Wednesday, 26 June 2019

The Victorians and Insanity

The Victorians and Insanity
1. Roman World. Lunacy: Lat. Luna = moon; moonstruck [poet, lover]; Brewer (1), SOED (2). Roman beliefs included influence of moon on mental derangement.
2. Old English. Madness: a broad concept, variously from Old English, gemad = insane; Old Saxon, gimed = foolish; Old High German, gemeit = vain, foolish, boastful. By M16-L16, SOED gives mad folly, great foolishness. ‘Master in lunacy’ was a legal officer, concerned with definitions & legality of incarceration. Roget (3) offers ‘Devil to pay’, ‘hell broke loose’, ‘all the fat in the fire’, ‘pretty kettle of fish’ and other synonyms.
3. 1407 A.D. Bedlam: vocal shortening of ‘Royal Bethlem Hospital, London; a Priory since 1247, then an institution for the insane - ‘madhouse’, ‘wild uproar’, ‘a bedlam’. By 1815, moved to Lambeth, London. By 1852 synonyms (3) included: madman, lunatic, bedlamite; dreamer, rhapsodist, enthusiast; fanatic, idiot, knight errant; mash, mess, muddle; tangled skein, knot, Babel, ferment, turmoil. [see (22: Index) for Lewis Carroll’s usage of many of these]. Mad-doctor: Lat. insanus, a specialist carer of the insane, the mad.
4. L16. Insanity: Lat. insanitas = mental derangement; M19, extreme folly, irrational.
5. L18. Alienisms, Alienist: pre-psychiatric terms, now obsolete. From Lat. alienus = different, foreign, beyond society. ‘Mad-doctors’ now become ‘alienists’.
6. M19. Psychiatry: formal medico-psychological term for appropriate care, under- standing, diagnosis. L19, Psychiatrist (2). From Gk. Psyche + iatros.
7. M19. Psychopathology, psychopathologist: 1872, Charcot at Paris; 1880, Breuer at Vienna; 1886, Freud at Vienna.
8. Historical. Childhood mental disorder: the near universal historical and cultural abuse and neglect of many children, by adults and societies themselves generally with illness and suffering from spiritual and psychological alienation; together with rarer underlying feeblemindedness [‘the village idiot’] and/or other biological handicaps or disfigurement; often with prejudicial economic/social rulings, incarcerations, semi-legal dictates, as opposed to informed medical-psychological assessment and care. Exceptions at individual levels; spiritual houses, priories; 19th-cent., early pedagogy.
9. E20. Child Psychopathology: formal and directed study of childhood mental disorders; supported by credible psychological models/theory, beyond mere lay care and observation. Contrary to view of Schatz (7a) and a few others, not a significant nineteenth-century development in C. L. Dodgson-Lewis Carroll’s active lifetime, nor before c. 1890-1900, with the passing of prior phases of moral condemnation and restraint, hypnosis and suggestion, and the electro-therapy of Erb’s 1882 Handbuch.

The Royal Bethlehem Hospital (now the Imperial War Museum) designed by James Lewis in 1815 with important additions by Sydney Smirke, 1835-1846. Click on image to enlarge it.
By 1815, when the Royal Bethlem Hospital for the Insane (The Hospital of St. Mary of Bethlehem, London) was removed from Moorgate, north of the River Thames, to Lambeth-Southwark, south of the river, the asylum had long developed an odious reputation and common name — of ‘Bedlam’, whose many discharged but uncured inmates, often previously licensed to beg, were the “Tm o’ Bedlam” and “Jack o’ Bedlam” of the sprawling unhygienic metropolis and its disorderly masses.
