A Brief Look at the Evolution of Mental Health Treatment Centers: Tracking Mental Health Institutions over 100 years

From Madness to Mental Health: Etymology and Literature

In the study of madhouse admittance, the term “institutionalization” refers to confinement. Changes in etymology reflect cultural changes and show how society agrees on the evolution of words and their meanings. Such changes are important alongside the later use of literature that will focus on the cultural use of institutionalization.

Etymologically, the first use of institutionalization indicated in the Oxford English Dictionary, in 1951, bears the definition, “The condition or state of being or becoming institutionalized” (“institutionalization”). However, the first use of the word “institution” dates back to 1460 and refers to businesses and government—segments of society that developed at a much quicker pace than studies of the mind and judgements of intellect. By comparison, the chronology of these developments reflects the importance of government identities versus individual ones. Because men dominated such social spheres of influence, this comparison also suggests a hierarchy—one that is implemented into the development of mental health studies.

Also, important to this subject is distinguishing the chronological uses of “asylum” and “madhouse,” which helps establish their interchangeability. The use of “asylum” dates back to 1430, with religious and political denotations, and to 1776 with connotations of housing the mentally ill—another congruency with the importance of government. The word “madhouse” in 1649 referred to the detention of the insane. While “asylum” precedes “madhouse,” and they later become synonymous, madhouse holds the first relevant denotation for this study.


The first and most familiar madhouse for the insane was Bedlam, or the Bethlem Royal Hospital. Important to note here is that in 1300, the word “hospital” meant a place to host and entertain travelers and strangers; it was not until 1418 that it was associated with the meaning, “a charitable institution for the housing and maintenance of the needy; an asylum for the destitute, infirm, or aged” (“hospital”), here again etymology reveals how slowly health care for human beings evolved.

Bedlam was established in 1247 by a former sheriff of London. In 1547 it was designated a hospital for the mentally ill by King Henry VII (Dyer). The ambiguity regarding the definitions of confinement and mental health is evident in the first three hundred years the building existed, as social leaders struggled to understand how to meet the needs of its inmates who were first sequestered by a sheriff, later called patients of a hospital by the king. Bedlam became well known because of its inhumane practices, mostly due to the cultural lack of understanding about mental illness, which led to improperly trained employees and therefore resulted in abusive treatment. It was also well known for its fee-based tours in the seventeenth and eighteenth centuries. These tours allowed the curious, the fearful, and the voyeuristic to venture inside the walls of the madhouse and observe those who were called “mad.”

Whether it was for entertainment or education, historical hindsight reveals multiple layers of problems surrounding the treatment of people who both inhabited and were employed in Bedlam. The difficulty in knowing how to treat people who suffered misunderstood medical conditions, combined with “spurious incarcerations of ‘inconvenient’ people” stemmed from the fact that “care models and associated treatment regimes at that period were still far from efficacious, humane or logical-impartial” (Dyer).

The lack of effective and medically accurate diagnoses and treatments for the “mad” are understandable considering the slow evolution of psychiatry, yet the ill treatment of patients is timelessly inexcusable, and pertinent to this study because it created loopholes that allowed for people to be wrongfully institutionalized, especially women in a society that obeyed the authority of men. Bedlam is a useful reference for the beginning of this study because it demonstrates the very relevant power dynamic. Its example shows the social need for attention to mental health, represents the physical building used to do so, and demonstrates the unfortunate byproduct of abuse of authority, all of which result in a general fear of madness in a society that strove to achieve cultural perfection.


According to literary theorist Michel Foucault, institutionalization did not begin with madness, but with confinement. In his book Madness & Civilization (1965), confinement in France was epitomized with the founding in 1656 of the “Hôpital Général de Paris.” He states that this building “had nothing to do with any medical concept. It was an instance of order, of the monarchical and bourgeois order being organized in France” (40). In a similar function to that of Bedlam, this system of order was led by King Louis XIII, upheld by men of high society, and specifically focused on extracting from civilized society the poor, those of low morality, and beggars.

Previously in that century, the poor were banished from the city and “to keep them from returning, an ordinance of 1607 established companies of archers at all the city gates to forbid entry to indigents” (47). At work in this French social structuring is the absolute power of the King, which further reinforces an existing patriarchal system, as well as social thought processes of segregation by force based on a judgment system that evaluated the combination of income and morality per person. In regards to gender among the mass of poverty-stricken people, the edict of 1657, in paragraph nine, states that no matter what conditions they suffered, if citizens begged they would be punished “‘under pain of being whipped for the first offense, and for the second condemned to the galleys if men and boys, banished if women and girls’” (48-9). This edict appeared severe towards men and boys with the punishment of death, and lenient towards women and girls with banishment, yet the difference in punishments reveals an inherent social inequality between the genders that turns unfavorably on women in the future, as this study will discuss.


Foucault explains the connection between the expectations of the poor-in- confinement and madness. Essentially, from a religious perspective, the fall of Adam and Eve forced God to curse the descendants of Adam with working the land. This “curse” became the void that social order longed to fulfill. Labor became the punishment and the cure for poverty as the poor were confined to buildings and expected to work. Labor served this purpose, and others, in institutions, yet it also revealed weakness in people who were unable to work and they became a new category of society—the mad.

