Dan Snow's History Hit - Mental Health in Victorian Britain

Episode Date: May 10, 2022

This week is Mental Health Awareness Week in the UK so we’ve got a special episode exploring the surprising way Victorians approached mental health treatment in the 19th century. Oral historian Stella Man from the Glenside Hospital Museum in Bristol tells Dan how the Victorians get a bad rap but in truth, they took a very forward thinking occupational approach. With no real medicines to prescribe at that time, psychiatric institutions like Glenside turned to exercise, nature, rest and finding meaningful activities and work for patients to do. 50% of patients who were admitted were able to leave the institution after treatment.Stella tells the stories of several patients that spent time at Glenside and how the approach to mental health treatment in Britain changed for the worse over the 20th century and is now returning to the same ideas prescribed by the Victorians.You can find out more information or visit Glenside Hospital Museum here: Glenside Hospital MuseumIf you are struggling with your mental health you can find advice and resources here: Mind.org.ukProduced by Mariana Des ForgesMixed and Mastered by Dougal PatmoreIf you'd like to learn more, we have hundreds of history documentaries, ad-free podcasts and audiobooks at History Hit - subscribe today! To download the History Hit app please go to the Android or Apple store.

This is History's Heroes. People with purpose, brave ideas, and the courage to stand alone. Including a pioneering surgeon who rebuilt the shattered faces of soldiers in the First World War. You know, he would look at these men and he would say, don't worry, Sonny, you'll have as good a face as any of us when I'm done with you. Join me, Alex von Tunzelman, for History's Heroes. Subscribe to History's Heroes wherever you get your podcasts. Hi everyone, welcome to Dan Snow's History Hit. This week is Mental Health Awareness Week here in the UK,

so we've got a special episode exploring the way that Victorians approached mental health treatment in the 19th century. Now, you're going to think it's all kind of beatings and cold baths, but actually, it's quite surprising. It's really interesting. The idea that people are locked away in dark and dingy asylums is actually something we probably get from Hollywood films and drama, rather than a dispassionate look at the reality. A dispassionate look at the reality. Certainly, it was a patchy old picture,

but in some corners of Victorian Britain, a very much more occupational view of mental health care emerged. Stella Mann is the oral historian working for the Glenside Hospital Museum. It's a brilliant museum. I've been there. It was once a psychiatric institution in Bristol, offered mental health treatment from 1861 to 1994. In the 19th century, it was opened up and offering treatment to what people referred to at the time as pauper lunatics. They were people from poor backgrounds who were suffering from mental illness. So there was no particular medicine available, and so the asylum focused, as you'll hear, on rest and nature and occupation, trying to help people work, do things, find value

and alleviate issues of melancholia, or probably depression as we call it today. So in this episode, Stella digs into a wonderful archive of that museum. She shares stories of various patients who walked through the doors of Glenside and back out again, some who didn't walk back out again, and she digs into the patient records to get a bit more of an accurate picture of how some Victorians did treat mental health. Fascinating stuff. If you want to come to a live event,

it's in three weeks' time. Anthony B. Vermeer, one of the great best-selling historians in the world. Remarkable historian. He's written, among other books, of course, his history of Stalingrad, which is the anniversary of this year. We're discussing his latest book, which is rather interestingly timed, The Russian Revolution, a gigantic new account, new source until the Russian Revolution.

You just go and Google Dan Snoyanty Beaver to get your tickets. It's going to be in London. It's going to be awesome. Make sure you go do that. In the meantime, folks, here's the very brilliant Stella Mann talking about Victorian mental health. Enjoy. Hi, Stella. Thanks very much for coming on. Hello, hi.

How is mental health crises characterised? Let's say early modern period, so 200 years, 1600 to 1800. How does society and doctors characterise it? It depended actually where you were. It was very much a postcode lottery, I think. But essentially across the world and still in some countries today, it's very much about if you're ill, any kind of illness, never mind mental illness, God is punishing you. And certainly in those times, religion had a much harder control on who you were and how you behaved. harder control on who you were and how you behaved. So very much actually to consider us having agency to make people better was considered quite a radical thought in the 1700s.

