Paths to the Asylum
The Lunacy Commission, in place from 1845-1913, oversaw the treatment and legislative system of all those certified as mad in England and Wales. The process of certification was centered around the desire to enforce care on someone who might not have wanted or thought they needed any help or could not afford care. Wandering lunatics could be taken into custody dating back to the Vagrancy Act of 1774, with two justices granting the order. Once the pauper asylums dotted the landscape across England, a pauper could be sent to the county asylum on a committal order signed by a magistrate, a relieving officer, or clergyman and a certificate of lunacy signed by a physician, surgeon or apothecary. At the time of admission, paupers sent to the workhouse were screened by medical officers, and those found of unsound mind could be sent to the infirmary or an asylum. Dangerous lunatics had to be sent to an asylum within two weeks. Whether a lunatic was a danger to themselves or others was a question required on every intake form. To house a lunatic in an asylum was far more expensive than a pauper in a workhouse, thus there was no financial motive on the part of the government to shift people from workhouses to asylums.
The threshold to certify a non-pauper lunatic in a private asylum was higher given the potential for financial motives to colour decisions of confinement. The 1774 Madhouses Act required medical certification for patients, increasing the specific power of doctors. Families had to secure two medical certificates gathered in separate interviews by doctors with no financial connection to the asylum where their relative would be confined. This process was designed to prevent collusion between families and doctors and was required for all non-pauper asylum patients and for patients under private care. All certified patients had recourse to the Lunacy Commissioners’ protection and oversight. Most families did not take this step lightly, and it had serious and immediate consequences.
For men of the upper classes, their families had a wealth of options. For families who chose an asylum in Britain, Ticehurst Asylum in Sussex was the benchmark of luxury. In 1877 it housed 63 patients and 150 servants and attendants plus a dozen companions for the lady and gentlemen patients. Such institutions maintained class distinctions, and in the 1880s there were regulations requiring attendants to salute their patients. Private asylums charged high fees and offered patients the opportunity to live in the style they were accustomed to. Their medical toolkit included champagne as a medicinal treatment among the more common drugs used across asylums. In public debates about the role of the asylum, the wealthy always remained aloof from calls to abolish private asylums. Wealthy families placed a premium on privacy above all else and therefore did not want to admit their family members to public asylums, no matter what provisions might be made available to them. However, as the campaign against private asylums reached a fever pitch in the 1880s, the number of patients in such institutions did finally start to decline. The Lunacy Act of 1890 finally restricted the expansion for the private system, granting no new licenses. It also limited medical power, insisting that all non-pauper lunatics’ certification had to be additionally witnessed by a magistrate. The requirements for a new reception order made the certification of private patients a matter for the courts, not an agreement between families and doctors. This attempt to add extra assurance that there were no cases of wrongful confinement made the lunatic judged by both medical and legal authorities, if anything adding more stigma to certification.
There had always been another legal process reserved for wealthy lunatics separate from the asylum system. When a man had control over significant amounts of money or property, families could turn to a Commission de Lunatico Inquirendo in the Court of Chancery. The roots of this court were in feudal ideas of land tenureship; the priority was the proper administration of the lunatic’s estate, an issue often of vital importance to the next of kin. In most cases of insane property holders, families turned to this court to formalize the transfer of legal control from a lunatic already in treatment. A significant minority of Chancery lunatics were never sent to an asylum but ended up in relatives’ homes or single care. The majority of these decisions were unchallenged, but when alleged lunatics wanted to contest the judgment there was a trial with 12-24 jurymen.Chancery also introduced a grey area of madness not covered by the certification process. Bypassing the Lunacy Commissioner’s normal practices, the court of Chancery decided on the level of oversight necessary, distinguishing if the patient’s property and/or their person needed guardianship. This nuance meant that the Chancery court could rule that a man was unable to manage his property, and yet capable to manage himself.
Specialized criminal asylums were also established in the nineteenth century, and criminal law evolved significantly over this time. Some men were found insane at trial and sent to asylums while others became insane while in prison. Ireland was the first to open a specific asylum for criminal lunatics. Dundrum opened in 1850 to immediate success. In England, criminal lunatics were held in county asylums and prisons, and at a specific ward at Bethlem until 1863 when Broadmoor opened as a specialized institution. Patients were admitted directly from trial at the Queen’s pleasure, or via prisons when convicts later became insane. Contemporaries in Scotland felt the pressure as the only system without a specific criminal lunatic asylum, as criminal lunatics were confined in a separate building of the general prison. Criminal lunatics were a particular problem to the asylum system that did not find an adequate solution.