According to Foucault, in the seventeenth century, “the old rites of excommunication were revived, but in the world of production and commerce. It was in these places of doomed and despised idleness, in this space invented by a society which had derived an ethical transcendence from the law of work, that madness would appear and soon expand until it had annexed them” (57). The concept of “madness” essentially evolved when production and commerce became the new “ethical” mode of operation and when society found a fresh identity with the abundance of labor and profits. In this new type of society, “madness” rendered its victims productionless. Hence, the emergence of madness did not depend on medical study, proper diagnosis or treatments; it was instead based on moral judgment and made confinement a political strategy.

Previously, the “mad” simply roamed and mixed with the general population, constituting subjects of humor, ridicule, and wonder. This new way of segregating people would further secure dominant male power both socially and culturally. Those with already existing authority would have the added power of reason to their side and the ability to confine those who lacked reason in a continuously developing civic space. Using Foucault’s study of the history of madness and how the mad were defined also helps us to grasp how easy it was for men to accuse women of madness under patriarchal rule.


Foucault’s study addresses issues specific to France, Western Europe, and England, yet his theories are applicable to asylums, work houses, and hospital institutions in general. His study is particularly useful to my work because he too sought to understand the source of power that elevates one part of society over another. He states that “[we] must describe, from the start of its trajectory, that ‘other form’ which relegates Reason and Madness to one side or the other of its action as things henceforth external, deaf to all exchange, and as though dead to one another” (ix). I would argue that for me, the “other form” in the nineteenth century is the patriarchy that decides between reason and madness, creating the appearance that reason can be both owned and even gendered, and is “deaf to all exchange.” Once the boundaries of madness were established by the male patriarchy, the female sex was especially vulnerable to legal confinement. Whereas society in the seventeenth and eighteenth centuries grappled with poverty and confinement, the nineteenth century saw increased social attention to the control of women due to an awareness of this constructed binary between reason and madness.

The growing national identity in nineteenth-century England saw global imperialism abroad, yet the local domestic space seemed to constrict women within patriarchal expectations that threatened grave consequences if defied, such as wrongful confinement. Women had to be pillars of the home, both grounding the family and holding up social standards while husbands toiled for the crown. Domesticated housewives were expected to display proper English culture for the next generation, and psychological conditions we understand today, such as postpartum depression, were no excuse for relaxing this strict moral code. Their sexuality was limited to reproduction in order to maintain a morally pure household, which created a feminine binary—the sexually prudent woman or the sexually promiscuous woman.

Women could be moral or sexual, but not both, because that constituted a moral contradiction and sexual women posed a threat to social etiquette. If a husband wanted a new wife, because divorce was not common at the time, he could accuse his wife of madness and have her committed to an asylum. In so many ways women could be segregated from proper society. Along with the prevalent criminal ills of madhouses similar to Bedlam, many authors from the eighteenth century onward made this wrongful institutionalization of women in particular the subject of their novels. Women became interesting fictional subject matter because of their vulnerability.

With the lack of medical structure in committing patients to the asylum, it required the certification of only two doctors to confine a woman. Madhouses easily became a tool of cultural, rather than medical, punishment. The end of the 1850s “saw a so-called ‘lunacy panic’ in Britain, the result of a spate of cases involving individuals wrongly diagnosed and certified insane, and forcibly committed to madhouses” (Sweet xxvi). Because of this rampant abuse, literature played a role through which authors explored, revealed, commented upon, and challenged the widespread use of the madhouse and the label of “mad,” used to maintain patriarchal order. Literature helped expose those connections which were not visible in the everyday discourse surrounding the madhouse, by focusing on the plights of fictional women who might be committed against their will, and who did not have audible voices in actual life.


Therefore, one way to grasp the depth of the cultural phenomenon of wrongful institutionalization is to study this literature. Literature helps create an understanding of the way people and societies operate, it contributes to social movements, and it divulges the ills surrounding core issues. Where historical records fail to paint the full picture of how a situation may negatively affect a vulnerable woman, literature, although fictitious, relies on an author who experiences some measure of those social ills and uses writing to help expose them. For example, in the eighteenth century, Mary Wollstonecraft was a lone literary feminist who argued for women’s rights and freedom and uses the recognizable phenomenon of an abusive husband who commits his wife to an asylum as a means of control in her novel Maria, or The Wrongs of Woman (1798). Maria’s intact intellect and absence of madness is apparent and challenges her husband’s authority to commit and separate her from their child.

Although the book was unfinished due to Wollstonecraft’s untimely death during childbirth, it provides a foundation for questioning the treatment and government of women in marriage, including its legal aspects. Wollstonecraft also incorporates into her novel the theory of Francophone Genevan philosopher Jean-Jacques Rousseau whose own novel, Julie, or The New Heloise (1761) promotes his idea that “while men should rule the world in public life, women should rule men in private life” (Cranston and Duignan). Rousseau’s proto-feminist point of view reveals the beginning stages of a man considering women with a form of publicly acknowledged power, if only in the domestic space of the home. While men ran public economies, Rousseau understood that women had the ability to have control over themselves and influence over men in private life. His philosophy was intriguing yet limiting as it promoted the form of domesticity we see in the nineteenth century.