And by the 1800s, they were beginning to make that sort of progress. So if you look at any research between scientists and the religious establishment, there's quite a lot of argument around what we have agency to do in the face of what God is prescribing. In that period, did you start to see the development of institutions like places where people can go and seek treatment? There was a very famous village or now town called Giel in Belgium and they from the middle ages looked after people with mental illness and took them into their families and that was a really quite an established model going back to the postcode lottery it was very very niche at the time and then William Tuke in the 1700s took that on and did a therapeutic Quaker

establishment, which very much influenced the Victorian mental health acts. That's interesting. So Tuke believed in sort of caring people in a community setting, not tying them down and basically torturing people. So he had a home and he looked after people and he looked after them with kindness. And that was quite an individual thought at the time. How did things develop into the 19th century? 1808, there was a mental health act which asked all counties to look after their mentally ill and criminally insane. You need to be looking after these people.

Not very many counties did anything about it. So in 1845, they said every county had to have a safe place for their mentally ill, which is why we've got so many or had so many county asylums built in the Victorian times. How did they think about people with mental illness in this period? They decided to build these big hospitals to look after people, to give them somewhere safe to be, to give them clean water, food, somewhere to exercise, three meals a day. And they very much believed in an ordered life. So if you had an ordered life, if you knew where you were and you had a purpose, your mental health would be improved. What's really interesting now is that those are all the things that we're

currently told today to do for our own well-being is to you know stick to a timetable look after ourselves exercise eat well sleep well tell me about the purpose-built facility how did that change things well if you think it was an 1845 act Bristol was a little bit slow in getting their building up and running they kept pretending that the workhouse was a fit place for their mentally ill. And in the letters, you can see them writing to the government, you know, you allowed us to call it an asylum. We've spent 100 quid on it. Why do we need to build anything better? But the lunacy commissioners who came to inspect were very, very insistent that this was not a fit place. And so eventually they built this really quite beautiful mansion in beautifully landscaped grounds in 1861 for about 300 patients.

patients. And then in 1880s, they extended it with some more wards on either side and a lovely clock tower to help with the ordered life so people could tell the time where they were meant to be at any given time. And the church where the museum is now in situ is a really good example of the attitude that the Victorians had. Because if you come to the church, not only is it a beautiful little church, it's got these stained glass windows and every single stained glass window is a positive story of Jesus curing people or people being resurrected. And the altar piece above the altar is of the baby Jesus being born. So we've got this nativity scene, which just is incredible, really. It took me years. I kept thinking, oh, it's such a beautiful carving and it's of the nativity. I wonder why it's of the nativity. And eventually

the penny dropped that, of course, the nativity is a really positive story compared to dead Christ on the cross. It's new beginnings. It's hope. And so in the 19th century, it seemed that you could actually cure these people. This was not just a sort of an arbitrary sign from above. I think William Chuke had kind of set the pattern. And across Europe, people were all becoming a little bit more enlightened. And across Europe, people were all becoming a little bit more enlightened. And I think the scientists were beginning to feel more confident and doctors were becoming more confident that they could have agency to help.

And in the Victorian times, they didn't actually have any medicine to speak of. They had a little bit of sedatives, opium, that sort of thing, but nothing really that could fix people in terms of drugs. So they literally treated people with that kind of well-being agenda. And we're so lucky at Glenside because we've had Dr. Paul Tobiah, who researched all 5,110 of our patients and he went to the records office he looked at every case note he was a mental health trained nurse himself so he said he identified that all of them had some form of illness that looked like it was a mental illness. And out of those 5,110, 48% of them were recovered or relieved. So they went home. So that caring treatment quickly established itself as a regime that worked. Were these conditions they were suffering with kind of environment,

like crushing poverty or the physical pain they're experiencing? Or is this more akin to perhaps today we might call depression? Well, it's really interesting because if you look at the whole spectrum of patients, is that they have as many mental health issues as we experience today. And you can sort of identify them. So there's like things where people are feeling really low so Anna Fear she was admitted after breaking a window in her home and then threatening to jump off a local bridge and the local policeman a police constable from Bedminster

police station picked her up and on her admission record at the asylum, it just says found wandering. So she obviously didn't want to say where she lived. And so she was admitted because the policeman thought she was suicidal because she was threatening to jump off a bridge. So he wanted to look after her. And so when she was admitted, they diagnosed her with melancholia, which is another word for a sort of quiet depression. But she was only with us for 18 days because they obviously decided she didn't have a medical condition. There was some sort of domestic upset causing her distress. And so when they discharged her, they discharged her into the care of friends rather than to her husband. And so that's a familiar story today that we get distressed by domestic circumstances.