 Clive Unsworth, ‘Law and Lunacy in Psychiatry’s ‘Golden Age,’’ Oxford Journal of Legal Studies Vol. 13, No. 4 (1993), p. 481.  An 1862 law allowed for harmless lunatics to stay at the workhouse which was not uncommon. R Adair, B Forsythe, and J Melling, ‘A Danger to the Public? Disposing of Pauper Lunatics in Late-Victorian and Edwardian England: Plympton St Mary Union and the Devon County Asylum, 1867-1914,’ Medical History 42, no. 1 (1998), p. 7.  For example, the reception order for 21-year-old Alfred Fuller noted that this was his first attack, that he was brought in as a wandering lunatic, and that he was dangerous to others. Fuller MH/85. National Archives, London.  MacKenzie, Psychiatry for the Rich, pp. 10, 18.  In the case of private care, however, it is clear that many people were treated without such formal proceedings. Both families seeking privacy and doctors who resented the oversight seemed to have avoided the certification process. N. Hervey, ‘A Slavish Bowing Down: The Lunacy Commission and the psychiatric profession 1845-60,’ in William F. Bynum, Roy Porter, Michael Shepherd, eds. The Anatomy of Madness: Essays in the History of Psychiatry vol. 2 (London: Tavistock Publications, 1985), pp. 114-117.  Patients were often admitted or removed from Ticehurst at the behest of their families, more often relieved than cured. This could have been an economic decision, or related to the fact after a year of treatment the prognosis for any cure was quite low. Trevor Turner, ‘Rich and Mad in Victorian England,’ Psychological Medicine 19, no. 1 (February 1989), pp. 43, 35.  Charlotte MacKenzie, Psychiatry for the Rich: A History of Ticehurst Private Asylum 1792-1917 (Routledge, 1993), pp. 137, 144.  Such luxuries were not always up to par. At Manor house asylum, Ernest William Radford, a barrister and literary man, complained of the quality of the champagne in a letter to Dr Tuke. In a subsequent note to Dr. Tuke, it was the subject of a poem wherein he asked for it at lunch and dinner. Note Two, Note Seven, c. 1892, MS6223.  For example, after fainting, and being unable to speak, Colonel Booth was prescribed champagne and milk every half hour. August 3 1883 MS5725.  MacKenzie, Psychiatry for the Rich, pp. 114, 169, 206.  Akinobu Takabayashi, ‘Surviving the Lunacy Act of 1890: English Psychiatrists and Professional Development during the Early Twentieth Century,’ Medical History vol. 61 No. 2 (2017), 249-250.  Jane Hamlett, At Home in the Institution: Material Life in Asylums, Lodging Houses and Schools in Victorian and Edwardian England (London: Palgrave Macmillan, 2014), 40.  Of 1,012 Chancery lunatics in 1877, 336 were being cared for outside of private asylums. Oppenheim, ‘Shattered Nerves,’ 71.  From 1853-1914 there were 3,722 Chancery trials in total, and only 160 of them resulted in trials. Of those trials, 111 of them were initiated by men. National Archives C211/30-C211/73.  Clive Unsworth, ‘Law and Lunacy in Psychiatry’s ‘Golden Age,’’ Oxford Journal of Legal Studies 13, no. 4 (1993): 490.  Joel Peter Eigen, Witnessing Insanity: Madness and Mad-Doctors in the English Court (New Haven: Yale University Press, 1995); Eigen, Unconscious Crime: Mental Absence and Criminal Responsibility in Victorian London. Baltimore: Johns Hopkins University Press, 2003); Eigen, Mad-Doctors in the Dock: Defending the Diagnosis, 1760-1913 (Baltimore: Johns Hopkins University Press, 2016).  The Lunacy Commissioners were very concerned about the intermixing of lunatics who committed crimes and criminals who later became lunatics while in prison. They were often wary and skeptical of the latter.  Jade Shepherd, ‘‘I am very glad and cheered when I hear the flute,’ The Treatment of Criminal Lunatics in Late Victorian Broadmoor,’ Medical History, Vol 60, No. 4 (2016), 474.  Jade Shepherd, ‘‘I am not very well I feel nearly mad when I think of you’: Male Jealousy, Murder and Broadmoor in Victorian Britain,’ Social History of Medicine, Vol. 30 No, 2 (2016): 278.  J. Bruce Thomson, ‘The Criminal Lunatics of Scotland,’ Journal of Mental Science, Vol 13 no. 61 (1867), 1-7.