The dreadful reputation of the place and its mad-doctors [doctors-in-charge of the mad] drew fierce condemnation from Parliament, which voted on Bills of the Select Committee on Madhouses, and Bills to amend the laws for Regulation of Pauper Lunatics. Foremost among campaigners for improvements — to the physical, hygienic and socio-economic conditions of hapless inmates, though scarcely yet their medical and psychological care — was Anthony Ashley Cooper, 1801-1885, Seventh Earl of Shaftesbury:1 Shaftesbury thus became the leading governmental Commissioner in Lunacy, and Chairman of The Board, 1829- 1885, op. cit., p. 132. His experiences were vivid and real — of “fearful evils” being perpetrated upon “unhappy persons”, “outcasts”, full of “pain” and neglect, whom he witnessed would “writhe under supposed contempt”, ibid, 130. Lord Ashley’s name rightly stood “at the head” of those Lunacy Commissioners whose struggles eventually provided for the “mighty change in the treatment” of lunacy, via the County Asylums system, whether for genuine cases of dissociation [from reality]-insanity, or spurious incarcerations of ‘inconvenient’ people.2
Specialist psychiatric historians, such as R. H. Rollin and Z. Kotowicz, have indicated how formal care models and associated treatment regimes at that period were still far from efficacious, humane or logical-impartial, and often continued a tradition of critical blame — both secular and religious — heaped upon the inmates, together with a deleterious marked separation of interest from and by the general medical profession.3 Thus,
(a) James Prichard, MD, 1786-1848, offered the diagnosis of ‘moral insanity’, which was rapidly and enthusiastically taken up.4
(b) Sir Alexander Morison, 1779-1866, routinely described child-patients through the above system, finding them “violent”, “mischievous” and “incoherent of speech”. Six year-old Eliza, admitted in 1842 with convulsions, was given into the care [sic] of an older patient [sic], and discharged ‘cured’ after two years (cited in Kotowicz).
( c) the saintly Dr. Isaac Watts, DD, 1674-1748, though long dead and departed, maintained a continued ‘moral’ standpoint via his published books, aimed against …The Sins and Follies of Childhood and Youth. His eventually pernicious framework was given a not too subtle drubbing by Lewis Carroll’s Alice,5 as Carroll-Dodgson had himself, meanwhile, discovered the non-moral psychological borderline between dreams and wakefulness, reality testing and the truer definition of madness.6 The moral-diagnostic route continued to be followed by authorities, including J. Crichton-Browne, for some time thereafter. 7
By c. 1855-60 the ‘moral treatment regime’, of enforced occupational therapy, food austerity and exercise-yards, was beginning to wane. More progressive alienists in the new County Asylums were now distinguishing the stubbornly incurable and the chronically insane [dissociated, hallucinatory] from the wrongfully confined [social misfits, feebleminded youth, senile aged; inebriates, and the merely ‘pauper lunatics’ with no social-economic recourse]. The County of York provided one region of new and especially improved practice, with the York Out-Patient Clinic, the Leeds Medical School and the Wakefield ‘West Yorkshire Pauper Asylum’. Here there came to some competence, if not wider medical prominence, such men as the later great J. Hughlings Jackson, 1835-1911; Daniel Hack Tuke, 1827-1895, and James Crichton-Browne, 1840-1938, the latter being Medical Superintendent at Wakefield, 1866-76, before moving to London. Innovations included visiting alienists, ward rounds, and exchanges of ideas via conversaziones as the order of the day. The alienists were nevertheless largely ignored, with their speciality suffering from the isolation from General Medicine (6). Children were especially still prone to lack of understanding, with critical attitudes maintained against their [developmentally normal] “flights of imagination” as a “pernicious practice.”8
By 1867 in England, broader diagnostic schemes, then including childhood epilepsy and melancholy, were becoming recommended, as by Henry Maudsley, 1835-1918, physician, Manchester Asylum, before becoming Professor of Medical Jurisprudence at University College London, 1869-79.9
Any formal emergence of psychopathological, psychiatric and especially child psychiatric disciplines however, even on crudely diagnostic criteria rather than on psychodynamic and developmental-pedagogic lines, was nevertheless slow and faltering — if not non-existent — in Victorian England (14), with roots continuing to incite controversy to the present day. Students of these fields, recently more pertinent to Lewis Carroll Studies, must therefore look elsewhere for the centre and lingua franca of scientific-based mental health studies in the period c. 1865-1898.