And quite a lot of our patients didn't actually have a mental illness. They had illnesses that affected your brain in the last stages. So at least one fifth to two fifths of our patients had chronic disease. And a lot of that chronic disease was the last stages of general paralysis of the insane, which is tertiary syphilis. And a lot of these diseases are now cured with antibiotics and pre antibiotics being used. There there was no cure you just got worse basically and one of the stories is Harriet Abbott she had a really nasty skin condition she was a 35 year old servant who was admitted in 1893 in the last stages of this nasty skin condition that she had, it spread to the brain and the other organs. So it started to eat you from within. And she probably was in the last

stages because she only was with us for seven weeks before she died. And we've got a very poignant photograph of her. And she does look in a lot of pain. A famous great philosopher died of the same disease, John Stuart Mills, in a similar period. So it was very rare, still very rare today, but it's caught with antibiotics. And that's why when you hear people worrying about us getting immune to antibiotics, it's so serious because some of these very nasty diseases are zapped. And if we can't zap them, they're quite serious for us. And we don't have the therapeutic interventions that we have now, the drugs. How did they make people better?

Well, it was very much an ordered life. So you would get up a certain time, you'd have breakfast. If you were fit and able to work, you were given a job to do within the community. So you would get up a certain time, you'd have breakfast. If you were fit and able to work, you were given a job to do within the community. So it was run as a therapeutic community, very much on the Tuke model. So everybody participated. They also obviously had regular meals. Sleep was quite important. So you went to bed quite early and also things that would lift your spirits. So the grounds are beautiful. They've actually put in trees, about 70 different species of trees. Again, Victorians thought that would support your spiritual well-being. The church, of course, was to support your spiritual well-being. And we've got a very nice organ as well to do the hymns.

So they tried to do uplifting occasions. There would have been sport. There was a theatre. So there would have been plays, dances. If you could play a brass instrument, Dan, you would have been asked to get your trumpet out. Yeah, one patient, John Weston, he wrote a book. And he was in the asylum for two years. He

was a commercial traveller, a sign writer, because of course all those beautiful painted pub signs, shop signs, somebody would do those. And we know that when he was in the asylum, people were given occupation as part of the therapy community. And if you had a skill like he had, that would have been employed. So we know he did a lot of painting within the asylum and signed writing for the asylum. So he did that as well as writing his book, of course. And it turns out that he and his wife lived in Bedminster, South Bristol.

And his wife was admitted just three months before John. And she was both physically and mentally unwell. She could hardly walk. And she's described as suffering from chronic mania. And John, her husband, said she had experienced similar problems 14 years ago. And both her notes, her case notes and his book confirm she had a long-standing drink problem and John describes it as an unnatural craving her drink problem was an unnatural craving the admission of his wife seems to have really badly affected him and in his own words he said, I sank under the pressure and at last could neither eat, work or rest. I have in fact been driven out of my mind. He then presented himself to the asylum, to the relieving officer and said, I'd like to be admitted. He was and he was with us for two years until he was released. Paul Tobiah has been

and if you look on our website he's done a lot of stories about our lovely Victorian patients all different aspects. Mental illness strikes people at all times of their life and for lots of different reasons and you can definitely see that in some of these stories. And some of our patients then in the Victorian times weren't actually what we would consider mentally ill now. So also we had about 10% to 20% of people who had epilepsy. And again, we don't consider that a psychiatric disease. And we've got a really interesting story of one family where the father got admitted at 36, quickly followed by his younger son, who was also epileptic. And then one of his other sons also got admitted when he developed epilepsy.

