2.2.2 Treatment regimes
As well as asylums which housed people with mental illness and learning difficulties there was a turn towards a style of mass provision generally.
Development of special schools for disabled children began in 1750 when the first private schools for blind and deaf children were opened in Britain. The earliest public institution, run on a charitable basis, the London Asylum for the ‘support and education of the deaf and dumb children of the poor’, was opened in Bermondsey, south London, in 1792. By the end of the nineteenth century, separate schools for blind, deaf, physically disabled and learning disabled children were common, though the extent to which they were educational rather than custodial was much debated. Poor Law children were similarly treated to segregated and reforming regimes. They might be fostered or ‘boarded out’ but were just as likely to be housed in district schools, ‘barrack schools’ or to be placed in voluntary society homes run by organisations such as Dr Barnardo's and the National Children's Home (Hendrick, 1994, pp. 76–8). Barnardo spoke for many reformers when he argued that if the children of the poor, whether or not they had parents, ‘can be removed from their surroundings early enough, and can be kept sufficiently long under training, heredity counts for little, environment counts for everything’ (quoted in Hendrick, 1994, p. 79). Today we might see these attitudes as rooted in the nineteenth century ethic of work and individual self-improvement.
It has been argued that institutional care increasingly came to be used by working class families who, under pressure from the effects of long working hours for most members of the family and urban overcrowding, found it less possible to care for people at home than in earlier, pre-industrial times and that factory work provided fewer opportunities for people with learning difficulties. As home and work became more separate, so care and support became less possible (Ignatieff, 1983). Wright argues that if family members were given over to asylum care this was not necessarily because parents and others had a medicalised understanding. Lay explanations of learning disability were more likely to be linked to growing children's inability to contribute to the household economy and especially to their apparent inability to benefit from education (Wright, 1996, p. 131). This theory fits well with James Lappin's explanation of why his father handed him over to hospital care.
While Wright's suggestion is an interesting one it needs to be borne in mind that care in the community and by families continued to be the dominant form of care throughout the period when institutions flourished. Many parents resisted pressure to put their children into institutions, as Ida Taylor, born in 1921 with cerebral palsy recalls:
They wanted to send me to a mental place and lock me up. They kept coming to our house when I was about six or seven years old to ask me and my mum questions. They asked me easy things like me name and how many days in the week and about money and that. Me and me mum got upset because I didn't want to go away and she didn't want them to take me. They said I should be in a mental place and that worried us a lot. What stopped it was that me mum took me to our doctor. He stopped those men coming round and told them I was no more mental than fly! They'd been on at us for about five years and it had made me mum ill with worry thinking I was going to be locked up.
(Quoted in Humphries and Gordon, 1992, p. 16)
Arguments that institutional solutions suited a society in which working class families had fewer resources to support their disabled relatives does not explain why institutional solutions were also taken up by wealthier middle and upper-class families who resorted to the private asylums. Though the treatment of poor children in the workhouse was satirised by Charles Dickens in his novel Oliver Twist there was no parallel popular exposure of the treatment of those who were considered ‘insane’ or ‘imbeciles’. Those, both staff and patients, who protested about conditions in the nineteenth century asylums, like John Perceval and his Alleged Lunatics’ Friend Association which was founded with the backing and help of lawyers, were isolated. They lacked the powers of resistance to what had come to be seen as a normal and acceptable way to treat certain groups of people judged to be in need of care and protection.
We've mentioned the impact of the 1845 and 1857 (Scotland) Lunacy Acts. These Acts made no distinction between people with a mental illness and people with learning difficulties. Separate provision for people with learning difficulties only came later with the 1913 Mental Deficiency Act, as we heard on the video. Until then only a tiny minority of people certified as ‘idiots’ lived in specialist ‘idiot asylums’ the rest lived in workhouses, prisons and lunatic asylums (Gladstone, 1996, p. 140).
The proportion of people living in mental hospitals peaked in the 1930s and began to decline in the 1950s. In contrast, the peak for numbers of people with learning difficulties in institutions came in the 1960s after the 1959 Mental Health Act which gave more emphasis to community care. Their numbers actually trebled between 1924 and 1954 to reach nearly 60,000 (Alaszewski, 1986, p. 15). The influence of institutional care persisted long and powerfully, as we've seen from the history of Lennox Castle Hospital.