During the Victorian period English psychology was a definite step-child and follower of medical-psychological authorities in Germany and France. A recent researcher has pointed to the role of “mental physiologists” of the era, citing sources and pioneers from entirely English-speaking countries, and in particular books known to have been in Dodgson-Carroll’s library.1 The term ‘mental physiologists’ is itself pre-psychological and occasions ambiguity, being here replaced by ‘medical psychologists’. The important psychological phenomena — and especially the medical psychologist’s ‘hypnagogic imagery’, echolalia, ‘dissociation’ and so on —  are poorly served by a physiological framework, and thus impair the impact of sources2 (17, 18 cited in 15). A key concept there, of ‘gradient consciousness’, would lead us to expect intimations of the dynamic ‘conscious-preconscious-unconscious’ so familiar from later psychoanalysis, and alike here at c. 1865-1889, familiar to Dodgson-Carroll in his dream musings, and to Breuer and Freud in their early studies of hysterics. What we find, however, from the “mental physiologists”, is a quite different ‘evolutionary-physiological gradient’, from lowly animal forms, through molluscs (“sluggish”), to higher forms, whose ‘consciousness’ must be inferred by the reader.
A further English ‘pioneer,’ according to Kohlt, is the supposed psychologist Herbert Spencer, but whose works show him to have been more interested and competent as a social philosopher than student of psychology.3 Kohlt’s final source was G. H. Lewes a fairly typical, wide-ranging, Victorian intellectual with little valuable to say about psychology.4 That most or all of such authors — and others such as ‘Mackay. Popular Delusions’ and ‘Lavater. Physiology’ — should have been collected by Dodgson-Carroll (LIB., Lots 579 & 580) — will not surprise any who have managed to arrive at an understanding of Dodgson’s sophisticated psychology and personality. Whether he lived by such contemporary medical-psychological texts, or satirised them, is discussed elsewhere with reference to his ‘Mad Tea-Party’ of Alice in Wonderland.5
Around 1858 the German physicist and optical-physiologist H. von Helmholtz, 1821-1894, was joined in his university laboratory by Wilhelm Wundt, 1832-1920 as assistant. The latter, over the following four decades, would establish a German-language domain of experimental physiology and early empirical psychology, which eventually came to influence American pioneers such as J. McKeen Cattell, Edward B. Titchener, and by 1883 the Johns Hopkins University psychology laboratory. German as the lingua franca also predominated in medical-psychology and psychiatric fields, led by pioneers such as Alois Alzheimer, 1864-1915, Emil Kraepelin, 1856-1926, Richard von Krafft-Ebing, 1840-1902, and Josef Breuer, 1842-1925. French-based continental studies of cognate fields were led by J. M. Charcot, in Paris at the Salpetriere from 1872; H. Bernheim and hypnosis at Nancy in 1880s; Pierre Janet replacing Charcot in Paris, 1890; and August Forel, 1848-1931 and Eugene Bleuler, b. 1857, at the German-Swiss Burgholzli Clinic , Zurich, where schizophrenia and autism began to be penetrated c. 1890s.
In the England of C. L. Dodgson, psychologically and therapeutically some decades behind the nearby continentals, the slow emergence of healthy therapeutic regimes, viable theoretical models and efficacious results, are here seen as instrumental in Carroll-Dodgson’s continued ‘flight to Romanticism’, prolonged throughout his life, and largely to the detriment of his late nascent Modernism. His own sophisticated grasp and understanding of dreams, inner world and psychological states, mental health and illness issues; creativity-originality-divergence, love and morality — whilst much of these must be credited in part to family upbringing — are here recommended as best regarded as stemming in large part, not from familiarity with Lunacy Commissioners and the texts of alienists — which latter he was eminently capable of parodying —  but rather from his life-long reading and empathy with such intuitive greats as Shakespeare, Bunyan, Blake, Coleridge, other Romantic Poets, artists, novelists and theatrical performers and their plays, all seen and read “over again” in his busy lifetime.

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