- Masters of Bedlam: The Transformation of the Mad-Doctoring Trade by Andrew Scull, Charlotte Mackenzie and Nicholas Hervey
Princeton, 363 pp, £23.00, February 1997, ISBN 0 691 03411 7
In 1843, the artist Richard Dadd murdered his father and was put away in Bethlem Hospital, Britain’s oldest lunatic asylum; his portrait of the alienist Sir Alexander Morison stares from the cover of Masters of Bedlam, gauntly silhouetted against a mottled sky. He seems to be looking at something he finds hard to bear. The brief biographies of 19th-century alienists through which Andrew Scull, Charlotte MacKenzie and Nicholas Hervey tell the story of the century’s dealings with the mad make it clear that Morison’s haunted expression could have been that of any of the seven ‘mad-doctors’ described here.
The first of them was born in 1764, the last died in 1918. Their life histories spell out a century of passionate idealism, and of vicious in-fighting. Part of these men’s struggle was to make respectable not just the work of the mad-doctor but of doctoring itself, never on a par with the few professions open to gentlemen – church, army, law. The public could see that medicine, and hospitals in particular, killed as many people as it cured. And doctoring the mad – the pauper mad, generally – had a taint of its own. As the alienist Sir John Bucknill acerbically wrote in 1860, ‘the feeling and conduct of the British public towards the insane reminds one of nothing so much as that of the enlightened citizens of the free States of America. Noble and just sentiments towards the negro race are in everyone’s mouth, but personal antipathy is in every man’s heart.’
Lunacy, as Bucknill also pointed out, is not only exhausting for its managers but sometimes catching:
He who efficiently discharges the arduous functions attendant on the care and treatment of the insane, dwells in a morbid atmosphere ... which he, who walks through even the most difficult paths of sane human effort, can little appreciate ... The number of mental physicians who have suffered more or less from the seeming contagion of mental disease, would form perhaps, if enquired into, a proportion of those who really fight in this warfare which might bear comparison even with that of men who fall in the strife of the sword.
Some of those who figure here became eccentric or distraught; others simply venal or hard-hearted. All of them became to a greater or lesser degree disillusioned. The great reform of lunacy treatment – the building of huge, supervised asylums to house and cure the mad – is a story of disappointed hopes, summed up in the therapeutic nihilism of Henry Maudsley at the end of the century. The doctor who had spent his life ministering to diseased minds, he wrote, might wonder ‘whether, notwithstanding impassioned aims, paeans of progress, endless pageants of self-illusions’, humanity’s ‘capacity of degeneration did not equal, and might some day exceed, its capacity of development’.
The telling of this melancholy story is not helped by the book’s joint authorship: some relevant facts are rehearsed several times, others scarcely appear. A chronology placing Parliamentary enquiries in 1807 and 1815-16, and the Act requiring asylums to be provided in 1845, would have been useful. There are few citations from contemporary letters, diaries or literature to broaden the picture, and few links with what else was going on during the century. The worst of the mad-doctoring world seems light years away from the rest of enquiring, energetic Victorianism – no doubt because any patient with money or a caring family stayed out of what the authors call ‘asylumdom’. And who actually were the ‘mad’ who filled these institutions? The book does not make this clear: we only suspect from one cited Report that they included the congenitally retarded, and from another that there were also patients delirious from typhus and tuberculosis, or speechless from strokes. Not enough is explained about attempts at diagnosis and classification, or the fact that general paralysis of the insane was not definitely identified with syphilis until this century.