And the thing is with epilepsy is it can now be treated. But in those days, the average fit was sort of three to four times a week so you were fitting an awful lot and there was a male epileptic ward and a female epileptic ward and I think it's something like 79 fits a week you know all together so a lot to look after and you couldn't work so this young man Sidney who was from the Lipton family he must have felt devastated he was a soldier he would have been really proud to have been a soldier it's a nice manly profession and then suddenly he couldn't be a soldier anymore and he couldn't even do what the rest of the family did. They were all hairdressers. So it was quite debilitating, but also he wasn't himself because of the illness. And do you think around 50% half of the patients in the 19th century were able to

return home? Yes, approximately 50, just under, yeah. And 70% of those returned home within the first year, which is interesting in itself because I imagine that mirrors statistics today that if you catch people quickly enough and early enough and look after them, then they're more likely to recover. Listen to Dan Snow's History Hit talking about Victorian mental health

more coming up Hi there, I'm Kate Lister sex historian and author and I am the host of Betwixt the Sheets the history of sex, scandal and society a new podcast from History Hit join me as I root around the topics which have been skipped

over in your school history lessons. Everything from the history of swearing to pubic hair, satanic panic, cults, there is nothing off limits. We'll be bed hopping around different time periods from ancient civilizations to the middle ages to renaissance and early modern right up to now. Listen and subscribe wherever you get your podcasts. This is History's Heroes. People with purpose, brave ideas and the courage to stand alone. Including a pioneering surgeon who rebuilt the shattered faces of soldiers in the First World War. You know, he would look at these men and he would say,

don't worry, Sonny, you'll have as good a face as any of us when I'm done with you. Join me, Alex von Tunzelman, for History's Heroes. Subscribe to History's Heroes wherever you get your podcasts. Then with the outbreak of the First World War, you have an important medical role to play as well. Well, for us, it changed significantly because we were closed as an asylum and turned into both at war hospital, which Dan is a huge, very fascinating, different story, because we were then turned into an orthopaedic specialist hospital. The museum tells that story as well. So we've got three hospital stories within the museum. We've got the orthopaedic First World War Hospital. And in those three years from 1915 to 1919,

we treated in our building alone, just under 30,000 wounded soldiers. So it gives you an idea of the extent of the number of men coming up through our railway station from the docks. Then the Second World War, you get back to your roots as a psychiatric hospital. The evolution of mental health care is quite complex. And the Second World War was very different because after the First World War, we've got a whole period of eugenics, of course, and a period where doctors and surgeons were starting to feel much more confident that they could help you with the advent of penicillin in the 1930s. There was a lot more confidence that you could help get people better quickly.

Talk to me about how things keep changing into the mid 20th century and beyond. Ah, so if you look at mental health care every decade, it's slightly different. Our attitudes, what we're able to do for them, what works and what doesn't work. And the period after the First World War was very much an experimental period where doctors were feeling confident and the vulnerable were not seen as particularly valid as human beings. So there was a lot of experimentation, which through our more modernised looks very barbaric, such as leucotomies, insulin coma therapies, there are all sorts of quite aggressive treatments that were, let's see if this works, let's see if that works. And one of the few

survivors from that experimental period is ECT, electroconvulsive therapy, which does work and was fairly overused and got a very bad reputation in the 50s, 60s and 70s, but is still used today with good effect for those people who do not respond to drugs and other treatment. And where are we now? How far have we moved on from the Victorians? It sounds to me like the Victorians had it going pretty well. I mean, how far have we moved? When I first started working at the museum, I came with all my prejudices that I have learnt through media mostly, news which is always sensational, never good news, always bad news and films like One Flew Over the Crookoo's Nest and almost every novel if they've got somebody with a mental health issue in it, the person with

the mental health issue is trouble. Certainly from the Victorian times, it was very illustrative. And I think really, we're often influenced by attitudes of fiction. And fiction isn't interesting unless you've got protagonist. And so I do think mental health care has gone through serious ups and downs. But I think the Victorians have probably been falsely accused of not understanding that care was what was needed. I think they did provide care in the best way they could without any medicine. They had no medicines. in the best way they could without any medicine. They had no medicines. So having people that are really seriously mentally ill, potentially psychotic, violent, seeing delusions is very

