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The Cuckoo's Nest

MASTERS OF BEDLAM: The Transformation of the Mad-Doctoring Trade. By Andrew Scull, Charlotte MacKenzie and Nicholas Hervey . Princeton University Press: 375 pp., $35

March 30, 1997|PATRICK McGRATH | Patrick McGrath is the author, most recently, of "Asylum: A Novel." will be published this month

Originally called an "asylum for the criminally insane," Broadmoor is the best known of Britain's top-security mental hospitals. Opened in 1863, this vast sprawl of handsome red brick on top of a hill in the countryside west of London houses many of the most notorious British murderers. In 1956, my father, then a young forensic psychiatrist, was appointed the medical superintendent and, for the next quarter century, we lived just outside the walls. Broadmoor was a moribund institution in those days, and my father spent the bulk of his career bringing it out of the Victorian age and into the 20th century. "Masters of Bedlam" is the story of his predecessors, the first of the British superintendents, and of how the asylums they ran evolved from the ghastly fetid dungeons of the late 18th century to the relatively humane places they became a hundred years later.

The large Victorian asylum has had bad press in recent years, but as "Masters of Bedlam" makes abundantly clear, it was an enormous improvement on what had come before it. In the 18th century, the incarcerated mad were treated little better than animals. Chained naked to the wall in crumbling, ill-ventilated buildings, they suffered gross abuse at the hands of their keepers and lived in filth. Interest in their treatment was first aroused toward the end of the century, and reports of the madness of King George III gave that interest added impetus. Medical men began thinking seriously about insanity; a growing affluence permitted families blighted by mental illness to pay others to care for their troubled, and troublesome, members. Thus at the dawn of the consumer society did the "mad-doctoring trade" come into being. "Masters of Bedlam" describes how that "trade" was eventually wrested from private entrepreneurial hands and brought under state control and how the mad-doctors--eccentric mavericks, many of them, in the early days--turned themselves into a respectable self-governing professional body.

There is a distinct danger in this sort of book that the reader will be bogged down in a morass of detail. The birth and growth of the modern asylum and the parallel development of the psychiatric profession necessarily have to do with parliamentary commissions of inquiry, the establishment of bureaucratic bodies, theories of insanity and so on. The authors of "Masters of Bedlam" have attempted to minimize the risk and give their story a human dimension by concentrating on seven of the most prominent men active in "mad-doctoring" in the 19th century. Several of these, the brilliant but cantankerous Henry Maudsley, for example, emerge with great vividness, and along the way some extraordinary events come to light, such as the grisly end of a Lunacy Commissioner called Lutwidge who, while inspecting an asylum, was murdered by a patient who drove a nail into his skull. But the general reader will inevitably find the going heavy for at least some of the time. This is academic rather than popular social history.

The most important early battle of reform was fought over mechanical restraints: fetters, manacles, whips, chains and straitjackets routinely used to control the insane. John Haslam, first of the masters of bedlam described here, advocated what became known as the "moral treatment," an approach that emphasized an attitude of kindness and gentleness toward the insane, active respect for their essential humanity and the desirability of inducing them to "collaborate peaceably in their own recapture by the forces of reason." Haslam was later disgraced when conditions in Bethlem Hospital, where he was the apothecary, were found to deviate scandalously from his precepts of the moral treatment, although the publicity generated did nothing but good for the reformers' cause.

Haslam later recovered his reputation and went on to argue forcefully that treatment of the mad was a matter for those with medical rather than religious training, another important battle that the doctors had to win if they were to secure their monopoly. He also testified frequently in legal proceedings and once, when asked to define the difference between a sound and unsound mind, snapped: "I never saw any human being who was of sound mind. I presume the deity is of sound mind, and he alone."

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