When Wollstonecraft incorporates his ideas into Maria, she appropriates it carefully to help develop her young, vulnerable protagonist Maria, while also acknowledging his philosophy’s limitations. Maria attempts in vain to impart reason to her philandering husband and to be a dutiful wife, yet when he arranges a subtle proposal of prostitution between her and his acquaintance, she gathers the resolution to leave him. Before she can, however, he places her in an insane asylum. While institutionalized, Maria reads Rousseau’s novel Heloise and develops a deep appreciation for its protagonist Saint-Preux, which she naïvely transfers to Darnford—a fellow inmate and another man who abandons her. This literary example speaks to the need for advocacy while also revealing skepticism of women depending on men as their sole advocates.

Wollstonecraft uses the asylum as a literal and metaphorical tool to help readers see the problem with women being vulnerable to institutionalization in a male dominated society—they are trapped in a place where they cannot get out. Both Wollstonecraft and Rousseau were ahead of their respective times, but their revolutionary ideas often fell onto deaf ears. Their literature, however, encouraged future generations to reconsider the treatment of women in society and in the domestic space, and it began the process of isolating the patriarchal power working against women.


The following century made many literary attempts to build on the ideas of Wollstonecraft and Rousseau in the short-lived genre of “sensation fiction” in the late- nineteenth century, but these attempts were not always taken seriously by Victorian readers and culture. In recent years, more critical attention has focused on the insights sensation fiction provides on cultural concepts of “madness” and “institutionalization.”

To explore this literary phenomenon, my study will take a look at sensation fiction novels that highlight the institutionalization of women from the Victorians onward. Three novels from the nineteenth century and two texts from the twenty-first century will help us examine the treatment of women in multiple social and domestic spaces and track the parallels between multi-cultural attitudes passed between continents through imperialism, and how women are treated in fiction and in fact.

The methodology of this tracking depends on the use of Victorian sensation fiction and its use of realism from the nineteenth century. It also depends on a genre that studies Victorian fiction called neo-Victorian theory and fiction from the twenty-first century. Neo-Victorianism supplies an academic lens for examining the history and culture found in literature and its function also applies to twenty-first century literature—which allows for the inclusion of a twenty-first-century biography. One particular arrival drawn from a neo-Victorian view point of this study is the complexity of gender power dynamics as it pertains to women controlling women using the “borrowed” influence of the patriarchy.

Looking at this collection of novels helps examine the characters and circumstances of women who are institutionalized across different plotlines and shows a variety of circumstances to focus on the vulnerability of women at different social levels, as well as the ease with which those in authority could confine them. Of the three Victorian novels that display this situation, the first is Jane Eyre by Charlotte Bronte, a Gothic novel published in 1847. The second is The Woman in White by Wilkie Collins, published in 1860. The third is Lady Audley’s Secret by Mary Elizabeth Braddon, published in 1862. Two twenty-first century texts are the neo-Victorian novel Fingersmith by Sarah Waters, published in 2002, and the biography Rosemary: The Hidden Kennedy Daughter by Kate Clifford Larson, published in 2015.

Each novel portrays a specific type of institutionalization and the patriarchal power involved in the process. Rosemary Kennedy’s biography will conclude the discussion, because of her real-life story of being wrongly institutionalized, and the profound difference her life as an invalid woman who depended on daily healthcare made in influencing new laws that protect the intellectually disabled, set by her brothers President John F. Kennedy and Senator Edward M. Kennedy. The conclusion also includes research conducted at one insane asylum and multiple institutions for mentally challenged people with special needs to state that this fiction correlates with fact.

The mixed use of novels, a biography, and research in this work focuses on a common denominator, the confinement of women by the power of a male dominated society. Fiction conveys the attitudes, ideologies, and concerns people feel about the treatment of women, and I argue that Victorian novels are more than mere sensationalism because they made an opportunity for profound change for women in their era; that the opportunity was denied and literarily minimized is a testament to the greater power of the patriarchy and we must listen to these voices to subvert that power. By using a biography, I aim to give a real-life example of a woman who was confined by the decisions of two men, which reinforces the portrayals found in fiction.

This combination of genres and research shows that female vulnerability to the “madhouse” has prevailed into the modern era and is worthy of further academic attention; it answers the call of Sandra M. Gilbert and Susan Gubar who are academically famous for their twentieth-century feminist criticism and the coined phrase “madwoman in the attic.” Gilbert and Gubar largely discuss the madwoman as a metaphor for the stifled female author. However, in a recent publication Gilbert says, “Can we feminist critics continue to speak in the larger world not as stereotypical ‘talking heads’ but as what have come to be called ‘public intellectuals’?” and “
perhaps our challenge today is to integrate the professional with both the political and the personal” (xlii). Gilbert seems to suggest that theory must go beyond academia. Therefore, combining genres is an attempt to effectively integrate academic work, political notions, and personal concern.


 

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