Madness: A Brief History

Roy Porter

4 ideas

1. Hannah Mills and the York Retreat

   In 1790 Hannah Mills, a Quaker widow, died in the York Asylum after her co-religionists were refused permission to visit her. In response, the tea merchant William Tuke founded the York Retreat, which opened in 1796 and replaced chains and bleeding with a domestic regime of kindness, work, routine and self-restraint encouraged by the hope of esteem. This 'moral treatment,' paralleled by Philippe Pinel's reforms in Paris, became the model for the nineteenth-century reformed asylum.

2. Therapeutic asylums silted up into warehouses

   The nineteenth-century public asylum was built on curative optimism: small, humane institutions would restore the insane to reason. Because admission was promoted as the path to cure, the asylums filled with chronic, elderly, epileptic and paralytic patients who never left, so they swelled to thousands of beds and cure rates fell. The staff's role shifted from healing to custody. The reform's own promise produced the overcrowded, custodial institution it had set out to replace.

3. Confinement grew from markets, not state edict

   Against the thesis of a sudden seventeenth-century 'Great Confinement,' the English case shows that locking up the mad expanded gradually. It was driven by a private, fee-paying 'trade in lunacy' of madhouses serving families who could no longer or would not care for relatives at home. Mass public asylum provision came only in the nineteenth century through legislation such as the 1845 Lunacy Act. Institutionalization followed commercial and family demand before it became state policy.

4. Psychiatry oscillates between body and mind

   Across its history, explanations of madness have swung between somatic models and psychological ones. Somatic models locate it in the body: humours, nerves, brain lesions, heredity, degeneration, neurochemistry. Psychological models locate it in passions, the unconscious, or social experience. Each swing tends to follow the therapeutic disappointments of the previous model rather than decisive new evidence. Reading any era's theory of madness as a reaction to the last one's failures explains more than reading it as steady scientific progress.

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