responsible for the increase in the number of asylums and other similar institutions, as most of those who found themselves settled or permanent residents in the workhouses were those who could not fend for themselves: children, so more orphanages were built; the sick, so more hospitals were built; or those with mental illness or learning disabilities and so more asylums were built.
Throughout the latter part of the 19th century there were various attempts to improve the condition of those detained in asylums, and various Acts of Parliament passed by champions of the cause such as Lord Ashley, Earl of Shaftesbury. Despite this there was no distinction between those who were suffering from mental illness such as schizophrenia and those who were mentally disabled or had learning difficulties until the 1886 Idiots Act which enabled the building of “idiot asylums” or “mental deficiency colonies”.