The Tradeiri Lunacy
A study of private madhouses in England in the eighteenth and nineteenth centuries by William LI. Parry-Jones Routledge & Kegan Paul, ?4.75 Confidence in the promise ? if not yet the achievements ? of psychiatry has brought renewed interest in its history. There is much to be learned from our predecessors. They too fought the perennial battle to gain for their patients the dignity and status of sick human beings against ignorance, parsimony and prejudice.
Their successes were the more remarkable for being achieved in harsher times, when medicine knew little of causes of disease and less about those which affect the brain and so derange the mind. Progress was made on two fronts which were, and remain, interdependent ? the humanitarian and the scientific. Patients are still treated in Victorian isolation miles from the mainstream of medical advance, where the old and the new rub along together as in no other speciality.
Because psychiatry bridges these two cultures ? the humanitarian and scientific ? its history can be explored from many angles. This gives it both its practical turn and its peculiar attractiveness. Dr ParryJones combines the role of cautious clinician and good historian. His study of the private madhouse system from its beginnings to its heyday in the late 18th and early 19th centuries is well-written, thoroughly readable and scholarly.
Until county asylums became the rule, private houses provided the bulk of the country’s psychiatric services and mostly did it well, if allowance is made for the standards of the times. These keepers and doctors who ran them also made contributions to knowledge. There is a detailed analysis of the work of two Oxfordshire madhouses whose records of admissions, discharges, etc. are complete for the second quarter of the 19th century. Interesting comparisons are made from these and other facts and figures.
Dr Parry-Jones also provides a guide through the maze of lunacy legislation spun like a cocoon around the rich ? and later also the poor ? patient, designed to protect the insane from exploitation and the sane from incarceration. Periodic waves of public suspicion are well described, and a double standard of care emerges clearly, which even the National Health Service has not remedied and which would not be tolerated in any other branch of medicine.
Those already acquainted with the field will meet many old friends and make some new ones, and will not fail to be delighted with his use and survey of first sources and meticulous documentation. It will prove an eye-opener and salutary corrective for those who still think psychiatry began with Kraepelin, Freud and Bleuler. Recent revelations make it even more imperative that all concerned with mental hospitals and mental health should read this book.
Richard Hunter
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