damaging to the individual, but it's also quite hard to manage in a hospital context. And nowadays we treat people with various drugs, both successfully and unsuccessfully. But certainly in the Victorian times, they did quite a good job. And in terms of whether other asylums behaved in the same way as ours, I do think it probably is a little bit like schools. It's very dependent on the head. So if you've got a good medical superintendent who believes that he can do good, then that will happen. And if you've got one that isn't so clever or not so enlightened, it won't be such a benign organisation. So I think at Glenside, certainly in the Bristol Asylum, in its early days, having done that analysis of the patients, we are very confident they were doing the best for the patients. And they did sack inappropriate staff. They had people that behaved inappropriately. And I think the hospital system, the county asylum

system was very much set up to look after people because their intention was that you went back home to work. Bristol Corporation didn't want to pay for you to linger in some hospital. It was expensive. In fact, the workhouse was cheaper, So they'd rather you stayed in the workhouse if you were poor or unable to work or ill. So I believe, but I can't tell you for sure because I can't look at the patient records, that in the 1930s, that's when mental health care became more medicalised, more structured, healthcare became more medicalised, more structured, less about the individual, more about how can we fix you quickly. We do put pressure on doctors. You know, we turn up, we don't want to hear that it's going to take six months or three months or even actually three weeks for us to get better. So we always put doctors under a lot of pressure and they're very keen to please. And if they haven't got much in their toolbox, which to

be fair, most doctors haven't really got for mental illness. We still don't understand our brain sufficiently to really know how to help people. So they've not got a huge amount in their toolbox to help us. It's increasing and I think it's hugely improved over the last 10 years, but it's still more of an art than a science. What are some of the objects, the artefacts in your museum that you think really take us back, connect us with that past? Oh, let me think. Well, if you're going back to the Victorian past, we've just basically got a lot of beautiful land and a very attractive building with lots of incredible detailing. And the asylum decorator who advised all British asylums, Sir Henry Burdett, he recommended colour as well. So the hospital would have been quite colourful. For instance, he said white ceilings were bad for

your health, a blue ceiling, any shade of blue, but if you can afford it, gold stars. And so there was a lot of that kind of detailing going on in the Victorian times. And then if you can afford it gold stars and so there was a lot of that kind of detailing going on in the Victorian times and then if you move forward we've got Walter Freeman who was a infamous neurosurgeon who perfected leucotomy so that you could do it in 10 minutes with something that he created out of an ice pick. We've got one of those in our collection and we've got a few very interestingly sewn straitjackets and again straitjackets are quite interesting because your first reaction to them is oh not nice, harsh, hard but actually when you unpick it a straitjacket particularly the Victorian one

was very much a treatment that we still use today so it would have forced you to hug yourself, it would have held your hands close so you no longer felt like you could run so depending on what was wrong with you your flight and fight mode could potentially be turned off and it could be a comfort to somebody that was feeling very aggressive and violent and potentially trying people with autism and learning disabilities, where you have a chair with arms that come round and close in on you. We still talk about swaddling babies to keep them comforted. Weighted blankets. It's all in that vein. So even though it's a kind of treatment, it's not just about control. 1930s is a different issue. Well, thank you so much. People can go to the museum, tell us about it. How do they do that?

We are open every Wednesday morning from 10 till 1 and all day Saturday from 10 till 4. You don't have to book, but we do have booking online and we charge £2.50 per person, £5 ticket for two. Thank you very much indeed. Thanks folks for listening to this episode of The Dance's History. As I say all the time, I love doing these podcasts. They are the best thing I do professionally. I feel very lucky to have you listening to them.

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dealing with all things military. Please go and check those out wherever you get your pods. things military. Please go and check those out wherever you get your parts. This is History's Heroes. People with purpose, brave ideas, and the courage to stand alone, including a pioneering surgeon who rebuilt the shattered faces of soldiers in the First World War. You know, he would look at these men and he would say, don't worry, Sonny, you'll have as good a face as any of us when I'm done with you. Join me, Alex von Tunzelman, for History's Heroes. Subscribe to History's Heroes wherever you get your podcasts.