Themes in Scottish asylum culture : the hospitalisation of the Scottish asylum 1880-1914
Having embarked on a vast journey of asylum construction from the 1860s, Scottish mental health care faced uncertainty as to the appropriate role of the asylum by the 1880s. Whereas the mid century was dominated by official efforts to lessen the asylum's custodial image, late Victorian asylum culture encompassed both traditional and new themes in the treatment and care of patients. These themes included hospitalisation, traditional moral approaches, and wider social influences such as the poor law, philanthropy, endemic disease and Victorian ethics. In an age of medical advance, Scottish asylum doctors and administrators introduced hospitalisation in a bid to enhance the status of asylum culture. The hospitalisation of the asylum was attempted through architectural change, transitions in mental nursing and the pursuit of laboratory research. Yet as a movement, hospitalisation was largely ornamental. Although hospitalisation paved the way for impressive new buildings, there was little additional funding to improve asylum infrastructure by raising nursing standards or to conduct laboratory research work. While the Commissioners in Lunacy proclaimed `hospitalisation' to be a distinctive part of the Scottish approach of mental health care, the policy's origins lay not with the policy makers but with individual medical superintendents. Although hospitalisation became an official approach by the General Board of Lunacy, like any other theme in asylum culture, the extent of hospitalisation's implementation relied on the support of individual doctors and local circumstance. Despite this attempt to emulate modern medicine, moral management rather than hospitalisation methods continued as the fundamental approach of treatment and control in most institutions. The main components of moral management were work and a system of rewards (implemented through liberties and accommodation privileges). The process of mental recovery continued to be linked to industriousness and behaviour. The thesis acknowledges the impact of local forces and wider society upon attitudes towards mental health care, such as the economically driven district lunacy boards and to a lessening extent the parochial boards and philanthropy. In viewing the asylum within the wider context of Scottish society, the asylum shared some characteristics with other Victorian institutions. Finally, although the patient's autonomy within the system should not be overplayed, the asylum doctor was also affected by the patients' co-operation with treatment and the involvement of family and friends in admission.